%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63378 %T Evaluating a Web-Based Application to Facilitate Family-School-Health Care Collaboration for Children With Neurodevelopmental Disorders in Inclusive Settings: Protocol for a Nonrandomized Trial %A Meyer,Eric %A Sauzéon,Hélène %A Saint-Supery,Isabeau %A Mazon,Cecile %+ Flowers team-project, Inria Research Center of the University of Bordeaux, 200 Avenue de la Vieille Tour, Talence Cedex, 33405, France, 33 0524574000, cecile.mazon@inria.fr %K neurodevelopmental disorders %K coeducation %K whole-school approach %K family-professional partnership %K web application %K inclusive education %K family-school-health care %D 2025 %7 17.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: An individual education plan (IEP) is a key element in the support of the schooling of children with special educational needs or disabilities. The IEP process requires effective communication and strong partnership between families, school staff, and health care practitioners. However, these stakeholders often report their collaboration as limited and difficult to maintain, leading to difficulties in implementing and monitoring the child’s IEP. Objective: This paper aims to describe the study protocol used to evaluate a technological tool (CoEd application) aiming at fostering communication and collaboration between family, school, and health care in the context of inclusive education. Methods: This protocol describes a longitudinal, nonrandomized controlled trial, with baseline, 3 month, and 6-month follow-up assessments. The intervention consisted of using the web-based CoEd application for 3 months to 6 months. This application is composed of a child’s file in which stakeholders of the support team can share information about the child’s profile, skills, aids and adaptations, and daily events. The control group is asked to function as usual to support the child in inclusive settings. To be eligible, a support team must be composed of at least two stakeholders, including at least one of the parents. Additionally, the pupil had to be aged between 10 years and 16 years, enrolled in secondary school, be taught in mainstream settings, and have an established or ongoing diagnosis of autism spectrum disorder, attention-deficit/hyperactivity disorder, or intellectual disability (IQ<70). Primary outcome measures cover stakeholders’ relationships, self-efficacy, and attitudes toward inclusive education, while secondary outcome measures are related to stakeholders’ burden and quality of life, as well as children’s school well-being and quality of life. We plan to analyze data using ANCOVA to investigate pre-post and group effects, with a technological skills questionnaire as the covariate. Results: After screening for eligibility, 157 participants were recruited in 37 support teams, composed of at least one parent and one professional (school, health care). In September 2023, after the baseline assessment, the remaining 127 participants were allocated to the CoEd intervention (13 teams; n=82) or control condition (11 teams; n=45). Conclusions: We expect that the CoEd application will improve the quality of interpersonal relationships in children’s IEP teams (research question [RQ]1), will show benefits for the child (RQ2), and improve the well-being of the child and the stakeholders (RQ3). Thanks to the participatory design, we also expect that the CoEd application will elicit a good user experience (RQ4). The results from this study could have several implications for educational technology research, as it is the first to investigate the impacts of a technological tool on co-educational processes. International Registered Report Identifier (IRRID): DERR1-10.2196/63378 %R 10.2196/63378 %U https://www.researchprotocols.org/2025/1/e63378 %U https://doi.org/10.2196/63378 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e66223 %T Leveraging Electronic Health Records in International Humanitarian Clinics for Population Health Research: Cross-Sectional Study %A Draugelis,Sarah %A Hunnewell,Jessica %A Bishop,Sam %A Goswami,Reena %A Smith,Sean G %A Sutherland,Philip %A Hickman,Justin %A Donahue,Donald A %A Yendewa,George A %A Mohareb,Amir M %K refugee %K population health %K disaster medicine %K humanitarian clinic %K electronic health record %K Fast Electronic Medical Record %K fEMR %D 2025 %7 17.4.2025 %9 %J JMIR Public Health Surveill %G English %X Background: As more humanitarian relief organizations are beginning to use electronic medical records in their operations, data from clinical encounters can be leveraged for public health planning. Currently, medical data from humanitarian medical workers are infrequently available in a format that can be analyzed, interpreted, and used for public health. Objectives: This study aims to develop and test a methodology by which diagnosis and procedure codes can be derived from free-text medical encounters by medical relief practitioners for the purposes of data analysis. Methods: We conducted a cross-sectional study of clinical encounters from humanitarian clinics for displaced persons in Mexico between August 3, 2021, and December 5, 2022. We developed and tested a method by which free-text encounters were reviewed by medical billing coders and assigned codes from the International Classification of Diseases, Tenth Revision (ICD-10) and the Current Procedural Terminology (CPT). Each encounter was independently reviewed in duplicate and assigned ICD-10 and CPT codes in a blinded manner. Encounters with discordant codes were reviewed and arbitrated by a more experienced medical coder, whose decision was used to determine the final ICD-10 and CPT codes. We used chi-square tests of independence to compare the ICD-10 codes for concordance across single-diagnosis and multidiagnosis encounters and across patient characteristics, such as age, sex, and country of origin. Results: We analyzed 8460 encounters representing 5623 unique patients and 2774 unique diagnosis codes. These free-text encounters had a mean of 20.5 words per encounter in the clinical documentation. There were 58.78% (4973/8460) encounters where both coders assigned 1 diagnosis code, 18.56% (1570/8460) encounters where both coders assigned multiple diagnosis codes, and 22.66% (1917/8460) encounters with a mixed number of codes assigned. Of the 4973 encounters with a single code, only 11.82% (n=588) had a unique diagnosis assigned by the arbitrator that was not assigned by either of the initial 2 coders. Of the 1570 encounters with multiple diagnosis codes, only 3.38% (n=53) had unique diagnosis codes assigned by the arbitrator that were not initially assigned by either coder. The frequency of complete concordance across diagnosis codes was similar across sex categories and ranged from 30.43% to 46.05% across age groups and countries of origin. Conclusions: Free-text electronic medical records from humanitarian relief clinics can be used to develop a database of diagnosis and procedure codes. The method developed in this study, which used multiple independent reviews of clinical encounters, appears to reliably assign diagnosis codes across a diverse patient population in a resource-limited setting. %R 10.2196/66223 %U https://publichealth.jmir.org/2025/1/e66223 %U https://doi.org/10.2196/66223 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63693 %T Testing a Machine Learning–Based Adaptive Motivational System for Socioeconomically Disadvantaged Smokers (Adapt2Quit): Protocol for a Randomized Controlled Trial %A Kamberi,Ariana %A Weitz,Benjamin %A Flahive,Julie %A Eve,Julianna %A Najjar,Reem %A Liaghat,Tara %A Ford,Daniel %A Lindenauer,Peter %A Person,Sharina %A Houston,Thomas K %A Gauvey-Kern,Megan E %A Lobien,Jackie %A Sadasivam,Rajani S %+ Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, United States, 1 774 317 1539, Ariana.Kamberi@umassmed.edu %K smoking cessation %K mHealth %K socioeconomically disadvantaged, biochemical verification %K machine learning %D 2025 %7 16.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Individuals who are socioeconomically disadvantaged have high smoking rates and face barriers to participating in smoking cessation interventions. Computer-tailored health communication, which is focused on finding the most relevant messages for an individual, has been shown to promote behavior change. We developed a machine learning approach (the Adapt2Quit recommender system), and our pilot work demonstrated the potential to increase message relevance and smoking cessation effectiveness among individuals who are socioeconomically disadvantaged. Objective: This study protocol describes our randomized controlled trial to test whether the Adapt2Quit recommender system will increase smoking cessation among individuals from socioeconomically disadvantaged backgrounds who smoke. Methods: Individuals from socioeconomically disadvantaged backgrounds who smoke were identified based on insurance tied to low income or from clinical settings (eg, community health centers) that provide care for low-income patients. They received text messages from the Adapt2Quit recommender system for 6 months. Participants received daily text messages for the first 30 days and every 14 days until the end of the study. Intervention participants also received biweekly texting facilitation messages, that is, text messages asking participants to respond (yes or no) if they were interested in being referred to the quitline. Interested participants were then actively referred to the quitline by study staff. Intervention participants also received biweekly text messages assessing their current smoking status. Control participants did not receive the recommender messages but received the biweekly texting facilitation and smoking status assessment messages. Our primary outcome is the 7-day point-prevalence smoking cessation at 6 months, verified by carbon monoxide testing. We will use an inverse probability weighting approach to test our primary outcome. This involves using a logistic regression model to predict nonmissingness, calculating the inverse probability of nonmissingness, and using it as a weight in a logistic regression model to compare cessation rates between the two groups. Results: The Adapt2Quit study was funded in April 2020 and is still ongoing. We have completed the recruitment of individuals (N=757 participants). The 6-month follow-up of all participants was completed in November 2024. The sample consists of 64% (486/757) female participants, 35% (265/757) Black or African American individuals, 51.1% (387/757) White individuals, and 16% (121/757) Hispanic or Latino individuals. In total, 52.6% (398/757) of participants reported having a high school education or being a high school graduate; 70% (529/757) smoked their first cigarette within 30 minutes of waking, and half (379/757, 50%) had stopped smoking for at least one day in the past year. Moreover, 16.6% (126/757) had called the quitline before study participation. Conclusions: We have recruited a diverse sample of individuals who are socioeconomically disadvantaged and designed a rigorous protocol to evaluate the Adapt2Quit recommender system. Future papers will present our main analysis of the trial. Trial Registration: ClinicalTrials.gov NCT04720625; https://clinicaltrials.gov/study/NCT04720625 International Registered Report Identifier (IRRID): DERR1-10.2196/63693 %M 40239194 %R 10.2196/63693 %U https://www.researchprotocols.org/2025/1/e63693 %U https://doi.org/10.2196/63693 %U http://www.ncbi.nlm.nih.gov/pubmed/40239194 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e67914 %T Evaluation of Large Language Models in Tailoring Educational Content for Cancer Survivors and Their Caregivers: Quality Analysis %A Liu,Darren %A Hu,Xiao %A Xiao,Canhua %A Bai,Jinbing %A Barandouzi,Zahra A %A Lee,Stephanie %A Webster,Caitlin %A Brock,La-Urshalar %A Lee,Lindsay %A Bold,Delgersuren %A Lin,Yufen %K large language models %K GPT-4 %K cancer survivors %K caregivers %K education %K health equity %D 2025 %7 7.4.2025 %9 %J JMIR Cancer %G English %X Background: Cancer survivors and their caregivers, particularly those from disadvantaged backgrounds with limited health literacy or racial and ethnic minorities facing language barriers, are at a disproportionately higher risk of experiencing symptom burdens from cancer and its treatments. Large language models (LLMs) offer a promising avenue for generating concise, linguistically appropriate, and accessible educational materials tailored to these populations. However, there is limited research evaluating how effectively LLMs perform in creating targeted content for individuals with diverse literacy and language needs. Objective: This study aimed to evaluate the overall performance of LLMs in generating tailored educational content for cancer survivors and their caregivers with limited health literacy or language barriers, compare the performances of 3 Generative Pretrained Transformer (GPT) models (ie, GPT-3.5 Turbo, GPT-4, and GPT-4 Turbo; OpenAI), and examine how different prompting approaches influence the quality of the generated content. Methods: We selected 30 topics from national guidelines on cancer care and education. GPT-3.5 Turbo, GPT-4, and GPT-4 Turbo were used to generate tailored content of up to 250 words at a 6th-grade reading level, with translations into Spanish and Chinese for each topic. Two distinct prompting approaches (textual and bulleted) were applied and evaluated. Nine oncology experts evaluated 360 generated responses based on predetermined criteria: word limit, reading level, and quality assessment (ie, clarity, accuracy, relevance, completeness, and comprehensibility). ANOVA (analysis of variance) or chi-square analyses were used to compare differences among the various GPT models and prompts. Results: Overall, LLMs showed excellent performance in tailoring educational content, with 74.2% (267/360) adhering to the specified word limit and achieving an average quality assessment score of 8.933 out of 10. However, LLMs showed moderate performance in reading level, with 41.1% (148/360) of content failing to meet the sixth-grade reading level. LLMs demonstrated strong translation capabilities, achieving an accuracy of 96.7% (87/90) for Spanish and 81.1% (73/90) for Chinese translations. Common errors included imprecise scopes, inaccuracies in definitions, and content that lacked actionable recommendations. The more advanced GPT-4 family models showed better overall performance compared to GPT-3.5 Turbo. Prompting GPTs to produce bulleted-format content was likely to result in better educational content compared with textual-format content. Conclusions: All 3 LLMs demonstrated high potential for delivering multilingual, concise, and low health literacy educational content for cancer survivors and caregivers who face limited literacy or language barriers. GPT-4 family models were notably more robust. While further refinement is required to ensure simpler reading levels and fully comprehensive information, these findings highlight LLMs as an emerging tool for bridging gaps in cancer education and advancing health equity. Future research should integrate expert feedback, additional prompt engineering strategies, and specialized training data to optimize content accuracy and accessibility. International Registered Report Identifier (IRRID): RR2-10.2196/48499 %R 10.2196/67914 %U https://cancer.jmir.org/2025/1/e67914 %U https://doi.org/10.2196/67914 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60587 %T Racial Disparities in Parkinson Disease Clinical Phenotype, Management, and Genetics: Protocol for a Prospective Observational Study %A Hall,Deborah A %A Shulman,Josh M %A Singleton,Andrew %A Bandres Ciga,Sara %A S Tosin,Michelle Hyczy %A Ouyang,Bichun %A Shulman,Lisa %+ Department of Neurological Sciences, Rush University, 1725 West Harrison St, Suite 755, Chicago, IL, 60612, United States, 1 312 563 2900, deborah_a_hall@rush.edu %K Parkinson disease %K racial disparities %K clinical protocol %K health disparities %K genetic risk factors %K quality of life %K quality of care %D 2025 %7 7.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Parkinson disease (PD) has been described and studied extensively in White populations, with little known about how the disease manifests and progresses in patients from the Black community. Studies investigating disease features in Black populations are uncommon, with some suggesting that the Black population with PD is more disabled and has greater disease severity and different clinical features compared with the White population with PD. These health disparities are likely to influence the quality of care for Black patients with PD. Objective: This study aimed to investigate the motor and nonmotor symptoms and quality of life in Black and White participants with PD in a case-case design. Methods: This is an observational, prospective, multicenter, case-case design study. Other aims will investigate the management of PD in Black individuals and the presence of shared or unique genetic risk factors among the Black PD population. A total of 400 Black and 200 White participants with PD will be recruited. Data will be collected at 7 US sites and entered into a Research Electronic Data Capture database. Linear multivariate regression analysis will be used, except for comparing PD management, which will be analyzed using the chi-square test or Fisher exact test. Bonferroni correction will be applied. This protocol also describes plans for educational programming for clinicians and patients at the end of the study in partnership with national PD organizations. Results: The Rush Institutional Review Board approved the project as the single-site institutional review board in February 2022, and it was funded by the National Institute of Neurological Disorders and Stroke in April 2022. Recruitment began in July 2022. At the time of submission of this manuscript, 131 participants had been recruited. Conclusions: To our knowledge, this is the largest study of PD phenotype and management in Black patients in the United States. The planned collaboration with the Global Parkinson’s Genetics Program and PD GENEration will enhance our understanding of genetic risk factors for PD in this understudied population. International Registered Report Identifier (IRRID): DERR1-10.2196/60587 %M 40193190 %R 10.2196/60587 %U https://www.researchprotocols.org/2025/1/e60587 %U https://doi.org/10.2196/60587 %U http://www.ncbi.nlm.nih.gov/pubmed/40193190 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e69048 %T Balancing Human Mobility and Health Care Coverage in Sentinel Surveillance of Brazilian Indigenous Areas: Mathematical Optimization Approach %A Oliveira,Juliane Fonseca %A Vasconcelos,Adriano O %A Alencar,Andrêza L %A Cunha,Maria Célia S L %A Marcilio,Izabel %A Barral-Netto,Manoel %A P Ramos,Pablo Ivan %K representative sentinel surveillance %K early pathogen detection %K indigenous health %K human mobility %K surveillance network optimization %K infectious disease surveillance %K public health strategy %K Brazil %D 2025 %7 1.4.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Optimizing sentinel surveillance site allocation for early pathogen detection remains a challenge, particularly in ensuring coverage of vulnerable and underserved populations. Objective: This study evaluates the current respiratory pathogen surveillance network in Brazil and proposes an optimized sentinel site distribution that balances Indigenous population coverage and national human mobility patterns. Methods: We compiled Indigenous Special Health District (Portuguese: Distrito Sanitário Especial Indígena [DSEI]) locations from the Brazilian Ministry of Health and estimated national mobility routes by using the Ford-Fulkerson algorithm, incorporating air, road, and water transportation data. To optimize sentinel site selection, we implemented a linear optimization algorithm that maximizes (1) Indigenous region representation and (2) human mobility coverage. We validated our approach by comparing results with Brazil’s current influenza sentinel network and analyzing the health attraction index from the Brazilian Institute of Geography and Statistics to assess the feasibility and potential benefits of our optimized surveillance network. Results: The current Brazilian network includes 199 municipalities, representing 3.6% (199/5570) of the country’s cities. The optimized sentinel site design, while keeping the same number of municipalities, ensures 100% coverage of all 34 DSEI regions while rearranging 108 (54.3%) of the 199 cities from the existing flu sentinel system. This would result in a more representative sentinel network, addressing gaps in 9 of 34 previously uncovered DSEI regions, which span 750,515 km² and have a population of 1.11 million. Mobility coverage would improve by 16.8 percentage points, from 52.4% (4,598,416 paths out of 8,780,046 total paths) to 69.2% (6,078,747 paths out of 8,780,046 total paths). Additionally, all newly selected cities serve as hubs for medium- or high-complexity health care, ensuring feasibility for pathogen surveillance. Conclusions: The proposed framework optimizes sentinel site allocation to enhance disease surveillance and early detection. By maximizing DSEI coverage and integrating human mobility patterns, this approach provides a more effective and equitable surveillance network, which would particularly benefit underserved Indigenous regions. %R 10.2196/69048 %U https://publichealth.jmir.org/2025/1/e69048 %U https://doi.org/10.2196/69048 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e55931 %T Evaluation of the Tu’Washindi Na PrEP Intervention to Reduce Gender-Based Violence and Increase Preexposure Prophylaxis Uptake and Adherence Among Kenyan Adolescent Girls and Young Women: Protocol for a Cluster Randomized Controlled Trial %A Roberts,Sarah T %A Minnis,Alexandra M %A Napierala,Sue %A Montgomery,Elizabeth T %A Digolo,Lina %A Cottrell,Mackenzie L %A Browne,Erica N %A Ndirangu,Jacqueline %A Boke,Joyce %A Agot,Kawango %+ Women's Global Health Imperative, RTI International, 300 Frank Ogawa Plaza, Oakland, CA, 94612, United States, 1 919 541 6000, sroberts@rti.org %K adolescent girls and young women %K HIV prevention %K preexposure prophylaxis %K PrEP %K adherence %K Kenya %K intimate partner violence %D 2025 %7 1.