JMIR Open Peer Review Submissions

Examining participant motives, expectations and experiences in a physical activity and nutrition intervention for men: the ManUp trial.

Tue, 18 Jun 2013 09:34:21 EDT

Background: Men experience a shorter life expectancy and higher rates of chronic diseases compared to their female counterparts. To improve health outcomes among men, interventions addressing male lifestyle behaviours are needed. Online-based interventions may be a promising intervention approach in this population group, however, little is known about how to maximise engagement and retention in online programs. Objective: The current study sought to explore the motives, expectations and experiences of participants enrolled in the ManUp study, a randomized controlled trial exploring the efficacy of an interactive online intervention for promoting physical activity and nutrition among middle-aged men. Methods: Semi-structured interviews were conducted and audio-taped with 20 of the ManUp participants. Interview recordings were transcribed and coded into themes. Results: Weight loss, increasing health and fitness levels and spousal pressure were key motivators for participating in the ManUP program. Participants expected that the program would provide guidance and advice, a solution to weight-loss, a lifestyle prescription, and strategies to stay disciplined. Unmet expectations seemed to impact on engagement in the program for some participants. The ability to record and track progress was valued by most. Participants suggested that improving the functionality of the website and providing access to healthy lifestyle tools would increase engagement. Conclusions: The results of this study direct some insight into how we can enhance male’s engagement, retention and maintenance in online interventions. Date Submitted: Jun 18, 2013. Open Peer Review Period: Jun 18, 2013 - Aug 13, 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This is an unpublished abstract - DO NOT CITE.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.

Online mental health resources in rural Australia: Clinician perceptions of acceptability

Mon, 17 Jun 2013 09:55:46 EDT

Background: Online mental health resources have been proposed as an innovative means of overcoming barriers to accessing rural mental health services. However clinicians tend to express lower satisfaction with online mental health resources than do clients. Objective: Understand rural clinicians’ attitudes towards the acceptability of online mental health resources as a treatment option in the rural context. Methods: In depth interviews were conducted with twenty-one rural clinicians (general practitioners, psychologists, psychiatrists and clinical social workers). Interviews were supplemented with rural-specific vignettes, which described clinical scenarios in which referral to online mental health resources might be considered. Interview transcripts were analyzed using a constant comparative method. Results: Clinicians were optimistic about the use of online mental health resources into the future, showing a preference for integration alongside existing services, and use as an adjunct, rather than an alternative, to traditional approaches. Key themes identified included perceptions of resources, clinician factors, client factors and the rural and remote context. Clinicians favored resources that were user-friendly and could be integrated into their clinical practice. Barriers to use included a lack of time to explore resources, difficulty accessing training in the rural environment and concerns about the lack of feedback from clients. Social pressure exerted within professional clinical networks contributed to a cautious approach to referring clients to online resources. Conclusions: Successful implementation of online mental health resources in the rural context requires attention to clinician perceptions of acceptability. Promotion of online mental health resources to rural clinicians should: include information about resource effectiveness, enable integration with existing services and provide opportunities for renegotiating the socially-defined role of the clinician in the e-health era. Date Submitted: Jun 16, 2013. Open Peer Review Period: Jun 17, 2013 - Aug 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.

Using the SADL questionnaire to assess patient satisfaction fitted through Telemedicine (Telefitting)

