%0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58542 %T Ambulance Commanders’ Reluctance to Enter Road Tunnels in Simulated Incidents and the Effects of a Tunnel-Specific e-Learning Course on Decision-Making: Web-Based Randomized Controlled Trial %A Hylander,Johan %A Gyllencreutz,Lina %A Haney,Michael %A Westman,Anton %+ Department of Diagnostics and Intervention, Surgery, Umeå University, Linnaeus väg 6, Umeå, 90736, Sweden, 46 90 786 50 00, johan.hylander@umu.se %K e-learning %K major incident %K incident management %K disaster medicine %K road tunnels %D 2025 %7 28.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The optimal response to a major incident in a road tunnel involves efficient decision-making among the responding emergency services (fire and rescue services, police, and ambulances). The infrequent occurrence of road tunnel incidents may entail unfamiliarity with the tunnel environment and lead to uncertain and inefficient decision-making among emergency services commanders. Ambulance commanders have requested tunnel-specific learning materials to improve their preparedness. Objective: We aimed to assess decision-making among ambulance commanders in simulated road tunnel incidents after they had participated in a tunnel-specific e-learning course designed to support timely and correct decisions in this context. Methods: We conducted a web-based intervention study involving 20 participants from emergency medical services in Sweden who were randomly allocated to a test or control group. The control group (n=10, 50%) received a lecture on general incident management, while the intervention group (n=10, 50%) completed an e-learning course consisting of 5 modules focused on tunnel structure, safety, and collaboration in response. The participants took part in 2 simulation-based assessments for ambulance commander decision-making in major road tunnel incidents 1 month and 6 months after their allocated study intervention. In each simulation, the participants decided on the best course of action at 15 independent decision points, designed as multiple-choice questions. The primary outcome was the correct response to the question regarding how to appropriately enter the road tunnel. The secondary outcome measurements were correct or incorrect responses and the time taken to decide for each of the 15 decisions. Limited in-depth follow-up interviews were conducted with participants (n=5, 25%), and collected data were analyzed using qualitative content analysis. Results: All 20 participants completed the first simulation, and 16 (80%) completed the second. The main finding was that none (0/20, 0%) of the participants correctly answered the question on entering the tunnel system in the 1-month assessment. There were no significant differences between the groups (P=.59; 2-sample test of proportions) in the second assessment. The e-learning course was not associated with more correct answers at the first assessment, including accounting for participant factors (mean difference between groups: –0.58 points, 95% CI –1.88 to 0.73; P=.36). The e-learning course was also not associated with a shorter time to completion compared to the nonintervention group in either assessment. Interviews identified 3 categories linked to the main outcome: information (lack of), risk (limited knowledge and equipment), and mitigation (access to maps and aide-mémoire). Conclusions: Participation in a tunnel-specific e-learning course did not result in a measurable change in ambulance commanders’ decision-making behavior during simulated road tunnel incidents. The observed hesitation to enter the road tunnel system may have several plausible causes, such as the lack of actionable intelligence and tunnel-specific plans. This novel approach to assessing commander decision-making may be transferable to other educational settings. %M 40153786 %R 10.2196/58542 %U https://formative.jmir.org/2025/1/e58542 %U https://doi.org/10.2196/58542 %U http://www.ncbi.nlm.nih.gov/pubmed/40153786 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e63557 %T Characteristics of In-Flight Medical Emergencies on a Commercial Airline in Mainland China: Retrospective Study %A Shi,Ruizi %A Jiang,Weisong %A Yang,Jing %A Dong,Xiaomei %A Yu,Pei %A Zhou,Shuai %A Shang,Hanbing %A Xu,Wanying %A Chen,Er-zhen %A Yang,Zhitao %A Zhou,Ying %K in-flight medical emergency %K onboard emergency %K aviation medicine %K China %K aircraft %K medical emergency %K aviation %K airline %K medical response %K retrospective study %D 2024 %7 19.12.2024 %9 %J JMIR Public Health Surveill %G English %X Background: In-flight medical emergencies (IMEs) can have severe outcomes, including the deaths of passengers and aircraft diversions. Information is lacking regarding the incidence rate and characteristics of IMEs in most countries, especially in mainland China. Objective: The objective of this study was to investigate the incidence, patterns, and associated risk factors of IMEs in mainland China and to provide medical suggestions for the evaluation and management of IMEs. Methods: This population-based retrospective study examined electronic records for all IME reports between January 1, 2018, and December 31, 2022, from a major airline company in mainland China. Outcome variables included the medical category of the IMEs, the outcomes of first aid, and whether or not the IMEs led to a flight diversion. We calculated the incidence rate and death rate of IMEs based on the number of passengers and flights, respectively. A logistic regression model was used to investigate the factors associated with aircraft diversions. Results: A total of 199 IMEs and 24 deaths occurred among 447.2 million passengers, yielding an incidence rate of 0.44 (95% CI 0.39‐0.51) events per million passengers and 66.56 (95% CI 50.55‐86.04) events per million flights, and an all-cause mortality rate of 0.05 (95% CI 0.03‐0.07) events per million passengers and 7.50 (95% CI 4.81‐11.16) events per million flights. From 2018 to 2022, the highest incidence and mortality rates were observed in 2019 and 2020, respectively, while the lowest were in 2020 and 2021, respectively. Additionally, the highest incidence and mortality rates were observed between 6 PM to 6 AM and noon to 6 PM, respectively. There was a higher incidence rate of IMEs in the winter months. Moreover, the highest case-fatality rates were observed in 2019 (12/74, 16.2%), on flights traveling ≥4000 km (9/43, 20.9%), and on wide-body planes (10/52, 19.2%). Seizures (29/199, 14.6%), cardiac symptoms (25/199, 12.6%), and syncope or presyncope (19/199, 9.6%) were the most common medical problems and main reasons for aircraft diversion. The incidence of aircraft diversion was 42.50 (95% CI 37.02‐48.12) events per million flights. Narrow-body planes (odds ratio [OR] 5.69, 95% CI 1.05-30.90), flights ≥4000 km (OR 16.40, 95% CI 1.78‐151.29), and the months of December to February (OR 12.70, 95% CI 3.09‐52.23), as well as the months of March to May (OR 23.21, 95% CI 3.75‐143.43), were significantly associated with a higher risk of diversion. Conclusions: The occurrence of and deaths associated with IMEs are rare in mainland China, but a temporal trend shows higher incidence rates at night and in winter. The leading IMEs are cardiac symptoms, seizures, and syncope. The establishment of a unified reporting system for IMEs and ground-to-air medical support are of great value for reducing IMEs and deaths in the global community. %R 10.2196/63557 %U https://publichealth.jmir.org/2024/1/e63557 %U https://doi.org/10.2196/63557 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55029 %T Effects of Injury Registry Data on Policy Making, Hospitalizations, and Mortality: Protocol for a Systematic Review and Meta-Analysis %A Medeiros-de-Souza,Ana Cláudia %A Lopes,Luana Emanuelly Sinhori %A de Oliveira,Bruno Zocca %A Rother,Edna Terezinha %A Correia,Lucas Reis %+ Hospital Israelita Albert Einstein, 755 Comendador Elias Jafet Street, L1 Floor, Room 134, Sao Paulo, 05653-000, Brazil, 55 11989249946, ana.cms@einstein.br %K injury registry %K trauma registry %K policy making %K health policy %K wounds and injuries %K outcome assessments, health surveillance %K hospitalizations %K mortality %D 2024 %7 30.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Initiated in 2021, a Brazilian project aims to establish a national injury registry, compiling comprehensive data on events and individuals across the country, irrespective of injury severity. The registry integrates information from prehospital and hospital care, diverse health systems lacking interoperability, and sectors such as firefighters and the police. Its primary goal is to enhance health surveillance by providing timely, high-quality information, guiding prevention strategies, and informing policy making. The project still aims to reduce long-term morbidity and mortality associated with injuries. Objective: A knowledge gap remains regarding the effects of injury registries in relation to policies and injury outcomes. This protocol outlines a systematic review and meta-analysis to answer “What is the effect of implementation and use of injury registry data on policy making, hospitalization, and mortality?” Methods: The systematic review follows PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, focusing on studies reporting results related to the implementation and use of injury registries, including trauma registries. Outcomes of interest include policy making, hospitalization rates or duration, and mortality. Registries within well-defined administrative boundaries will be included. Data will be collected from PubMed, Embase, Scopus, Web of Science, Lilacs, and references. Records will be independently screened by 2 reviewers, with any disagreements resolved through arbitration by a third reviewer. Homogeneous studies, with 3 or more evaluating the same outcome, may undergo meta-analysis. Subgroup analyses by registry type, injury groups, and other selected variables of interest will be conducted. Sensitivity analysis, risk of bias assessment, publication bias evaluation, and quality appraisal will also be performed. Results: This systematic review will run from November 2023 to June 2024. No identical review was found. Search strategies were finalized, the bibliographic search started, duplicates were eliminated, and title and abstract screening began. Of 35 studies retrieved, 85 were excluded due to duplication, leaving 50 for selection. Conclusions: This study is timely, aligning with ongoing national efforts to implement an injury registry. By synthesizing available evidence, we will identify the potential of injury registries to guide the decisions of Brazilian policy makers. Trial Registration: PROSPERO CRD42023481528; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=481528 International Registered Report Identifier (IRRID): PRR1-10.2196/55029 %M 39475822 %R 10.2196/55029 %U https://www.researchprotocols.org/2024/1/e55029 %U https://doi.org/10.2196/55029 %U http://www.ncbi.nlm.nih.gov/pubmed/39475822 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e53067 %T Visual “Scrollytelling”: Mapping Aquatic Selfie-Related Incidents in Australia %A Cornell,Samuel %A Peden,Amy E %+ School of Population Health, University of New South Wales, High St, Kensington, Sydney, 2052, Australia, 61 (2) 9065 38, s.cornell@unsw.edu.au %K selfie %K map %K social media %K selfies %K scrollama %K JavaScript %K scrollytelling %K Mapbox %K incidence %K incidents %K incident %K fatality %K fatalities %K injury %K injuries %K retrieval %K prevalence %K image %K images %K photo %K photos %K photograph %K photographs %K prevalence %K Australia %K emergency %K visualization %K visualizations %K interactive %K location %K geography %K geographic %K geographical %K spatial %K artificial intelligence %K longitude %K latitude %K visual representation %K visual representations %D 2024 %7 23.5.2024 %9 Research Letter %J Interact J Med Res %G English %X %M 38781002 %R 10.2196/53067 %U https://www.i-jmr.org/2024/1/e53067 %U https://doi.org/10.2196/53067 %U http://www.ncbi.nlm.nih.gov/pubmed/38781002 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55297 %T Effect of Rural Trauma Team Development on the Outcomes of Motorcycle Accident–Related Injuries (Motor Registry Project): Protocol for a Multicenter Cluster Randomized Controlled Trial %A Lule,Herman %A Mugerwa,Micheal %A Ssebuufu,Robinson %A Kyamanywa,Patrick %A Bärnighausen,Till %A Posti,Jussi P %A Wilson,Michael Lowery %+ Injury Epidemiology and Prevention (IEP) Research Group, Turku Brain Injury Centre, Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turun Yliopisto, Turku, FI-20014, Finland, 358 465699821, helule@utu.fi %K randomized controlled trial %K medical education %K trauma team %K trauma registry %K rural health %K global health %K team development %K Africa %K rural %K trauma %K motorcycle injury %K multicenter cluster randomized controlled clinical trial %K injury %K accident %K low- and middle-income countries %K patient outcomes %K education program %D 2024 %7 7.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Injury is a global health concern, and injury-related mortality disproportionately impacts low- and middle-income countries (LMICs). Compelling evidence from observational studies in high-income countries shows that trauma education programs, such as the Rural Trauma Team Development Course (RTTDC), increase clinician knowledge of injury care. There is a dearth of such evidence from controlled clinical trials to demonstrate the effect of the RTTDC on process and patient outcomes in LMICs. Objective: This multicenter cluster randomized controlled clinical trial aims to examine the impact of the RTTDC on process and patient outcomes associated with motorcycle accident–related injuries in an African low-resource setting. Methods: This is a 2-arm, parallel, multi-period, cluster randomized, controlled, clinical trial in Uganda, where rural trauma team development training is not routinely conducted. We will recruit regional referral hospitals and include patients with motorcycle accident–related injuries, interns, medical trainees, and road traffic law enforcement professionals. The intervention group (RTTDC) and control group (standard care) will include 3 hospitals each. The primary outcomes will be the interval from the accident to hospital admission and the interval from the referral decision to hospital discharge. The secondary outcomes will be all-cause mortality and morbidity associated with neurological and orthopedic injuries at 90 days after injury. All outcomes will be measured as final values. We will compare baseline characteristics and outcomes at both individual and cluster levels between the intervention and control groups. We will use mixed effects regression models to report any absolute or relative differences along with 95% CIs. We will perform subgroup analyses to evaluate and control confounding due to injury mechanisms and injury severity. We will establish a motorcycle trauma outcome (MOTOR) registry in consultation with community traffic police. Results: The trial was approved on August 27, 2019. The actual recruitment of the first patient participant began on September 01, 2019. The last follow-up was on August 27, 2023. Posttrial care, including linkage to clinical, social support, and referral services, is to be completed by November 27, 2023. Data analyses will be performed in Spring 2024, and the results are expected to be published in Autumn 2024. Conclusions: This trial will unveil how a locally contextualized rural trauma team development program impacts organizational efficiency in a continent challenged with limited infrastructure and human resources. Moreover, this trial will uncover how rural trauma team coordination impacts clinical outcomes, such as mortality and morbidity associated with neurological and orthopedic injuries, which are the key targets for strengthening trauma systems in LMICs where prehospital care is in the early stage. Our results could inform the design, implementation, and scalability of future rural trauma teams and trauma education programs in LMICs. Trial Registration: Pan African Clinical Trials Registry (PACTR202308851460352); https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25763 International Registered Report Identifier (IRRID): DERR1-10.2196/55297 %M 38713507 %R 10.2196/55297 %U https://www.researchprotocols.org/2024/1/e55297 %U https://doi.org/10.2196/55297 %U http://www.ncbi.nlm.nih.gov/pubmed/38713507 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e47902 %T Trends in Cause-Specific Injury Mortality in China in 2005-2019: Longitudinal Observational Study %A Ji,Zixiang %A Wu,Hengjing %A Zhu,Rongyu %A Wang,Lu %A Wang,Yuzhu %A Zhang,Lijuan %+ Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital, Tongji University School of Medicine, Tongji University, 50 Chifeng Road, Yangpu, Shanghai, 201619, China, 86 13817934887, zhangxiaoyi@tongji.edu.cn %K reverse %K age-standardized mortality rate %K injury %K suicide %K trend %K potential years of life lost %K average years of life lost %K crude mortality rate %K falls %K older adults %K young adults %D 2023 %7 15.9.