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescent girls and young women constitute a priority population disproportionately affected by HIV, accounting for 25% of annual HIV incidence among people older than 15 years in Kenya. Although oral preexposure prophylaxis (PrEP) is effective in reducing HIV acquisition, its protective benefit has been limited among adolescent girls and young women in sub-Saharan Africa because of low uptake, adherence, and persistence. Intimate partner violence (IPV) and relationship power inequities are widespread among adolescent girls and young women and contribute to higher HIV incidence and lower PrEP use. Interventions are needed to support sustained PrEP use among adolescent girls and young women by addressing IPV and relationship dynamics. Objective: This study aims to test the effectiveness of Tu’Washindi na PrEP (“We are Winners with PrEP”), a multilevel community-based intervention, to increase uptake and adherence to PrEP and reduce IPV among adolescent girls and young women in Siaya County, Kenya. Methods: The Tu’Washindi na PrEP intervention was co-designed by our team and adolescent girls and young women using participatory methods and includes 3 components delivered over 6 months: an 8-session, empowerment-based support club for adolescent girls and young women, community sensitization targeted toward male partners, and PrEP education events for couples. The intervention will be evaluated using a cluster randomized controlled trial across 22 administrative wards in Siaya County, Kenya, enrolling 72 adolescent girls and young women per ward (total N=1584). The primary objectives are to test the effectiveness of the intervention on PrEP uptake and adherence immediately after delivery (month 6 after enrollment) and 6 months later (month 12). As secondary objectives, we will test the intervention effect on IPV. A rigorous process evaluation will explore mechanisms of change, contextual factors, and implementation considerations to inform future refinement and scale-up, using programmatic data, participant questionnaires, and qualitative interviews with participants and intervention providers. Results: Data collection started in September 2022. As of December 2024, enrollment has been completed in 16 of the 22 study wards, with 72.6% (1150/1584) of participants enrolled. We anticipate that data collection will be completed in May 2026 and results will be available by mid-2027. Conclusions: The study builds directly on our promising formative and pilot research to develop the evidence base for this youth-designed, multilevel HIV prevention intervention. If effective, Tu’Washindi will be ideally positioned for sustainable integration into existing youth-focused programming to expand and support PrEP use in this priority population. Trial Registration: ClinicalTrials.gov NCT05599581; https://www.clinicaltrials.gov/study/NCT05599581 International Registered Report Identifier (IRRID): DERR1-10.2196/55931 %M 40168655 %R 10.2196/55931 %U https://www.researchprotocols.org/2025/1/e55931 %U https://doi.org/10.2196/55931 %U http://www.ncbi.nlm.nih.gov/pubmed/40168655 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70404 %T Primary Care Practice Factors Associated With Telehealth Adoption in the United States: Cross-Sectional Survey Analysis %A Mackwood,Matthew %A Fisher,Elliott %A Schmidt,Rachel O %A O'Malley,A James %A Rodriguez,Hector P %A Shortell,Stephen %A Akré,Ellesse-Roselee %A Berube,Alena %A Schifferdecker,Karen E %+ Department of Community & Family Medicine, Geisel School of Medicine, Dartmouth College, One Medical Center Drive, Hanover, NH, 03756, United States, 1 6036504000, matthew.b.mackwood@hitchcock.org %K telehealth %K telemedicine %K remote consultation %K primary health care %K general practice %K internet access %K health policy %K health care economics and organizations %K access to primary care %K digital divide %K vulnerable populations %K medically underserved area %D 2025 %7 28.3.2025 %9 Research Letter %J J Med Internet Res %G English %X In this national study of primary care practice–level factors associated with telehealth adoption in 2022, we found that training and assisting patients with the use of telehealth, broadband expansion efforts, and a higher proportion of low-income patients were associated with higher practice-level telehealth use, suggesting both opportunities for telehealth expansion and potential populations with higher need for its use. %M 40152920 %R 10.2196/70404 %U https://www.jmir.org/2025/1/e70404 %U https://doi.org/10.2196/70404 %U http://www.ncbi.nlm.nih.gov/pubmed/40152920 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e67487 %T Vaccine Hesitancy and Associated Factors Among Caregivers of Children With Special Health Care Needs in the COVID-19 Era in China: Cross-Sectional Study %A Li,Mingyan %A Sun,Changxuan %A Ji,Chai %A Gao,Meiying %A Wang,Xia %A Yao,Dan %A Guo,Junxia %A Sun,Lidan %A Rafay,Abdul %A George,Antonita Shereen %A Muhandiramge,Sanduni Hasara Samararathna Samararathna %A Bai,Guannan %K COVID-19 %K caregivers %K children with special health care needs %K vaccination hesitancy %K decision-making %D 2025 %7 26.3.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Immunization is a cost-effective way to prevent infectious diseases in children, but parental hesitancy leads to low vaccination rates, leaving children at risk. Caregivers of children with special health care needs are more hesitant about vaccines than those of healthy children. Objective: The aim of the study is to investigate the changes in caregivers’ vaccination hesitation of children with special health care needs before, during, and after the COVID-19 pandemic in China and to identify associated factors for caregivers’ attitudes toward National Immunization Program (NIP) and non-NIP vaccines. Methods: We included 7770 caregivers of children with special health care needs (median age 7.0, IQR 2.4-24.1 months) who visited the Vaccination Consultation Clinic at Children’s Hospital, Zhejiang University School of Medicine (Hangzhou, China) from May 2017 to May 2023. General and clinical information was extracted from the immunization evaluation system for children with special health care needs and medical records. We compared the differences in caregivers’ willingness and hesitation for vaccinating their children across the 3 stages of the COVID-19 pandemic using chi-square tests. Multinomial logistic regression models were used to identify independent variables that were associated with caregivers’ willingness and hesitation toward NIP and non-NIP vaccines. Results: There is a statistically significant difference in caregivers’ vaccine hesitancy before, during, and after the COVID-19 pandemic (P<.05). During the COVID-19 pandemic, the percentages of choosing NIP, alternative non-NIP, and non-NIP vaccines are highest (n=1428, 26%, n=3148, 57.4%, and n=3442, 62.7%, respectively) than those at other 2 stages. In comparison, caregivers’ hesitation toward NIP and non-NIP vaccines is lowest (n=911, 16.6% and n=2045, 37.3%, respectively). Despite the stages of the COVID-19 pandemic, multiple factors, including children’s age and sex, parents’ educational level, comorbidities, and history of allergy, were significantly associated with caregivers’ attitude toward NIP and non-NIP vaccines (P<.05). The profiles of risk factors for hesitancy toward NIP and non-NIP vaccines are different, as indicated by the results from the logistic regression models. Conclusions: This study demonstrated that caregivers’ willingness to vaccinate their children with special health care needs with NIP and non-NIP vaccines was highest during the COVID-19 pandemic in China, and their hesitancy was lowest. Additionally, we have identified multiple factors associated with caregivers’ willingness and hesitancy to vaccinate their children. These findings provide evidence-based support for developing personalized health education strategies. %R 10.2196/67487 %U https://publichealth.jmir.org/2025/1/e67487 %U https://doi.org/10.2196/67487 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70983 %T Dying in Darkness: Deviations From Data Sharing Ethics in the US Public Health System and the Data Genocide of American Indian and Alaska Native Communities %A Schmit,Cason D %A O’Connell,Meghan Curry %A Shewbrooks,Sarah %A Abourezk,Charles %A Cochlin,Fallon J %A Doerr,Megan %A Kum,Hye-Chung %+ Department of Health Policy and Management, School of Public Health, Texas A&M University, 212 Adriance Lab Rd, College Station, TX, 77843, United States, 1 9794360277, schmit@tamu.edu %K ethics %K information dissemination %K indigenous peoples %K public health surveillance %K privacy %K data sharing %K deidentification %K data anonymization %K public health ethics %K data governance %D 2025 %7 26.3.2025 %9 Viewpoint %J J Med Internet Res %G English %X Tribal governments and Tribal Epidemiology Centers face persistent challenges in obtaining the public health data that are essential to accomplishing their legal and ethical duties to promote health in American Indian and Alaska Native communities. We assessed the ethical implications of current impediments to data sharing among federal, state, and Tribal public health partners. Public health ethics obligates public health data sharing and opposes data collection without dissemination to affected communities. Privacy practices, like deidentification and data suppression, often obstruct data access, disproportionately affect American Indian and Alaska Native populations, and exacerbate health disparities. The 2020-2024 syphilis outbreak illustrates how restricted data access impedes effective public health responses. These practices represent a source of structuralized violence throughout the US public health system that contributes to the data genocide of American Indian and Alaska Native populations. Good governance practices like transparent data practices and the establishment of a social license (ie, the informal permission of a community to collect and use data) is essential to ethically balancing collective well-being with individual privacy in public health. %M 40138677 %R 10.2196/70983 %U https://www.jmir.org/2025/1/e70983 %U https://doi.org/10.2196/70983 %U http://www.ncbi.nlm.nih.gov/pubmed/40138677 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64745 %T Increasing Access to Mental Health Supports for 18- to 25-Year-Old Indigenous Youth With the JoyPop Mobile Mental Health App: Study Protocol for a Randomized Controlled Trial %A MacIsaac,Angela %A Neufeld,Teagan %A Malik,Ishaq %A Toombs,Elaine %A Olthuis,Janine V %A Schmidt,Fred %A Dunning,Crystal %A Stasiuk,Kristine %A Bobinski,Tina %A Ohinmaa,Arto %A Stewart,Sherry H %A Newton,Amanda S %A Mushquash,Aislin R %+ Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON, P7B5E1, Canada, 1 8073438010 ext 8771, aislin.mushquash@lakeheadu.ca %K mental health %K youth %K Indigenous %K First Nations %K eHealth %K mHealth %K JoyPop %K protocol %K mobile mental health app %K mobile app %K Canada %K mobile health %K emotion regulation %D 2025 %7 30.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Transitional-aged youth have a high burden of mental health difficulties in Canada, with Indigenous youth, in particular, experiencing additional circumstances that challenge their well-being. Mobile health (mHealth) approaches hold promise for supporting individuals in areas with less access to services such as Northern Ontario. Objective: The primary objective of this study is to evaluate the effectiveness of the JoyPop app in increasing emotion regulation skills for Indigenous transitional-aged youth (aged 18-25 years) on a waitlist for mental health services when compared with usual practice (UP). The secondary objectives are to (1) evaluate the impact of the app on general mental health symptoms and treatment readiness and (2) evaluate whether using the app is associated with a reduction in the use (and therefore cost) of other services while one is waiting for mental health services. Methods: The study is a pragmatic, parallel-arm randomized controlled superiority trial design spanning a 4-week period. All participants will receive UP, which involves waitlist monitoring practices at the study site, which includes regular check-in phone calls to obtain any updates regarding functioning. Participants will be allocated to the intervention (JoyPop+UP) or control (UP) condition in a 1:1 ratio using stratified block randomization. Participants will complete self-report measures of emotion regulation (primary outcome), mental health, treatment readiness, and service use during 3 assessments (baseline, second [after 2 weeks], and third [after 4 weeks]). Descriptive statistics pertaining to baseline variables and app usage will be reported. Linear mixed modeling will be used to analyze change in outcomes over time as a function of condition assignment, while a cost-consequence analysis will be used to evaluate the association between app use and service use. Results: Recruitment began September 1, 2023, and is ongoing. In total, 2 participants have completed the study. Conclusions: This study will assess whether the JoyPop app is effective for Indigenous transitional-aged youth on a waitlist for mental health services. Positive findings may support the integration of the app into mental health services as a waitlist management tool. Trial Registration: ClinicalTrials.gov NCT05991154; https://clinicaltrials.gov/study/NCT05991154 International Registered Report Identifier (IRRID): DERR1-10.2196/64745 %M 39883939 %R 10.2196/64745 %U https://www.researchprotocols.org/2025/1/e64745 %U https://doi.org/10.2196/64745 %U http://www.ncbi.nlm.nih.gov/pubmed/39883939 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60829 %T Designing the First Pregnancy Guaranteed Income Program in the United States: Qualitative Needs Assessment and Human-Centered Design to Develop the Abundant Birth Project %A Karasek,Deborah %A Williams,Jazzmin C %A Taylor,Michaela A %A De La Cruz,Monica M %A Arteaga,Stephanie %A Bell,Sabra %A Castillo,Esperanza %A Chand,Maile A %A Coats,Anjeanette %A Hubbard,Erin M %A Love-Goodlett,Latriece %A Powell,Breezy %A Spellen,Solaire %A Malawa,Zea %A Gomez,Anu Manchikanti %+ Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall, MC 7400, Berkeley, CA, 94720-7400, United States, 1 510 6420722, anugomez@berkeley.edu %K maternal and child health %K economics %K public health %K qualitative research methods %K programs (evaluation and funding) %K community-centered %K pregnancy %K first pregnancy %K behavioral interventions %K racial health %K financial stress %K Abundant Birth Project %K infant health %K infant %K Black %D 2025 %7 27.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Racial inequities in pregnancy outcomes persist despite investments in clinical, educational, and behavioral interventions, indicating that a new approach is needed to address the root causes of health disparities. Guaranteed income during pregnancy has the potential to narrow racial health inequities for birthing people and infants by alleviating financial stress. Objective: We describe community-driven formative research to design the first pregnancy-guaranteed income program in the United States—the Abundant Birth Project (ABP). Informed by birth equity and social determinants of health perspectives, ABP targets upstream structural factors to improve racial disparities in maternal and infant health. Methods: The research team included community researchers, community members with lived experience as Black or Pacific Islander pregnant, and parenting people in the San Francisco Bay Area. The team conducted needs assessment interviews and facilitated focus groups with participants using human-centered design methods. Needs assessment participants later served as co-designers of the ABP program and research, sharing their experiences with financial hardships and government benefits programs and providing recommendations on key program elements, including fund disbursement, eligibility, and amount. Results: Housing affordability and the high cost of living in San Francisco emerged as significant sources of stress in pregnancy. Participants reported prohibitively low income eligibility thresholds and burdensome enrollment processes as challenges or barriers to existing social services. These insights guided the design of prototypes of ABP’s program components, which were used in a design sprint to determine the final components. Based on this design process, the ABP program offered US $1000/month for 12 months to pregnant Black and Pacific Islander people, selected through a lottery called an abundance drawing. Conclusions: The formative design process maximized community input and shared decision-making to co-design a guaranteed income program for Black and Pacific Islander women and people. Our upstream approach and community research model can inform the development of public health and social service programs. %M 39869889 %R 10.2196/60829 %U https://formative.jmir.org/2025/1/e60829 %U https://doi.org/10.2196/60829 %U http://www.ncbi.nlm.nih.gov/pubmed/39869889 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e66496 %T Effect of a Short, Animated Storytelling Video on Transphobia Among US Parents: Randomized Controlled Trial %A Amsalem,Doron %A Greuel,Merlin %A Liu,Shuyan %A Martin,Andrés %A Adam,Maya %K public health communication %K vulnerable population %K stigma reduction %K stigma %K transphobia %K transgender %K gender diverse %K LGBTQ %K parent %K mental health %K mental illness %K transgender children %K children %K youth %K adolescent %K storytelling %K animation %D 2025 %7 20.1.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Parents play a pivotal role in supporting transgender and gender diverse (TGD) youth. Yet only 35% of TGD youth describe their home as a gender-affirming place. Lack of parental support contributes to recent findings that TGD youth are approximately three times more likely to attempt suicide than their cisgender peers. In contrast, parents’ affirmation of their children’s gender identity significantly improves their mental health outcomes, by reducing anxiety, depression, and suicidality. Objective: Addressing the urgent need for effective, scalable interventions, this study evaluates a novel digital approach: short, animated storytelling videos. We hypothesized that our 2.5-minute video intervention would reduce antitransgender stigma, or transphobia, and improve attitudes toward gender diverse children among US parents. Methods: We recruited 1267 US parents, through the Prolific Academic (Prolific) online research platform, and randomized them into video intervention or control groups. We measured transphobia using the Transgender Stigma Scale, and attitudes toward transgender children using the gender thermometer, before and after watching the video. We compared outcomes between the two groups using 2 × 3 ANOVA. Both groups were invited to return 30 days later for follow-up assessment, before being offered posttrial access to the intervention video, which portrayed an authentic conversation between a mother and her transgender child. Results: Single exposure to a short, animated story video significantly reduced transphobia and improved attitudes toward transgender children among US parents, immediately post intervention. We observed a significant group-by-time interaction in mean Transgender Stigma Scale scores (F2,1=3.7, P=.02) and significant between-group changes when comparing the video and control groups from baseline to post intervention (F1=27.4, P<.001). Effect sizes (Cohen d) indicated small to moderate immediate changes in response to the 2.5-minute video, though the effect was no longer observed at the 30-day follow-up. Gender thermometer scores revealed significant immediate improvements in the attitudes of participants in the video intervention arm, and this improvement was sustained at the 30-day time point. Conclusions: Short, animated storytelling is a novel digital approach with the potential to boost support and affirmation of transgender children, by offering authentic insights into the lived experiences of TGD youth. Repeated exposures to such interventions may be necessary to sustain improvements over time. Future studies could test a series of short, animated storytelling videos featuring the lived experiences of several TGD youth. Evaluating the effect of such a series could contribute to the fields of digital health communication and transgender health. Digital approaches, such as short, animated storytelling videos, that support empathy and acceptance of TGD youth could foster a more inclusive society in which every child can thrive. Trial Registration: AsPredicted.org 159248; https://aspredicted.org/ptmd-3kfs.pdf %R 10.2196/66496 %U https://publichealth.jmir.org/2025/1/e66496 %U https://doi.org/10.2196/66496 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e58546 %T Evaluating the Impacts of Community-Campus Engagement on Population Health in Ottawa and Thunder Bay, Canada: Protocol for a Mixed Methods Contribution Analysis %A Buetti,David %A Larche,Cynthia %A Fitzgerald,Michael %A Bourgeois,Isabelle %A Cameron,Erin %A Carr,Kady %A Aubry,Tim %A Persaud,Sydney %A Kendall,Claire E %+ Bruyère Health Research Institute, 43 Bruyère Street, Ottawa, ON, K1N 5C8, Canada, 1 6135626262 ext 1614, ckendall@uottawa.ca %K community-campus engagement %K population health %K contribution analysis %K mixed methods %K health determinants %K community health %K CityStudio %K theory of change %K impact evaluation %D 2025 %7 17.