Fri, 14 Jun 2013 13:58:51 EDT

Hearing loss can reach levels of 15% in children and up to 40% of the elderly population. The standard treatment of sensorineural hearing loss is marked out with the selective amplification provisioned through a hearing individual, also known as hearing aid or hearing instrument: an electronic device equipped with a topology of only three major components of aggregate cost. Since 2004 Brazil has a public policy named National Hearing Health Care established by Ordinance n ° 2.073/04 GM, this policy which includes the diagnosis, tests, therapy, culminating in the donation of hearing aids for any Brazilians seeking one of 139 centers accredited by the National Health System in various locations throughout Brazil. Despite the benefit of gratuity, patients mostly consisted of adults and the elderly should return with a certain periodicity to these centers to receive necessary adjustments, in such a way to adjust your hearing aids in its environmental conditions, or to ask questions of operation. These factors combined with difficulty in the transfer of their homes, which often demand a chaperone, may hinder the success of hearing rehabilitation. Telemedicine evolves into many areas, with greater coverage area of operation and lower operating costs. Fitting hearing aids remotly is a relatively simple procedure, demand for low computer hardware requirements and an internet access, employing user-friendly applications. The use of evaluation questionnaires is a trivial way to objectively assess the success of a fitting. Questionarries outcomes can help managers to improve the National Policy on Hearing Health Care in Brazil. Date Submitted: Jun 14, 2013. Open Peer Review Period: Jun 14, 2013 - Aug 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.

Challenging dose-response: the impact of adherence upon outcome in an online intervention for depression

Fri, 14 Jun 2013 13:38:55 EDT

Background: Web-based interventions are now widely accepted as effective. However, only recently has there been an interest in the impact of adherence to the intervention on outcomes. To date, persistence with or completion of the intervention has been the most commonly reported metric of use, but this does little to understand the relationship between program use (adherence), and outcome. Understanding this relationship will help to understand how much of the intervention users may need to obtain a clinically significant benefit from the program. Objective: To determine which adherence metrics, if any, are more important in predicting outcomes in an online depression treatment trial. Methods: CREDO is a randomised controlled trial (RCT) evaluating an unguided, web-based based on Cognitive Behavioural Therapy (CBT) & Interpersonal Therapy (IPT) based program (E-couch) for people with depression and cardiovascular disease. 280 participants in the active arm commenced the program, delivered in 12 modules, containing pages of text and activities. Adherence data in the form of number of logins, modules completed, time spent online, and activities completed was captured automatically. We estimated the association of these, and composite, metrics with the outcome of a clinically significant improvement in depression score on the PHQ-9 of 5 or more points. Results: 214 (76.4%) participants provided outcome data at the end of the 12-week period. Ninety-four (43.9%) participants obtained clinically significant improvement. Participants logged into the program an average of 18.7 times (SD=8.3) with the majority (62%) completing all 12 modules Average time online per login was 17.3 (SD=10.5) minutes and participants completed an average of 9 out of 18 activities available within the program. In a multivariate regression model, only the number of activities completed per login was associated with a clinically significant outcome (OR 2.82, 95% CI 1.05-7.59). Conclusions: Only one objective measure of adherence was associated with better outcome of a web-based intervention of known effectiveness, and the four best adherence metrics accounted for little outcome variance. This suggests that assumptions of a linear relationship between adherence and outcome may be too simple and further models and variables need to be explored to adequately understand the relationship. Clinical Trial: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12610000085077; http://www.anzctr.org.au/ACTRN12610000085077.aspx Date Submitted: Jun 13, 2013. Open Peer Review Period: Jun 14, 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.

Factors associated with Adoption of the Electronic Health Record system among Primary Care Physicians

Thu, 13 Jun 2013 10:04:30 EDT

Background: A territory-wide electronic patient record allows better patient care in different sectors. Objective: This survey measured the adoption level, enabling factors and hindering factors of electronic Medical Record (eMR), among private physicians in Hong Kong. It also evaluated the key functions and the popularity of electronic systems and vendors used by these private practitioners. Methods: A central registry consisting of 4,324 private practitioners was set up and invitations for self-administered surveys were sent via fax, emails, postal mails and on-site clinic visits. The questionnaires were returned by any of these means. Current users and non-users of eMR system were compared according to their demographic and practice characteristics. Student’s t-tests and chi-square tests were used for continuous and categorical variables, respectively. Results: A total of 524 completed surveys (response rate 12.1%) were collected. The proportion of using eMR in private clinics was 79.6%. When compared with non-users, the eMR users were younger (48.4 years vs. 61.7 years; P 20 years: 62.6% vs. 86.9%, P<.001); fewer worked under a Health Maintenance Organization (83.2% vs 90.7%; P<.001) and more worked with practice partners (30.2% vs 3.7%; P<.001). Efficiency (90.9%) and reduction of medical errors (54.9%) were the major enabling factors while patient-unfriendliness (54.9%) and limited consultation time (50.5%) were the most commonly reported hindering factors. The key functions of computer software among eMR users consisted of electronic patient registration system (90.2%), drug dispensing system (78.7%) and electronic drug labels (71.0%). Softlink Clinic SolutionTM was the most popular vendor (38.4%). Conclusions: These findings identified several physician groups who should be targeted for more assistance on eMR installation and its adoption. Future studies should address the barriers of using eMR to enhance its adoption. Date Submitted: Jun 13, 2013. Open Peer Review Period: Jun 13, 2013 - Aug 8, 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.