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Over the last few decades, although the age-standardized mortality rate (ASMR) of injury has shown a significant declining trend in China, this pattern has dramatically reversed recently. Objective: We aimed to elucidate the geographical, demographic, and temporal trends of cause-specific injuries, the reversal phenomenon of these trends, and the fluctuations of injury burden from 2005 to 2019 in China. Methods: A longitudinal observational study was performed using the raw data of injury deaths in the National Cause-of-Death surveillance data provided by the disease surveillance points system in 2005-2019. The cause-specific injuries were divided into disparate subgroups by sex, age, urban/rural region, and eastern/central/western areas of China. The burden of injury was assessed using potential years of life lost (PYLL), average years of life lost (AYLL), and PYLL rate (PYLLR). Temporal trends of mortality rates and burden were evaluated using best-fitting joinpoint models. Results: Injury deaths accounted for 7.51% (1,156,504/15,403,835) of all-cause deaths in China in 2005-2019. The crude mortality rate of all-cause injury was 47.74 per 100,000 persons. The top 3 injury types (traffic accident, falls, and suicide) accounted for 70.57% (816,145/1,156,504) of all injury-related deaths. The ASMR of all-cause injury decreased (P=.003), while the crude mortality rate remained unchanged (P=.52) during 2005-2019. A significant reverse trend in ASMR of all-cause injury was observed in urban older adults since 2013, mainly due to the inverted trend in injuries from falls. A reverse trend in ASMR of suicide was observed among individuals aged 10-24 years, with notable increases by 35.18% (annual percentage change 15.4%, 95% CI 4.1%-28.0%) in men since 2017. The AYLL and PYLLR of all-cause injury among older adults showed consistent ascending trends from 2005 to 2019 (average annual percentage change [AAPC] 6.1%, 95% CI 5.4%-6.9%, 129.04% increase for AYLL; AAPC 5.4%, 95% CI 2.4%-8.4%, 105.52% increase for PYLLR). The AYLL due to suicide for individuals aged 10-24 years showed a considerable upswing tendency (AAPC 0.5%, 95% CI 0.4%-0.7%, 8.02% increase). Conclusions: Although the ASMR of all-cause injury decreased in China from 2005 to 2019, the trend in suicide among adolescents and young adults and falls among older adults has been on the rise in recent years. Interventions should be encouraged to mitigate the cause-specific burdens of injury death. %M 37713250 %R 10.2196/47902 %U https://publichealth.jmir.org/2023/1/e47902 %U https://doi.org/10.2196/47902 %U http://www.ncbi.nlm.nih.gov/pubmed/37713250 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42231 %T Safety Concerns in Mobility-Assistive Products for Older Adults: Content Analysis of Online Reviews %A Mali,Namrata %A Restrepo,Felipe %A Abrahams,Alan %A Sands,Laura %A Goldberg,David M %A Gruss,Richard %A Zaman,Nohel %A Shields,Wendy %A Omaki,Elise %A Ehsani,Johnathon %A Ractham,Peter %A Kaewkitipong,Laddawan %+ Center of Excellence in Operations and Information Management, Thammasat Business School, Thammasat University, 2 Prachan Rd., Pranakorn, Bangkok, 10200, Thailand, 66 26132200, laddawan@tbs.tu.ac.th %K injury prevention %K consumer-reported injuries %K older adults %K online reviews %K mobility-assistive devices %K product failures %D 2023 %7 2.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Older adults who have difficulty moving around are commonly advised to adopt mobility-assistive devices to prevent injuries. However, limited evidence exists on the safety of these devices. Existing data sources such as the National Electronic Injury Surveillance System tend to focus on injury description rather than the underlying context, thus providing little to no actionable information regarding the safety of these devices. Although online reviews are often used by consumers to assess the safety of products, prior studies have not explored consumer-reported injuries and safety concerns within online reviews of mobility-assistive devices. Objective: This study aimed to investigate injury types and contexts stemming from the use of mobility-assistive devices, as reported by older adults or their caregivers in online reviews. It not only identified injury severities and mobility-assistive device failure pathways but also shed light on the development of safety information and protocols for these products. Methods: Reviews concerning assistive devices were extracted from the “assistive aid” categories, which are typically intended for older adult use, on Amazon’s US website. The extracted reviews were filtered so that only those pertaining to mobility-assistive devices (canes, gait or transfer belts, ramps, walkers or rollators, and wheelchairs or transport chairs) were retained. We conducted large-scale content analysis of these 48,886 retained reviews by coding them according to injury type (no injury, potential future injury, minor injury, and major injury) and injury pathway (device critical component breakage or decoupling; unintended movement; instability; poor, uneven surface handling; and trip hazards). Coding efforts were carried out across 2 separate phases in which the team manually verified all instances coded as minor injury, major injury, or potential future injury and established interrater reliability to validate coding efforts. Results: The content analysis provided a better understanding of the contexts and conditions leading to user injury, as well as the severity of injuries associated with these mobility-assistive devices. Injury pathways—device critical component failures; unintended device movement; poor, uneven surface handling; instability; and trip hazards—were identified for 5 product types (canes, gait and transfer belts, ramps, walkers and rollators, and wheelchairs and transport chairs). Outcomes were normalized per 10,000 posting counts (online reviews) mentioning minor injury, major injury, or potential future injury by product category. Overall, per 10,000 reviews, 240 (2.4%) described mobility-assistive equipment–related user injuries, whereas 2318 (23.18%) revealed potential future injuries. Conclusions: This study highlights mobility-assistive device injury contexts and severities, suggesting that consumers who posted online reviews attribute most serious injuries to a defective item, rather than user misuse. It implies that many mobility-assistive device injuries may be preventable through patient and caregiver education on how to evaluate new and existing equipment for risk of potential future injury. %M 36862459 %R 10.2196/42231 %U https://www.jmir.org/2023/1/e42231 %U https://doi.org/10.2196/42231 %U http://www.ncbi.nlm.nih.gov/pubmed/36862459 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e40985 %T Estimating the Burden of Disability From Road Traffic Injuries in 5 Low- and Middle-Income Countries: Protocol for a Prospective Observational Study %A Khalaf,Mohammad K %A Rosen,Heather E %A Mitra,Sudeshna %A Neki,Kazuyuki %A Mbugua,Leah Watetu %A Hyder,Adnan A %A Paichadze,Nino %+ Department of Global Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, NW, Washington, DC, 20052, United States, 1 202 994 0261, mkhalaf@gwu.edu %K road traffic injuries %K road traffic crashes %K trauma care %K disabilities %K rehabilitation environmental factors %K low- and middle-income countries %D 2023 %7 1.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Road traffic injuries (RTIs) are a leading cause of death and unintentional injuries globally. They claim 1.35 million lives and produce up to 50 million injuries each year, causing a major drain on health systems. Despite this high burden, there is a lack of robust data on the long-term consequences of RTIs, specifically the level of disability experienced by many survivors and its impact on their everyday lives. Objective: This study aims to characterize RTIs, disability level, and related consequences affecting adult road traffic crash survivors in 5 low- and middle-income countries (LMICs). In addition, this study estimates the role of demographic and crash- and treatment-related factors in predicting adverse outcomes and disability as well as examining the disability level among patients with RTIs, likelihood of return to normal life, and the environmental factors that may influence these outcomes after discharge from the hospital. Methods: This prospective observational study was conducted at selected hospitals in Bangladesh, Cambodia, Ethiopia, Mexico, and Zambia. The study sample included all adult patients with RTIs admitted to the hospital for at least 24 hours. Consecutive sampling was performed until the minimum required sample size of 400 was reached for each participating country. Data were collected from patients or their caregivers using a hospital-based surveillance tool administered at the participating sites as well as a telephone-based follow-up instrument administered 1, 3, and 6 months after discharge. Descriptive analysis and multivariate models will be used to estimate the contribution of a range of factors in predicting adverse outcomes, disability, and return to normal life. Results: Enrollment began in June 2021 and was completed in April 2022. Follow-up data collection ended in September 2022. Data analysis is currently underway, with results expected for publication in mid-2023. Expected results include estimates of disability among patients with RTIs as well as identifying the predictors of adverse outcomes, disability, and the likelihood of return to normal life. Conclusions: Research findings will help better understand the long-term burden of disability from RTIs in the 5 LMICs and the challenges facing survivors of road traffic crashes. They will be used to inform interventions aimed at improving the health care, social, physical, and policy conditions in LMICs that can facilitate recovery and rehabilitation for patients with RTIs, reduce the burden of disability, and enhance their participation in society. International Registered Report Identifier (IRRID): DERR1-10.2196/40985 %M 36723997 %R 10.2196/40985 %U https://www.researchprotocols.org/2023/1/e40985 %U https://doi.org/10.2196/40985 %U http://www.ncbi.nlm.nih.gov/pubmed/36723997 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 8 %P e36861 %T Development and Validation of Indicators for Population Injury Surveillance in Hong Kong: Development and Usability Study %A Tung,Keith T S %A Wong,Rosa S %A Ho,Frederick K %A Chan,Ko Ling %A Wong,Wilfred H S %A Leung,Hugo %A Leung,Ming %A Leung,Gilberto K K %A Chow,Chun Bong %A Ip,Patrick %+ Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, NCB 123, Queen Mary Hospital, Hong Kong, Hong Kong, 852 22554090, patricip@hku.hk %K injury %K indicators %K modified Delphi research design %K surveillance %D 2022 %7 18.8.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Injury is an increasingly pressing global health issue. An effective surveillance system is required to monitor the trends and burden of injuries. Objective: This study aimed to identify a set of valid and context-specific injury indicators to facilitate the establishment of an injury surveillance program in Hong Kong. Methods: This development of indicators adopted a multiphased modified Delphi research design. A literature search was conducted on academic databases using injury-related search terms in various combinations. A list of potential indicators was sent to a panel of experts from various backgrounds to rate the validity and context-specificity of these indicators. Local hospital data on the selected core indicators were used to examine their applicability in the context of Hong Kong. Results: We reviewed 142 articles and identified 55 indicators, which were classified into 4 domains. On the basis of the ratings by the expert panel, 13 indicators were selected as core indicators because of their good validity and high relevance to the local context. Among these indicators, 10 were from the construct of health care service use, and 3 were from the construct of postdischarge outcomes. Regression analyses of local hospitalization data showed that the Hong Kong Safe Community certification status had no association with 5 core indicators (admission to intensive care unit, mortality rate, length of intensive care unit stay, need for a rehabilitation facility, and long-term behavioral and emotional outcomes), negative associations with 4 core indicators (operative intervention, infection rate, length of hospitalization, and disability-adjusted life years), and positive associations with the remaining 4 core indicators (attendance to accident and emergency department, discharge rate, suicide rate, and hospitalization rate after attending the accident and emergency department). These results confirmed the validity of the selected core indicators for the quantification of injury burden and evaluation of injury-related services, although some indicators may better measure the consequences of severe injuries. Conclusions: This study developed a set of injury outcome indicators that would be useful for monitoring injury trends and burdens in Hong Kong. %M 35980728 %R 10.2196/36861 %U https://publichealth.jmir.org/2022/8/e36861 %U https://doi.org/10.2196/36861 %U http://www.ncbi.nlm.nih.gov/pubmed/35980728 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e34413 %T Exploring Infant Fall Events Using Online Parenting Discussion Forums: Infodemiology Study %A Cooray,Nipuna %A Sun,Si Louise %A Adams,Susan %A Keay,Lisa %A Nassar,Natasha %A Brown,Julie %+ The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Level 5/1 King Street, Newtown, 2042, Australia, 61 468311723, ncooray@georgeinstitute.org.au %K falls %K child injury %K online discussion forums %D 2022 %7 10.5.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Falls represent the most common mechanism of injury requiring hospitalization among children under 12 months, and they commonly result in traumatic brain injury. Epidemiological studies exploring infant falls demonstrate the experienced burden, but they lack contextual information vital to the development of preventive interventions. Objective: The objective of this study was to examine contextual information for falls involving children under 12 months, using online parenting discussion forums. Methods: Online parenting forums provide an unobtrusive rich data source for collecting detailed information about fall events. Relevant discussions related to fall incidents were identified and downloaded using site-specific Google Search queries and a programming script. A qualitative descriptive approach was used to analyze the incidents and categorize contextual information into “precursor events” and “influencing factors” for infant falls. Results: We identified 461 infant fall incidents. Common fall mechanisms included falls from furniture, falls when being carried or supported by someone, falls from baby products, and falls on the same level. Across the spectrum of fall mechanisms, common precursor events were infant rolling off, infant being alone on furniture, product misuse, caretaker falling asleep while holding the infant, and caretaker tripping/slipping while carrying the infant. Common influencing factors were infant’s rapid motor development, lapses in caretaker attention, and trip hazards. Conclusions: The findings define targets for interventions to prevent infant falls and suggest that the most viable intervention approach may be to target parental behavior change. Online forums can provide rich information critical for preventive interventions aimed at changing behavior. %M 35536607 %R 10.2196/34413 %U https://pediatrics.jmir.org/2022/2/e34413 %U https://doi.org/10.2196/34413 %U http://www.ncbi.nlm.nih.gov/pubmed/35536607 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e35862 %T COVID-19 Return to Sport: NFL Injury Prevalence Analysis %A Puga,Troy B %A Schafer,Joshua %A Agbedanu,Prince N %A Treffer,Kevin %+ College of Osteopathic Medicine, Kansas City University, 1750 Independence Ave, Kansas City, MO, 64106, United States, 1 719 821 9272, troy.puga@kansascity.edu %K COVID-19 %K sport %K injury %K prevalence %K cause %K data %K statistics %K pain %K training %K practice %K physiology %K adaptation %D 2022 %7 22.4.2022 %9 Original Paper %J JMIRx Med %G English %X Background: Sport injuries have been common among athletes across the globe for decades and have the potential to disrupt athletic careers, performance, and psyche. Many health professionals and organizations have undertaken injury mitigation strategies to prevent sport injuries through protective equipment, training protocols, and a host of other evidence-based practices. Many of these specialized training methods were disrupted due to protocols to mitigate the spread of COVID-19. This research examines the effects of the COVID-19 pandemic in relation to the prevalence of athletic injuries in the National Football League (NFL). Objective: During the COVID-19 pandemic, NFL teams and athletes across all levels of sport were reported to have reduced training in preparation for their seasons due to protocols to mitigate the spread of COVID-19. This study compares the prevalence of injury during the 2018, 2019, and 2020 NFL seasons, with the aim to determine the potential causes of the differences in injury prevalence. Methods: Official injury reports from each team were counted during the 17-week regular season of each year (2018, 2019, and 2020). The data were analyzed using an unpaired t test to compare the injury prevalence between each of the three seasons. Results: The 2018 season produced a total of 1561 injuries and a mean of 48.8 injuries per team. The 2019 season produced a total of 1897 injuries and a mean of 59.3 injuries per team, while the 2020 season produced a total of 2484 injuries and a mean of 77.6 injuries per team. An unpaired t test was performed using the data to compare the mean number of injuries per team during each of the seasons. Comparison of the 2020 season against the 2019 season showed a statistically significant difference (P<.001); comparison of the 2020 season to the 2018 season found a statistically significant difference (P<.001); and comparison between the 2019 and the 2018 seasons found a statistically significant difference (P=.03). Conclusions: Although the 2019 and 2018 seasons showed a statistically significant difference (P=.03), this difference is not as large when we compare the 2020 seasons versus the 2019 (P<.001) and 2018 (P<.001) seasons. The astronomical increase in injury prevalence during the 2020 season over the previous years raises the possibility that there was a reduced physiological adaptation to stress, due to the limited amount of training as a result of the closure of practice facilities in order to slow the spread of COVID-19. %M 35511457 %R 10.2196/35862 %U https://med.jmirx.org/2022/2/e35862 %U https://doi.org/10.2196/35862 %U http://www.ncbi.nlm.nih.gov/pubmed/35511457 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 