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Municipalities play a crucial role in population health due to their community connections and influence on health determinants. Community-campus engagement (CCE), that is, collaboration between academic institutions and communities, is a promising approach to addressing community health priorities. However, evidence of CCE’s impact on population health remains limited. Measuring the impacts of CCE is inherently complex due to factors such as diverse stakeholders, context-specific variables, and dynamic interactions within a community. Objective: This study aims to develop robust evidence on the impacts of CCE on population health outcomes in Ottawa and Thunder Bay, Ontario, Canada, focusing on 5 shared health priorities: housing, discrimination, poverty, violence, and mental health. Methods: We will use a proven CCE model called CityStudio, which has been implemented in both cities. We will use Mayne's mixed methods contribution analysis in three stages: (1) formulating a theory of change that outlines the expected contributions of CCE to population health outcomes; (2) gathering qualitative and quantitative data in line with the established Theory of Change; the data will be collected from various sources, including case studies of existing CityStudio projects, a web-based CCE stakeholder survey, a literature review, and population and community health data; and (3) reviewing the gathered evidence to determine the extent of CCE impacts on population health. Results: Ethical approval for this project was granted in May 2023. We have since initiated stage 1 by reviewing the literature to inform the development of the theory of change. We expect to complete this study by May 2026. Conclusions: This study will address two critical gaps about how improving health outcomes depends on CCE: (1) how academic institutions can best engage with their communities to improve population health outcomes, and (2) how municipalities can engage with academic institutions to address their community health priorities. Conducting our work in differing contexts will allow us to consider a broader range of other influences on outcomes, thus making our work applicable to various settings and outcomes. International Registered Report Identifier (IRRID): PRR1-10.2196/58546 %M 39819858 %R 10.2196/58546 %U https://www.researchprotocols.org/2025/1/e58546 %U https://doi.org/10.2196/58546 %U http://www.ncbi.nlm.nih.gov/pubmed/39819858 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60189 %T Building a Digital Health Research Platform to Enable Recruitment, Enrollment, Data Collection, and Follow-Up for a Highly Diverse Longitudinal US Cohort of 1 Million People in the All of Us Research Program: Design and Implementation Study %A Klein,Dave %A Montgomery,Aisha %A Begale,Mark %A Sutherland,Scott %A Sawyer,Sherilyn %A McCauley,Jacob L %A Husbands,Letheshia %A Joshi,Deepti %A Ashbeck,Alan %A Palmer,Marcy %A Jain,Praduman %+ Vibrent Health, Inc, 4114 Legato Rd #900, Fairfax, VA, 22033, United States, 1 6784686545, aisha.montgomery@gmail.com %K longitudinal studies %K cohort studies %K health disparities %K minority populations %K vulnerable populations %K precision medicine %K biomedical research %K decentralization %K digital health technology %K database management system %D 2025 %7 15.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Longitudinal cohort studies have traditionally relied on clinic-based recruitment models, which limit cohort diversity and the generalizability of research outcomes. Digital research platforms can be used to increase participant access, improve study engagement, streamline data collection, and increase data quality; however, the efficacy and sustainability of digitally enabled studies rely heavily on the design, implementation, and management of the digital platform being used. Objective: We sought to design and build a secure, privacy-preserving, validated, participant-centric digital health research platform (DHRP) to recruit and enroll participants, collect multimodal data, and engage participants from diverse backgrounds in the National Institutes of Health’s (NIH) All of Us Research Program (AOU). AOU is an ongoing national, multiyear study aimed to build a research cohort of 1 million participants that reflects the diversity of the United States, including minority, health-disparate, and other populations underrepresented in biomedical research (UBR). Methods: We collaborated with community members, health care provider organizations (HPOs), and NIH leadership to design, build, and validate a secure, feature-rich digital platform to facilitate multisite, hybrid, and remote study participation and multimodal data collection in AOU. Participants were recruited by in-person, print, and online digital campaigns. Participants securely accessed the DHRP via web and mobile apps, either independently or with research staff support. The participant-facing tool facilitated electronic informed consent (eConsent), multisource data collection (eg, surveys, genomic results, wearables, and electronic health records [EHRs]), and ongoing participant engagement. We also built tools for research staff to conduct remote participant support, study workflow management, participant tracking, data analytics, data harmonization, and data management. Results: We built a secure, participant-centric DHRP with engaging functionality used to recruit, engage, and collect data from 705,719 diverse participants throughout the United States. As of April 2024, 87% (n=613,976) of the participants enrolled via the platform were from UBR groups, including racial and ethnic minorities (n=282,429, 46%), rural dwelling individuals (n=49,118, 8%), those over the age of 65 years (n=190,333, 31%), and individuals with low socioeconomic status (n=122,795, 20%). Conclusions: We built a participant-centric digital platform with tools to enable engagement with individuals from different racial, ethnic, and socioeconomic backgrounds and other UBR groups. This DHRP demonstrated successful use among diverse participants. These findings could be used as best practices for the effective use of digital platforms to build and sustain cohorts of various study designs and increase engagement with diverse populations in health research. %M 39813673 %R 10.2196/60189 %U https://www.jmir.org/2025/1/e60189 %U https://doi.org/10.2196/60189 %U http://www.ncbi.nlm.nih.gov/pubmed/39813673 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58460 %T Testing a Web-Based Interactive Comic Tool to Decrease Obesity Risk Among Racial and Ethnic Minority Preadolescents: Randomized Controlled Trial %A Leung,May May %A Mateo,Katrina F %A Dublin,Marlo %A Harrison,Laura %A Verdaguer,Sandra %A Wyka,Katarzyna %+ Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, United States, 1 6176363676, maymay.leung@tufts.edu %K childhood obesity %K preadolescents %K racial and ethnic minority populations %K dietary behaviors %K BMI %K digital health %D 2025 %7 15.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Childhood obesity prevalence remains high, especially in racial and ethnic minority populations with low incomes. This epidemic is attributed to various dietary behaviors, including increased consumption of energy-dense foods and sugary beverages and decreased intake of fruits and vegetables. Interactive, technology-based approaches are emerging as promising tools to support health behavior changes. Objective: This study aimed to assess the feasibility and acceptability of Intervention INC (Interactive Nutrition Comics for Urban, Minority Preadolescents), a 6-chapter web-based interactive nutrition comic tool. Its preliminary effectiveness on diet-related psychosocial variables and behaviors was also explored. Methods: A total of 89 Black or African American and Hispanic preadolescents with a mean age of 10.4 (SD 1.0) years from New York City participated in a pilot 2-group randomized study, comprising a 6-week intervention and a 3-month follow-up (T4) period. Of the 89 participants, 61% were female, 62% were Black, 42% were Hispanic, 53% were overweight or obese, and 34% had an annual household income of 40 years was 4.5% (n=1815), compared to 2.77% (n=1183) in prisoners aged ≤40 years. Prisoners aged >40 years had a higher prevalence (prevalence ratio: 1.69, P<.001). Other disorders of the urethra and urinary tract (ICD-9-CM: 599), including urinary tract infection, urinary obstruction, and hematuria, were the most prevalent diseases of the urethra and urinary tract across age and sex groups. Women and older prisoners had a higher prevalence of most urinary tract diseases. There were no significant sex-specific differences in adjusted prevalence ratios for acute glomerulonephritis, nephrotic syndrome, kidney infections, urethritis (nonsexually transmitted), or urethral syndrome. However, based on the age-specific adjusted prevalence ratio analysis, cystitis was more prevalent among younger prisoners (prevalence ratio: 0.69, P=.004). Conclusions: Urinary system infections and inflammation are common in prisons. Our findings advocate for policy reforms aimed at improving health care accessibility in prisons, with a particular focus on the needs of high-risk groups such as women and older prisoners. Further research linking claims data with prisoner information is crucial to providing more comprehensive medical services and achieving health equity. %R 10.2196/60136 %U https://publichealth.jmir.org/2024/1/e60136 %U https://doi.org/10.2196/60136 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54366 %T Investigating eHealth Lifestyle Interventions for Vulnerable Pregnant Women: Scoping Review of Facilitators and Barriers %A Smit,Ashley JP %A Al-Dhahir,Isra %A Schiphof-Godart,Lieke %A Breeman,Linda D %A Evers,Andrea WM %A Joosten,Koen FM %+ Department of Neonatal and Pediatric Intensive Care, Erasmus Medical Center, Sophia Children's Hospital, Dr. Molewaterplein 40, Rotterdam, 3015 GD, Netherlands, 31 10 704 0704, a.j.p.smit@erasmusmc.nl %K eHealth %K pregnancy %K vulnerability %K socioeconomic status %K lifestyle intervention %K intervention development %K barriers %K facilitators %K mobile phone %K PRISMA %D 2024 %7 20.12.2024 %9 Review %J J Med Internet Res %G English %X Background: The maintenance of a healthy lifestyle significantly influences pregnancy outcomes. Certain pregnant women are more at risk of engaging in unhealthy behaviors due to factors such as having a low socioeconomic position and low social capital. eHealth interventions tailored to pregnant women affected by these vulnerability factors can provide support and motivation for healthier choices. However, there is still a lack of insight into how interventions for this target group are best designed, used, and implemented and how vulnerable pregnant women are best reached. Objective: This review aimed to identify the strategies used in the design, reach, use, and implementation phases of eHealth lifestyle interventions for vulnerable pregnant women; assess whether these strategies acted as facilitators; and identify barriers that were encountered. Methods: We conducted a search on MEDLINE, Embase, Web of Science, CINAHL, and Google Scholar for studies that described an eHealth intervention for vulnerable pregnant women focusing on at least one lifestyle component (diet, physical activity, alcohol consumption, smoking, stress, or sleep) and provided information on the design, reach, use, or implementation of the intervention. Results: The literature search identified 3904 records, of which 29 (0.74%) met our inclusion criteria. These 29 articles described 20 eHealth lifestyle interventions, which were primarily delivered through apps and frequently targeted multiple lifestyle components simultaneously. Barriers identified in the design and use phases included financial aspects (eg, budgetary constraints) and technological challenges for the target group (eg, limited internet connectivity). In addition, barriers were encountered in reaching vulnerable pregnant women, including a lack of interest and time constraints among eligible participants and limited support from health care providers. Facilitators identified in the design and use phases included collaborating with the target group and other stakeholders (eg, health care providers), leveraging existing eHealth platforms for modifications or extensions, and adhering to clinical and best practice guidelines and behavior change frameworks. Furthermore, tailoring (eg, matching the content of the intervention to the target groups’ norms and values) and the use of incentives (eg, payments for abstaining from unhealthy behavior) were identified as potential facilitators to eHealth use. Facilitators in the interventions’ reach and implementation phases included stakeholder collaboration and a low workload for the intervention deliverers involved in these phases. Conclusions: This scoping review offers a comprehensive overview of strategies used in different phases of eHealth lifestyle interventions for vulnerable pregnant women, highlighting specific barriers and facilitators. Limited reporting on the impact of the strategies used and barriers encountered hinders a complete identification of facilitators and barriers. Nevertheless, this review sheds light on how to optimize the development of eHealth lifestyle interventions for vulnerable pregnant women, ultimately enhancing the health of both future mothers and their offspring. %M 39705692 %R 10.2196/54366 %U https://www.jmir.org/2024/1/e54366 %U https://doi.org/10.2196/54366 %U http://www.ncbi.nlm.nih.gov/pubmed/39705692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54664 %T Developing Components of an Integrated mHealth Dietary Intervention for Mexican Immigrant Farmworkers: Feasibility Usability Study of a Food Photography Protocol for Dietary Assessment %A Fernandez,Isabel Diana %A Yang,Yu-Ching %A Chang,Wonkyung %A Kautz,Amber %A Farchaus Stein,Karen %+ Department of Public Health Sciences, Division of Epidemiology, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd., CU 420644, Rochester, NY, 14642-0644, United States, 1 585 275 9554, Diana_fernandez@urmc.rochester.edu %K Mexican immigrant farmworker %K diet-related noncommunicable diseases %K mHealth %K dietary assessment %K image-based %K healthcare disparities %K minority %K feasibility study %K food photography %K rural health %K health literacy %K culutural adaptation %K women %K technology acceptance %K mobile health %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Rural-urban disparities in access to health services and the burden of diet-related noncommunicable diseases are exacerbated among Mexican immigrant farmworkers due to work demands, social and geographical isolation, literacy issues, and limited access to culturally and language-competent health services. Although mobile health (mHealth) tools have the potential to overcome structural barriers to health services access, efficacious mHealth interventions to promote healthy eating have not considered issues of low literacy and health literacy, and food preferences and norms in the Mexican immigrant farmworker population. To address this critical gap, we conducted a series of preliminary studies among Mexican immigrant farmworkers with the long-term goal of developing a culture- and literacy-specific smartphone app integrating dietary assessment through food photography, diet analyses, and a non–text-based dietary intervention. Objective: This study aimed to report adherence and reactivity to a 14-day food photography dietary assessment protocol, in which Mexican immigrant farmworker women were instructed to take photos of all foods and beverages consumed. Methods: We developed a secure mobile app with an intuitive graphical user interface to collect food images. Adult Mexican immigrant farmworker women were recruited and oriented to the photography protocol. Adherence and reactivity were examined by calculating the mean number of food photos per day over time, differences between the first and second week, and differences between weekdays and weekends. The type of foods and meals photographed were compared with reported intake in three 24-hour dietary recalls. Results: In total, 16 Mexican farmworker women took a total of 1475 photos in 14 days, with a mean of 6.6 (SD 2.3) photos per day per participant. On average, participants took 1 fewer photo per day in week 2 compared with week 1 (mean 7.1, SD 2.5 in week 1 vs mean 6.1, SD 2.6 in week 2; P=.03), and there was a decrease of 0.6 photos on weekdays versus weekends (mean 6.4, SD 2.5 on weekdays vs mean 7, SD 2.7 on weekends; P=.50). Of individual food items, 71% (352/495) of foods in the photos matched foods in the recalls. Of all missing food items (n=138) and meals (n=36) in the photos, beverages (74/138, 54%), tortillas (15/138, 11%), snacks 16/36, 44%), and dinners (10/36, 28%) were the most frequently missed. Most of the meals not photographed (27/36, 75%) were in the second week of the protocol. Conclusions: Dietary assessment through food photography is feasible among Mexican immigrant farmworker women. For future protocols, substantive adjustments will be introduced to reduce the frequency of missing foods and meals. Our preliminary studies are a step in the right direction to extend the benefits of mHealth technologies to a hard-to-reach group and contribute to the prevention and control of diet-related noncommunicable diseases. %M 39671581 %R 10.2196/54664 %U https://formative.jmir.org/2024/1/e54664 %U https://doi.org/10.2196/54664 %U http://www.ncbi.nlm.nih.gov/pubmed/39671581 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60963 %T Global and Regional Prevalence of Domestic Violence During the COVID-19 Pandemic and Its Determinants: Protocol for a Systematic Review and Meta-Analysis %A Bidhendi-Yarandi,Razieh %A Biglarian,Akbar %A Nosrati Nejad,Farhad %A Roshanfekr,Payam %A Behboudi-Gandevani,Samira %+ Faculty of Nursing and Health Sciences, Nord University, Postbox 1490, Bodø, 8049, Norway, 47 75517670, samira.behboudi-gandevani@nord.no %K COVID-19 %K domestic violence %K systematic review and meta-analysis %K lockdowns %K pandemic effects %K intimate partner violence %K elder abuse %K child abuse %K vulnerable populations %D 2024 %7 9.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Domestic violence is one of the most significant global public health priorities. This social problem could be accelerated by global catastrophes such as the COVID-19 pandemic. The structural changes due to the imposition of health measures, combined with personal and social problems, may worsen the situation. Objective: This study aims to investigate the global and regional prevalence of domestic violence during the COVID-19 pandemic and its determinants. Methods: We will perform a comprehensive review of the literature in PubMed, PsycINFO, Embase, Cochrane COVID-19 Register, and Applied Social Sciences Index and Abstracts, up to July 2024. This review will adhere to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. Observational studies will be considered eligible if they have a population-based design, report the number of cases or prevalence of domestic violence during the COVID-19 pandemic, and report potential determinants. Studies in languages other than English, those with unclear data, case reports, conference proceedings, reviews, and letters will be excluded. To assess the methodological quality, a standardized critical appraisal checklist for studies reporting prevalence data will be used. A robust Bayesian approach will be applied using the STATA software package (version 14; STATA Inc) and JASP 0.19.1 (GNU Affero General Public License [GNU AGPL]) software. Results: The search and screening for the systematic literature review are anticipated to be finished in October 2024. Data extraction, quality appraisal, and subsequent data synthesis will begin in November 2024. The review is expected to be completed by April 2025, and the study results will be published in 2025. Conclusions: This systematic review and meta-analysis will address significant gaps in understanding the pandemic’s impact on domestic violence, providing a comprehensive assessment of its prevalence and contributing factors. Despite some limitations, the study incorporates diverse data sources and vulnerable groups to offer a detailed and accurate picture. The findings will inform targeted interventions and policy responses to mitigate the impact of future global crises on domestic violence rates. Trial Registration: PROSPERO CRD42022351634; https://tinyurl.com/yth37jkx International Registered Report Identifier (IRRID): PRR1-10.2196/60963 %M 39652848 %R 10.2196/60963 %U https://www.researchprotocols.org/2024/1/e60963 %U https://doi.org/10.2196/60963 %U http://www.ncbi.nlm.nih.gov/pubmed/39652848 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e53280 %T The Use of a Digital Well-Being App (Stay Strong App) With Indigenous People in Prison: Randomized Controlled Trial %A Perdacher,Elke %A Kavanagh,David %A Sheffield,Jeanie %A Dale,Penny %A Heffernan,Edward %+ Queensland Forensic Mental Health Service, Level 5, 270 Roma Street, Brisbane, Queensland, 4000, Australia, 61 7 3837 5820, elke.perdacher@health.qld.gov.au %K First Nations %K Indigenous %K digital mental health %K e-mental health %K mental health %K social and emotional well-being %K SEWB %K prisoner %K prison %D 2024 %7 6.12.