Having mentors prevents depressive symptoms via decreasing internet gaming: A moderated mediation analysis

Wed, 12 Jun 2013 11:39:30 EDT

Background: Easy access to the internet has spawned a wealth of research to investigate the effects of its use on depression. However, one limitation of many previous studies is that they disregard the interactive mechanisms of risk and protective factors. Identifying both the risks and protective factors in the same model could provide a comprehensive picture regarding what factors should be targeted for the prevention of depression and who should be selected as being particularly at risk of developing depression. Objective: The aim of the present study was to investigate a resilience model in the relationship between worry, daily internet video game playing, daily sleep duration, mentors, social networks and depression, using a moderated mediation analysis. This was the first study to examine the risks and protective factors in the same model and their interactive mechanisms (the potential moderated mediators) for depression in university students. Methods: 6173 Korean undergraduate and graduate students participated in this study. The participants completed a web-based mental health screening questionnaire including the Beck Depression Inventory (BDI) and information about number of worries, number of mentors, number of campus social networks, daily sleep duration, daily amount of internet video game playing and daily amount of internet searching on computer or smartphone. A moderated mediation analysis was executed using the PROCESS macro which allowed the inclusion of mediators and moderator in the same model. Results: The results showed that the daily amount of internet video game playing and daily sleep duration partially mediated the association between number of worries and the severity of depression. In addition, the mediating effect of daily amount of internet video game playing was moderated by both the number of mentors and number of campus social networks. In particular, students with 4 mentors and 1 or more campus social network, compared to those with a lower number of mentors and campus social networks, were more likely to be protected from depression, even if both groups suffered from a similar number of worries. Conclusions: The current findings indicate that the negative impact of worry on depression through internet video game playing can be buffered when students seek to have a number of mentors and campus social networks. Interventions should therefore target the group who has higher number of worries but seek only a few mentors or campus social networks. Social support via campus mentorship and social networks ameliorate the severity of depression in university students. Date Submitted: Jun 7, 2013. Open Peer Review Period: Jun 12, 2013 - Aug 7, 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.

Assessing the internal and external validity of mobile health physical activity promotion interventions: A systematic literature review using the RE-AIM Framework

Sat, 01 Jun 2013 15:47:17 EDT

Background: Mobile health (mhealth) interventions are effective in promoting physical activity (PA); however the degree to which external validity indicators are reported is unclear. Objective: The purpose of this systematic review was to use the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to examine the extent to which mhealth interventions for promoting PA are generalizable across settings and populations; and provide recommendations for investigators planning to conduct this type of research. Methods: Twenty articles reflecting 15 trials published between 2000 and 2012 were identified through a systematic review process (i.e., queries of three online databases, reference lists of eligible articles) and met inclusion criteria (i.e., implementation of mobile technologies, target physical activity, and provide original data). Two researchers coded each article, using a validated RE-AIM data extraction tool (reach, efficacy/effectiveness, adoption, implementation, maintenance). Two members of the study team independently abstracted information from each article (inter-rater reliability >90%) and group meetings were used to gain consensus on discrepancies. Results: The majority of studies were randomized controlled trials (n=14). The average reporting across RE-AIM indicators varied by dimension (reach=54.7%; effectiveness/efficacy=77.8%; adoption=11.1%; implementation=24.4%; maintenance=0%). While most studies described changes in the primary outcome (effectiveness), few addressed the representativeness of participants (reach) or settings (adoption) and few reported on issues related to maintenance and degree of implementation fidelity. Conclusions: This review suggests that more efforts need to focus on research designs that highlight and report on both internal and external validity indicators. Specific recommendations are provided to encourage future mhealth interventionists and investigators to report on representativeness, settings, delivery agents for planned interventions, the extent to which protocol is delivered as intended, and maintenance of effects at the individual or organizational level. Date Submitted: Jun 1, 2013. Open Peer Review Period: Jun 1, 2013 - Jul 27, 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.