1 %P e34369 %T Trauma Care Training in Vietnam: Narrative Scoping Review %A Nguyen,Ba Tuan %A Phung,Toi Lam %A Khuc,Thi Hong Hanh %A Nguyen,Van Anh Thi %A Blizzard,Christopher Leigh %A Palmer,Andrew %A Nguyen,Huu Tu %A Cong Quyet,Thang %A Nelson,Mark %+ Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, 7000, Australia, 61 460918919, batuan.nguyen@utas.edu.au %K trauma training %K Vietnamese medical education system %K medical curricula %K short course %D 2022 %7 24.1.2022 %9 Review %J JMIR Med Educ %G English %X Background: The model of trauma in Vietnam has changed significantly over the last decade and requires reforming medical education to deal with new circumstances. Our aim is to evaluate this transition regarding the new target by analyzing trauma and the medical training system as a whole. Objective: This study aimed to establish if medical training in the developing country of Vietnam has adapted to the new disease pattern of road trauma emerging in its economy. Methods: A review was performed of Vietnamese medical school, Ministry of Health, and Ministry of Education and Training literature on trauma education. The review process and final review paper were prepared following the guidelines on scoping reviews and using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart. Results: The current trauma training at the undergraduate level is minimal and involves less than 5% of the total credit. At the postgraduate level, only the specialties of surgery and anesthesia have a significant and increasing trauma training component ranging from 8% to 22% in the content. Trauma training, which focuses on practical skills, accounts for 31% and 32% of the training time of orientation courses for young doctors in “basic surgery” and “basic anesthesia,” respectively. Other relevant short course trainings, such as continuing medical education, in trauma are available, but they vary in topics, facilitators, participants, and formats. Conclusions: Medical training in Vietnam has not adapted to the new emerging disease pattern of road trauma. In the interim, the implementation of short courses, such as basic trauma life support and primary trauma care, can be considered as an appropriate method to compensate for the insufficient competency-related trauma care among health care workers while waiting for the effectiveness of medical training reformation. %M 34967756 %R 10.2196/34369 %U https://mededu.jmir.org/2022/1/e34369 %U https://doi.org/10.2196/34369 %U http://www.ncbi.nlm.nih.gov/pubmed/34967756 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e25897 %T Online Newspaper Reports on Ambulance Accidents in Austria, Germany, and Switzerland: Retrospective Cross-sectional Review %A Boldt,Johanna %A Steinfort,Femke %A Müller,Martin %A Exadaktylos,Aristomenis K %A Klukowska-Roetzler,Jolanta %+ Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern University, Freiburgerstrasse 16C, Berne, 3010, Switzerland, 41 31 632 33 96, jolanta.klukowska-roetzler@insel.ch %K ambulance accidents %K ambulance collisions %K ambulance crashes %K media-based %K media-based review %K newspaper review %K Austria %K Germany %K Switzerland %K German-speaking European countries %K retrospective %K cross-sectional %K review %K ambulance %K accident %K data %K media %K newspaper %D 2021 %7 12.11.2021 %9 Review %J JMIR Public Health Surveill %G English %X Background: Ambulance accidents are an unfortunate indirect result of ambulance emergency calls, which create hazardous environments for personnel, patients, and bystanders. However, in European German-speaking countries, factors contributing to ambulance accidents have not been optimally researched and analyzed. Objective: The objective of this study was to extract, analyze, and compare data from online newspaper articles on ambulance accidents for Austria, Germany, and Switzerland. We hope to highlight future strategies to offset the deficit in research data and official registers for prevention of ambulance and emergency vehicle accidents. Methods: Ambulance accident data were collected from Austrian, German, and Swiss free web-based daily newspapers, as listed in Wikipedia, for the period between January 2014 and January 2019. All included newspapers were searched for articles reporting ambulance accidents using German terms representing “ambulance” and “ambulance accident.” Characteristics of the accidents were compiled and analyzed. Only ground ambulance accidents were covered. Results: In Germany, a total of 597 ambulance accidents were recorded, corresponding to 0.719 (95% CI 0.663-0.779) per 100,000 inhabitants; 453 of these accidents left 1170 people injured, corresponding to 1.409 (95% CI 1.330-1.492) per 100,000 inhabitants, and 28 of these accidents caused 31 fatalities, corresponding to 0.037 (95% CI 0.025-0.053) per 100,000 inhabitants. In Austria, a total of 62 ambulance accidents were recorded, corresponding to 0.698 (95% CI 0.535-0.894) per 100,000 inhabitants; 47 of these accidents left 115 people injured, corresponding to 1.294 (95% CI 1.068-1.553) per 100,000 inhabitants, and 6 of these accidents caused 7 fatalities, corresponding to 0.079 (95% CI 0.032-0.162) per 100,000 inhabitants. In Switzerland, a total of 25 ambulance accidents were recorded, corresponding to 0.293 (95% CI 0.189-0.432) per 100,000 inhabitants; 11 of these accidents left 18 people injured, corresponding to 0.211(95% CI 0.113-0.308) per 100,000 inhabitants. There were no fatalities. In each of the three countries, the majority of the accidents involved another car (77%-81%). In Germany and Switzerland, most accidents occurred at an intersection. In Germany, Austria, and Switzerland, 38.7%, 26%, and 4%, respectively, of ambulance accidents occurred at intersections for which the ambulance had a red light (P<.001). In all three countries, most of the casualties were staff and not uncommonly a third party. Most accidents took place on weekdays and during the daytime. Ambulance accidents were evenly distributed across the four seasons. The direction of travel was reported in 28%-37% of the accidents and the patient was in the ambulance approximately 50% of the time in all countries. The cause of the ambulance accidents was reported to be the ambulance itself in 125 (48.1% of accidents where the cause was reported), 22 (42%), and 8 (40%) accidents in Germany, Austria, and Switzerland, respectively (P=.02), and another vehicle in 118 (45.4%), 29 (56%), and 9 (45%) accidents, respectively (P<.001). A total of 292 accidents occurred while blue lights and sirens were used, which caused 3 deaths and 577 injuries. Conclusions: This study draws attention to much needed auxiliary sources of data that may allow for creation of a contemporary registry of all ambulance accidents in Austria, Germany, and Switzerland. To improve risk management and set European standards, it should be mandatory to collect standardized goal-directed and representative information using various sources (including the wide range presented by the press and social media), which should then be made available for audit, analysis, and research. %M 34766915 %R 10.2196/25897 %U https://publichealth.jmir.org/2021/11/e25897 %U https://doi.org/10.2196/25897 %U http://www.ncbi.nlm.nih.gov/pubmed/34766915 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e30990 %T Feasibility and Acceptability of a Web-Based Caregiver Decision Aid (Safety in Dementia) for Firearm Access: Pilot Randomized Controlled Trial %A Betz,Marian E %A Polzer,Evan %A Nearing,Kathryn %A Knoepke,Christopher E %A Johnson,Rachel L %A Meador,Lauren %A Matlock,Daniel D %+ Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue, B-215, Aurora, CO, 80045, United States, 1 7208486777, marian.betz@ucdenver.edu %K dementia %K cognitive impairment %K firearm %K decision aid %K caregivers %K safety %K feasibility %K pilot trial %K Alzheimer disease %K caregiver support %D 2021 %7 22.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Firearms are common in the households of persons with Alzheimer disease and related dementias (ADRD). Safety in Dementia (SiD) is a free web-based decision aid that was developed to support ADRD caregivers in addressing firearm access. Objective: We aimed to evaluate the feasibility and acceptability of SiD among a web-based sample of ADRD caregivers. Methods: SiD was tested in 2 phases by using participants who were recruited from a web-based convenience sample (Amazon Mechanical Turk participants). In phase 1, caregivers were randomized to view either the intervention (SiD) or the control (Alzheimer’s Association materials), and the blinding of participants to the study arms was conducted. In phase 2, caregivers of individuals with ADRD and firearm access were recruited; all of these participants viewed the firearm section of SiD. In both phases, participants viewed SiD independently for as long as they wanted. Measures for evaluating decision-making and SiD acceptability were used, and these were assessed via a self-administered web-based questionnaire. Results: Participants were recruited for phases 1 (n=203) and 2 (n=54). Although it was feasible to collect the study outcome data in a web-based format, in phase 1, there were no significant differences between SiD and the control in terms of decision-making and self-efficacy. The majority (137/203, 67.5%) of phase 1 participants spent between 5 and 10 minutes reviewing the resources. In phase 2, 61% (33/54) of participants spent 5 to 10 minutes viewing the firearm section, and 31% (17/54) spent 10 to 20 minutes viewing this section. Usability and acceptability were high across the phases. Conclusions: SiD represents a new resource for promoting safety among people with dementia, and high acceptability was achieved in a pilot trial. In this sample, SiD performed similarly to Alzheimer’s Association materials in supporting decision-making and self-efficacy. %M 34550082 %R 10.2196/30990 %U https://formative.jmir.org/2021/9/e30990 %U https://doi.org/10.2196/30990 %U http://www.ncbi.nlm.nih.gov/pubmed/34550082 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e28680 %T Pregnant Women’s Attitudes Toward and Experiences With a Tablet Intervention to Promote Safety Behaviors in a Randomized Controlled Trial: Qualitative Study %A Walter,Bente %A Indreboe,Hege %A Lukasse,Mirjam %A Henriksen,Lena %A Garnweidner-Holme,Lisa %+ Department of Nursing and Health Promotion, Oslo Metropolitan University, St Olavs Plass, PO Box 4, Oslo, 0130, Norway, 47 +4748091956, lgarnwei@oslomet.no %K intimate partner violence %K eHealth %K pregnancy %K antenatal care, safety behaviors %K tablet intervention %D 2021 %7 20.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Intimate partner violence (IPV) is recognized as a global health problem. Women with low education and limited resources are more vulnerable, as are immigrant women. There is a lack of evidence on how health care professionals should communicate about and intervene against IPV during pregnancy. Earlier research has shown that when women manage digital questionnaires, they are more likely to disclose IPV. However, little is known about how women experience eHealth interventions with safety behaviors to prevent IPV. Objective: The aim of this study was to explore pregnant women’s attitudes toward and experiences with a tablet intervention to promote safety behaviors in a randomized controlled trial (RCT) in antenatal care. Methods: Individual semistructured interviews were conducted with 10 women who participated in the Safe Pregnancy Study. The Safe Pregnancy Study was a randomized controlled trial (RCT) using a tablet intervention containing IPV questions and a film to promote safety behaviors. Six women from the intervention group and four women from the control group were recruited. The content was available in Norwegian, Somali, and Urdu. Five of the women participating in the interviews spoke Norwegian at home and five spoke another language. The majority of the women who did not speak Norwegian at home perceived themselves as relatively well integrated. The interviews were conducted at different maternal and child health centers (MCHCs) in Norway between March 2020 and June 2020. The analysis was guided by thematic analysis. Results: Women who participated in the tablet intervention appreciated being asked questions about IPV on a tablet. However, it was important to supplement the tablet intervention with face-to-face communication with a midwife. The MCHC was regarded as a suitable place to answer questions and watch a film about safety behaviors. Women suggested making the tablet intervention available in other settings where women meet health care professionals. Some women expressed uncertainty about their anonymity regarding their answers in the questionnaire. We found no real differences between ethnic Norwegian and immigrant women’s attitudes toward and experiences with the tablet intervention. Conclusions: Questions about IPV and a film about safety behaviors on a tablet, as a supplement to face-to-face communication, might initiate and facilitate communication about IPV in antenatal care. Uncertainty regarding anonymity has to be addressed when questions about IPV are being asked on a tablet. Trial Registration: ClinicalTrials.gov NCT03397277; https://clinicaltrials.gov/ct2/show/NCT03397277 %M 34283023 %R 10.2196/28680 %U https://formative.jmir.org/2021/7/e28680 %U https://doi.org/10.2196/28680 %U http://www.ncbi.nlm.nih.gov/pubmed/34283023 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e23242 %T Using Social Media for the Prevention of Pediatric Burn Injuries: Pilot Design and Usability Study %A Batra,Nikita %A Colson,Cindy D %A Alberto,Emily C %A Burd,Randall S %+ Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, United States, 1 202 476 2151, rburd@cnmc.org %K accident prevention %K burns %K pediatric %K public health %K social media %D 2021 %7 15.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Most pediatric burn injuries are preventable. Social media is an effective method for delivering large-scale messaging and may be useful for injury prevention in this domain. Objective: This study evaluates the feasibility of creating a social media campaign for pediatric burn injury prevention. Methods: Ad spots containing a headline, short introduction, and video were created and posted on Facebook and Instagram over 4 months. Ad spots were targeted to parents and caregivers of children in our region with the highest number of burn injuries. We assessed the impact of each ad set using ThruPlays, reach, and video plays. Results: We created 55 ad spots, with an average length of 24.1 (range 10-44) seconds. We reached 26,496 people during the campaign. The total ThruPlays of the 55 ad spots were 14,460 at US $0.19 per ThruPlay. Ad spots related to home safety had a significantly higher daily ThruPlay rate than those related to fire safety (6.5 vs 0.5 per day; P<.001). Conclusions: Social media is a feasible modality for delivering public health messages focused on preventing pediatric burn injuries. Engagement with these ads is influenced by ad presentation and the focus of the underlying injury prevention message. %M 34264194 %R 10.2196/23242 %U https://formative.jmir.org/2021/7/e23242 %U https://doi.org/10.2196/23242 %U http://www.ncbi.nlm.nih.gov/pubmed/34264194 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e24974 %T Examining the Relationship Between Environmental Factors and Inpatient Hospital Falls: Protocol for a Mixed Methods Study %A Shorr,Ronald I %A Ahrentzen,Sherry %A Luther,Stephen L %A Radwan,Chad %A Hahm,Bridget %A Kazemzadeh,Mahshad %A Alliance,Slande %A Powell-Cope,Gail %A Fischer,Gary M %+ Shimberg Center for Housing Studies, College of Design, Construction and Planning, University of Florida, 1480 Inner Road, Gainesville, FL, United States, 1 352 317 8172, m.kazemzadeh@ufl.edu %K falls %K accidental falls %K hospital design and construction %K health facility environment %K hospital units %K evidence-based facility design %K nursing %K environmental factors %K well-being %K accident %D 2021 %7 13.