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Indigenous Australians in custody experience much greater rates of poor mental health and well-being than those of the general community, and these problems are not adequately addressed. Digital mental health strategies offer innovative opportunities to address the problems, but little is known about their feasibility in or impact on this population. Objective: This study aims to conduct a pilot trial evaluating the impact of adding the Stay Strong app to mental health and well-being services for Indigenous women and men in custody. The trial compared immediate and 3-month delayed use of the app by the health service, assessing its effects on well-being, empowerment, and psychological distress at 3 and 6 months after the baseline. Methods: Indigenous participants were recruited from 3 high-security Australian prisons from January 2017 to September 2019. The outcome measures assessed well-being (Warwick-Edinburgh Mental Wellbeing Scale), empowerment (Growth and Empowerment Measure [GEM]—giving total, 14-item Emotional Empowerment Scale, and 12 Scenarios scores), and psychological distress (Kessler Psychological Distress Scale). Intention-to-treat effects on these outcomes were analyzed using linear mixed models. Results: Substantial challenges in obtaining ethical and institutional approval for the trial were encountered, as were difficulties in timely recruitment and retention due to staff shortages and the release of participants from prison before follow-up assessments and an inability to follow up with participants after release. A total of 132 prisoners (age: mean 33, SD 8 y) were randomized into either an immediate (n=82) or a delayed treatment (n=52) group. However, only 56 (42.4%) could be assessed at 3 months and 37 (28%) at 6 months, raising questions concerning the representativeness of the results. Linear improvements over time were seen in all outcomes (GEM total: Cohen d=0.99; GEM 14-item Emotional Empowerment Scale: Cohen d=0.94; GEM 12 Scenarios: Cohen d=0.87; Warwick-Edinburgh Mental Wellbeing Scale: Cohen d=0.76; Kessler Psychological Distress Scale: Cohen d=0.49), but no differential effects for group or the addition of the Stay Strong app were found. Conclusions: We believe this to be Australia’s first evaluation of a digital mental health app in prison and the first among Indigenous people in custody. While the study demonstrated that the use of a well-being app within a prison was feasible, staff shortages led to delayed recruitment and a consequent low retention, and significant beneficial effects of the app’s use within a forensic mental health service were not seen. Additional staff resources and a longer intervention may be needed to allow a demonstration of satisfactory retention and impact in future research. Trial Registration: ANZCTR ACTRN12624001261505; https://www.anzctr.org.au/ACTRN12624001261505.aspx %M 39642362 %R 10.2196/53280 %U https://mental.jmir.org/2024/1/e53280 %U https://doi.org/10.2196/53280 %U http://www.ncbi.nlm.nih.gov/pubmed/39642362 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e51424 %T Psychometric Properties of Measuring Antiretroviral Therapy Adherence Among Young Latino Sexual Minority Men With HIV: Ecological Momentary Assessment and Electronic Pill Dispenser Study %A Sheehan,Diana M %A Gwanzura,Tendai %A Ibarra,Cynthia %A Ramirez-Ortiz,Daisy %A Swendeman,Dallas %A Duncan,Dustin T %A Muñoz-Laboy,Miguel %A Devieux,Jessy G %A Trepka,Mary Jo %K human immunodeficiency virus %K HIV %K MSM %K sexual minority %K antiretroviral therapy %K Latino %K Hispanic %K adherence %K psychometric %K ecological momentary assessment %K electronic pill dispenser %K validity %K acceptability %K compliance %K medication dispenser %K reminder %K alert %K digital health %K young adult %D 2024 %7 21.11.2024 %9 %J Online J Public Health Inform %G English %X Background: Increasing HIV rates among young Latino sexual minority men (YLSMM) warrant innovative and rigorous studies to assess prevention and treatment strategies. Ecological momentary assessments (EMAs) and electronic pill dispensers (EPDs) have been used to measure antiretroviral therapy (ART) adherence repeatedly in real time and in participants’ natural environments, but their psychometric properties among YLSMM are unknown. Objective: The study’s objective was to assess the concurrent validity, acceptability, compliance, and behavioral reactivity of EMAs and EPDs among YLSMM with HIV. Methods: A convenience sample of 56 YLSMM with HIV with suboptimal ART adherence, aged 18‐34 years, was recruited into a 28-consecutive-day EMA study. Concurrent validity was analyzed by comparing median ART adherence rates and calculating Spearman correlations between ART adherence measured by EMA, EPD, and baseline retrospective validated 3-item and single-item measures. Acceptability was assessed in exit interviews asking participants to rate EMA and EPD burden. Compliance was assessed by computing the percent lost to follow-up, the percent of EMAs missed, and the percentage of days the EPD was not opened that had corresponding EMA data self-reporting adherence to ARTs. Behavioral reactivity was assessed by computing the median change in ART adherence during the study period, using generalized mixed models to assess whether the cumulative number of EMAs completed and days of EPD use predicted ART adherence over time, and by asking participants to rate perceived reactivity using a Likert scale. Results: EMA ART adherence was significantly correlated with baseline validated 3-item (r=0.41, P=.003) and single-item (r=0.52, P<.001) measures, but correlations were only significant for participants that reported EMA was not burdensome. Correlations for EPD ART adherence were weaker but significant (r=0.36, P=.009; r=0.34, P=.01, respectively). Acceptability was high for EMAs (48/54, 89%) and EPDs (52/54, 96%) per self-report. Loss to follow-up was 4% (2/56), with the remaining participants completing 88.6% (1339/1512) of study-prompted EMAs. The percentage of missed EMA surveys increased from 5.8% (22/378) in week 1 of the study to 16.7% (63/378) in week 4. Of 260 days when EPDs were not opened, 68.8% (179) had a corresponding EMA survey self-reporting ART adherence. Reactivity inferred from the median change in ART adherence over time was 8.8% for EMAs and −0.8% for EPDs. Each completed EMA was associated with 1.03 odds (95% CI 1‐1.07) of EMA ART adherence over time, and each day of EPD use with 0.97 odds (95% CI 0.96‐0.99) of EPD ART adherence over time. Self-reported perceived behavioral reactivity was 39% for EMAs and 35% for EPDs. Conclusions: This study provides evidence of concurrent validity with retrospective validated measures for EMA- and EPD-measured ART adherence among YLSMM, when participant burden is carefully considered, without significant behavioral reactivity. While acceptability and compliance of EMAs and EPDs were high overall, noncompliance increased over time, suggesting respondent fatigue. %R 10.2196/51424 %U https://ojphi.jmir.org/2024/1/e51424 %U https://doi.org/10.2196/51424 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56392 %T Factors Influencing Domestic Human Trafficking in Africa: Protocol for a Scoping Review %A Belaid,Loubna %A Sarmiento,Ivan %A Dion,Anna %A Rojas Cardenas,Andrés %A Cockcroft,Anne %A Andersson,Neil %+ École Nationale d'Administration Publique, 4750 Henri Julien, Montreal, QC, H2T2C8, Canada, 1 5148493989 ext 3810, loubna.belaid@enap.ca %K domestic human trafficking %K Africa %K scoping review protocol %K protocol %K human trafficking %K trafficking %K modern slavery %K human rights violation %K discourse analysis %K exploitation %K fuzzy cognitive map %D 2024 %7 18.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Human trafficking is a human rights violation in every region of the world. The African continent is not spared. Every year, millions of people experience significant health and social consequences. International organizations and governments combating human trafficking are hindered by a lack of knowledge about what factors influence domestic (within-country) human trafficking. Objective: This study aims to conduct a scoping review to collate and synthesize literature on factors influencing domestic trafficking in Africa. Methods: We will follow Arksey and O’Malley’s framework to answer the question about reported influences on domestic human trafficking and their relative weight. The search strategy will explore PubMed, CINAHL, Web of Science, and Scopus. A total of 2 independent researchers will select quantitative, qualitative, or mixed methods studies that examine relationships influencing domestic human trafficking. We will document our results by following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. We will extract a list of all reported relationships between identified factors influencing domestic human trafficking in each study. Based on a discourse analysis approach, we will weigh the strengths of the relationships based on how frequently they are reported across the included studies. We will summarize the findings as fuzzy cognitive maps depicting the relationships reported in the literature. The maps represent the influences between concepts (nodes) linked by arrows (edges) going from each cause to its outcomes. These maps are helpful visual summaries of the factors associated with domestic human trafficking, allowing a comparison with maps to be created by stakeholder groups. Results: This project received financial support in March 2023. We expect to start the project in March 2024. We recruited 2 research staff members to conduct the scoping review and expect to publish the results in March 2025. Conclusions: The review will provide a comprehensive understanding of factors influencing domestic human trafficking in Africa. The overlap of human trafficking with other forms of exploitation, the limited literature on domestic human trafficking, and the likely diversity of factors are challenges for the review. We propose strategies to address these challenges. International Registered Report Identifier (IRRID): PRR1-10.2196/56392 %M 39556420 %R 10.2196/56392 %U https://www.researchprotocols.org/2024/1/e56392 %U https://doi.org/10.2196/56392 %U http://www.ncbi.nlm.nih.gov/pubmed/39556420 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e64358 %T Neighborhoods, Networks, and HIV Care Among Men Who Have Sex With Men: Proposal for a Longitudinal Study %A Tieu,Hong Van %A Nandi,Vijay %A Diaz,José E %A Greene,Emily %A Walcott,Melonie %A Curriero,Frank %A Desjardins,Michael R %A Wychgram,Cara %A Latkin,Carl %A Rundle,Andrew G %A Frye,Victoria A %A , %+ Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, 310 E. 67th Street, New York, NY, 10065, United States, 1 2125703081, htieu@nybc.org %K neighborhoods %K social networks %K HIV care outcomes %K men who have sex with men %K living with HIV %K activity spaces %D 2024 %7 13.11.2024 %9 Proposal %J JMIR Res Protoc %G English %X Background: The majority of people living with HIV in the United States are men who have sex with men (MSM), with race- and ethnicity-based disparities in HIV rates and care continuum. In order to uncover the neighborhood- and network-involved pathways that produce HIV care outcome disparities, systematic, theory-based investigation of the specific and intersecting neighborhood and social network characteristics that relate to the HIV care continuum must be engaged. Objective: Using socioecological and intersectional conceptual frameworks, we aim to identify individual-, neighborhood-, and network-level characteristics associated with HIV care continuum outcomes (viral suppression, retention in care, and antiretroviral adherence) among MSM living with HIV in New York City. Methods: In the longitudinal cohort study, we assess 3 neighborhoods of potential influence (residential, social, and health care access activity spaces) using Google Earth. We investigate the influence of neighborhood composition (eg, concentrated poverty and racial segregation) and four neighborhood-level characteristics domains: (1) community violence, physical disorder, and social disorganization (eg, crime rates and housing vacancy); (2) alcohol and other drug use; (3) social norms (eg, homophobia and HIV stigma); and (4) community resources (eg, social services and public transit access). We test theoretical pathways of influence, including stress or coping, stigma or resilience, and access to resources, across the different neighborhoods in which MSM live, socialize, and receive HIV care. At each visit, we locate each participant’s reported activity spaces (ie, neighborhoods of potential influence) and collect individual-level data on relevant covariates (including perceptions of or exposure to neighborhoods) and social network inventory data on the composition, social support, and perceived social norms. The outcomes are HIV viral suppression, retention in care, and antiretroviral adherence. These data are combined with an existing, extensive geospatial database of relevant area characteristics. Spatial analysis and multilevel modeling are used to test the main theory-driven hypotheses and capture independent neighborhood-level and network-level effects and changes over time. Results: The study began enrollment in March 2019 and concluded visits in December 2023, with a total of 327 participants enrolled. The median age was 44.1 (SD 11.5) years. Almost all participants self-identified as cisgender men (n=313, 98.1%) and as gay, homosexual, or bisexual (n=301, 94.4%). Overall, 192 (60.1%) participants identified as non-Hispanic Black, and 81 (25.3%) identified as Hispanic. Most (n=201, 63%) reported at least occasional difficulty in meeting basic needs (eg, rent and food) in the past 6 months. The mean number of years living with HIV was 15.4 (SD 10.1). Conclusions: This study will have direct implications for the design of multilevel interventions, addressing factors at the neighborhood, network, and individual levels. Results may inform urban planning and program design to improve HIV care outcomes for MSM, particularly for Black and Latino MSM living in urban areas. International Registered Report Identifier (IRRID): PRR1-10.2196/64358 %M 39536314 %R 10.2196/64358 %U https://www.researchprotocols.org/2024/1/e64358 %U https://doi.org/10.2196/64358 %U http://www.ncbi.nlm.nih.gov/pubmed/39536314 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57931 %T Clinical and Biochemical Outcomes in Transgender Individuals Undergoing Hormone Therapy: Protocol for a Systematic Review %A Sattora,Emily %A Teelin,Karen %A Prendergast,Christopher %A Smith,Abigail %A Evans,James %A Imdad,Aamer %+ Division of Pediatric Gastroenterology, Hepatology, Pancreatology, and Nutrition, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, United States, 1 319 356 2950, aamer-imdad@uiowa.edu %K transgender %K lipid levels %K hormone therapy %K biochemical outcomes %K clinical outcomes %K comprehensive data %K systematic review %K meta-analysis %K adolescent %K adults %K electronic databases %K testosterone %K estrogen %D 2024 %7 12.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Monitoring of various clinical outcomes and parameters, such as lipid levels, is recommended in transgender individuals undergoing hormone therapies. However, comprehensive data to inform these recommendations is scarce. Objective: This study aims to conduct a systematic review and meta-analysis to synthesize evidence from existing literature on the effect of exogenous hormone therapy on clinical and biochemical outcomes for transgender adolescents and adults. Methods: We will search multiple electronic databases and will include prospective and retrospective observational studies with and without a control group. The study population will include transgender individuals undergoing hormone therapy with testosterone or estrogen. Comparisons will include age-matched, cisgender individuals and changes from baseline. Primary outcomes include changes in or the development of abnormal lipid parameters. Secondary outcomes include BMI, weight, height, and blood pressure for age, serum testosterone or estrogen levels, and development of disease including hypertension, diabetes, fatty liver disease, obesity, adverse cardiac events, as well as all-cause mortality. The meta-analysis will pool the studies where applicable, and meta-regressions will be conducted to evaluate effect modifiers. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach will be used to evaluate the overall certainty of evidence. Results: We will summarize the selection of the eligible studies using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart. The results will be presented in a table summarizing the evidence. Data collection is ongoing, and the paper is expected to be published in Spring 2025. Conclusions: This systematic review will summarize and evaluate the evidence of the clinical and biochemical outcomes associated with hormone therapies for transgender individuals. Trial Registration: PROSPERO CRD42024483138; https://tinyurl.com/yc4sfvnb International Registered Report Identifier (IRRID): PRR1-10.2196/57931 %M 39531266 %R 10.2196/57931 %U https://www.researchprotocols.org/2024/1/e57931 %U https://doi.org/10.2196/57931 %U http://www.ncbi.nlm.nih.gov/pubmed/39531266 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57040 %T How Do Scholars Conceptualize and Conduct Health and Digital Health Literacy Research? Survey of Federally Funded Scholars %A Sakhuja,Mayank %A Yelton,Brooks %A Kavarana,Simone %A Schaurer,Lauren %A Rumthao,Jancham Rachel %A Noblet,Samuel %A Arent,Michelle A %A Macauda,Mark M %A Donelle,Lorie %A Friedman,Daniela B %+ UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 323A Rosenau Hall, Chapel Hill, NC, 27599-7295, United States, 1 8034468063, msakhuja@unc.edu %K health literacy %K digital health literacy %K eHealth literacy %K social determinants of health %K SDoH %K research scholarship %K health care %K public health research %K digital health tools %K community health %D 2024 %7 31.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The concept of health literacy (HL) is constantly evolving, and social determinants of health (SDoH) have been receiving considerable attention in public health scholarship. Since a 1-size-fits-all approach for HL fails to account for multiple contextual factors and as a result poses challenges in improving literacy levels, there is a need to develop a deeper understanding of the current state of HL and digital health literacy (DHL) research. Objective: This study examined scholars’ conceptualization and scope of work focused on HL and DHL. Methods: Using a search string, investigators (N=2042) focusing on HL, DHL, or both were identified from the grantee websites of the National Institutes of Health RePORTER (RePORT Expenditures and Results) and the Canadian Institutes of Health Research. The investigators were emailed a survey via Qualtrics. Survey questions examined the focus of work; whether the investigators studied HL/DHL in combination with other SDoH; the frameworks, definitions, and approaches used; and research settings. We analyzed survey data using SPSS Statistics version 28 and descriptive analysis, including frequencies and percentages, was conducted. Chi-square tests were performed to explore the association between the focus of work, settings, and age groups included in the investigators’ research. Results: A total of 193 (9.5%) of 2042 investigators responded to the online survey. Most investigators (76/153, 49.7%) were from public health, 83/193 (43%) reported their research focused on HL alone, 46/193 (23.8%) mentioned DHL, and 64/193 (33.2%) mentioned both. The majority (133/153, 86.9%) studied HL/DHL in combination with other SDoH, 106/135 (78.5%) conducted HL/DHL work in a community setting, and 100/156 (64.1%) reported not using any specific definition to guide their work. Digital tools (89/135, 65.9%), plain-language materials (82/135, 60.7%), and visual guides (56/135, 41.5%) were the top 3 approaches used. Most worked with adults (131/139, 94.2%) and all races and ethnicities (47/121, 38.8%). Conclusions: HL and DHL research largely considered SDoH. Multiple HL tools and approaches were used that support the examination and improvement of literacy and communication surrounding health care issues. %M 39481097 %R 10.2196/57040 %U https://www.jmir.org/2024/1/e57040 %U https://doi.org/10.2196/57040 %U http://www.ncbi.nlm.nih.gov/pubmed/39481097 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57886 %T The Implementation of the Advocacy Intervention for Midlife and Older Women Who Have Experienced Intimate Partner Violence: Protocol for a Randomized Controlled Trial %A Weeks,Lori %A Allen,Kathleen %A Holtmann,Catherine %A Leger,Joni %A Dupuis-Blanchard,Suzanne %A MacQuarrie,Colleen %A Macdonald,Marilyn %A Moody,Elaine %A Stilwell,Christie %A Helpard,Heather %A Gagnon,Danie %+ School of Health Administration, Dalhousie University, Sir Charles Tupper Medical Building, 2nd Floor, 5850 College Street, PO Box 15000, Halifax, NS, B3H 4R2, Canada, 1 902 494 7114, lori.weeks@dal.ca %K intimate partner violence %K intervention %K virtual %K midlife %K aging %D 2024 %7 30.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Midlife and older women who experience intimate partner violence (IPV) often have less access to supports and services than younger women. There is far less focus on research and supports for midlife and older women compared to younger women experiencing IPV, and often, neither elder abuse nor IPV services meet their needs. Few interventions are available to meet the needs of midlife and older women. Objective: The goal of this randomized controlled trial is to test the effectiveness of an advocacy intervention for midlife and older women who experience IPV and to learn from the experiences of those who implement and participate in the program. Methods: This trial is a 2-arm, unblinded, parallel, pragmatic randomized controlled trial with a qualitative component. Eligible participants will be women who live in the Maritime provinces of Canada (New Brunswick, Nova Scotia, and Prince Edward Island), who are in midlife and older (aged approximately ≥50 years), and who are currently in a relationship with an abusive partner or have recently left an abusive partner. Facilitators will be trained to deliver the intervention. The intervention will be entirely virtual and will consist of 2 components: (1) an empowerment component, which will involve sharing resources and information with the women; and (2) a social support component, which will include providing support and encouragement to women for 12 weeks. Quantitative effectiveness data will be collected from all trial participants at baseline, 3 months after the intervention, and 9 months after the intervention about the incidence and severity of IPV, physical and mental health, and safety behaviors and strategies. Qualitative interviews will be conducted with the facilitators and intervention group participants. Control group participants will receive a static, nontailored version of the advocacy intervention for midlife and older women (AIM) intervention materials after baseline data collection. Results: A total of 12 facilitators have been trained to deliver the AIM intervention to trial participants. Participant recruitment and data collection will be completed in January 2025. Data analysis will continue throughout the data collection period, and the results will be disseminated by December 2025. Conclusions: This research will result in the adaptation and testing of a program to support and empower midlife and older women in the Maritime provinces of Canada who experience IPV. Trial Registration: International Standard Randomized Controlled Trial Registry ISRCTN30646991; https://doi.org/10.1186/ISRCTN30646991 International Registered Report Identifier (IRRID): DERR1-10.2196/57886 %M 39476849 %R 10.2196/57886 %U https://www.researchprotocols.org/2024/1/e57886 %U https://doi.org/10.2196/57886 %U http://www.ncbi.nlm.nih.gov/pubmed/39476849 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e57124 %T Leveraging Artificial Intelligence and Data Science for Integration of Social Determinants of Health in Emergency Medicine: Scoping Review %A Abbott,Ethan E %A Apakama,Donald %A Richardson,Lynne D %A Chan,Lili %A Nadkarni,Girish N %K data science %K social determinants of health %K natural language processing %K artificial intelligence %K NLP %K machine learning %K review methods %K review methodology %K scoping review %K emergency medicine %K PRISMA %D 2024 %7 30.10.2024 %9 %J JMIR Med Inform %G English %X Background: Social determinants of health (SDOH) are critical drivers of health disparities and patient outcomes. However, accessing and collecting patient-level SDOH data can be operationally challenging in the emergency department (ED) clinical setting, requiring innovative approaches. Objective: This scoping review examines the potential of AI and data science for modeling, extraction, and incorporation of SDOH data specifically within EDs, further identifying areas for advancement and investigation. Methods: We conducted a standardized search for studies published between 2015 and 2022, across Medline (Ovid), Embase (Ovid), CINAHL, Web of Science, and ERIC databases. We focused on identifying studies using AI or data science related to SDOH within emergency care contexts or conditions. Two specialized reviewers in emergency medicine (EM) and clinical informatics independently assessed each article, resolving discrepancies through iterative reviews and discussion. We then extracted data covering study details, methodologies, patient demographics, care settings, and principal outcomes. Results: Of the 1047 studies screened, 26 met the inclusion criteria. Notably, 9 out of 26 (35%) studies were solely concentrated on ED patients. Conditions studied spanned broad EM complaints and included sepsis, acute myocardial infarction, and asthma. The majority of studies (n=16) explored multiple SDOH domains, with homelessness/housing insecurity and neighborhood/built environment predominating. Machine learning (ML) techniques were used in 23 of 26 studies, with natural language processing (NLP) being the most commonly used approach (n=11). Rule-based NLP (n=5), deep learning (n=2), and pattern matching (n=4) were the most commonly used NLP techniques. NLP models in the reviewed studies displayed significant predictive performance with outcomes, with F1-scores ranging between 0.40 and 0.75 and specificities nearing 95.9%. Conclusions: Although in its infancy, the convergence of AI and data science techniques, especially ML and NLP, with SDOH in EM offers transformative possibilities for better usage and integration of social data into clinical care and research. With a significant focus on the ED and notable NLP model performance, there is an imperative to standardize SDOH data collection, refine algorithms for diverse patient groups, and champion interdisciplinary synergies. These efforts aim to harness SDOH data optimally, enhancing patient care and mitigating health disparities. Our research underscores the vital need for continued investigation in this domain. %R 10.2196/57124 %U https://medinform.jmir.org/2024/1/e57124 %U https://doi.org/10.2196/57124 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e59009 %T Gender and Sexuality Awareness in Medical Education and Practice: Mixed Methods Study %A Khamisy-Farah,Rola %A Biras,Eden %A Shehadeh,Rabie %A Tuma,Ruba %A Atwan,Hisham %A Siri,Anna %A Converti,Manlio %A Chirico,Francesco %A Szarpak,Łukasz %A Biz,Carlo %A Farah,Raymond %A Bragazzi,Nicola %+ Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100, robertobragazzi@gmail.com %K gender medicine %K medical education %K clinical practice %K gender-sensitive care %K gender awareness %K sexuality awareness %K awareness %K medical education and practice %K healthcare %K patient outcomes %K patient %K patients %K medical professionals %K training %K educational interventions %K status-based %K survey %K effectiveness %K medical workforce %D 2024 %7 8.10.