Adherence to a Web-based Physical Activity Intervention for Patients with Knee and/or Hip Osteoarthritis: A Mixed Method Study

Fri, 31 May 2013 12:06:37 EDT

Background: Web-based interventions are promising to promote a healthy lifestyle, but their effectiveness is hampered by high rates of non-usage. Predictors and reasons of (non)usage are not well known. Identification which factors are related to adherence contributes to the recognition of subgroups who benefit most from web-based interventions and to new development strategies to increase adherence. Objective: The aim of this mixed method study was to identify patient-, intervention- and study characteristics which facilitate or impede adherence to a web-based physical activity intervention for patients with knee and/or hip osteoarthritis. Methods: As part of a randomized controlled trial, a quantitative and qualitative study was conducted to investigate program usage, potential predictors and patient’s reasons for adherence. Patients were defined as completers if they completed at least six out of nine modules. Logistic regression analyses with a stepwise backward selection procedure were executed to build a multivariate prediction model of adherence. For the qualitative part, semi-structured interviews were conducted. Both inductive and deductive analyses were used to identify patterns in reported reasons for non-usage. Results: Of the 100 participants who received a password and username, 46 users reached the threshold of adherence. Multivariate regression analyses revealed that higher age in years (OR=.94, p=.08) and the presence of a comorbidity (OR= .33, p=.02) predicted non-usage. Results from the interviews showed that a lack of personal guidance, lack of motivation, presence of physical and mental problems were reasons for non-usage. In addition, the absence of human involvement within the intervention was viewed as a disadvantage and negatively impacted program usage. Factors which influence adherence positively were trust and reliability in the program, functionality of the intervention, social support from family or friends and commitment to the research team. Conclusions: In this study we identified a wide range of patient-, intervention- and study characteristics which were related to usage and non-usage of a web-based physical activity intervention for patients with knee and/or hip osteoarthritis. Although the self-guided components provide several advantages such as costs, reach and access, for older patients and participants with a co-morbid condition a more personal approach is needed. For these groups the integration of web-based interventions in a health care environment seems to be promising. Clinical Trial: The Netherlands National Trial Register (NTR). Trial number: NTR2483; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2483 (Archived by Webcite at http://www.webcitation.org/67NqS6Beq) Date Submitted: May 31, 2013. Open Peer Review Period: May 31, 2013 - Jul 26, 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.

An Exploration of Social Circles and Prescription Drug Abuse through Twitter

Wed, 29 May 2013 14:22:56 EDT

Background: Prescription drug abuse (PDA) has become a major public health problem. Relationships and social context are important contributing factors. Social media provides online channels for people to build relationships that may influence attitudes and behaviors. Objective: To determine whether people who show signs of prescription drug abuse connect online with others who reinforce this behavior, and to observe the conversation and engagement of these networks with regard to prescription abuse. Methods: Twitter statuses mentioning prescription drugs were collected from November 2011 to November 2012. From this set, 25 Twitter users were selected that discussed topics indicative of prescription drug abuse. Social circles of 100 people were discovered around each of these Twitter users and the tweets of the Twitter users in these networks were collected and analyzed according to PDA discussion and interaction with other users about the topic. Results: 3,389,771 mentions of prescription drug terms were observed from November 2011 to November 2012. For the 25 social circles, on average 53.96% of the Twitter users used prescription drug terms at least once in their posts, and 37.76% mentioned another Twitter user by name in a post with a prescription drug term. Strong correlation was found between the kinds of drugs mentioned by the index user and his/her network (mean r = 0.73) and between the amount of interaction about prescription drugs and a level of abusiveness shown by the network (r = 0.85, P < 0.001). Conclusions: Twitter users who discuss prescription drug abuse online are surrounded by others who also discuss it - potentially reinforcing a negative behavior and social norm. Date Submitted: May 29, 2013. Open Peer Review Period: May 29, 2013 - Jul 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.