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patient falls are the most common adverse events reported in hospitals. Although it is well understood that the physical hospital environment contributes to nearly 40% of severe or fatal hospital falls, there are significant gaps in the knowledge about the relationship between inpatient unit design and fall rates. The few studies that have examined unit design have been conducted in a single hospital (non-Veterans Health Administration [VHA]) or a small number of inpatient units, limiting generalizability. The goal of this study is to identify unit design factors contributing to inpatient falls in the VHA. Objective: The first aim of the study is to investigate frontline and management perceptions of and experiences with veteran falls as they pertain to inpatient environmental factors. An iterative rapid assessment process will be used to analyze the data. Interview findings will directly inform the development of an environmental assessment survey to be conducted as part of aim 2 and to contribute to interpretation of aim 2. The second aim of this study is to quantify unit design factors and compare spatial and environmental factors of units with higher- versus lower-than-expected fall rates. Methods: We will first conduct walk-through interviews with facility personnel in 10 medical/surgical units at 3 VHA medical centers to identify environmental fall risk factors. Data will be used to finalize an environmental assessment survey for nurse managers and facilities managers. We will then use fall data from the VA Inpatient Evaluation Center and patient data from additional sources to identify 50 medical/surgical nursing units with higher- and lower-than-expected fall rates. We will measure spatial factors by analyzing computer-aided design files of unit floorplans and environmental factors from the environmental assessment survey. Statistical tests will be performed to identify design factors that distinguish high and low outliers. Results: The VA Health Services Research and Development Service approved funding for the study. The research protocol was approved by institutional review boards and VA research committees at both sites. Data collection started in February 2018. Results of the data analysis are expected by February 2022. Data collection and analysis was completed for aim 1 with a manuscript of results in progress. For aim 2, the medical/surgical units were categorized into higher- and lower-than-expected fall categories, the environmental assessment surveys were distributed to facility managers and nurse managers. Data to measure spatial characteristics are being compiled. Conclusions: To our knowledge, this study is the first to objectively identify spatial risks for falls in hospitals within in a large multihospital system. Findings can contribute to evidence-based design guidelines for hospitals such as those of the Facility Guidelines Institute and the Department of Veterans Affairs. The metrics for characterizing spatial features are quantitative indices that could be incorporated in larger scale contextual studies examining contributors to falls, which to date often exclude physical environmental factors at the unit level. Space syntax measures could be used as physical environmental factors in future research examining a range of contextual factors—social, personal, organizational, and environmental—that contribute to patient falls. International Registered Report Identifier (IRRID): DERR1-10.2196/24974 %M 34255724 %R 10.2196/24974 %U https://www.researchprotocols.org/2021/7/e24974 %U https://doi.org/10.2196/24974 %U http://www.ncbi.nlm.nih.gov/pubmed/34255724 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e24458 %T Receptiveness and Responsiveness Toward Using Social Media for Safe Firearm Storage Outreach: Mixed Methods Study %A Lam,Esther %A Moreno,Megan %A Bennett,Elizabeth %A Rowhani-Rahbar,Ali %+ Department of Epidemiology, School of Public Health, University of Washington, UW Box #351619, Seattle, WA, 98195, United States, 1 4088901256, estherwmlam@gmail.com %K firearm storage %K gun safety %K public health outreach %K social media %K mixed methods %K family %D 2021 %7 18.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Childhood and adolescent firearm injury and death rates have increased over the past decade and remain major public health concerns in the United States. Safe firearm storage has proven to be an effective measure to prevent firearm injury and death among youth. Social media has been used as an avenue to promote safe firearm storage, but perceptions of this tool remain unknown. Objective: The aim of this study was to determine receptiveness and responsiveness in promoting firearm lock box and trigger lock giveaway events on social media, and to describe the characteristics of participants who learned of these events through social media. Methods: We performed a mixed methods study combining a content analysis of Facebook event post comments, quantitative analysis of positive and negative feedback on social media, and a descriptive analysis of event participant characteristics. Through a qualitative content analysis approach, we thematically coded comments from each event’s social media page posting. Interrater reliability and κ statistics were calculated. We calculated the prevalence of positive and negative feedback data. Further, we calculated descriptive statistics for demographic characteristics gathered from day-of-event intake surveys. Differences between collected measures were analyzed with χ2 and t tests according to how the participant found out about the event (social media vs other means). Using concurrent analysis, we synthesized the results from both the qualitative and quantitative aims. Results: Through qualitative content analysis, 414 comments from 13 events were coded. Seven themes emerged through the comment coding process with the most common being “positive receptiveness” (294/414, 71.0%). From quantitative analysis of the social media content, we found higher levels of positive feedback compared to negative feedback. The average number of event post “likes” was 1271.3 per event, whereas the average count in which “hide post” was clicked was 72.3 times per event. Overall, 35.9% (1457/4054) of participants found out about the event through social media. The participants who learned about the event through social media were on average significantly younger than those who learned about the event through other means (–6.4 years, 95% CI –5.5 to –7.3). Among the group that learned of the event through social media, 43.9% (629/1433) identified as female, whereas 35.5% (860/2420) identified as female among the group that learned of the event through other means. Conclusions: There was overall positive receptiveness and responsiveness toward firearm lock box and trigger lock giveaway events when promoted on social media. Compared with other promotional tools, social media has the ability to reach those who are younger and those who identify as female. Future studies should extend this research to determine whether there is a difference between rural and urban settings, and consider other social media platforms in the analysis. %M 34142974 %R 10.2196/24458 %U https://www.jmir.org/2021/6/e24458 %U https://doi.org/10.2196/24458 %U http://www.ncbi.nlm.nih.gov/pubmed/34142974 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e25310 %T Development of an Android-Based Self-Report Assessment for Elderly Driving Risk (SAFE-DR) App: Mixed Methods Study %A Hwang,Ho Sung %A Choi,Seong-Youl %+ Department of Occupational Therapy, Gwangju Women’s University, 201, Yeodae-gil, Gwangsan-gu, Gwangju, , Republic of Korea, 82 10 3209 ext 9146, ckshrj6@hanmail.net %K Android driving app %K driving safety %K reliability %K self-assessment %K validity %K mHealth %K driving %D 2021 %7 17.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Self-report assessments for elderly drivers are used in various countries for accessible, widespread self-monitoring of driving ability in the elderly population. Likewise, in South Korea, a paper-based Self-Report Assessment for Elderly Driving Risk (SAFE-DR) has been developed. Here, we implemented the SAFE-DR through an Android app, which provides the advantages of accessibility, convenience, and provision of diverse information, and verified its reliability and validity. Objective: This study tested the validity and reliability of a mobile app-based version of a self-report assessment for elderly persons contextualized to the South Korean culture and compared it with a paper-based test. Methods: In this mixed methods study, we recruited and interviewed 567 elderly drivers (aged 65 years and older) between August 2018 and May 2019. For participants who provided consent, the app-based test was repeated after 2 weeks and an additional paper-based test (Driver 65 Plus test) was administered. Using the collected data, we analyzed the reliability and validity of the app-based SAFE-DR. The internal consistency of provisional items in each subdomain of the SAFE-DR and the test-retest stability were analyzed to examine reliability. Exploratory factor analysis was performed to examine the validity of the subdomain configuration. To verify the appropriateness of using an app-based test for older drivers possibly unfamiliar with mobile technology, the correlation between the results of the SAFE-DR app and the paper-based offline test was also analyzed. Results: In the reliability analysis, Cronbach α for all items was 0.975 and the correlation of each item with the overall score ranged from r=0.520 to r=0.823; 4 items with low correlations were removed from each of the subdomains. In the retest after 2 weeks, the mean correlation coefficient across all items was r=0.951, showing very high reliability. Exploratory factor analysis on 40 of the 44 items established 5 subdomains: on-road (8 items), coping (16 items), cognitive functions (5 items), general conditions (8 items), and medical health (3 items). A very strong negative correlation of –0.864 was observed between the total score for the app-based SAFE-DR and the paper-based Driver 65 Plus with decorrelation scales. The app-based test was found to be reliable. Conclusions: In this study, we developed an app-based self-report assessment tool for elderly drivers and tested its reliability and validity. This app can help elderly individuals easily assess their own driving skills. Therefore, this assessment can be used to educate drivers and for preventive screening for elderly drivers who want to renew their driver’s licenses in South Korea. In addition, the app can contribute to safe driving among elderly drivers. %M 33934068 %R 10.2196/25310 %U https://mhealth.jmir.org/2021/6/e25310 %U https://doi.org/10.2196/25310 %U http://www.ncbi.nlm.nih.gov/pubmed/33934068 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e29869 %T Integrated Prevention at Work: Protocol for a Concept Analysis %A Lecours,Alexandra %A Major,Marie-Ève %A Vincent,Claude %A Lederer,Valérie %A Lamontagne,Marie-Ève %+ Département d'ergothérapie, Université du Québec à Trois-Rivières, 3351, boulevard des Forges,, Trois-Rivières, QC, G8Z 4M3, Canada, 1 376 5011 ext 2936, Alexandra.Lecours@uqtr.ca %K integrated prevention at work %K concept analysis %K occupational injury %K meta-narrative review %K qualitative research %K focus groups %D 2021 %7 17.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Integrated prevention at work promises to eliminate the boundaries between primary, secondary, and tertiary prevention actions taken by stakeholders in the world of work. It is receiving increasing attention from the scientific community because of its concerted and harmonized approach, which promotes employment access, return, and healthy long-term continuation. Although promising, integrated prevention is not yet well-defined, which makes it difficult to operationalize. Objective: This manuscript exposes the protocol of a study aiming to conceptualize integrated prevention at work on the basis of scientific and experiential knowledge. Methods: Using a concept analysis research design, data collection has been planned in 2 parts. A meta-narrative literature review will first be conducted to document how integrated prevention has been defined in the literature. Then, phone interviews will be conducted with key informers (ie, managers, workers, ergonomists, occupational therapists, psychologists, physiotherapists, union and insurance representatives) to document their viewpoints and understanding of integrated prevention at work. Qualitative data gathered during these 2 parts of research will be analyzed using template analysis, which allows data from literature and empirical collection to be analyzed simultaneously. The analysis will bring out the points of convergence, divergence, and complementarity between the information gleaned from literature and key informers’ experiences to arrive at a conceptualization of integrated prevention at work by identifying its uses, attributes, antecedents, and consequences. As a final step, validation and interpretation with a TRIAGE (Technique for Research of Information by Animation of a Group of Experts) group will be carried out in collaboration with the key informers to identify the tools for the implementation of integrated prevention at work and promote workers’ health and safety. Results: This study is expected to offer a contemporary conceptualization of integrated prevention at work that clearly lays out the variables of this concept and elicits the viewpoints of the different stakeholders. Conclusions: This study will contribute to the advancement of knowledge about the professional injury prevention continuum. The clear identification of the uses, attributes, antecedents, and consequences of integrated prevention at work will offer concrete tools to stakeholders to implement innovative and promising approaches to integrated prevention at work. International Registered Report Identifier (IRRID): PRR1-10.2196/29869 %M 34137727 %R 10.2196/29869 %U https://www.researchprotocols.org/2021/6/e29869 %U https://doi.org/10.2196/29869 %U http://www.ncbi.nlm.nih.gov/pubmed/34137727 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e24156 %T Perceptions and Acceptability of a Smartphone App Intervention (ChildSafe) in Malaysia: Qualitative Exploratory Study %A Yong,Teresa Sui Mien %A Perialathan,Komathi %A Ahmad,Masitah %A Juatan,Nurashma %A Abdul Majid,Liana %A Johari,Mohammad Zabri %+ Institute for Health Behavioural Research, National Institutes of Health, Ministry of Health Malaysia, Block B3, No 1, Jalan Setia Murni U13/52, Section U13, Shah Alam, 40170, Malaysia, 60 333627600 ext 8612, teresa_yong@yahoo.co.uk %K child safety %K unintentional injuries %K consolidated framework for implementation research (CFIR) %K characteristics of individuals %K Mobile App Rating Scale (MARS) %D 2021 %7 1.6.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Home is a vulnerable place for accidental child injuries. Unintentional injuries are a leading cause of death, hospitalization, and disabilities. These injuries are considered preventable and if not tackled, they will continue to be a persisting problem. Smartphones have become increasingly important in our everyday life and is an important tool not only for communication but also for other purposes—they have apps that can be used for various purposes. Therefore, an app-based intervention (ChildSafe) was developed to assess and reduce child injury at home. Objective: This study aimed to evaluate the acceptance of the ChildSafe smartphone app intervention by parents/guardians. Methods: This study was conducted using a qualitative exploratory approach on selected participants of the ChildSafe intervention app study. A total of 27 semistructured in-depth interviews were carried out among parents or guardians who have at least one child between the age of 0 and 59 months in the area of Sungai Buloh, Selangor, between November 2017 and March 2018. Interview questions were developed from the consolidated framework for implementation research (CFIR). Interviews were recorded, transcribed verbatim, and data were thematically analyzed guided by CFIR. Results: The study revealed users’ perception on usability, feasibility, and acceptability toward the ChildSafe app. Three CFIR domains were identified: intervention characteristics, inner setting, and characteristics of individuals. A total of 5 constructs were revealed under intervention characteristics: evidence strength and quality, relative advantage, adaptability, trialability, and design quality and packaging; 2 under inner setting: implementation climate and readiness for implementation; and 4 under characteristics of individuals: knowledge and beliefs about the intervention, self-efficacy, individual stage of change, and other personal attributes. In general, participants felt the app is extremely useful and effective, easy to use, and purposeful in achieving home safety assessment via reminders. The app replaces the need for participants to search for information on home safety and dangers, as the app itself was designed as a tool to assess for this specific purpose. Even at the nascent stage and despite its limitations, the app has prompted users to consider and make changes around their own home. However, future versions of the app should be expanded to make it more attractive to users as it lacks interactive feedback and additional features. Conclusions: Parents/guardians are accepting the use of the ChildSafe app to prevent child injury at home. However, further expansion and improvements are needed to increase the acceptability of this app by parents/guardians. %M 34061039 %R 10.2196/24156 %U https://pediatrics.jmir.org/2021/2/e24156 %U https://doi.org/10.2196/24156 %U http://www.ncbi.nlm.nih.gov/pubmed/34061039 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e22851 %T Evaluating the Consistency Between Conceptual Frameworks and Factors Influencing the Safe Behavior of Iranian Workers in the Petrochemical Industry: Mixed Methods Study %A Zahiri Harsini,Azita %A Bohle,Philip %A Matthews,Lynda R %A Ghofranipour,Fazlollah %A Sanaeinasab,Hormoz %A Amin Shokravi,Farkhondeh %A Prasad,Krishan %+ Department of Health Education, Faculty of Medical Sciences, Tarbiat Modares University, Jalal AleAhmad, Nasr, North Kargar St, Tehran, 14115-111, Iran, 98 912 250 5977, AMINSH_F@modares.ac.ir %K safe behavior %K petrochemical industry %K conceptual frameworks %K literature review %K occupational health %D 2021 %7 27.