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: The integration of gender and sexuality awareness in health care is increasingly recognized as vital for patient outcomes. Despite this, there is a notable lack of comprehensive data on the current state of physicians’ training and perceptions in these areas, leading to a gap in targeted educational interventions and optimal health care delivery. Objective: The study’s aim was to explore the experiences and perceptions of attending and resident physicians regarding the inclusion of gender and sexuality content in medical school curricula and professional practice in Israel. Methods: This cross-sectional survey targeted a diverse group of physicians across various specializations and experience levels. Distributed through Israeli Medical Associations and professional networks, it included sections on experiences with gender and sexuality content, perceptions of knowledge, the impact of medical school curricula on professional capabilities, and views on integrating gender medicine in medical education. Descriptive and correlational analyses, along with gender-based and medical status-based comparisons, were used, complemented, and enhanced by qualitative analysis of participants’ replies. Results: The survey, encompassing 189 respondents, revealed low-to-moderate exposure to gender and sexuality content in medical school curricula, with a similar perception of preparedness. A need for more comprehensive training was widely recognized. The majority valued training in these areas for enhancing professional capabilities, identifying 10 essential gender-related knowledge areas. The preference for integrating gender medicine throughout medical education was significant. Gender-based analysis indicated variations in exposure and perceptions. Conclusions: The study highlights a crucial need for the inclusion of gender and sexuality awareness in medical education and practice. It suggests the necessity for curriculum development, targeted training programs, policy advocacy, mentorship initiatives, and research to evaluate the effectiveness of these interventions. The findings serve as a foundation for future directions in medical education, aiming for a more inclusive, aware, and prepared medical workforce. %M 39152652 %R 10.2196/59009 %U https://mededu.jmir.org/2024/1/e59009 %U https://doi.org/10.2196/59009 %U http://www.ncbi.nlm.nih.gov/pubmed/39152652 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60387 %T United Voices Group-Singing Intervention to Address Loneliness and Social Isolation Among Older People With HIV During the COVID-19 Pandemic: Intervention Adaption Study %A Hill,Miranda %A Greene,Meredith %A Johnson,Julene K %A Tan,Judy Y %+ Cancer Research Center for Health Equity, Division of Population Sciences, Department of Biomedical Sciences, Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Los Angeles, CA, 90048, United States, 1 3104231499, judy.tan@cshs.org %K HIV %K AIDS %K mental health %K loneliness %K older adults %K music-based interventions %K technology %K mobile phone %D 2024 %7 8.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: People living with HIV experience HIV stigma alongside a spectrum of aging-related health conditions that accelerate their vulnerability to the ill effects of loneliness and social isolation. Group-singing interventions are efficacious in improving psychosocial well-being among older people in the general population; however, the social curative effects of group singing have not been explored in relation to HIV stigma. By promoting group identification, bonding, and pride, group singing may reduce loneliness, social isolation, and other negative impacts of HIV stigma among older people living with HIV. Access to group-singing programs may be enhanced by technology. Objective: While group singing has been extensively studied in older adults, group-singing interventions have not been adapted for older people living with HIV to target loneliness and social isolation in the context of HIV stigma. The objective of this study was to describe the systematic development of a group-singing intervention to reduce loneliness and social isolation among older people living with HIV. Methods: In the San Francisco Bay Area between February 2019 and October 2019, we engaged older people living with HIV in a rigorous, 8-stage, community-engaged intervention adaptation process using the Assessment, Decision, Adaptation, Production, Topical Experts, Integration, Training, and Testing (ADAPT-ITT) framework. On the basis of a formative assessment of the needs and preferences of older people living with HIV, we selected an evidence-based group-singing intervention for older adults and systematically adapted the intervention components by administering them to a community advisory council (n=13). Results: The result was United Voices, a 12-week hybrid (web-based and in-person) group-singing intervention for older people living with HIV. United Voices comprises 12 web-based (ie, via Zoom [Zoom Video Communications]) rehearsals, web-based and in-person drop-in helpdesk sessions, and a professionally produced final concert recording. Conclusions: Through an iterative process and in consultation with stakeholders and topic experts, we refined and manualized United Voices and finalized the design of a pilot randomized controlled trial to evaluate the feasibility and acceptability of the intervention protocol and procedures. The findings provide insights into the barriers and facilitators involved in culturally tailoring interventions for older people living with HIV, implementing intervention adaptations within web-based environments, and the promise of developing hybrid music-based interventions for older adults with HIV. %M 39378071 %R 10.2196/60387 %U https://formative.jmir.org/2024/1/e60387 %U https://doi.org/10.2196/60387 %U http://www.ncbi.nlm.nih.gov/pubmed/39378071 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57633 %T A Clinical Decision Support Tool for Intimate Partner Violence Screening Among Women Veterans: Development and Qualitative Evaluation of Provider Perspectives %A Rossi,Fernanda S %A Wu,Justina %A Timko,Christine %A Nevedal,Andrea L %A Wiltsey Stirman,Shannon %+ Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1070 Arastradero Rd, Stanford, CA, 94304, United States, 1 650 721 3990, fsrossi@stanford.edu %K intimate partner violence %K clinical decision support %K intimate partner violence screening %K women veterans %D 2024 %7 25.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Women veterans, compared to civilian women, are especially at risk of experiencing intimate partner violence (IPV), pointing to the critical need for IPV screening and intervention in the Veterans Health Administration (VHA). However, implementing paper-based IPV screening and intervention in the VHA has revealed substantial barriers, including health care providers’ inadequate IPV training, competing demands, time constraints, and discomfort addressing IPV and making decisions about the appropriate type or level of intervention. Objective: This study aimed to address IPV screening implementation barriers and hence developed and tested a novel IPV clinical decision support (CDS) tool for physicians in the Women’s Health Clinic (WHC), a primary care clinic within the Veterans Affairs Palo Alto Health Care System. This tool provides intelligent, evidence-based, step-by-step guidance on how to conduct IPV screening and intervention. Methods: Informed by existing CDS development frameworks, developing the IPV CDS tool prototype involved six steps: (1) identifying the scope of the tool, (2) identifying IPV screening and intervention content, (3) incorporating IPV-related VHA and clinic resources, (4) identifying the tool’s components, (5) designing the tool, and (6) conducting initial tool revisions. We obtained preliminary physician feedback on user experience and clinical utility of the CDS tool via the System Usability Scale (SUS) and semistructured interviews with 6 WHC physicians. SUS scores were examined using descriptive statistics. Interviews were analyzed using rapid qualitative analysis to extract actionable feedback to inform design updates and improvements. Results: This study includes a detailed description of the IPV CDS tool. Findings indicated that the tool was generally well received by physicians, who indicated good tool usability (SUS score: mean 77.5, SD 12.75). They found the tool clinically useful, needed in their practice, and feasible to implement in primary care. They emphasized that it increased their confidence in managing patients reporting IPV but expressed concerns regarding its length, workflow integration, flexibility, and specificity of information. Several physicians, for example, found the tool too time consuming when encountering patients at high risk; they suggested multiple uses of the tool (eg, an educational tool for less-experienced health care providers and a checklist for more-experienced health care providers) and including more detailed information (eg, a list of local shelters). Conclusions: Physician feedback on the IPV CDS tool is encouraging and will be used to improve the tool. This study offers an example of an IPV CDS tool that clinics can adapt to potentially enhance the quality and efficiency of their IPV screening and intervention process. Additional research is needed to determine the tool’s clinical utility in improving IPV screening and intervention rates and patient outcomes (eg, increased patient safety, reduced IPV risk, and increased referrals to mental health treatment). %M 39321455 %R 10.2196/57633 %U https://formative.jmir.org/2024/1/e57633 %U https://doi.org/10.2196/57633 %U http://www.ncbi.nlm.nih.gov/pubmed/39321455 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56878 %T Ascertaining Out-of-Pocket Costs of Dementia Care: Feasibility Study of a Web-Based Weekly Survey %A Dawson,Walter D %A Mattek,Nora %A Gothard,Sarah %A Kaye,Jeffrey %A Lindauer,Allison %+ Oregon Alzheimer’s Disease Research Center, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CR131, Portland, OR, 97239, United States, 1 5034946976, dawsonw@ohsu.edu %K Alzheimer disease %K caregiving %K out-of-pocket costs %K behavioral and psychological symptoms of dementia %K technological interventions %K clinical trials %K dementias %D 2024 %7 25.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Caring for a family member living with dementia is costly. A major contributor to care demands, and therefore to the costs, are the behavioral symptoms of dementia. Here, we examine the feasibility of ascertaining costs related to caregiving from weekly web-based surveys collected during a telehealth-based behavioral intervention study—Support via Technology: Living and Learning with Advancing Alzheimer Disease. Objective: This study aims to determine the feasibility and acceptability of using a web-based weekly survey to capture real-time data on out-of-pocket caregiving expenses and time commitments associated with dementia care. To examine relationships between behavioral symptoms, care partner reactivity, burden, and out-of-pocket dementia care costs. Methods: Feasibility was measured by accrual, retention, and data completion by participating care partners. Behavioral symptoms, care partner reactivity, and burden were collected before and after the intervention from 13 care partners. Weekly web-based surveys queried Support via Technology: Living and Learning with Advancing Alzheimer Disease care partners about their out-of-pocket costs associated with care-related activities. The surveys included questions on out-of-pocket costs care partners incurred from hospitalizations and emergency department use, primary care provider visits, use of paid in-home care or respite services, use of prescription medications, and use of over-the-counter medications. The surveys also queried the amount of time care partners devoted to these specific care–related activities. Results: Out-of-pocket costs of dementia care were collected via a web-based weekly survey for up to 18 months. In-home assistance was the most frequently reported type of out-of-pocket care expense and the costliest. care partners who paid for in-home assistance or respite reported more behavioral and psychological symptoms of dementia behaviors, higher reactivity, and higher burden than those who did not. Conclusions: This novel web-based weekly survey–based approach offers lessons for designing and implementing future cost-focused studies and care partner–supportive telehealth-based interventions for Alzheimer disease and related dementias (ADRD). The results correspond with the existing understanding of ADRD in that high family-related out-of-pocket costs are a typical part of the caregiving experience, and those costs likely increase with dementia severity. The results may also offer potential insights to health systems and policy makers as they seek to implement telehealth-based and related interventions that seek to better support people living with ADRD and their family care partners. Trial Registration: ClinicalTrials.gov NCT04335110; https://clinicaltrials.gov/ct2/show/NCT04335110 %M 39321453 %R 10.2196/56878 %U https://formative.jmir.org/2024/1/e56878 %U https://doi.org/10.2196/56878 %U http://www.ncbi.nlm.nih.gov/pubmed/39321453 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52345 %T From Digital Inclusion to Digital Transformation in the Prevention of Drug-Related Deaths in Scotland: Qualitative Study %A Daneshvar,Hadi %A Carver,Hannah %A Strachan,Graeme %A Greenhalgh,Jessica %A Matheson,Catriona %+ School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, 9 Sighthill Court, Edinburgh, EH11 4BN, United Kingdom, 44 (0)131455 2929, h.daneshvar@napier.ac.uk %K digital inclusion %K digital transformation %K digital health %K drug-related death %K digitalization %K drug overdose %K drug overdose death %K harm reduction %K mobile phone %K digital divide %D 2024 %7 24.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Globally, drug-related deaths (DRDs) are increasing, posing a significant challenge. Scotland has the highest DRD rate in Europe and one of the highest globally. The Scottish Government launched the Digital Lifelines Scotland (DLS) program to increase the provision of digital technology in harm reduction services and other support services. Digital technology responses to DRDs can include education through digital platforms, improved access to treatment and support via telehealth and mobile apps, analysis of data to identify risk factors, and the use of digital tools for naloxone distribution. However, digital technology should be integrated into a comprehensive approach that increases access to services and addresses underlying causes. Digital transformation could enhance harm reduction service and support, but challenges must be addressed for successful implementation. The DLS program aims to enhance digital inclusion and improve health outcomes for people who use or are affected by drug use to reduce the risk of DRDs. Objective: This study aims to explore the role of digital technology as an enabler and supporter in enhancing existing services and innovating new solutions, rather than being a stand-alone solution. Specifically focusing on individuals who use drugs, the research investigates the potential of digital inclusion and technology provision for preventing DRDs within the context of the DLS program. Methods: Semistructured interviews were conducted with 47 people: 21 (45%) service users, 14 (30%) service providers, and 12 (26%) program staff who were all involved in DLS. Interviews were audio recorded, transcribed, and then coded. Analysis was done in three phases: (1) thematic analysis of interview data to identify the benefits of digital technologies in this sector; (2) identification of the challenges and enablers of using digital technologies using the Technology, People, Organizations, and Macroenvironment conceptual framework; and (3) mapping digital technology provision to services offered to understand the extent of digital transformation of the field. Results: Participants identified increased connectivity, enhanced access to services, and improved well-being as key benefits. Digital devices facilitated social connections, alleviated loneliness, and fostered a sense of community. Devices enabled engagement with services and support workers, providing better access to resources. In addition, digital technology was perceived as a preventive measure to reduce harmful drug use. Lack of technical knowledge, organizational constraints, and usability challenges, including device preferences and security issues, were identified. Conclusions: The study found that digital inclusion through the provision of devices and connections has the potential to enhance support in the harm reduction sector. However, it highlighted the limitations of existing digital inclusion programs in achieving comprehensive digital transformation. To progress, there is a need for sustained engagement, cultural change, and economic considerations to overcome barriers. %M 39316786 %R 10.2196/52345 %U https://www.jmir.org/2024/1/e52345 %U https://doi.org/10.2196/52345 %U http://www.ncbi.nlm.nih.gov/pubmed/39316786 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48047 %T Inequality in Mortality and Cardiovascular Risk Among Young, Low-Income, Self-Employed Workers: Nationwide Retrospective Cohort Study %A Yun,Byungyoon %A Park,Heejoo %A Choi,Jaesung %A Oh,Juyeon %A Sim,Juho %A Kim,Yangwook %A Lee,Jongmin %A Yoon,Jin-Ha %K self-employed %K employee %K all-cause mortality %K cardiovascular disease %K mental illness %K socioeconomic status %K nationwide study %K inequality %K effect modification %K health checkups %D 2024 %7 20.9.