Pediatric Caregiver Attitudes toward Email Communication in an Urban Primary Care Setting

Wed, 29 May 2013 10:22:51 EDT

Background: Overall usage of email communication between patients and physicians continues to increase, due in part to expanding adoption of electronic health records and patient portals. Unequal access and acceptance of these technologies has the potential to exacerbate disparities in care. Little is known about the attitudes of pediatric caregivers with regard to their acceptance of email as a means to communicate with their healthcare providers. Objective: We conducted a survey to assess pediatric caregiver access to and attitudes towards the use of electronic communication modalities to communicate with healthcare providers in an urban pediatric primary care clinic. Methods: Participants were pediatric caregivers recruited from an urban pediatric primary care clinic who completed a 35-item questionnaire in this cross-sectional study. Results: Of the 229 caregivers who completed the survey (91% response rate), 171 (75%) reported that they use email to communicate with others. Of the email users 145 respondents (86%) state that they would like to email doctors, though only 18 (11%) actually do so. Among email users, African-American caregivers were much less likely to support the expanded use of email communication with healthcare providers (AOR=0.34 [95%CI: 0.14-0.82]) as were those with annual incomes <$30,000 (AOR=0.26 [95%CI: 0.09-0.74]). Conclusions: Caregivers of children have access to email and many would be interested in communicating with healthcare providers. However, African-Americans and those in lower socioeconomic groups were much less likely to have positive attitudes toward email. Date Submitted: May 28, 2013. Open Peer Review Period: May 29, 2013 - Jul 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.

A Cardiac Electrical Activity Simulator (CEAS) for virtual worlds

Mon, 27 May 2013 11:09:43 EDT

Background: The electrical behavior of the cardiac myocytes is taught in medical education by studying the ionic currents through the membrane's channels and the phases of the action potential. Simulation of this electrical activity is done using the more complex but accurate reaction-diffusion systems and the simpler cellular automata models. In the latter, each cell is represented by an automaton having a number of states. Each state corresponds to a phase of the action potential curve providing an easy way to visualize the stimulus propagation. Objective: To create a user friendly educational simulator of the cardiac electrical activity with adjustable features in Second Life (SL) virtual world, able to reproduce normal and pathological conditions. Methods: We represent tissue though a network of cells, each having the option of being a generator. Each of the cells, when stepping into the depolarization phase of the cardiac action potential, broadcast messages across the board. When a message is received by a cell, the distance is calculated based on a geometric formula and compared to a limit so that distant cells do not activate when they are too far apart. On the other hand, the cells that are close to other cells in refractory 1 will be activated by the broadcasted message. This is combined with a probabilistic model of diffusion in order to simulate the stimulus transmission. Using automata that are able to commute from one state to the other, we build a model that is able to describe various instances of the cardiac action potential which we exemplify and explain in detail. Compared to the gathered literature and similar attempts, we add new possibilities such as necrotic cells and the means to create critical pathologies by inducing fibrillation across the network of cells. Results: A simulator was created in SL letting the user build networks of linked cellular automata, create cells that act as pulse generators and adjust the parameters of the action potential of selected cells. The spread of the electrical stimulus across the tissue is visualized through the different colored states of the cells. Normal propagation and pathological circuits, such as reentry arrhythmia were simulated in our experiments. The online virtual environment promotes e-learning processes through constructivism allowing users to edit, expand and improve the simulator’s code. Conclusions: By combining automata concepts, probabilistic model of diffusion and the Linden Scripting Language (LSL), we developed an educational tool in Second Life able to create visualizations of normal and pathological myocardial electrical activity. Date Submitted: May 24, 2013. Open Peer Review Period: May 27, 2013 - Jul 22, 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.