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Unsafe worker behavior is often identified as a major cause of dangerous incidents in the petrochemical industry. Behavioral safety models provide frameworks that may help to prevent such incidents by identifying factors promoting safe or unsafe behavior. We recently conducted a qualitative study to identify factors affecting workers' unsafe behaviors in an Iranian petrochemical company. Objective: The aims of this study were to (1) conduct a review of the relevant research literature between the years 2000 and 2019 to identify theoretical models proposed to explain and predict safe behavior in the workplace and (2) to select the model that best reflects our qualitative findings and other evidence about the factors influencing safe behaviors among petrochemical workers. Methods: This research used mixed methods. Initially, we conducted a qualitative study of factors that Iranian petrochemical workers believed affected their safety behavior. Four themes emerged from the semistructured interviews: (1) poor direct safety management and supervision; (2) unsafe workplace conditions; (3) workers’ perceptions, skills, and training; and (4) broader organizational factors. Electronic databases, including PubMed, Embase, Scopus, Google Scholar, EBSCOhost, and Science Direct, were then searched for eligible studies on models to explain and predict safe behaviors, which were published between the years 2000 and 2019. Medical subject headings were used as the primary analytical element. Medical subject headings and subheadings were then extracted from the literature. One researcher conducted the search and 3 researchers performed screening and data extraction. Then, constructs described in each study were assessed to determine which were the most consistent with themes derived from our qualitative analysis. Results: A total of 2032 publications were found using the search strategy. Of these, 142 studies were assessed and 28 studies met the inclusion criteria and were included in the review. The themes identified in the qualitative study most closely matched 3 scales included in Wu et al's model that measured safety behavior and performance, safety leadership, and safety climate in petrochemical industries. Poor direct safety management and supervision matched with safety leadership and its subscales; unsafe workplace conditions matched with safety climate and its subscales; workers' perceptions, skills, and training matched with safety performance and its subscales; and broader organizational factors matched with some subscales of the model. Conclusions: This is the first literature review to identify models intended to explain and predict safe behavior and select the model most consistent with themes elicited from a qualitative study. Our results showed that effective safety leadership and management and safety climate and culture systems are the most frequently identified factors affecting safe behaviors in the petrochemical industry. These results can further help safety researchers and professionals design effective behavior-based safety interventions, which can have a more sustainable and persistent impact on workers’ safety behaviors. Trial Registration: Iranian Registry of Clinical Trials IRCT20170515033981N2; https://www.irct.ir/trial/26107 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7126-1 %M 34042605 %R 10.2196/22851 %U https://publichealth.jmir.org/2021/5/e22851 %U https://doi.org/10.2196/22851 %U http://www.ncbi.nlm.nih.gov/pubmed/34042605 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e29161 %T Using an Information Package to Reduce Patients’ Risk of Renal Damage: Protocol for a Randomized Feasibility Trial %A Leitch,Sharon %A Smith,Alesha %A Zeng,Jiaxu %A Stokes,Tim %+ Department of General Practice and Rural Health, Otago Medical School – Dunedin Campus, University of Otago, 55 Hanover Street, Dunedin, 9016, New Zealand, 64 0212619996, sharon.leitch@otago.ac.nz %K triple whammy %K medication safety %K patient education %K general practice %K NSAID %K digital intervention %K primary care %K safety %K protocol %K feasibility %K randomized controlled trial %K risk %K kidney %K renal %K information %K acceptability %D 2021 %7 30.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are a common cause of renal damage, especially when taken together with angiotensin-converting enzyme inhibitors (ACE-i) or angiotensin II receptor blockers (ARBs) plus a diuretic — a combination known as the “triple whammy.” New Zealand patients are at high risk of the “triple whammy” because they can easily purchase NSAIDs without a prescription and in nonpharmacy retail settings (eg, the supermarket), there is no legal requirement to include patient information sheets with medication, and direct-to-consumer drug advertising is permitted. A patient information package has been developed for those at greatest risk of the “triple whammy,” consisting of a printable PDF and an interactive online learning activity. This information package aims to inform patients about their elevated risk of harm from NSAIDS and discourage use of NSAIDs. A randomized control trial was planned to assess the effect of the information package. Objective: This study aims to pilot the trial procedures for recruiting patients and providing patient information online and to assess the acceptability of the patient information package. Methods: A two-armed randomized feasibility trial will be undertaken in Northland, New Zealand. We will recruit 50 patients who are at least 18 years old from those who have signed up to receive email alerts through their general practice. Patients eligible for this study have been prescribed an ACE-i or ARB plus a diuretic in the past 3 months. They will be randomly allocated to 2 study arms. The intervention arm will receive access to an information package plus usual care; the control arm will receive usual care alone. Online surveys will be used to assess NSAID knowledge and NSAID use at baseline and after 2 weeks for both arms. The intervention arm will also evaluate the information package in an additional survey based on Normalization Process Theory (NPT) concepts. We will report the number and proportion of participants who are eligible and consent to participate in the trial. Response and drop-out rates will be reported for each trial arm. The numbers of patients who interact with the education package will be reported together with the patient evaluation of it. Results: Funding has been obtained from the Health Research Council of New Zealand (HRC 18-031). The University of Otago Human Research Ethics Committee (H21/016) has approved this trial. Consultation has been undertaken with The Ngai Tahu research consultation committee. The trial commenced on April 12, 2021. Conclusions: This feasibility trial will test the study processes prior to commencing a randomized controlled trial and will determine the acceptability of the patient information package. We anticipate this work will provide useful information for other researchers attempting similar work. International Registered Report Identifier (IRRID): PRR1-10.2196/29161 %M 33929338 %R 10.2196/29161 %U https://www.researchprotocols.org/2021/4/e29161 %U https://doi.org/10.2196/29161 %U http://www.ncbi.nlm.nih.gov/pubmed/33929338 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e24861 %T A Web-Based and In-Person Risk Reframing Intervention to Influence Mothers’ Tolerance for, and Parenting Practices Associated With, Children’s Outdoor Risky Play: Randomized Controlled Trial %A Brussoni,Mariana %A Han,Christina S %A Lin,Yingyi %A Jacob,John %A Pike,Ian %A Bundy,Anita %A Faulkner,Guy %A Gardy,Jennifer %A Fisher,Brian %A Mâsse,Louise %+ Department of Pediatrics, Faculty of Medicine, University of British Columbia, F508 – 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada, 1 6048753712, mbrussoni@bcchr.ubc.ca %K outdoor play %K mothering %K independent mobility %K physical activity %K risk perception %K risky play %K risk reframing %D 2021 %7 27.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Outdoor risky play, such as climbing, racing, and independent exploration, is an important part of childhood and is associated with various positive physical, mental, and developmental outcomes for children. Parental attitudes and fears, particularly mothers’, are a major deterrent to children’s opportunities for outdoor risky play. Objective: The aim of this study was to evaluate the efficacy of 2 versions of an intervention to reframe mothers’ perceptions of risk and change parenting behaviors: a web-based intervention or an in-person workshop, compared with the control condition. Methods: The Go Play Outside! randomized controlled trial was conducted in Canada from 2017 to 2018. Participants were recruited through social media, snowball sampling, and community notices. Mothers of children aged 6-12 years were self-assessed through eligibility questions, and those eligible and consented to participate in the study were randomized into a fully automated web-based intervention, the in-person workshop, or the control condition. The intervention was underpinned by social cognitive theory, incorporating behavior change techniques. Participants progressed through a series of self-reflection exercises and developed a goal for change. Control participants received the Position Statement on Active Outdoor Play. The primary outcome was increase in tolerance of risky play and the secondary outcome was goal attainment. Data were collected online via REDCap at baseline, 1 week, and 3 months after the intervention. Randomization was conducted using sealed envelope. Allocations were concealed to researchers at assignment and data analysis. We conducted mediation analyses to examine whether the intervention influenced elements of social cognitive theory, as hypothesized. Results: A total of 451 mothers were randomized and completed baseline sociodemographic assessments: 150 in the web-based intervention, 153 in the in-person workshop, and 148 in the control condition. Among these, a total of 351 mothers completed the intervention. At 1 week after the intervention, 113, 85, and 135 mothers completed assessments for each condition, respectively, and at 3 months after the intervention, 105, 84, and 123 completed the assessments, respectively. Compared with mothers in the control condition, mothers in the web-based intervention had significantly higher tolerance of risky play at 1 week (P=.004) and 3 months after the intervention (P=.007); and mothers in the in-person workshop had significantly higher tolerance of risky play at 1 week after the intervention (P=.02). No other significant outcomes were found. None of the potential mediators were found to significantly mediate the outcomes. Conclusions: The trial demonstrates that the web-based intervention was effective in increasing mothers’ tolerance for risk in play. Trial Registration: ClinicalTrials.gov NCT03374683; https://clinicaltrials.gov/ct2/show/NCT03374683 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2552-4 %M 33904820 %R 10.2196/24861 %U https://www.jmir.org/2021/4/e24861 %U https://doi.org/10.2196/24861 %U http://www.ncbi.nlm.nih.gov/pubmed/33904820 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e27667 %T Using Speech Data From Interactions With a Voice Assistant to Predict the Risk of Future Accidents for Older Drivers: Prospective Cohort Study %A Yamada,Yasunori %A Shinkawa,Kaoru %A Kobayashi,Masatomo %A Takagi,Hironobu %A Nemoto,Miyuki %A Nemoto,Kiyotaka %A Arai,Tetsuaki %+ IBM Research, Nihonbashi, Hakozaki-cho, Chuo-ku, Tokyo, 103-8510, Japan, 81 80 6706 9381, ysnr@jp.ibm.com %K cognitive impairment %K smart speaker %K speech analysis %K accident %K prevention %K older adults %K prediction %K risk %K assistant %D 2021 %7 8.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: With the rapid growth of the older adult population worldwide, car accidents involving this population group have become an increasingly serious problem. Cognitive impairment, which is assessed using neuropsychological tests, has been reported as a risk factor for being involved in car accidents; however, it remains unclear whether this risk can be predicted using daily behavior data. Objective: The objective of this study was to investigate whether speech data that can be collected in everyday life can be used to predict the risk of an older driver being involved in a car accident. Methods: At baseline, we collected (1) speech data during interactions with a voice assistant and (2) cognitive assessment data—neuropsychological tests (Mini-Mental State Examination, revised Wechsler immediate and delayed logical memory, Frontal Assessment Battery, trail making test-parts A and B, and Clock Drawing Test), Geriatric Depression Scale, magnetic resonance imaging, and demographics (age, sex, education)—from older adults. Approximately one-and-a-half years later, we followed up to collect information about their driving experiences (with respect to car accidents) using a questionnaire. We investigated the association between speech data and future accident risk using statistical analysis and machine learning models. Results: We found that older drivers (n=60) with accident or near-accident experiences had statistically discernible differences in speech features that suggest cognitive impairment such as reduced speech rate (P=.048) and increased response time (P=.040). Moreover, the model that used speech features could predict future accident or near-accident experiences with 81.7% accuracy, which was 6.7% higher than that using cognitive assessment data, and could achieve up to 88.3% accuracy when the model used both types of data. Conclusions: Our study provides the first empirical results that suggest analysis of speech data recorded during interactions with voice assistants could help predict future accident risk for older drivers by capturing subtle impairments in cognitive function. %M 33830066 %R 10.2196/27667 %U https://www.jmir.org/2021/4/e27667 %U https://doi.org/10.2196/27667 %U http://www.ncbi.nlm.nih.gov/pubmed/33830066 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e27381 %T Technology-Based Fall Risk Assessments for Older Adults in Low-Income Settings: Protocol for a Cross-sectional Study %A Thiamwong,Ladda %A Stout,Jeffrey R %A Park,Joon-Hyuk %A Yan,Xin %+ College of Nursing, University of Central Florida, 12201 Research Parkway, Orlando, FL, 32826, United States, 1 4072830470, ladda.thiamwong@ucf.edu %K body composition %K falls %K risk assessment %K technology %K wearable devices %K accidental falls %K fear %D 2021 %7 7.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: One-third of older adults have maladaptive fall risk appraisal (FRA), a condition in which there is a discrepancy between the level of fear of falling (FOF) and physiological fall risk (balance performance). Older adults who overestimate their physiological fall risk and report a high FOF are less likely to participate in physical activity. Limited data suggest that the association among FOF, body composition, and physical activity intensity differs by fear severity. Objective: This study aims to examine the associations among FRA, body composition, and physical activity using assistive health technology, including the BTrackS balance system, bioelectrical impedance analysis, and activity monitoring devices. This study also aims to examine the feasibility of recruitment and acceptability of technologies and procedures for use among older adults in low-income settings. Methods: This cross-sectional study will be conducted in older adults’ homes or apartments in low-income settings in Central Florida, United States. Following consent, participants will be contacted, and our team will visit them twice. The first visit includes questionnaire completion (eg, sociodemographic or FOF) and balance performance test using the BTrackS balance system. The participants will be stratified by the FRA matrix. In addition, they will perform hand grip strength and dynamic balance performance tests. Participants will then be asked to wear the ActiGraph GT9X Link wireless activity monitor on the nondominant wrist for 7 consecutive days. The second visit includes body composition testing and a structured interview about the acceptability of the technologies and procedures. Results: Ethical approval was obtained from the institutional review board of the University of Central Florida (protocol number 2189; September 10, 2020). As of December 2020, participation enrollment is ongoing and the results are expected to be published in Summer 2022. Conclusions: Accurate FRA is essential for implementing physical activity programs, especially in older adults with low income. This study will provide data for developing technology-based fall risk assessments to improve participation in physical activity, thus enhancing healthy longevity among older adults in low-income settings. International Registered Report Identifier (IRRID): PRR1-10.2196/27381 %M 33825688 %R 10.2196/27381 %U https://www.researchprotocols.org/2021/4/e27381 %U https://doi.org/10.2196/27381 %U http://www.ncbi.nlm.nih.gov/pubmed/33825688 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e24455 %T The Geriatric Acute and Post-Acute Fall Prevention Intervention (GAPcare) II to Assess the Use of the Apple Watch in Older Emergency Department Patients With Falls: Protocol for a Mixed Methods Study %A Strauss,Daniel H %A Davoodi,Natalie M %A Healy,Margaret %A Metts,Christopher L %A Merchant,Roland C %A Banskota,Swechya %A Goldberg,Elizabeth M %+ Department of Emergency Medicine, Alpert Medical School of Brown University, 55 Claverick Street, Second Floor, Room 203, Providence, RI, 02903, United States, 1 401 527 1740, elizabeth_goldberg@brown.edu %K fall intervention %K geriatric care %K Apple Watch %K wearable technology %D 2021 %7 1.