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Self-employment is a significant component of South Korea’s labor force; yet, it remains relatively understudied in the context of occupational safety and health. Owing to different guidelines for health checkup participation among economically active individuals, disparities in health maintenance may occur across varying employment statuses. Objective: This study aims to address such disparities by comparing the risk of all-cause mortality and comorbidities between the self-employed and employee populations in South Korea, using nationwide data. We sought to provide insights relevant to other countries with similar cultural, social, and economic contexts. Methods: This nationwide retrospective study used data from the Korean National Health Insurance Service database. Participants (aged 20‐59 y) who maintained the same insurance type (self-employed or employee insurance) for ≥3 years (at least 2008‐2010) were recruited for this study and monitored until death or December 2021—whichever occurred first. The primary outcome was all-cause mortality. The secondary outcomes were ischemic heart disease, ischemic stroke, cancer, and hospitalization with a mental illness. Age-standardized cumulative incidence rates were estimated through an indirect method involving 5-unit age standardization. A multivariable Cox proportional hazards model was used to estimate the adjusted hazard ratio (HR) and 95% CI for each sex stratum. Subgroup analyses and an analysis of the effect modification of health checkup participation were also performed. Results: A total of 11,652,716 participants were analyzed (follow-up: median 10.92, IQR 10.92-10.92 y; age: median 42, IQR 35-50 y; male: n=7,975,116, 68.44%); all-cause mortality occurred in 1.27% (99,542/7,851,282) of employees and 3.29% (124,963/3,801,434) of self-employed individuals (P<.001). The 10-year cumulative incidence rates of all-cause mortality differed significantly by employment status (1.1% for employees and 2.8% for self-employed individuals; P<.001). The risk of all-cause mortality was significantly higher among the self-employed individuals when compared with that among employees, especially among female individuals, according to the final model (male: adjusted HR 1.44, 95% CI 1.42‐1.45; female: adjusted HR 1.89, 95% CI 1.84‐1.94; P<.001). The risk of the secondary outcomes, except all types of malignancies, was significantly higher among the self-employed individuals (all P values were <.001). According to subgroup analyses, this association was prominent in younger individuals with lower incomes who formed a part of the nonparticipation groups. Furthermore, health checkup participation acted as an effect modifier for the association between employment status and all-cause mortality in both sexes (male: relative excess risk due to interaction [RERI] 0.76, 95% CI 0.74‐0.79; female: RERI 1.13, 95% CI 1.05‐1.21). Conclusions: This study revealed that self-employed individuals face higher risks of all-cause mortality, cardio-cerebrovascular diseases, and mental illnesses when compared to employees. The mortality risk is particularly elevated in younger, lower-income individuals who do not engage in health checkups, with health checkup nonparticipation acting as an effect modifier for this association. %R 10.2196/48047 %U https://publichealth.jmir.org/2024/1/e48047 %U https://doi.org/10.2196/48047 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52293 %T A Suicide Prevention Digital Technology for Individuals Experiencing an Acute Suicide Crisis in Emergency Departments: Naturalistic Observational Study of Real-World Acceptability, Feasibility, and Safety %A Dimeff,Linda A %A Koerner,Kelly %A Heard,Kandi %A Ruork,Allison K %A Kelley-Brimer,Angela %A Witterholt,Suzanne T %A Lardizabal,Mary Beth %A Clubb,Joseph R %A McComish,Julie %A Waghray,Arpan %A Dowdy,Roger %A Asad-Pursley,Sara %A Ilac,Maria %A Lawrence,Hannah %A Zhou,Frank %A Beadnell,Blair %+ Evidence-Based Practice Institute, 9450 SW Gemini Dr, PMB 68735, Beaverton, OR, 97008-7105, United States, 1 253 765 0455, linda.dimeff@jasprhealth.com %K suicide %K emergency department %K ED %K digital technology %K suicide prevention best practices %K individual %K particular %K suicide prevention %K evidence-based intervention %K Emergency department %K hospital %K vulnerable population %K Jaspr Health %K psychiatric %K psychiatrist %K care %K safety %D 2024 %7 16.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Emergency departments (EDs) are the front line in providing suicide care. Expert consensus recommends the delivery of several suicide prevention evidence-based interventions for individuals with acute suicidal ideation in the ED. ED personnel demands and staff shortages compromise delivery and contribute to long wait times and unnecessary hospitalization. Digital technologies can play an important role in helping EDs deliver suicide care without placing further demands on the care team if their use is safe to patients in a routine care context. Objective: This study evaluates the safety and effectiveness of an evidence-based digital technology (Jaspr Health) designed for persons with acute suicidal ideation seeking psychiatric crisis ED services when used as part of routine ED-based suicide care. This study deployed Jaspr Health for real-world use in 2 large health care systems in the United States and aimed to evaluate (1) how and whether Jaspr Health could be safely and effectively used outside the context of a researcher-facilitated clinical trial, and (2) that Jaspr’s use would be associated with improved patient agitation and distress. Methods: Under the auspices of a nonsignificant risk device study, ED patients with acute suicidal ideation (N=962) from 2 health care systems representing 10 EDs received access to Jaspr Health as part of their routine suicide care. Primary outcome measures included how many eligible patients were assigned Jaspr Health, which modules were assigned and completed, and finally, the number of adverse events reported by patients or by medical staff. Secondary outcome measures were patient agitation, distress, and satisfaction. Results: The most frequent modules assigned were Comfort and Skills (98% of users; n=942) and lethal means assessment (90% of patient users; n=870). Patient task completion rates for all modules ranged from 51% to 79%. No adverse events were reported, suggesting that digital technologies can be safely used for people seeking ED-based psychiatric services. Statistically significant (P<.001) reductions in agitation and distress were reported after using the app. Average patient satisfaction ratings by site were 7.81 (SD 2.22) and 7.10 (SD 2.65), with 88.8% (n=325) and 84% (n=90) of patients recommending the app to others. Conclusions: Digital technologies such as Jaspr Health may be safely and effectively integrated into existing workflows to help deliver evidence-based suicide care in EDs. These findings hold promise for the use of digital technologies in delivering evidence-based care to other vulnerable populations in complex environments. %M 39283664 %R 10.2196/52293 %U https://formative.jmir.org/2024/1/e52293 %U https://doi.org/10.2196/52293 %U http://www.ncbi.nlm.nih.gov/pubmed/39283664 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e62765 %T Rethinking the Social Determination of Food in Chile Through Practices and Interactions of Actors in Food Environments: Nonexperimental, Cross-Sectional Study %A Gálvez Espinoza,Patricia %A Rodríguez Osiac,Lorena %A Franch Maggiolo,Carolina %A Egaña Rojas,Daniel %+ Department of Primary Care and Family Health, Universidad de Chile, Avenida José Miguel Carrera 3100, San Miguel, Santiago, 8320000, Chile, 56 997579767, degana@uchile.cl %K mixed methods %K research design %K food environments %K food intake %K obesity %D 2024 %7 13.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Food environments are crucial for promoting healthy and sustainable eating and preventing obesity. However, existing food environment frameworks assume an already installed causality and do not explain how associations in food environments are established or articulated, especially from an integrative and transdisciplinary approach. This research attempts to bridge these gaps through the use of Actor-Network Theory, which traces the relationship network between human (and nonhuman) actors in order to describe how these interact and what agencies (direct or remote) are involved. Objective: This study aims to explain the practices and interactions of actors in food environments in order to approach the problem of unhealthy eating with a transdisciplinary approach. Methods: This is a nonexperimental, cross-sectional study. Due to the complexity of the study phenomena, a mixed methods approach with 4 consecutive phases will be developed in Chile. Phase 1 involves a systematic literature review of food environment evidence since 2015, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol; phase 2 involves the application of a shortened version of the Nutrition Environment Measure Scale—Perceptions adapted to Chile (NEMS-P-Ch) in 2 neighborhoods with different socioeconomic levels; in phase 3, six focus groups in each neighborhood will be conducted to address social determinants such as gender, employment status, and migration; and in phase 4, participant observation and in-depth interviews will be used to analyze the direct and empirical exploration of the actors in their daily interaction with food environments. The triangulation and complementarity of the data will allow us to create a practical model about the practices and interactions of actors in their food environments, which reflects the complexity and transdisciplinary nature of the study. Results: We have advanced in phases 1-3 of the study. In phase 1, a total of 109 manuscripts are being revised for data extraction. In phase 2, we applied the NEMS-P-Ch to 785 people, 49.4% (388/785) of whom belong to a low socioeconomic neighborhood. Participants from phase 2 are being contacted to participate in the focus groups (phase 3). By the end of July, we have conducted 6 focus groups with 5-11 participants. Conclusions: This study will provide a comprehensive understanding of how individuals interact with their food environments, offering deep insights into the factors influencing their food-related decisions. In addition, the study aims to develop a model that more accurately reflects reality by examining not only the food environments themselves but also the interactions among various stakeholders within these environments and their daily practices. The findings of this study will offer evidence-based insights to inform public policies tailored to the specific territories and communities under investigation or those with similar characteristics. International Registered Report Identifier (IRRID): DERR1-10.2196/62765 %M 39270213 %R 10.2196/62765 %U https://www.researchprotocols.org/2024/1/e62765 %U https://doi.org/10.2196/62765 %U http://www.ncbi.nlm.nih.gov/pubmed/39270213 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57343 %T Community Health Workers as Mental Health Paraprofessionals: Protocol for a Mixed-Methods Pilot Feasibility Study %A Moyce,Sally %A Crawford,Cassidy %+ College of Health and Human Development, Montana State University, PO Box 173560, Bozeman, MT, 59717, United States, 1 970 846 8424, cassacrawford8@gmail.com %K behavioral activation %K community health workers %K implementation science %K Latino %K mental health provider shortage area %K pilot study %K evidence-based treatments %D 2024 %7 12.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Community health workers (CHWs) are effective in delivering behavioral activation (BA), especially in low-resource settings. In an area with a lack of Spanish-speaking mental health counselors, such as southwest Montana, CHWs can provide needed care. Objective: The goal of this pilot study protocol is to test the feasibility, acceptability, and preliminary efficacy of a model of care that engages CHWs as providers of BA. Methods: We will train 2 CHWs in BA methodology. We will enroll 20 participants who screen positive for depression in a 12-week telephone intervention for BA. Preliminary efficacy will be tested in pre- and postscores of the Beck Depression Inventory and semistructured interviews. Feasibility and acceptability will be measured through participant retention and treatment adherence. The Therapeutic Alliance with Clinician Scale will be used to measure the strength of the therapeutic relationship. Descriptive statistics will measure alliances and repeated measures ANOVA will measure trends and changes in depression scores. Results: Enrollment began in October 2023. A total of 12 participants completed at least 10 BA sessions and all study measures by the time the study concluded in May 2024. In August 2024, data analysis occurred with an anticipated manuscript to be submitted for publication in October 2024. Conclusions: Results from this study will inform future studies into the implementation of an evidence-based mental health intervention in a limited resource setting for Latino people with limited English proficiency. International Registered Report Identifier (IRRID): DERR1-10.2196/57343 %M 39264699 %R 10.2196/57343 %U https://www.researchprotocols.org/2024/1/e57343 %U https://doi.org/10.2196/57343 %U http://www.ncbi.nlm.nih.gov/pubmed/39264699 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e45826 %T Co-Designing Digital Health Intervention for Monitoring Medication and Consultation Among Transgender People in Underserved Communities: Collaborative Approach %A Oluokun,Emmanuel Oluwatosin %A Adedoyin,Festus Fatai %A Dogan,Huseyin %A Jiang,Nan %+ Department of Computing and Informatics, Faculty of Science and Technology, Bournemouth University, Fern Barrow, Poole, Dorset, BH12 5BB, United Kingdom, 44 01202524111, eoluokun@bournemouth.ac.uk %K digital health %K HIV/AIDS medication %K data-driven health care %K ART %K transgender %K LGTBQI+ %K interactive management %D 2024 %7 12.9.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In many parts of the world, men who have sex with men and transgender individuals face criminalization and discrimination. As a result, they are less likely to seek medical help, despite experiencing higher rates of HIV/AIDS, mental health issues, and other health problems. Reaching key populations (KPs) with essential testing, care, and treatment services can be challenging, as they often have a higher likelihood of contracting and spreading the virus. They have limited access to antiretroviral (ARV) therapy (ART) services, which means that KPs may continue to serve as reservoirs for new HIV infections if they do not receive effective HIV programming. This ongoing issue complicates efforts to control the epidemic. Therefore, modeling a digital health system to track ARV medication access and use is crucial. This paper advocates for the use of digital interventions to manage the health of KPs in underserved regions, using Nigeria as a case study. Objective: This study aims to assess digital health interventions for monitoring medication and consultations among transgender people in underserved communities. It also sought to determine whether a system exists that could support ART adherence in Nigeria. Additionally, the study evaluated design strategies to address privacy and confidentiality concerns, aiming to reduce nonadherence to ARV medications among KPs in Nigeria. Methods: A qualitative approach was adopted for this research, involving a thematic analysis of information collected from interviews with clinicians and other health practitioners who work directly with these communities, as well as from an interactive (virtual) workshop. Results: The findings from the thematic analysis indicate a need to increase attendance at ART therapy sessions through the implementation of an intensive care web app. Unlike previous solutions, this study highlights the importance of incorporating a reminder feature that integrates with an in-app telemedicine consultancy platform. This platform would facilitate discussions about client challenges, such as adverse drug effects, counseling sessions with clinical psychologists, and the impact of identity discrimination on mental health. Other data-driven health needs identified in the study are unique drug request nodes, client-led viral load calculators, remote requests, and drug delivery features within the web app. Participants also emphasized the importance of monitoring medication compliance and incorporating user feedback mechanisms, such as ratings and encouragement symbols (eg, stars, checkmarks), to motivate adherence. Conclusions: The study concludes that technology-driven solutions could enhance ART adherence and reduce HIV transmission among transgender people. It also recommends that local governments and international organizations collaborate and invest in health management services that prioritize health needs over identity. %M 39264700 %R 10.2196/45826 %U https://humanfactors.jmir.org/2024/1/e45826 %U https://doi.org/10.2196/45826 %U http://www.ncbi.nlm.nih.gov/pubmed/39264700 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58939 %T Research Into Digital Health Intervention for Mental Health: 25-Year Retrospective on the Ethical and Legal Challenges %A Hall,Charlotte L %A Gómez Bergin,Aislinn D %A Rennick-Egglestone,Stefan %+ School of Health Sciences, Institute of Mental Health, University of Nottingham, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 11582 ext 30926, stefan.egglestone@nottingham.ac.uk %K digital mental health intervention %K research ethics %K compliance %K regulation %K digital health %K mobile health %K mhealth %K intervention %K interventions %K mental health %K retrospective %K ethical %K legal %K challenge %K challenges %D 2024 %7 9.9.2024 %9 Viewpoint %J J Med Internet Res %G English %X Digital mental health interventions are routinely integrated into mental health services internationally and can contribute to reducing the global mental health treatment gap identified by the World Health Organization. Research teams designing and delivering evaluations frequently invest substantial effort in deliberating on ethical and legal challenges around digital mental health interventions. In this article, we reflect on our own research experience with digital mental health intervention design and evaluation to identify 8 of the most critical challenges that we or others have faced, and that have ethical or legal consequences. These include: (1) harm caused by online recruitment work; (2) monitoring of intervention safety; (3) exclusion of specific demographic or clinical groups; (4) inadequate robustness of effectiveness and cost-effectiveness findings; (5) adequately conceptualizing and supporting engagement and adherence; (6) structural barriers to implementation; (7) data protection and intellectual property; and (8) regulatory ambiguity relating to digital mental health interventions that are medical devices. As we describe these challenges, we have highlighted serious consequences that can or have occurred, such as substantial delays to studies if regulations around Software as a Medical Device (SaMD) are not fully understood, or if regulations change substantially during the study lifecycle. Collectively, the challenges we have identified highlight a substantial body of required knowledge and expertise, either within the team or through access to external experts. Ensuring access to knowledge requires careful planning and adequate financial resources (for example, paying public contributors to engage in debate on critical ethical issues or paying for legal opinions on regulatory issues). Access to such resources can be planned for on a per-study basis and enabled through funding proposals. However, organizations regularly engaged in the development and evaluation of digital mental health interventions should consider creating or supporting structures such as advisory groups that can retain necessary competencies, such as in medical device regulation. %M 39250796 %R 10.2196/58939 %U https://www.jmir.org/2024/1/e58939 %U https://doi.org/10.2196/58939 %U http://www.ncbi.nlm.nih.gov/pubmed/39250796 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55092 %T Piloting the Inclusion of the Key Populations Unique Identifier Code in the South African Routine Health Information Management System: Protocol for a Multiphased Study %A Rampilo,Mashudu %A Phalane,Edith %A Phaswana-Mafuya,Refilwe Nancy %+ South African Medical Research Council/University of Johannesburg (SAMRC/UJ) Pan African Centre for Epidemics Research (PACER) Extramural Unit, PO Box 524, Auckland Park, Johannesburg, 2006, South Africa, 27 115594196, refilwep@uj.ac.za %K key populations %K unique identifier code %K biometric %K biometrics %K alphanumeric code %K routine health management information system %K health management %K management %K protocol %K mixed methods study %K South Africa %K human immunodeficiency %K immunodeficiency %K HIV %K AIDS %K transgender %K epidemiology %K data extraction %K HIV transmission %D 2024 %7 6.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The global community has set an ambitious goal to end HIV/AIDS as a public health threat by 2030. Significant progress has been achieved in pursuing these objectives; however, concerns remain regarding the lack of disaggregated routine data for key populations (KPs) for a targeted HIV response. KPs include female sex workers, transgender populations, gay men and other men who have sex with men, people who are incarcerated, and people who use drugs. From an epidemiological perspective, KPs play a fundamental role in shaping the dynamics of HIV transmission due to specific behaviors. In South Africa, routine health information management systems (RHIMS) do not include a unique identifier code (UIC) for KPs. The purpose of this protocol is to develop the framework for improved HIV monitoring and programming through piloting the inclusion of KPs UIC in the South African RHIMS. Objective: This paper aims to describe the protocol for a multiphased study to pilot the inclusion of KPs UIC in RHIMS. Methods: We will conduct a multiphased study to pilot the framework for the inclusion of KPs UIC in the RHIMS. The study has attained the University of Johannesburg Research Ethics Committee approval (REC-2518-2023). This study has four objectives, including a systematic review, according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (objective 1). Second, policy document review and in-depth stakeholder interviews using semistructured questionnaires (objective 2). Third, exploratory data analysis of deidentified HIV data sets (objective 3), and finally, piloting the framework to assess the feasibility of incorporating KPs UIC in RHIMS using findings from objectives 1, 2, and 3 (objective 4). Qualitative and quantitative data will be analyzed using ATLAS.ti (version 6; ATLAS.ti Scientific Software Development GmbH) and Python (version 3.8; Python Software Foundation) programming language, respectively. Results: The results will encompass a systematic review of literature, qualitative interviews, and document reviews, along with exploratory analysis of deidentified routine program data and findings from the pilot study. The systematic review has been registered in PROSPERO (International Prospective Register of Systematic Reviews; CRD42023440656). Data collection is planned to commence in September 2024 and expected results for all objectives will be published by December 2025. Conclusions: The study will produce a framework to be recommended for the inclusion of the KP UIC national rollout. The study results will contribute to the knowledge base around the inclusion of KPs UIC in RHIMS data. Trial Registration: PROSPERO CRD42023440656; https://tinyurl.com/msnppany International Registered Report Identifier (IRRID): PRR1-10.2196/55092 %M 39240683 %R 10.2196/55092 %U https://www.researchprotocols.org/2024/1/e55092 %U https://doi.org/10.2196/55092 %U http://www.ncbi.nlm.nih.gov/pubmed/39240683 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55354 %T Using Text Messaging Surveys in General Practice Research to Engage With People From Low-Income Groups: Multi-Methods Study %A Sturgiss,Elizabeth %A Advocat,Jenny %A Barton,Christopher %A Walker,Emma N %A Nielsen,Suzanne %A Wright,Annemarie %A Lam,Tina %A Gunatillaka,Nilakshi %A Oad,Symrin %A Wood,Christopher %+ School of Primary and Allied Health Care, Monash University, Peninsula Campus, Moorooduc Highway, Frankston, 3199, Australia, 61 412233119, liz.sturgiss@monash.edu %K SMS %K data collection %K research methods %K disadvantaged population %K priority populations %K message %K messages %K messaging %K disadvantaged %K underserved %K survey %K surveys %K digital divide %K marginalized %K access %K accessibility %K barrier %K barriers %K smartphone %K smartphones %K digital health %K underrepresented %K data collection %K mobile phone %K short message service %D 2024 %7 5.9.