Design and evaluation of a simulation for pediatric dentistry in virtual worlds

Mon, 27 May 2013 11:04:27 EDT

Background: Three dimensional virtual worlds are becoming very popular among educators in the medical field. Virtual clinics and patients are already used for case study and role play in both undergraduate and continuing education levels. Dental education can also take advantage of the virtual world’s pedagogical features in order to give students the opportunity to interact with virtual patients (VPs) and practice in treatment planning. Objective: The objective of this study was to design and evaluate a virtual patient as a supplemental teaching tool for pediatric dentistry. Methods: A child VP, called Erietta was implemented by utilizing the programming and building tools that online virtual worlds offer. The case is about an eight year old girl visiting the dentist with her mother for the first time. Communication techniques such as Tell-Show-Do, and parents’ interference management were the basic elements of the educational scenario on which the VP was based. An evaluation of the simulation was made by 103 dental students in their fourth year of study. Two groups were formed, an experimental (N=52) and a control group (N=51). At the end, both groups were asked to fill a feedback form and the results were compared. Results: A statistically significant difference between the two groups was found that showed a positive learning effect of the VP. The majority of the participants evaluated the aspects of the simulation very positively and expressed their preference of using this module as an additional teaching tool. Conclusions: This study demonstrated that a pediatric-dentistry VP built in a virtual world has a significant learning potential when used as a supplement to the traditional teaching techniques. Date Submitted: May 24, 2013. Open Peer Review Period: May 27, 2013 - Jul 22, 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.

Mindfulness-based Mobile Applications: Literature Review and Analysis of Current Features

Mon, 27 May 2013 10:00:39 EDT

Background: Interest in mindfulness has increased exponentially, particularly in the fields of psychology and medicine. The trait or state of mindfulness is significantly related to several indicators of psychological health, and mindfulness-based therapies (MBTs) are effective at preventing and treating many chronic diseases. Interest in mobile applications for health promotion and disease self-management is also growing. Despite the explosion of interest, research on both the design and potential uses of mindfulness-based mobile applications (MBMAs) is scarce. Objective: Our main objective was to study the features of current MBMAs and compare them to current evidence-based literature in the health and clinical setting. Methods: We searched online vendor markets, scientific journal databases, and grey literature related to MBMAs. We included mobile applications that featured a mindfulness-based component related to training or daily practice of mindfulness techniques. We excluded opinion-based articles from the literature. Results: The literature search resulted in eight eligible matches, of which only one completely met our selection criteria: a pilot study designed to evaluate the feasibility of an MBMA to train the practice of “walking meditation”. The online market search eventually analysed 50 available MBMAs, which were devoted to daily meditation practice (58.7%), mindfulness training (13%), assessments or tests (10.8%), attention focus (8.7%), and mixed objectives (8.7%). The main resources used were reminders, alarms, or bells (19%), statistics tools (16%), audio tracks (14%) and educational texts (10%). Daily, weekly or monthly statistics or reports were provided by 74% of the apps. No information about sensors was available. The analysed applications seemed not to use any external sensor. Twenty-one out of fifty analysed applications used alerts or reminders. Fifty-two percent of them permitted access to a social network. We did not find any evaluations of health outcomes resulting from the use of MBMAs. The most common operating system was Android. English was the language of 82% of the apps, and only 8% provided information in Spanish. Conclusions: While a wide selection of MBMAs seem to be available to interested people, this study shows an almost complete lack of evidence supporting the usefulness of those applications. We found no randomised clinical trials evaluating the impact of these applications on mindfulness training or health indicators, and the potential for mobile mindfulness applications remains largely unexplored. Date Submitted: May 27, 2013. Open Peer Review Period: May 27, 2013 - Jul 22, 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.