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Falls are a common problem among older adults that lead to injury, emergency department (ED) visits, and institutionalization. The Apple Watch can detect falls and alert caregivers and clinicians that help is needed; the device could also be used to objectively collect data on gait, fitness, and falls as part of clinical trials. However, little is known about the ease of use of this technology among older adult ED patients, a population at high risk of recurrent falls. Objective: The goal of this study—the Geriatric Acute and Post-Acute Fall Prevention Intervention (GAPcare) II—is to examine the feasibility, acceptability, and usability of the Apple Watch Series 4 paired with the iPhone and our research app Rhode Island FitTest (RIFitTest) among older adult ED patients seeking care for falls. Methods: We will conduct field-testing with older adult ED patients (n=25) who sustained a fall and their caregivers (n=5) to determine whether they can use the Apple Watch, iPhone, and app either (1) continuously or (2) periodically, with or without telephone assistance from the research staff, to assess gait, fitness, and/or falls over time. During the initial encounter, participants will receive training in the Apple Watch, iPhone, and our research app. They will receive an illustrated training manual and a number to call if they have questions about the research protocol or device usage. Participants will complete surveys and cognitive and motor assessments on the app during the study period. At the conclusion of the study, we will solicit participant feedback through semistructured interviews. Qualitative data will be summarized using framework matrix analyses. Sensor and survey response data will be analyzed using descriptive statistics. Results: Recruitment began in December 2019 and was on pause from April 2020 until September 2020 due to the COVID-19 pandemic. Study recruitment will continue until 30 participants are enrolled. This study has been approved by the Rhode Island Hospital Institutional Review Board (approval 1400781-16). Conclusions: GAPcare II will provide insights into the feasibility, acceptability, and usability of the Apple Watch, iPhone, and the RIFitTest app in the population most likely to benefit from the technology: older adults at high risk of recurrent falls. In the future, wearables could be used as part of fall prevention interventions to prevent injury before it occurs. Trial Registration: ClinicalTrials.gov NCT04304495; https://clinicaltrials.gov/ct2/show/NCT04304495 International Registered Report Identifier (IRRID): DERR1-10.2196/24455 %M 33792553 %R 10.2196/24455 %U https://www.researchprotocols.org/2021/4/e24455 %U https://doi.org/10.2196/24455 %U http://www.ncbi.nlm.nih.gov/pubmed/33792553 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e24323 %T Evidence Supporting the Management of Medical Conditions During Long-Duration Spaceflight: Protocol for a Scoping Review %A Tran,Kim-Anh %A Pollock,Neal William %A Rhéaume,Caroline %A Razdan,Payal Sonya %A Fortier,Félix-Antoine %A Dutil-Fafard,Lara %A Morin,Camille %A Monnot,David Pierre-Marie %A Huot-Lavoie,Maxime %A Simard-Sauriol,Philippe %A Chandavong,Sam %A Le Pabic,Geneviève %A LeBlanc,Jean-Philippe %A Lafond,Daniel %A Marion,Andréanne %A Archambault,Patrick Michel %+ Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centres intégrés de santé et de services sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC, G6V 3Z1, Canada, 1 418 835 7121 ext 3905, patrick.archambault@fmed.ulaval.ca %K spaceflight %K astronauts %K microgravity %K weightlessness %K acute coronary syndrome %K arrhythmia %K atrial fibrillation %K eye penetration %K intraocular foreign body %K herniated disk %K nephrolithiasis %K pulmonary embolism %K retinal detachment %K sepsis %K stroke %K spaceflight associated neuro-ocular syndrome %D 2021 %7 29.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Future long-duration space exploration missions, such as traveling to Mars, will create an increase in communication time delays and disruptions and remove the viability of emergency returns to Earth for timely medical treatment. Thus, higher levels of medical autonomy are necessary. Crew selection is proposed as the first line of defense to minimize medical risk for future missions; however, the second proposed line of defense is medical preparedness and crew member autonomy. In an effort to develop a decision support system, the Canadian Space Agency mandated a team of scientists from Thales Research and Technology Canada (Québec, QC) and Université Laval (Québec, QC) to create an evidence-based medical condition database linking mission-critical human conditions with key causal factors, diagnostic and treatment information, and probable outcomes. Objective: To complement this database, we are currently conducting a scoping review to better understand the depth and breadth of evidence about managing medical conditions in space. Methods: This scoping review will adhere to quality standards for scoping reviews, employing Levac, Colquhoun, and O’Brien's 6-stage methodology; the reported results will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews. In stage 1, we identified the research question in collaboration with the Canadian Space Agency (CSA), the main knowledge user. We prioritized 10 medical conditions: (1) acute coronary syndrome, (2) atrial fibrillation, (3) eye penetration, (4) herniated disk, (5) nephrolithiasis, (6) pulmonary embolism, (7) retinal detachment, (8) sepsis, (9) stroke, and (10) spaceflight associated neuro-ocular syndrome. In stage 2, with the help of an information specialist from Cochrane Canada Francophone, papers were identified through searches of the following databases: ARC, Embase, IeeeXplore, Medline Ovid, PsychINFO, and Web of Science. In stage 3, studies will be selected and assessed using a 3-step process and emerging, refined exclusion criteria. In stage 4, the data will be charted in a table based on parameters required by the CSA and developed using Google spreadsheets for shared access. In stage 5, evidence-based descriptive summaries will be produced for each condition, as well as descriptive analyses of collected data. Finally, in stage 6, the findings will be shared with the CSA to guide the completion of this project. Results: This study was planned in December 2018. Stage 1 has been completed. The initial database search strategy with all target conditions combined identified a total of 10,403 citations to review through title and abstract screening and after duplicate removal. We plan to complete stages 2-6 by the beginning of 2021. Conclusions: This scoping review will map the literature on the management of 10 priority medical conditions in space. It will also enable us to identify knowledge gaps that must be addressed in future research, ensuring successful and medically safe future missions as humankind embarks upon new frontiers of space exploration. International Registered Report Identifier (IRRID): DERR1-10.2196/24323 %M 33779571 %R 10.2196/24323 %U https://www.researchprotocols.org/2021/3/e24323 %U https://doi.org/10.2196/24323 %U http://www.ncbi.nlm.nih.gov/pubmed/33779571 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e21636 %T Factors Associated With Dropout of Participants in an App-Based Child Injury Prevention Study: Secondary Data Analysis of a Cluster Randomized Controlled Trial %A Li,Jie %A Ning,Peishan %A Cheng,Peixia %A Schwebel,David C %A Yang,Yang %A Wei,Xiang %A He,Jieyi %A Wang,Wanhui %A Li,Ruotong %A Hu,Guoqing %+ Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, China, 86 731 84805414, huguoqing009@gmail.com %K app-based intervention %K unintentional injury %K attrition %K influencing factors %D 2021 %7 29.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health (mHealth) interventions offer great potential to reach large populations and improve public health. However, high attrition rates threaten evaluation and implementation of mHealth intervention studies. Objective: We explored factors associated with attrition of study participants in an mHealth randomized controlled trial (RCT) evaluating an intervention to reduce unintentional child injury risk in China. Methods: The cluster RCT compared two groups of an app-based intervention for caregivers of 3-6–year-old children (Bao Hu San). The intervention group received unintentional child injury and parenting education, whereas only parenting education was implemented in the control group. The trial included 2920 study participants in Changsha, China, and lasted 6 months. Data on participant engagement (using the app) were collected electronically throughout the 6-month period. Associations between participant attrition and demographic characteristics, and between attrition and intervention engagement were tested and quantified separately for the intervention and control groups using the adjusted odds ratio (aOR) based on generalized linear mixed models. Results: In total, 2920 caregivers from 20 eligible preschools participated, with 1510 in the intervention group and 1410 in the control group. The 6-month attrition rate differed significantly between the two groups (P<.001), at 28.9% (437/1510) in the intervention group and 35.7% (503/1410) in the control group. For the intervention group, the only significant predictor of attrition risk was participants who learned fewer knowledge segments (aOR 2.69, 95% CI 1.19-6.09). For the control group, significant predictors of attrition risk were lower monthly login frequency (aOR 1.48, 95% CI 1.00-2.18), learning fewer knowledge segments (aOR 1.70, 95% CI 1.02-2.81), and shorter learning durations during app engagement (aOR 2.39, 95% CI 1.11-5.15). Demographic characteristics were unrelated to attrition. Conclusions: Engagement in the app intervention was associated with participant attrition. Researchers and practitioners should consider how to best engage participants in app-based interventions to reduce attrition. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IOR-17010438; http://www.chictr.org.cn/showproj.aspx?proj=17376 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5790-1 %M 33512318 %R 10.2196/21636 %U https://www.jmir.org/2021/1/e21636 %U https://doi.org/10.2196/21636 %U http://www.ncbi.nlm.nih.gov/pubmed/33512318 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e21200 %T Web-based Self-help Program for Adjustment Problems After an Accident (SelFIT): Protocol for a Randomized Controlled Trial %A Hegy,Julia Katharina %A Brog,Noemi Anja %A Berger,Thomas %A Znoj,Hansjoerg %+ Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Fabrikstrasse 8, Bern, 3012, Switzerland, 41 31 631 54 21, julia.hegy@psy.unibe.ch %K accidents %K adjustment problems %K e-mental health %K guidance on demand %K online %K psychological prevention %K psychological self-help %K study protocol %K web-based %D 2020 %7 17.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Accidents and the resulting injuries are among the world’s biggest health care issues, often causing long-term effects on psychological and physical health. With regard to psychological consequences, accidents can cause a wide range of burdens including adjustment problems. Although adjustment problems are among the most frequent mental health problems, there are few specific interventions available. The newly developed program SelFIT (German acronym: Selber wieder fit nach einem Unfall; “fit again after an accident”) aims to remedy this situation by offering a low-threshold, web-based self-help intervention for psychological distress after an accident. Objective: The overall aim is to evaluate the efficacy and cost-effectiveness of the SelFIT program plus care as usual (CAU) compared to only CAU. Furthermore, the program’s user-friendliness, acceptance, and adherence are assessed. We expect that the use of SelFIT will be associated with a greater reduction in psychological distress, greater improvement in mental and physical well-being, and greater cost-effectiveness compared to CAU. Methods: Adults (n=240) experiencing adjustment problems due to an accident they had between 2 weeks and 2 years before entering the study will be randomized into either the intervention or control group. Participants in the intervention group receive direct access to SelFIT. The control group receives access to the program after 12 weeks. There are 6 measurement points for both groups (baseline as well as after 4, 8, 12, 24, and 36 weeks). The main outcome is a reduction in anxiety, depression, and stress symptoms that indicate adjustment problems. Secondary outcomes include well-being, optimism, embitterment, self-esteem, self-efficacy, emotion regulation, pain, costs of health care consumption, and productivity loss, as well as the program’s adherence, acceptance, and user-friendliness. Results: Recruitment began in December 2019 and will continue at least until January 2021, with the option to extend this for another 6 months until July 2021. As of July 2020, 324 people have shown interest in participating, and 48 people have given their informed consent. Conclusions: To the best of our knowledge, this is the first study examining a web-based self-help program designed to treat adjustment problems resulting from an accident. If effective, the program could complement the still limited offerings for secondary and tertiary prevention of psychological distress after an accident. Trial Registration: ClinicalTrials.gov NCT03785912; https://clinicaltrials.gov/ct2/show/NCT03785912 International Registered Report Identifier (IRRID): DERR1-10.2196/21200 %M 33331830 %R 10.2196/21200 %U http://www.researchprotocols.org/2020/12/e21200/ %U https://doi.org/10.2196/21200 %U http://www.ncbi.nlm.nih.gov/pubmed/33331830 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e18945 %T Importance of Educating Teenagers on Appropriate Safety Gear for E-Scooters. Comment on “Follow-Up Investigation on the Promotional Practices of Electric Scooter Companies: Content Analysis of Posts on Instagram and Twitter” %A SooHoo,Claire %A SooHoo,Jackson %+ Geffen Academy at UCLA, 11270 Exposition Blvd, PO Box 64171, Los Angeles, CA, 90064, United States, 1 310 869 6936, csoohoo99@geffenacademy.ucla.edu %K e-scooters %K trauma %K electric scooter %K public safety %K road safety %K public health %K safety equipment %K teenagers %D 2020 %7 27.10.2020 %9 Letter to the Editor %J JMIR Public Health Surveill %G English %X %M 33107834 %R 10.2196/18945 %U http://publichealth.jmir.org/2020/4/e18945/ %U https://doi.org/10.2196/18945 %U http://www.ncbi.nlm.nih.gov/pubmed/33107834 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e16958 %T SMS Text Messages for Parents for the Prevention of Child Drowning in Bangladesh: Acceptability Study %A Hossain,Md Mosharaf %A Mani,Kulanthayan %A Mat Min,Ruhani %+ Safe Kids Malaysia and Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia, 60 0397692398, kulan@upm.edu.my %K acceptability %K SMS %K drowning %K parents %D 2020 %7 23.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In many cases, greater use is being made of mobile phone text messages as a means of communication between patients and health care providers in countries around the world. Objective: We studied the use of mobile phones and the factors related to the acceptability of text messages for parents for the prevention of child drowning in Bangladesh. Methods: From a randomized controlled trial involving 800 parents, 10% (80/800) were selected, and socioeconomic status, mobile phone use, and acceptability of SMS text messages for drowning prevention were measured. Participants with at least one child under 5 years of age were selected from rural areas in Rajshahi District in Bangladesh. Mobile phone–based SMS text messages were sent to the participants. Multivariate regression was used to determine the factors related to the acceptability of text messages for the prevention of child drowning in Bangladesh. Results: The acceptability of SMS text messages for the prevention of child drowning in Bangladesh was significantly lower among women (odds ratio [OR] 0.50, 95% CI 0.12-1.96, P=.02) than among men, lower for parents older than 30 years (OR 0.17, 95% CI 0.14-1.70, P=.01) compared to parents younger than 30 years, higher among parents who had an education (OR 1.63, 95% CI 1.11-5.80, P=.04) than among illiterate parents, and higher among parents with a monthly household income over 7000 Bangladeshi Taka (approximately US $82.54; OR 1.27, 95% CI 1.06-1.96, P=.05) than among parents whose monthly income was less than 7000 Bangladeshi Taka. Conclusions: The high percentage of mobile phone use and the acceptability of SMS text messages for parents for the prevention of child drowning are encouraging, in terms of identifying the best strategy for using such technologies, and deserve further evaluation. %M 32965224 %R 10.2196/16958 %U http://mhealth.jmir.org/2020/9/e16958/ %U https://doi.org/10.2196/16958 %U http://www.ncbi.nlm.nih.gov/pubmed/32965224 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19350 %T Factors Influencing the Smartphone Usage Behavior of Pedestrians: Observational Study on “Spanish Smombies” %A Fernández,César %A Vicente,María Asunción %A Carrillo,Irene %A Guilabert,Mercedes %A Mira,José Joaquín %+ Telematics Engineering Area, Miguel Hernández University, Avenida de la Universidad s/n, Edificio Innova, Elche, 03202, Spain, 34 966658385, suni@umh.es %K smartphone addiction %K smartphone overuse %K smombies %K pedestrian safety %K mobile phone %D 2020 %7 14.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphone addiction has become a reality accepted by all. Some previous studies have shown that the use of smartphones on public roads while walking is very common among the young population. The term “smombie” or smartphone zombie has been coined for this behavior. Such behavior causes a reduction in the attention given to other pedestrians and drivers and may result in accidents or collisions. However, there are no precise data about how many people use the phone while they are walking on the street. Smartphone usage habits are evolving rapidly, and more in-depth information is required, particularly about how users interact with their devices while walking: traditional phone conversations (phone close to the ear), voice chats (phone in front of the head), waiting for notifications (phone in hand), text chats (user touching the screen), etc. This in-depth information may be useful for carrying out specific preventive actions in both the education field (raising awareness about the risks) and in the infrastructure field (redesigning the cities to increase safety). Objective: This study aimed to gather information about pedestrians’ smartphone usage and to identify population groups wherein interventions should be focused to prevent accidents. The main hypothesis was that gender, age, and city area can significantly influence the smartphone usage of the pedestrians while walking. Methods: An observational study of pedestrians in the street was carried out in Elche, a medium-sized Spanish city of 230,000 inhabitants. The following data were gathered: gender, age group, location, and type of smartphone interaction. A specific smartphone app was developed to acquire data with high reliability. The statistical significance of each variable was evaluated using chi-squared tests, and Cramér’s V statistic was used to measure the effect sizes. Observer agreement was checked by the Cohen kappa analysis. Results: The behavior of 3301 pedestrians was analyzed, of which 1770 (53.6%) were females. As expected, the effect of the main variables studied was statistically significant, although with a small effect size: gender (P<.001, V=0.12), age (P<.001, V=0.18), and city area (P<.001, V=0.16). The phone in hand or “holding” behavior was particularly dependent on gender for all age groups (P<.001, V=0.09) and to a greater extent in young people (P<.001, V=0.16). Approximately 39.7% (222/559) of the young women observed showed “holding” or “smombie” behavior, and they comprised the highest proportion among all age and gender groups. Conclusions: An in-depth analysis of smartphone usage while walking revealed that certain population groups (especially young women) have a high risk of being involved in accidents due to smartphone usage. Interventions aimed at reducing the risk of falls and collisions should be focused in these groups. %M 32667896 %R 10.2196/19350 %U http://www.jmir.org/2020/8/e19350/ %U https://doi.org/10.2196/19350 %U http://www.ncbi.nlm.nih.gov/pubmed/32667896 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e17756 %T A Mobile Game (Safe City) Designed to Promote Children’s Safety Knowledge and Behaviors: Protocol for a Randomized Controlled Trial %A Wong,Rosa S %A Tung,Keith TS %A Wong,Hiu Tung %A Ho,Frederick KW %A Wong,Hing Sang %A Fu,King-Wa %A Pong,Ting Chuen %A Chan,Ko Ling %A Chow,Chun Bong %A Ip,Patrick %+ Department of Paediatrics & Adolescent Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, China (Hong Kong), 852 2255 4090, patricip@hku.hk %K serious game %K safety training %K mobile game %K mobile phone %K injury prevention %K randomized controlled trial %K game-based intervention %D 2020 %7 12.6.