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: SMS text messages through mobile phones are a common means of interpersonal communication. SMS text message surveys are gaining traction in health care and research due to their feasibility and patient acceptability. However, challenges arise in implementing SMS text message surveys, especially when targeting marginalized populations, because of barriers to accessing phones and data as well as communication difficulties. In primary care, traditional surveys (paper-based and online) often face low response rates that are particularly pronounced among disadvantaged groups due to financial limitations, language barriers, and time constraints. Objective: This study aimed to investigate the potential of SMS text message–based patient recruitment and surveys within general practices situated in lower socioeconomic areas. This study was nested within the Reducing Alcohol-Harm in General Practice project that aimed to reduce alcohol-related harm through screening in Australian general practice. Methods: This study follows a 2-step SMS text message data collection process. An initial SMS text message with an online survey link was sent to patients, followed by subsequent surveys every 3 months for consenting participants. Interviews were conducted with the local primary health network organization staff, the participating practice staff, and the clinicians. The qualitative data were analyzed using constructs from the Consolidated Framework for Implementation Research. Results: Out of 6 general practices, 4 were able to send SMS text messages to their patients. The initial SMS text message was sent to 8333 patients and 702 responses (8.2%) were received, most of which were not from a low-income group. This low initial response was in contrast to the improved response rate to the ongoing 3-month SMS text message surveys (55/107, 51.4% at 3 months; 29/67, 43.3% at 6 months; and 44/102, 43.1% at 9 months). We interviewed 4 general practitioners, 4 nurses, and 4 administrative staff from 5 of the different practices. Qualitative data uncovered barriers to engaging marginalized groups including limited smartphone access, limited financial capacity (telephone, internet, and Wi-Fi credit), language barriers, literacy issues, mental health conditions, and physical limitations such as manual dexterity and vision issues. Practice managers and clinicians suggested strategies to overcome these barriers, including using paper-based surveys in trusted spaces, offering assistance during survey completion, and offering honoraria to support participation. Conclusions: While SMS text message surveys for primary care research may be useful for the broader population, additional efforts are required to ensure the representation and involvement of marginalized groups. More intensive methods such as in-person data collection may be more appropriate to capture the voice of low-income groups in primary care research. International Registered Report Identifier (IRRID): RR2-10.3399/BJGPO.2021.0037 %M 39235843 %R 10.2196/55354 %U https://mhealth.jmir.org/2024/1/e55354 %U https://doi.org/10.2196/55354 %U http://www.ncbi.nlm.nih.gov/pubmed/39235843 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e60021 %T Investigation of Mother-to-Child Transmission of Hepatitis B in Yinchuan, China: Cross-Sectional Survey Study %A Gu,Jie %A Xu,Yiyuan %A Yuan,Jiao %A Chen,Yuxiang %A Luo,Jingxia %A Guo,Cui %A Zhang,Guanbin %+ Department of Laboratory Medicine, Fujian Medical University, 1 Xuefu North Road, University Town, Minhou County, Fuzhou, 350122, China, 86 13811332083, gbzhang@capitalbio.com %K hepatitis B virus %K mother-to-child transmission %K antiviral therapy %K immunization failure %K cord blood %D 2024 %7 4.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Hepatitis B poses a significant global public health challenge, with mother-to-child transmission (MTCT) being the primary method of hepatitis B virus (HBV) transmission. The prevalence of HBV infection in China is the highest in Asia, and it carries the greatest burden globally. Objective: This study aims to critically evaluate the existing local strategies for preventing MTCT and the proposed potential enhancements by analyzing the prevalence of hepatitis B among pregnant women and their neonates in Yinchuan. Methods: From January 2017 to December 2021, 37,557 prenatal screening records were collected. Among them, 947 pregnant women who tested positive for hepatitis B surface antigen (HBsAg) near delivery and their 960 neonates were included in an HBV-exposed group, while 29 pregnant women who tested negative and their 30 neonates were included in an HBV-nonexposed group. HBV markers in maternal peripheral blood and neonatal cord blood were analyzed using the least absolute shrinkage and selection operator (LASSO) regression, logistic regression, chi-square test, t-test, and U-test. Additionally, to further evaluate the diagnostic value of HBsAg positivity in cord blood, we conducted an additional follow-up study on 103 infants who tested positive for HBsAg in their cord blood. Results: The prevalence of HBV among pregnant women was 2.5% (947/37,557), with a declining trend every year (χ²4=19.7; P=.001). From 2018 to 2020, only 33.0% (35/106) of eligible pregnant women received antiviral medication treatment. Using LASSO regression to screen risk factors correlated with HBsAg positivity in cord blood (when log [λ] reached a minimum value of –5.02), 5 variables with nonzero coefficients were selected, including maternal hepatitis B e-antigen (HBeAg) status, maternal hepatitis B core antibody (HBcAb) status, maternal HBV DNA load, delivery method, and neonatal birth weight. Through univariate and multivariate logistic regression, delivery by cesarean section (adjusted odds ratio [aOR] 0.52, 95% CI 0.31-0.87), maternal HBeAg positivity (aOR 2.05, 95% CI 1.27-3.33), low maternal viral load (aOR 2.69, 95% CI 1.33-5.46), and high maternal viral load (aOR 2.69, 95% CI 1.32-5.51) were found to be strongly associated with cord blood HBsAg positivity. In the additional follow-up study, 61 infants successfully completed the follow-up, and only 2 were found to be infected with HBV. The mothers of both these infants had detectable HBV DNA levels and should have received standard antiviral therapy. The results of the hepatitis B surface antibody (HBsAb) positivity rate and titer test indicated a gradual decline in the immunity of vaccinated infants as the interval after vaccination increased. Conclusions: The clinical relevance of HBV marker detection in cord blood is restricted within the current prevention measures for MTCT. There is an emphasis on the significance of public education regarding hepatitis B and the reinforcement of postnatal follow-up for the prevention of MTCT. %M 39230944 %R 10.2196/60021 %U https://publichealth.jmir.org/2024/1/e60021 %U https://doi.org/10.2196/60021 %U http://www.ncbi.nlm.nih.gov/pubmed/39230944 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51054 %T Self-Reported COVID-19 Vaccine and Booster Acceptance and Hesitancy Among Autistic Adults in Pennsylvania: Cross-Sectional Analysis of Survey Data %A Shea,Lindsay %A Cooper,Dylan %A Ventimiglia,Jonas %A Frisbie,Shelby %A Carlton,Conner %A Song,Wei %A Salzer,Mark %A Lee,Brian %A Hotez,Emily %A Vanness,David J %+ AJ Drexel Autism Institute, Drexel University, Suite 560, 3020 Market St, Philadelphia, PA, 19104, United States, 1 5708502948, ljl42@drexel.edu %K autism %K COVID-19 %K vaccination %K public health %K autism spectrum disorder %K autistic %K vaccine %K vaccines %K acceptance %K hesitancy %K immunize %K immunization %K immunizations %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %K neurodevelopmental %K infectious %K respiratory %K survey %K surveys %D 2024 %7 28.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The autistic population is rapidly increasing; meanwhile, autistic adults face disproportionate risks for adverse COVID-19 outcomes. Limited research indicates that autistic individuals have been accepting of initial vaccination, but research has yet to document this population’s perceptions and acceptance of COVID-19 boosters. Objective: This study aims to identify person-level and community characteristics associated with COVID-19 vaccination and booster acceptance among autistic adults, along with self-reported reasons for their stated preferences. Understanding this information is crucial in supporting this vulnerable population given evolving booster guidelines and the ending of the public health emergency for the COVID-19 pandemic. Methods: Data are from a survey conducted in Pennsylvania from April 11 to September 12, 2022. Demographic characteristics, COVID-19 experiences, and COVID-19 vaccine decisions were compared across vaccination status groups. Chi-square analyses and 1-way ANOVA were conducted to test for significant differences. Vaccination reasons were ranked by frequency; co-occurrence was identified using phi coefficient correlation plots. Results: Most autistic adults (193/266, 72.6%) intended to receive or received the vaccine and booster, 15% (40/266) did not receive or intend to receive any vaccine, and 12.4% (33/266) received or intended to receive the initial dose but were hesitant to accept booster doses. Reasons for vaccine acceptance or hesitancy varied by demographic factors and COVID-19 experiences. The most significant were previously contracting COVID-19, desire to access information about COVID-19, and discomfort with others not wearing a mask (all P=.001). County-level factors, including population density (P=.02) and percentage of the county that voted for President Biden (P=.001) were also significantly associated with differing vaccination acceptance levels. Reasons for accepting the initial COVID-19 vaccine differed among those who were or were not hesitant to accept a booster. Those who accepted a booster were more likely to endorse protecting others and trusting the vaccine as the basis for their acceptance, whereas those who were hesitant about the booster indicated that their initial vaccine acceptance came from encouragement from someone they trusted. Among the minority of those hesitant to any vaccination, believing that the vaccine was unsafe and would make them feel unwell were the most often reported reasons. Conclusions: Intention to receive or receiving the COVID-19 vaccination and booster was higher among autistic adults than the population that received vaccines in Pennsylvania. Autistic individuals who accepted vaccines prioritized protecting others, while autistic individuals who were vaccine hesitant had safety concerns about vaccines. These findings inform public health opportunities and strategies to further increase vaccination and booster rates among generally accepting autistic adults, to better support the already strained autism services and support system landscape. Vaccination uptake could be improved by leveraging passive information diffusion to combat vaccination misinformation among those not actively seeking COVID-19 information to better alleviate safety concerns. %M 39196609 %R 10.2196/51054 %U https://publichealth.jmir.org/2024/1/e51054 %U https://doi.org/10.2196/51054 %U http://www.ncbi.nlm.nih.gov/pubmed/39196609 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59918 %T Implementation and Impact of Intimate Partner Violence Screening Expansion in the Veterans Health Administration: Protocol for a Mixed Methods Evaluation %A Portnoy,Galina A %A Relyea,Mark R %A Dichter,Melissa E %A Iverson,Katherine M %A Presseau,Candice %A Brandt,Cynthia A %A Skanderson,Melissa %A Bruce,LeAnn E %A Martino,Steve %+ VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, United States, 1 2039325711, galina.portnoy@va.gov %K screening %K intimate partner violence %K implementation %K evaluation %K national rollout %K health care %K quality improvement %K veterans %D 2024 %7 28.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Intimate partner violence (IPV) is a significant public health problem with far-reaching consequences. The health care system plays an integral role in the detection of and response to IPV. Historically, the majority of IPV screening initiatives have targeted women of reproductive age, with little known about men’s IPV screening experiences or the impact of screening on men’s health care. The Veterans Health Administration (VHA) has called for an expansion of IPV screening, providing a unique opportunity for a large-scale evaluation of IPV screening and response across all patient populations. Objective: In this protocol paper, we describe the recently funded Partnered Evaluation of Relationship Health Innovations and Services through Mixed Methods (PRISM) initiative, aiming to evaluate the implementation and impact of the VHA’s IPV screening and response expansion, with a particular focus on identifying potential gender differences. Methods: The PRISM Initiative is guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) and Consolidated Framework for Implementation Research (CFIR 2.0) frameworks. We will use mixed methods data from 139 VHA facilities to evaluate the IPV screening expansion, including electronic health record data and qualitative interviews with patients, clinicians, and national IPV program leadership. Quantitative data will be analyzed using a longitudinal observational design with repeated measurement periods at baseline (T0), year 1 (T1), and year 2 (T2). Qualitative interviews will focus on identifying multilevel factors, including potential implementation barriers and facilitators critical to IPV screening and response expansion, and examining the impact of screening on patients and clinicians. Results: The PRISM initiative was funded in October 2023. We have developed the qualitative interview guides, obtained institutional review board approval, extracted quantitative data for baseline analyses, and began recruitment for qualitative interviews. Reports of progress and results will be made available to evaluation partners and funders through quarterly and end-of-year reports. All data collection and analyses across time points are expected to be completed in June 2026. Conclusions: Findings from this mixed methods evaluation will provide a comprehensive understanding of IPV screening expansion at the VHA, including the implementation and impact of screening and the scope of IPV detected in the VHA patient population. Moreover, data generated by this initiative have critical policy and clinical practice implications in a national health care system. International Registered Report Identifier (IRRID): PRR1-10.2196/59918 %M 39194059 %R 10.2196/59918 %U https://www.researchprotocols.org/2024/1/e59918 %U https://doi.org/10.2196/59918 %U http://www.ncbi.nlm.nih.gov/pubmed/39194059 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57353 %T Patterns of the Health and Economic Burden of 33 Rare Diseases in China: Nationwide Web-Based Study %A Yu,Jiazhou %A Chen,Shanquan %A Zhang,Huanyu %A Zhang,Shuyang %A Dong,Dong %+ Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, 4/F, School of Public Health Building, Prince of Wales Hospital, Sha Tin, 0000, China (Hong Kong), 852 2252 8461, dongdong@cuhk.edu.hk %K rare disease %K burden %K quality of life %K economic %K pattern %K China %D 2024 %7 27.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Rare diseases (RDs) affect millions of individuals collectively worldwide, contributing to significant burdens on patients and families in various aspects. However, there is a lack of evidence on the underlying patterns of burdens among diverse RDs for informing targeted social and health policies to address the unmet needs of this vulnerable population. Objective: This study aimed to examine the underlying patterns of the health and economic burden of 33 different RDs in China and identify the potential determinants. Methods: A nationwide internet-based cross-sectional survey was conducted in China between 2019 and 2020. Physical and mental health burden was measured by health-related quality of life. Economic burden was evaluated based on the proportions of direct medical, direct nonmedical, and indirect costs relative to household income. We used cluster analysis to identify patterns of health and economic burdens and conducted multinomial logistic regression to explore potential predictors of cluster membership. Results: The study included 8454 adults and 8491 children affected by 33 RDs. The following 3 clusters were identified: “extremely high burden” (representing 92/8454, 1.1% and 19/8491, 0.2% of adult and pediatric patients, respectively), “overall high burden” (5933/8454, 70.2% and 4864/8491, 57.3%, respectively), and “overall low burden” (2429/8454, 28.7% and 3608/8491, 42.5%, respectively). Wilson disease, Marfan syndrome, and Langerhans cell histiocytosis more likely resulted in an “extremely high burden” than others. Poverty was significantly associated with being in this extremely high burden group. Diseases causing neuromuscular symptoms and requiring long-term treatment (eg, amyotrophic lateral sclerosis, spinocerebellar ataxia, and Dravet syndrome) were prevalent in the “overall high burden” group. Key predictors of this group included older age, lower socioeconomic status, diagnostic delay, and comorbidity. Conclusions: This study provides novel and valuable evidence on the burden of RDs in developing regions like China. The findings reveal significant disparities in the impact of RDs, emphasizing the need for targeted health care interventions and policies. %M 39190906 %R 10.2196/57353 %U https://publichealth.jmir.org/2024/1/e57353 %U https://doi.org/10.2196/57353 %U http://www.ncbi.nlm.nih.gov/pubmed/39190906 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59846 %T Enhanced Cohort Methods for HIV Research and Epidemiology (ENCORE): Protocol for a Nationwide Hybrid Cohort for Transgender Women in the United States %A Wirtz,Andrea L %A Poteat,Tonia %A Borquez,Annick %A Linton,Sabriya %A Stevenson,Megan %A Case,James %A Brown,Carter %A Lint,Arianna %A Miller,Marissa %A Radix,Asa %A Althoff,Keri N %A Schneider,Jason S %A Haw,J Sonya %A Wawrzyniak,Andrew J %A Rodriguez,Allan %A Cooney,Erin %A Humes,Elizabeth %A Pontes,Ceza %A Seopaul,Shannon %A White,Camille %A Beyrer,Chris %A Reisner,Sari L %A , %+ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, United States, 1 410 502 0800, awirtz1@jhu.edu %K transgender women %K cohort %K United States %K HIV %K digital methods %D 2024 %7 27.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In the United States, transgender women are disproportionately impacted by HIV and prioritized in the national strategy to end the epidemic. Individual, interpersonal, and structural vulnerabilities underlie HIV acquisition among transgender women and fuel syndemic conditions, yet no nationwide cohort monitors their HIV and other health outcomes. Objective: Our objective is to develop a nationwide cohort to estimate HIV incidence, identify risk factors, and investigate syndemic conditions co-occurring with HIV vulnerability or acquisition among US transgender women. The study is informed by the Syndemics Framework and the Social Ecological Model, positing that stigma-related conditions are synergistically driven by shared multilevel vulnerabilities. Methods: To address logistical and cost challenges while minimizing technology barriers and research distrust, we aim to establish a novel, hybrid community hub–supported digital cohort (N=3000). The digital cohort is the backbone of the study and is enhanced by hubs strategically located across the United States for increased engagement and in-person support. Study participants are English or Spanish speakers, are aged ≥18 years, identify as transgender women or along the transfeminine spectrum, reside in 1 of the 50 states or Puerto Rico, and do not have HIV (laboratory confirmed). Participants are followed for 24 months, with semiannual assessments. These include a questionnaire and laboratory-based HIV testing using self-collected specimens. Using residential zip codes, person-level data will be merged with contextual geolocated data, including population health measures and economic, housing, and other social and structural factors. Analyses will (1) evaluate the contribution of hub support to the digital cohort using descriptive statistics; (2) estimate and characterize syndemic patterns among transgender women using latent class analysis; (3) examine the role of contextual factors in driving syndemics and HIV prevention over time using multilevel regression models; (4) estimate HIV incidence in transgender women and examine the effect of syndemics and contextual factors on HIV incidence using Poisson regression models; and (5) develop dynamic, compartmental models of multilevel combination HIV prevention interventions among transgender women to simulate their impact on HIV incidence through 2030. Results: Enrollment launched on March 15, 2023, with data collection phases occurring in spring and fall. As of February 24, 2024, a total of 3084 individuals were screened, and 996 (32.3%) met the inclusion criteria and enrolled into the cohort: 2.3% (23/996) enrolled at a hub, and 53.6% (534/996) enrolled through a community hub–supported strategy. Recruitment through purely digital methods contributed 61.5% (1895/3084) of those screened and 42.7% (425/996) of those enrolled in the cohort. Conclusions: Study findings will inform the development of evidence-based interventions to reduce HIV acquisition and syndemic conditions among US transgender women and advance efforts to end the US HIV epidemic. Methodological findings will also have critical implications for the design of future innovative approaches to HIV research. International Registered Report Identifier (IRRID): DERR1-10.2196/59846 %M 39190916 %R 10.2196/59846 %U https://www.researchprotocols.org/2024/1/e59846 %U https://doi.org/10.2196/59846 %U http://www.ncbi.nlm.nih.gov/pubmed/39190916 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54034 %T Acceptance of Social Media Recruitment for Clinical Studies Among Patients With Hepatitis B: Mixed Methods Study %A Willem,Theresa %A Zimmermann,Bettina M %A Matthes,Nina %A Rost,Michael %A Buyx,Alena %+ Institute of History and Ethics in Medicine, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, Munich, 81675, Germany, 49 89 4140 4041, bettina.zimmermann@tum.de %K Facebook %K Twitter %K social media %K clinical trial %K enrollment %K health technology acceptance %K ethics %K infectious diseases %K privacy %K data protection %K stigma %K discrimination %D 2024 %7 26.