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Children have high levels of curiosity and eagerness to explore. This makes them more vulnerable to danger and hazards, and they thus have a higher risk of injury. Safety education such as teaching safety rules and tips is vital to prevent children from injuries. Although game-based approaches have the potential to capture children’s attention and sustain their interest in learning, whether these new instructional approaches are more effective than traditional approaches in delivering safety messages to children remains uncertain. Objective: The aim of this study is to test the effectiveness of a game-based intervention in promoting safety knowledge and behaviors among Hong Kong school children in Grades 4-6. It will also examine the potential effect of the game-based intervention on these children’s functioning and psychosocial difficulties. Methods: This study comprises the development of a city-based role-playing game Safe City, where players are immersed as safety inspectors to prevent dangerous situations and promote safety behavior in a virtual city environment. The usability and acceptability tests will be conducted with children in Grades 4-6 who will trial the gameplay on a mobile phone. Adjustments will be made based on their feedback. A 4-week randomized controlled trial with children studying in Grades 4-6 in Hong Kong elementary schools will be conducted to assess the effectiveness of the Safe City game–based intervention. In this trial, 504 children will play Safe City, and 504 children will receive traditional instructional materials (electronic and printed safety information). The evaluation will be conducted using both child self-report and parent proxy-report data. Specifically, child safety knowledge and behaviors will be assessed by a questionnaire involving items on knowledge and behaviors, respectively, for home safety, road safety, and sport-related safety; child functioning will be assessed by PedsQL Generic Core Scales; and psychosocial difficulties will be assessed by the Strength and Difficulties Questionnaire. These questionnaires will be administered at 3 time points: before, 1 month, and 3 months after the intervention. Game usage statistics will also be reviewed. Results: This project was funded in September 2019. The design and development of the Safe City game are currently under way. Recruitment and data collection will begin from September 2020 and will continue up to March 1, 2021. Full analysis will be conducted after the end of the data collection period. Conclusions: If the Safe City game is found to be an effective tool to deliver safety education, it could be used to promote safety in children in the community and upgraded to incorporate more health-related topics to support education and empowerment for the larger public. Trial Registration: ClinicalTrials.gov NCT04096196; https://clinicaltrials.gov/ct2/show/NCT04096196 International Registered Report Identifier (IRRID): PRR1-10.2196/17756 %M 32530436 %R 10.2196/17756 %U http://www.researchprotocols.org/2020/6/e17756/ %U https://doi.org/10.2196/17756 %U http://www.ncbi.nlm.nih.gov/pubmed/32530436 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e15477 %T Assessing the Emergent Public Health Concern of All-Terrain Vehicle Injuries in Rural and Agricultural Environments: Initial Review of Available National Datasets in the United States %A Weichelt,Bryan %A Gorucu,Serap %A Jennissen,Charles %A Denning,Gerene %A Oesch,Stephen %+ National Farm Medicine Center, Marshfield Clinic Research Institute, Marshfield Clinic Health System, 1000 N Oak Ave, Marshfield, WI, 54449, United States, 1 2217276, weichelt.bryan@marshfieldresearch.org %K agriculture %K all-terrain vehicle %K fatality %K injury %K off-road vehicle %K rural %D 2020 %7 29.5.2020 %9 Review %J JMIR Public Health Surveill %G English %X Background: Injuries related to the operation of off-road vehicles (ORVs), including all-terrain vehicles (ATVs), continue to be a significant public health concern, especially in rural and agricultural environments. In the United States alone, ATVs have played a role in thousands of fatalities and millions of injuries in the recent decades. However, no known centralized federal surveillance system consistently captures these data. Traditional injury data sources include surveys, police reports, trauma registries, emergency department data, newspaper and online media reports, and state and federal agency databases. Objective: The objectives of this study paper were to (1) identify published articles on ORV-related injuries and deaths that used large databases and determine the types of datasets that were used, (2) examine and describe several national US-based surveillance systems that capture ORV-related injuries and fatalities, and (3) promote and provide support for the establishment of a federally-funded agricultural injury surveillance system. Methods: In this study, we examined several national United States–based injury datasets, including the web-based AgInjuryNews, the Fatality Analysis Reporting System, databases compiled by the US Consumer Product Safety Commission, and the National Fatality Review Case Reporting System. Results: Our review found that these data sources cannot provide a complete picture of the incidents or the circumstantial details needed to effectively inform ORV injury prevention efforts. This is particularly true with regard to ORV-related injuries in agricultural production. Conclusions: We encourage the establishment of a federally funded national agricultural injury surveillance system. However, in lieu of this, use of multiple data sources will be necessary to provide a more complete picture of ORV- and other agriculture-related injuries and fatalities. %M 32469319 %R 10.2196/15477 %U http://publichealth.jmir.org/2020/2/e15477/ %U https://doi.org/10.2196/15477 %U http://www.ncbi.nlm.nih.gov/pubmed/32469319 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e10877 %T Injuries Reported by Selected Health Facilities During the Arbaeenia Mass Gathering at Babel Governorate, Iraq, 2014: Retrospective Records Analysis %A Chitheer,Abdulaal %A Lami,Faris %A Radhi,Ahmed %A Arbaji,Ali %+ Department of Community and Family Medicine, College of Medicine, University of Baghdad, Baghdad College of Medicine, Baghdad, 00964, Iraq, 964 7901402692, farislami@gmail.com %K mass gathering %K Injury %K Karbala, Iraq %D 2020 %7 28.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Arbaeenia is the largest religious mass gathering in Iraq. The conditions associated with mass gatherings result in high rates of injury. There have been no prior studies on injuries during the Arbaeenia mass gathering. Objective: This study describes the injuries observed during the Arbaeenia mass gathering in Babel Governorate in Iraq between November 24 and December 14, 2014. Methods: The study was conducted in Babel Governorate at the emergency departments of six public hospitals and two major temporary medical units that were located along the three roads connecting the Middle and Southern Iraqi governorates. We used the Iraq Injury Surveillance System modified form to collect information on injured patients treated in the selected facilities. Data on fatal injuries was obtained from the coroner’s office. The following data were collected from the patients: demographics, outcome of injury, place and time of occurrence, mode of evacuation and medical care before arriving at the hospital, duration of travel from place of occurrence to hospital, disposition of non-fatal injury, cause and mode of injury, and whether the injury occurred in connection with the Arbaeenia mass gathering. Results: Information was collected on 1564 injury cases, of which 73 were fatal. About half of the reported nonfatal injuries, 687/1404 (48.9%), and a quarter of fatalities, 18/73 (25%) were related to the Arbaeenia mass gathering (P<.001). Most of the reported injuries were unintentional, 1341/1404 (95.51%), occurred on the street, 864/1323 (65.6%), occurred during the daytime 1103/1174 (93.95 %). Most of those injured were evacuated by means other than ambulance 1107/1206 (91.79%) and did not receive pre-hospital medical care 788/1163 (67.7%). Minor injuries 400/1546 (25.9%) and traffic accidents 394/1546 (25.5%) were the most common types of injuries, followed by falls 270/1546 (17.5%). Among fatal injuries, traffic accidents 38/73 (52%) and violence 18/73 (25%) were the leading causes of death. Mass gathering injuries were more likely to occur among individuals aged 21-40 years (odds ratio [OR] 3.5; 95% CI 2.7-4.5) and >41 years (OR 7.6; 95% CI 5.4-10.6) versus those <21 years; more likely to be unintentional than assault (OR 5.3; 95% CI 1.8-15.5); more likely to happen on the street versus at home (OR 37.7; 95% CI 22.4-63.6); less likely to happen at night than during the day (OR 0.2; 95% CI 0.1-0.4); and less likely to result in hospital admission (OR 0.5; 95% CI 0.3-0.7). Conclusions: The study shows that most injuries were minor, unintentional, and nonfatal, and most people with injuries had limited access to ambulance transportation and did not require hospitalization. %M 32463371 %R 10.2196/10877 %U http://publichealth.jmir.org/2020/2/e10877/ %U https://doi.org/10.2196/10877 %U http://www.ncbi.nlm.nih.gov/pubmed/32463371 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 1 %P e15812 %T Occupational Exposure to Needle Stick Injuries and Hepatitis B Vaccination Coverage Among Clinical Laboratory Staff in Sana’a, Yemen: Cross-Sectional Study %A Al-Abhar,Nabil %A Moghram,Ghuzlan Saeed %A Al-Gunaid,Eshrak Abdulmalek %A Al Serouri,Abdulwahed %A Khader,Yousef %+ Jordan Field Epidemiology Training Program, Jordan Ministry of Health, Pr. Hamzah St, Amman, 11118, Jordan, 962 796802040, yskhader@just.edu.jo %K injury %K hepatitis B %K vaccination %K biosafety %K laboratory staff %K Yemen %D 2020 %7 31.3.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Laboratory staff handling blood or biological samples are at risk for accidental injury or exposure to blood-borne pathogens. Hepatitis B virus (HBV) vaccinations for laboratory staff can minimize these risks. Objective: The aims of this study were to determine the prevalence of occupational exposure to needle stick injuries (NSIs) and assess HBV vaccination coverage among clinical laboratory staff in Sana’a, Yemen. Methods: A cross-sectional survey was conducted among clinical laboratory staff who were involved in handling and processing laboratory samples at the main public and private clinical laboratories in Sana’a. Data collection was done using a semistructured questionnaire. The questionnaire was divided into 3 parts. Part 1 included information on sociodemographic characteristics of participants. Part 2 included information on the availability of the personal protective equipment in the laboratories, such as lab coats and gloves. Part 3 included questions about the history of injury during work in the laboratory and the vaccination status for HBV. Results: A total of 219/362 (60%) participants had been accidentally injured while working in the laboratory. Of those, 14.6% (32/219) had been injured during the last 3 months preceding the data collection. Receiving the biosafety manual was significantly associated with lower risk of injury. Out of those who were injured, 54.8% (120/219) had received first aid. About three-quarters of respondents reported that they had been vaccinated against HBV. The vaccination against HBV was significantly higher among laboratory staff who were working at private laboratories (P=.01), who had postgraduate degrees (P=.005), and who received the biosafety manual (P=.03). Conclusions: Occupational exposure to NSI is still a major problem among laboratory staff in public and private laboratories in Sana’a, Yemen. The high incidence of injuries among laboratory staff and the low rate of receiving first aid in laboratories combined with low vaccination coverage indicates that all laboratory staff are at risk of exposure to HBV. Therefore, strengthening supervision, legalizing HBV vaccinations for all laboratory staff, and optimizing laboratory practices regarding the management of sharps can minimize risks and prerequisites in Yemen. %M 32229462 %R 10.2196/15812 %U http://publichealth.jmir.org/2020/1/e15812/ %U https://doi.org/10.2196/15812 %U http://www.ncbi.nlm.nih.gov/pubmed/32229462 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 1 %P e16833 %T Follow-Up Investigation on the Promotional Practices of Electric Scooter Companies: Content Analysis of Posts on Instagram and Twitter %A Dormanesh,Allison %A Majmundar,Anuja %A Allem,Jon-Patrick %+ Keck School of Medicine of USC, 2001 N Soto Street, 3rd Floor, Los Angeles, CA, STE K318, United States, 1 13234427921, allem@usc.edu %K electric scooter %K scooters %K public safety %K road safety %K social media %K marketing %K technology %K ride sharing %K public health %D 2020 %7 23.1.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Electric scooters (e-scooters) have become a popular mode of transportation in both the United States and Europe. In the wake of this popularity, e-scooters have changed the commuting experience in many metropolitan areas. Although e-scooters offer an efficient and economical way to travel short distances in traffic-congested areas, recent studies have raised concerns over their safety. Bird and Tier Mobility are 2 popular e-scooter companies in the United States and Europe, respectively. Both companies maintain active social media accounts with hundreds of posts and tens of thousands of followers. Recent studies have shown that consumer behavior may be influenced by the content posted to popular social media platforms, such as Instagram and Twitter. Objective: This study aimed to examine the official Instagram and Twitter accounts of Bird and Tier Mobility to determine whether these companies promote and demonstrate the use of safety gear in their posts to their consumers. Methods: Posts to Bird’s (n=287) and Tier Mobility’s (n=190) official Instagram accounts, as well as Bird’s (n=313) and Tier Mobility’s (n=67) official Twitter accounts, were collected from November 9, 2018, to October 7, 2019. Rules for coding content of posts were informed by previous research. Results: Among posts to Bird’s Instagram account, 69.3% (199/287) had a person visible with an e-scooter, 9.1% (26/287) contained persons wearing protective gear, and there were no mentions of protective gear in captions corresponding to the post. Among posts to Tier Mobility’s Instagram account, 84.7% (161/190) contained a person visible with an e-scooter, 36.3% (69/190) contained persons wearing protective gear, and 4.2% (8/190) of captions corresponding to posts mentioned protective gear. Among posts to Bird’s Twitter account, 71.9% (225/313) had an image, of which 44.0% (99/225) contained a person visible with an e-scooter and 15.1% (34/225) contained persons wearing protective gear. Among posts to Tier Mobility’s Twitter account, 78% (52/67) had an image, of which 52% (27/52) contained a person with an e-scooter and 21% (11/52) contained persons wearing protective gear. Conclusions: Findings show that modeling and promoting safety is rare on Bird’s and Tier Mobility’s official social media accounts, which may contribute to the normalization of unsafe riding practices. Social media platforms may offer a potential avenue for public health officials to intervene with rider safety campaigns for public education. %M 32012087 %R 10.2196/16833 %U http://publichealth.jmir.org/2020/1/e16833/ %U https://doi.org/10.2196/16833 %U http://www.ncbi.nlm.nih.gov/pubmed/32012087 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e13519 %T An App-Based Intervention for Caregivers to Prevent Unintentional Injury Among Preschoolers: Cluster Randomized Controlled Trial %A Ning,Peishan %A Cheng,Peixia %A Schwebel,David C %A Yang,Yang %A Yu,Renhe %A Deng,Jing %A Li,Shukun %A Hu,Guoqing %+ Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, China, 86 731 84805414, huguoqing009@gmail.com %K unintentional injury %K preschoolers %K cluster randomized controlled trial %K app %K mobile health %K intervention %D 2019 %7 09.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: App-based interventions have the potential to reduce child injury in countries with limited prevention resources, but their effectiveness has not been rigorously examined. Objective: This study aimed to assess the effectiveness of an app-based intervention for caregivers of preschoolers to prevent unintentional injury among Chinese preschoolers. Methods: A 6-month cluster randomized controlled trial was conducted from December 2017 to June 2018. Recruitment was conducted through preschools, which were randomly allocated to either the control group (ie, app-based parenting education excluding unintentional injury prevention) or the intervention group (ie, app-based parenting education including unintentional injury prevention). A total of 2920 caregivers of preschoolers aged 3-6 years from 20 preschools in Changsha, China, were recruited offline through the schools. The primary outcome was unintentional injury incidences among preschoolers in the past 3 months; this measure was assessed through an online caregiver-report at the baseline visit and at 3-month and 6-month follow-up visits. Secondary outcome measures included caregivers’ self-reported attitudes and behaviors concerning child supervision during the last week. Generalized estimating equations (GEEs) were used to assess the effectiveness of the app-based intervention on responses at 3 and 6 months after adjusting for sociodemographic variables, baseline level of the outcome variable, and engagement with interventions in the assigned group. All analyses were intention-to-treat. A per-protocol sensitivity analysis was also conducted. Results: In total, 1980 of the 2920 caregivers completed the study. The mean age of participants was 32.0 years (SD 5.5) and 68.99% (1366/1980) of them were female. During the 6-month follow-up visit, unintentional injury incidence did not change significantly in either group: incidence in the intervention group went from 8.76% (94/1073) to 8.11% (87/1073), P=.59; incidence in the control group went from 9.4% (85/907) to 7.5% (69/907), P=.15. The changes did not differ between the groups (odds ratio [OR] 1.14, 95% CI 0.80-1.62). Changes in the average score in attitude concerning unintentional injury prevention were also similar between the groups (B .05, 95% CI -0.03 to 0.13). Changes in unintentional injury prevention behaviors were greater in the intervention group than in the control group after the intervention (B .87, 95% CI 0.33-1.42). Analyses of individual injury prevention behaviors showed that the intervention reduced three risky behaviors: unsafe feeding of children (OR 0.73, 95% CI 0.60-0.89); incorrectly placing children in cars (OR 0.73, 95% CI 0.57-0.93); and allowing children to ride bicycles, electric bicycles, or motorcycles unsupervised (OR 0.80, 95% CI 0.64-0.99). The intervention also improved scores on three safety-focused behaviors: testing water temperature before giving children a bath (OR 1.26, 95% CI 1.05-1.52); properly storing sharp objects (OR 1.24, 95% CI 1.01-1.52); and safely storing medicines, detergents, and pesticides (OR 1.24, 95% CI 1.02-1.51). Conclusions: The app-based intervention did not reduce unintentional injury incidence among preschoolers but significantly improved caregivers’ safety behaviors. This app-based intervention approach to improve caregiver behaviors surrounding child injury risk offers promise to be modified and ultimately disseminated broadly. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IOR-17010438; http://www.chictr.org.cn/showproj.aspx?proj=17376 (Archived by WebCite at http://www.webcitation.org/75jt17X84) International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5790-1 %M 31400105 %R 10.2196/13519 %U https://mhealth.jmir.org/2019/8/e13519/ %U https://doi.org/10.2196/13519 %U http://www.ncbi.nlm.nih.gov/pubmed/31400105 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e13621 %T Redesigning a Sentinel Surveillance System for Collecting and Disseminating Near Real-Time Agricultural Injury Reports: System Usability Study %A Weichelt,Bryan %A Heimonen,Tomi %A Gorucu,Serap %A Redmond,Emily %A Vechinski,Josef %A Pflughoeft,Kurt %A Bendixsen,Casper %A Salzwedel,Marsha %A Scott,Erika %A Namkoong,Kang %A Purschwitz,Mark %A Rautiainen,Risto %A Murphy,Dennis J %+ National Farm Medicine Center, Marshfield Clinic Research Institute, 1000 N Oak Ave, Marshfield, WI, 54449, United States, 1 7152217276, weichelt.bryan@marshfieldresearch.org %K agriculture %K risk %K wounds and injuries %K safety %K farms %K news %K newspaper article %D 2019 %7 02.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Injury data and reports provide valuable information for both public and private organizations to guide programming, policy, and prevention, but in the increasingly complex and dangerous industry of US agriculture, the injury surveillance needed to produce this data is lacking. To address the gap, AgInjuryNews was established in 2015. The system includes fatal and nonfatal injury cases derived from publicly available reports, including occupational and nonoccupational injuries, occurring in the agricultural, forestry, and fishing (AFF) industry. Objective: The study aimed to develop a stakeholder-engaged redesign of the interactive, up-to-date, and publicly available dataset of US AFF injury and fatality reports. Methods: Instructor-led heuristic evaluations within a 15-student undergraduate course, data from 8 student participants of laboratory-based usability testing and 2016 and 2017 AgInjuryNews-registered user surveys, coupled with input from the National Steering Committee informed the development priorities for 2018. An interdisciplinary team employed an agile methodology of 2-week sprints developing in ASP.NET and Structured Query Language to deliver an intuitive frontend and a flexible, yet structured, backend, including a case report input form for capturing more than 50 data points on each injury report. Results: AgInjuryNews produced 17,714 page views from 43 countries in 2018 captured via Google Analytics, whereas 623 injury reports were coded and loaded, totaling more than 31,000 data points. Newly designed features include customizable email alerts, an interactive map, and expanded search and filter options. User groups such as the Bureau of Labor Statistics and the Agricultural Safety and Health Council of America have endorsed the system within their networks. News media have cited or referenced the system in national outlets such as the New York Times, Politico, and the Washington Post. Conclusions: The new system’s features, functions, and improved data granularity have sparked innovative lines of research and increased collaborative interest domestically and abroad. It is anticipated that this nontraditional sentinel surveillance system and its dataset will continue to serve many purposes for public and private agricultural safety and health stakeholders in the years to come.  %M 31376278 %R 10.2196/13621 %U http://formative.jmir.org/2019/3/e13621/ %U https://doi.org/10.2196/13621 %U http://www.ncbi.nlm.nih.gov/pubmed/31376278 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 1 %P e12022 %T Qualitative and Quantitative Evaluation of the Make Safe Happen App: Mobile Technology–Based Safety Behavior Change Intervention for Parents %A Roberts,Kristin J %A McAdams,Rebecca J %A Kristel,Orie V %A Szymanski,Alison M %A McKenzie,Lara B %+ Center for Injury Research and Policy, The Research Institute, Nationwide Children’s Hospital, Research Building III, 5th Floor, 700 Children's Drive, Columbus, OH, 43205, United States, 1 614 355 5858, kristin.roberts@nationwidechildrens.org %K smartphone %K mobile phone %K mobile app %K parents %K focus groups %K technology %D 2019 %7 14.03.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Nearly half of the unintentional injuries in children happen in and around the home; many of these injuries are preventable. Providing parents and caregivers with proper injury prevention information that is easily accessible may help them make their homes safer for children. Objective: The aim of this study was to evaluate parental injury prevention awareness and home safety behaviors, motivations for and challenges to taking injury prevention and safety actions for parents as well as user experience following the use of the Make Safe Happen mobile app. Methods: A total of 40 parents with children aged 0-12 years living in Columbus, Ohio, participated in 1 of 5 focus group discussions following the completion of (1) a pretest survey, (2) use of the Make Safe Happen app, and (3) a posttest survey. Results: Following the use of the Make Safe Happen app, parents reported a significant increase in injury prevention awareness and completed 45% more home safety behaviors in and around their homes. Nearly all of the parents felt the app provided them with the information needed to make their home safer for their children; the great majority of parents intended to make such changes in the future. Conclusions: The combination of qualitative and quantitative data collection allowed for rich data capture and provided a deeper understanding of parents’ safety knowledge, behaviors, app use, and decision making regarding child injury prevention in and around the home. The Make Safe Happen app provides the information and motivation parents and caregivers need to help them take steps to prevent child injuries that may occur in and around their homes. %M 31518322 %R 10.2196/12022 %U http://pediatrics.jmir.org/2019/1/e12022/ %U https://doi.org/10.2196/12022 %U http://www.ncbi.nlm.nih.gov/pubmed/31518322 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11942 %T Technology-Based Interventions, Assessments, and Solutions for Safe Driving Training for Adolescents: Rapid Review %A Sezgin,Emre %A Lin,Simon %+ Research Information Solutions and Innovation, The Research Institute, Nationwide Children's Hospital, RB3 Building, 3rd Floor, 700 Children's Drive, Columbus, OH, 43205, United States, 1 6143556814, emre.sezgin@nationwidechildrens.org %K adolescent health %K assessment %K driving safety %K teen driving %K technology-based intervention %D 2019 %7 24.01.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Safe driving training for adolescents aims to prevent injury and promote their well-being. In that regard, information and communication technologies have been used to understand adolescent driving behavior and develop interventions. Objective: The purpose of this review is to explore and discuss existing approaches to technology-based driving interventions, driving assessments, and solutions in the literature. Methods: We searched the Web of Science and PubMed databases following a review protocol to collect relevant peer-reviewed journal articles. Inclusion criteria were (1) being published in the English language, (2) being published in a peer-reviewed journal, (3) testing the driving behavior of teens with technology-based intervention methods, and (4) being published between January 2000 and March 2018. We appraised the articles by reading their abstracts to select studies matching the inclusion criteria and reading the full text of articles for final refinement. Results: Initial keyword searches on technology-based solutions resulted in 828 publications that we refined further by title screening (n=131) and abstract evaluation against inclusion criteria (n=29). Finally, we selected 16 articles that met the inclusion criteria and examined them regarding the use of technology-based interventions, assessments, and solutions. Use of built-in tracking devices and installation of black box devices were widely used methods for capturing driving events. Smartphones were increasingly adapted for data collection, and use of gamification for intervention design was an emerging concept. Visual and audio feedback also were used for intervention. Conclusions: Our findings suggest that social influence is effective in technology-based interventions; parental involvement for promoting safe driving behavior is highly effective. However, the use of smartphones and gamification needs more study regarding their implementation and sustainability. Further developments in technology for predicting teen behavior and programs for behavioral change are needed. %M 30679149 %R 10.2196/11942 %U http://mhealth.jmir.org/2019/1/e11942/ %U https://doi.org/10.2196/11942 %U http://www.ncbi.nlm.nih.gov/pubmed/30679149 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e25 %T Behavior Change for Youth Drivers: Design and Development of a Smartphone-Based App (BackPocketDriver) %A Warren,Ian %A Meads,Andrew %A Whittaker,Robyn %A Dobson,Rosie %A Ameratunga,Shanthi %+ Department of Computer Science, University of Auckland, Science Centre Building, 38 Princess Street, Auckland, 1010, New Zealand, 64 9 373 7599 ext 88784, ian-w@cs.auckland.ac.nz %K smartphone %K public health %K telemedicine %K telemetry %D 2018 %7 26.11.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The over-representation of youth in road crash injury and fatality rates is a major public health issue globally. In New Zealand, youth drivers are most vulnerable in the restricted license period when they can drive without the requirement for supervision by an experienced adult. Behavioral change interventions delivered using mobile phone technology to young drivers could serve as a useful mechanism to develop safe driving skills, but this potential remains to be fully explored. Objective: This study aimed to apply behavioral change principles to design and develop a smartphone-based intervention with the aim of helping youth drivers to develop and hone safe driving skills. Methods: An iterative process was used to support development of the smartphone intervention. We reviewed behavioral change literature, identifying fundamental principles and exploring use of behavior change techniques (BCTs) in other areas of public health. We engaged with key stakeholders, including young drivers, government agencies, and relevant organizations. We also took into account technology adoption considerations when designing the app. Results: We developed BackPocketDriver (BPD), an Android smartphone app that uses in-built sensors to monitor and infer driver behavior. The app implements features that were identified during the design process and are traceable to BCTs and theory. A key feature is messaging, which is used to instruct, motivate, educate, and relay feedback to participants. In addition, messaging addresses attitudes and beliefs. Other features include journey feedback summaries, goal setting, achievements, and leaderboards. Conclusions: BPD’s design rests on a sound foundation of theory and evidence. With explicit links between theory and features, the app aims to be an effective intervention to change and improve youth driver behavior. The next phase of this study is to run a small pilot study to assess BPD’s effectiveness. %M 30684435 %R 10.2196/formative.9660 %U http://formative.jmir.org/2018/2/e25/ %U https://doi.org/10.2196/formative.9660 %U http://www.ncbi.nlm.nih.gov/pubmed/30684435 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e69 %T Measuring Risky Driving Behavior Using an mHealth Smartphone App: Development and Evaluation of gForce %A Freidlin,Raisa Z %A Dave,Amisha D %A Espey,Benjamin G %A Stanley,Sean T %A Garmendia,Marcial A %A Pursley,Randall %A Ehsani,Johnathon P %A Simons-Morton,Bruce G %A Pohida,Thomas J %+ Center for Information Technology, National Institutes of Health, 12A South Dr, Bldg 12A, Room 2023, Bethesda, MD, 20892, United States, 1 402 2788, raisa@mail.nih.gov %K kinematic risky driving behavior %K naturalistic driving studies %K elevated g-force %K lateral acceleration %K longitudinal acceleration %K iPhone %D 2018 %7 19.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Naturalistic driving studies, designed to objectively assess driving behavior and outcomes, are conducted by equipping vehicles with dedicated instrumentation (eg, accelerometers, gyroscopes, Global Positioning System, and cameras) that provide continuous recording of acceleration, location, videos, and still images for eventual retrieval and analyses. However, this research is limited by several factors: the cost of equipment installation; management and storage of the large amounts of data collected; and data reduction, coding, and analyses. Modern smartphone technology includes accelerometers built into phones, and the vast, global proliferation of smartphones could provide a possible low-cost alternative for assessing kinematic risky driving. Objective: We evaluated an in-house developed iPhone app (gForce) for detecting elevated g-force events by comparing the iPhone linear acceleration measurements with corresponding acceleration measurements obtained with both a custom Android app and the in-vehicle miniDAS data acquisition system (DAS; Virginia Tech Transportation Institute). Methods: The iPhone and Android devices were dashboard-mounted in a vehicle equipped with the DAS instrumentation. The experimental protocol consisted of driving maneuvers on a test track, such as cornering, braking, and turning that were performed at different acceleration levels (ie, mild, moderate, or hard). The iPhone gForce app recorded linear acceleration (ie, gravity-corrected). The Android app recorded gravity-corrected and uncorrected acceleration measurements, and the DAS device recorded gravity-uncorrected acceleration measurements. Lateral and longitudinal acceleration measures were compared. Results: The correlation coefficients between the iPhone and DAS acceleration measurements were slightly lower compared to the correlation coefficients between the Android and DAS, possibly due to the gravity correction on the iPhone. Averaging the correlation coefficients for all maneuvers, the longitudinal and lateral acceleration measurements between iPhone and DAS were rlng=0.71 and rlat=0.83, respectively, while the corresponding acceleration measurements between Android and DAS were rlng=0.95 and rlat=0.97. The correlation coefficients between lateral accelerations on all three devices were higher than with the corresponding longitudinal accelerations for most maneuvers. Conclusions: The gForce iPhone app reliably assessed elevated g-force events compared to the DAS. Collectively, the gForce app and iPhone platform have the potential to serve as feature-rich, inexpensive, scalable, and open-source tool for assessment of kinematic risky driving events, with potential for research and feedback forms of intervention. %M 29674309 %R 10.2196/mhealth.9290 %U http://mhealth.jmir.org/2018/4/e69/ %U https://doi.org/10.2196/mhealth.9290 %U http://www.ncbi.nlm.nih.gov/pubmed/29674309