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media platforms are increasingly used to recruit patients for clinical studies. Yet, patients’ attitudes regarding social media recruitment are underexplored. Objective: This mixed methods study aims to assess predictors of the acceptance of social media recruitment among patients with hepatitis B, a patient population that is considered particularly vulnerable in this context. Methods: Using a mixed methods approach, the hypotheses for our survey were developed based on a qualitative interview study with 6 patients with hepatitis B and 30 multidisciplinary experts. Thematic analysis was applied to qualitative interview analysis. For the cross-sectional survey, we additionally recruited 195 patients with hepatitis B from 3 clinical centers in Germany. Adult patients capable of judgment with a hepatitis B diagnosis who understood German and visited 1 of the 3 study centers during the data collection period were eligible to participate. Data analysis was conducted using SPSS (version 28; IBM Corp), including descriptive statistics and regression analysis. Results: On the basis of the qualitative interview analysis, we hypothesized that 6 factors were associated with acceptance of social media recruitment: using social media in the context of hepatitis B (hypothesis 1), digital literacy (hypothesis 2), interest in clinical studies (hypothesis 3), trust in nonmedical (hypothesis 4a) and medical (hypothesis 4b) information sources, perceiving the hepatitis B diagnosis as a secret (hypothesis 5a), attitudes toward data privacy in the social media context (hypothesis 5b), and perceived stigma (hypothesis 6). Regression analysis revealed that the higher the social media use for hepatitis B (hypothesis 1), the higher the interest in clinical studies (hypothesis 3), the more trust in nonmedical information sources (hypothesis 4a), and the less secrecy around a hepatitis B diagnosis (hypothesis 5a), the higher the acceptance of social media as a recruitment tool for clinical hepatitis B studies. Conclusions: This mixed methods study provides the first quantitative insights into social media acceptance for clinical study recruitment among patients with hepatitis B. The study was limited to patients with hepatitis B in Germany but sets out to be a reference point for future studies assessing the attitudes toward and acceptance of social media recruitment for clinical studies. Such empirical inquiries can facilitate the work of researchers designing clinical studies as well as ethics review boards in balancing the risks and benefits of social media recruitment in a context-specific manner. %M 39186322 %R 10.2196/54034 %U https://www.jmir.org/2024/1/e54034 %U https://doi.org/10.2196/54034 %U http://www.ncbi.nlm.nih.gov/pubmed/39186322 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56197 %T Exploring New Models for Implementing Sustainable Integrated Health Access for People in Vulnerable Positions: Protocol for a Mixed Methods Multiple Case Study %A Mejsner,Sofie Buch %A Aslaug,Jane %A Bech,Mickael %A Burau,Viola %A Mark,Dorte %A Vixø,Kathrine %A Westergaard,Caroline Louise %A Fehsenfeld,Michael %+ Department of Public Health, Aarhus University, Bartholins alle 2, Aarhus, 8000, Denmark, 45 8715 0000, sbm@ph.au.dk %K health care organization %K social inequality in health %K vulnerable people %K integrated health access %K healthcare access %K accessibility %K healthcare %K Europe %K social inequalities %K health inequalities %K mental illness %K inequality %K Denmark %D 2024 %7 23.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health care is a strongly universal right across European welfare states; however, social inequalities in health persist. This literature argues that health care organization is an important but overlooked determinant of social inequalities in health, as health systems buffer or amplify structural and individual health determinants. The Client-Centered Coordination Platform (3CP) model offers integrated health access to people with severe mental illness, through core groups of professionals from across health and social services. Objective: This study focuses on vulnerable people with severe mental health problems and aims to analyze how the model can give people with severe mental illness more integrated access to health and social care. This can form a stepping-stone for the upscaling of the 3CP model. Methods: We conduct a 5-year multiple case study of 3 municipalities in Denmark, where 3CP is being implemented. In a 1-year pilot study, we expect to gather quantitative registry data from the municipalities and the Central Denmark Region to explore the characteristics of people included in 3CP. We will also collect qualitative data, including 21 hours of observations; 36 interviews with users, professionals, and managers; and 3 focus groups across the 3 municipalities. In a subsequent, 4-year qualitative study, we aim to conduct 120 hours of observations, 120 interviews, and 24 focus groups. In parallel with the qualitative study, we will facilitate a cocreation process to develop tools for sustaining integrated health access. Results: As of January 2024, we have completed the individual interviews with users of 3CP and professionals and the focus groups. Individual interviews of managers will be conducted during the 1st quarter of 2024. The quantitative data are being collected. Conclusions: Inequality is one of the greatest challenges that European societies face. Understanding new and innovative approaches to integrated care may provide valuable solutions to the challenges posed. Especially understanding and designing health and social care systems that meet the needs and abilities of those users requiring them most, is vitally important to tackle inequality. International Registered Report Identifier (IRRID): DERR1-10.2196/56197 %M 39178409 %R 10.2196/56197 %U https://www.researchprotocols.org/2024/1/e56197 %U https://doi.org/10.2196/56197 %U http://www.ncbi.nlm.nih.gov/pubmed/39178409 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48289 %T Further Exploring the Public Health Implications of the Network Scale-Up Method: Cross-Sectional Survey Study %A Jing,Liwei %A Yu,Hongmei %A Lu,Qing %K network scale-up method %K public health implications %K people who inject drugs %K popularity ratio %K information transmission rate %K PWID %D 2024 %7 23.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: The decline in the number of new HIV infections among adults has slowed down, gradually becoming the biggest obstacle to achieving the 2030 target of ending the HIV/AIDS epidemic. Thus, a political declaration to ensure that 90% of people at high risk of HIV infection can access comprehensive prevention services was proposed by the United Nations General Assembly. Therefore, obtaining an accurate estimated size of high-risk populations is required as a prior condition to plan and implement HIV prevention services. The network scale-up method (NSUM) was recommended by the United Nations Programme on HIV/AIDS and the World Health Organization to estimate the sizes of populations at high risk of HIV infection; however, we found that the NSUM also revealed underlying population characteristics of female sex workers in addition to being used to estimate the population size. Such information on underlying population characteristics is very useful in improving the planning and implementation of HIV prevention services. This is especially relevant for people who inject drugs, where in addition to stigma and discrimination, criminalization further hinders access to HIV prevention services. Objective: We aimed to conduct a further exploration of the public health implications of the NSUM by using it to estimate the population size, popularity ratio, and information transmission rate among people who inject drugs. Methods: A stratified 2-stage cluster survey of the general population and a respondent-driven sampling survey of people who inject drugs were conducted in the urban district of Taiyuan, China, in 2021. Results: The estimated size of the population of people who inject drugs in Taiyuan was 1241.9 (95% CI 1009.2‐1474.9), corresponding to 4.4×10−2% (95% CI 3.6×10−2% to 5.2×10−2%) of the adult population aged 15‐64 years. The estimated popularity ratio of people who inject drugs was 53.6% (95% CI 47.2%‐60.1%), and the estimated information transmission rate was 87.9% (95% CI 86.5%‐89.3%). Conclusions: In addition to being used to estimate the size of the population of people who inject drugs, the NSUM revealed that they have smaller-sized personal social networks while concealing their drug use, and these underlying population characteristics are extremely useful for planning appropriate service delivery approaches with the fewest barriers for people who inject drugs to access HIV prevention services. Therefore, more cost-effectiveness brings new public health implications for the NSUM, which makes it even more promising for its application. %R 10.2196/48289 %U https://publichealth.jmir.org/2024/1/e48289 %U https://doi.org/10.2196/48289 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e38189 %T Recruitment in Appalachian, Rural and Older Adult Populations in an Artificial Intelligence World: Study Using Human-Mediated Follow-Up %A Milliken,Tabitha %A Beiler,Donielle %A Hoffman,Samantha %A Olenginski,Ashlee %A Troiani,Vanessa %+ Research Institute, Geisinger, 100 N. Academy Ave, Danville, PA, 17821, United States, 1 215 681 1733, vtroiani@geisinger.edu %K telecommunication %K enrollment rate %K Northern Appalachia %K web-based %K aging %K recruitment %K rural %D 2024 %7 22.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Participant recruitment in rural and hard-to-reach (HTR) populations can present unique challenges. These challenges are further exacerbated by the need for low-cost recruiting, which often leads to use of web-based recruitment methods (eg, email, social media). Despite these challenges, recruitment strategy statistics that support effective enrollment strategies for underserved and HTR populations are underreported. This study highlights how a recruitment strategy that uses email in combination with follow-up, mostly phone calls and email reminders, produced a higher-than-expected enrollment rate that includes a diversity of participants from rural, Appalachian populations in older age brackets and reports recruitment and demographic statistics within a subset of HTR populations. Objective: This study aims to provide evidence that a recruitment strategy that uses a combination of email, telephonic, and follow-up recruitment strategies increases recruitment rates in various HTR populations, specifically in rural, older, and Appalachian populations. Methods: We evaluated the overall enrollment rate of 1 recruitment arm of a larger study that aims to understand the relationship between genetics and substance use disorders. We evaluated the enrolled population’s characteristics to determine recruitment success of a combined email and follow-up recruitment strategy, and the enrollment rate of HTR populations. These characteristics included (1) enrollment rate before versus after follow-up; (2) zip code and county of enrollee to determine rural or urban and Appalachian status; (3) age to verify recruitment in all eligible age brackets; and (4) sex distribution among age brackets and rural or urban status. Results: The email and follow-up arm of the study had a 17.4% enrollment rate. Of the enrolled participants, 76.3% (4602/6030) lived in rural counties and 23.7% (1428/6030) lived in urban counties in Pennsylvania. In addition, of patients enrolled, 98.7% (5956/6030) were from Appalachian counties and 1.3% (76/6030) were from non-Appalachian counties. Patients from rural Appalachia made up 76.2% (4603/6030) of the total rural population. Enrolled patients represented all eligible age brackets from ages 20 to 75 years, with the 60-70 years age bracket having the most enrollees. Females made up 72.5% (4371/6030) of the enrolled population and males made up 27.5% (1659/6030) of the population. Conclusions: Results indicate that a web-based recruitment method with participant follow-up, such as a phone call and email follow-up, increases enrollment numbers more than web-based methods alone for rural, Appalachian, and older populations. Adding a humanizing component, such as a live person phone call, may be a key element needed to establish trust and encourage patients from underserved and rural areas to enroll in studies via web-based recruitment methods. Supporting statistics on this recruitment strategy should help researchers identify whether this strategy may be useful in future studies and HTR populations. %M 39173153 %R 10.2196/38189 %U https://formative.jmir.org/2024/1/e38189 %U https://doi.org/10.2196/38189 %U http://www.ncbi.nlm.nih.gov/pubmed/39173153 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57351 %T Perceptions of HIV-Related Comorbidities and Usability of a Virtual Environment for Cardiovascular Disease Prevention Education in Sexual Minority Men With HIV: Formative Phases of a Pilot Randomized Controlled Trial %A Ramos,S Raquel %A Reynolds,Harmony %A Johnson,Constance %A Melkus,Gail %A Kershaw,Trace %A Thayer,Julian F %A Vorderstrasse,Allison %+ School of Nursing, Yale University, 400 West Campus Drive, Orange, CT, 06477, United States, 1 2037372339, raquel.ramos@yale.edu %K virtual environment %K digital health %K gamification %K eHealth %K sexual minorities %K cardiovascular disease %K HIV %K cardiometabolic risk %K mental health %K lesbian, gay, bisexual, transgender, and queer %K LGBTQ health %K HIV care %K prevention %K virtual %K minority %K men %K Latin %K Black %K men who have sex with men %K intervention %K high blood pressure %K myocardial infarction %K preventive health screenings %K gay %K bisexual %K patients %K cancer %D 2024 %7 22.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexual minority men with HIV are at an increased risk of cardiovascular disease (CVD) and have been underrepresented in behavioral research and clinical trials. Objective: This study aims to explore perceptions of HIV-related comorbidities and assess the interest in and usability of a virtual environment for CVD prevention education in Black and Latinx sexual minority men with HIV. Methods: This is a 3-phase pilot behavioral randomized controlled trial. We report on formative phases 1 and 2 that informed virtual environment content and features using qualitative interviews, usability testing, and beta testing with a total of 25 individuals. In phase 1, a total of 15 participants completed interviews exploring HIV-related illnesses of concern that would be used to tailor the virtual environment. In phase 2, usability testing and beta testing were conducted with 10 participants to assess interest, features, and content. Results: In phase 1, we found that CVD risk factors included high blood pressure, myocardial infarction, stroke, and diabetes. Cancer (prostate, colon, and others) was a common concern, as were mental health conditions. In phase 2, all participants completed the 12-item usability checklist with favorable feedback within 30 to 60 minutes. Beta-testing interviews suggested (1) mixed perceptions of health and HIV, (2) high risk for comorbid conditions, (3) virtual environment features were promising, and (4) the need for diverse avatar representations. Conclusions: We identified several comorbid conditions of concern, and findings carry significant implications for mitigating barriers to preventive health screenings, given the shared risk factors between HIV and related comorbidities. Highly rated aspects of the virtual environment were anonymity; meeting others with HIV who identify as gay or bisexual; validating lesbian, gay, bisexual, transgender, queer, and others (LGBTQ+) images and content; and accessibility to CVD prevention education. Critical end-user feedback from beta testing suggested more options for avatar customization in skin, hair, and body representation. Our next phase will test the virtual environment as a new approach to advancing cardiovascular health equity in ethnic and racial sexual minority men with HIV. Trial Registration: ClinicalTrials.gov NCT04061915; https://clinicaltrials.gov/study/NCT05242952 International Registered Report Identifier (IRRID): RR2-10.2196/38348 %M 38924481 %R 10.2196/57351 %U https://www.jmir.org/2024/1/e57351 %U https://doi.org/10.2196/57351 %U http://www.ncbi.nlm.nih.gov/pubmed/38924481 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54383 %T Social Vulnerability and Compliance With World Health Organization Advice on Protective Behaviors Against COVID-19 in African and Asia Pacific Countries: Factor Analysis to Develop a Social Vulnerability Index %A Pongutta,Suladda %A Tangcharoensathien,Viroj %A Leung,Kathy %A Larson,Heidi J %A Lin,Leesa %+ International Health Policy Program, Ministry of Public Health, Muang, , Nonthaburi, , Thailand, 66 25902376, suladda@ihpp.thaigov.net %K social vulnerability Index %K COVID-19 %K protective behavior %K Africa %K Western Pacific %K social vulnerability %K African countries %K Western countries %K predict %K predicts %K prediction %K propensity %K baseline data %K Factor analysis %K polychoric %K varimax rotation %K protective %K behaviour %K behaviours %K preventive %K precautionary %K linear regression %K predictability %K Omicron %K sociodemographic %K media use %K communication %K health risk perception %K socioeconomic %D 2024 %7 13.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 protective behaviors are key interventions advised by the World Health Organization (WHO) to prevent COVID-19 transmission. However, achieving compliance with this advice is often challenging, particularly among socially vulnerable groups. Objective: We developed a social vulnerability index (SVI) to predict individuals’ propensity to adhere to the WHO advice on protective behaviors against COVID-19 and identify changes in social vulnerability as Omicron evolved in African countries between January 2022 and August 2022 and Asia Pacific countries between August 2021 and June 2022. Methods: In African countries, baseline data were collected from 14 countries (n=15,375) during the first Omicron wave, and follow-up data were collected from 7 countries (n=7179) after the wave. In Asia Pacific countries, baseline data were collected from 14 countries (n=12,866) before the first Omicron wave, and follow-up data were collected from 9 countries (n=8737) after the wave. Countries’ socioeconomic and health profiles were retrieved from relevant databases. To construct the SVI for each of the 4 data sets, variables associated with COVID-19 protective behaviors were included in a factor analysis using polychoric correlation with varimax rotation. Influential factors were adjusted for cardinality, summed, and min-max normalized from 0 to 1 (most to least vulnerable). Scores for compliance with the WHO advice were calculated using individuals’ self-reported protective behaviors against COVID-19. Multiple linear regression analyses were used to assess the associations between the SVI and scores for compliance to WHO advice to validate the index. Results: In Africa, factors contributing to social vulnerability included literacy and media use, trust in health care workers and government, and country income and infrastructure. In Asia Pacific, social vulnerability was determined by literacy, country income and infrastructure, and population density. The index was associated with compliance with the WHO advice in both time points in African countries but only during the follow-up period in Asia Pacific countries. At baseline, the index values in African countries ranged from 0.00 to 0.31 in 13 countries, with 1 country having an index value of 1.00. The index values in Asia Pacific countries ranged from 0.00 to 0.23 in 12 countries, with 2 countries having index values of 0.79 and 1.00. During the follow-up phase, the index values decreased in 6 of 7 African countries and the 2 most vulnerable Asia Pacific countries. The index values of the least vulnerable countries remained unchanged in both regions. Conclusions: In both regions, significant inequalities in social vulnerability to compliance with WHO advice were observed at baseline, and the gaps became larger after the first Omicron wave. Understanding the dimensions that influence social vulnerability to protective behaviors against COVID-19 may underpin targeted interventions to enhance compliance with WHO recommendations and mitigate the impact of future pandemics among vulnerable groups. %M 39137034 %R 10.2196/54383 %U https://publichealth.jmir.org/2024/1/e54383 %U https://doi.org/10.2196/54383 %U http://www.ncbi.nlm.nih.gov/pubmed/39137034 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59975 %T Ameliorating Racial Disparities in HIV Prevention via a Nurse-Led, AI-Enhanced Program for Pre-Exposure Prophylaxis Utilization Among Black Cisgender Women: Protocol for a Mixed Methods Study %A Zhang,Chen %A Wharton,Mitchell %A Liu,Yu %+ School of Nursing, University of Rochester, 255 Crittenden Boulevard, Hellen Wood Hall, Room 2w-218, Rochester, NY, 14622, United States, 1 5852766495, chen_zhang@urmc.rochester.edu %K artificial intelligence %K PrEP care %K PrEP %K pre-exposure prophylaxis %K nurse-led %K AI %K HIV prevention %K HIV %K prevention %K AIDS %K nurse %K Black cisgender women %K Black %K cisgender %K women %K HIV pre-exposure prophylaxis %K prophylaxis %K biomedical %K effectiveness %K medical mistrust %K Black women %K nurse practitioners %K chatbot %K socioeconomic %K HumanX technology %K health care interventions %D 2024 %7 13.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: HIV pre-exposure prophylaxis (PrEP) is a critical biomedical strategy to prevent HIV transmission among cisgender women. Despite its proven effectiveness, Black cisgender women remain significantly underrepresented throughout the PrEP care continuum, facing barriers such as limited access to care, medical mistrust, and intersectional racial or HIV stigma. Addressing these disparities is vital to improving HIV prevention outcomes within this community. On the other hand, nurse practitioners (NPs) play a pivotal role in PrEP utilization but are underrepresented due to a lack of awareness, a lack of human resources, and insufficient support. Equipped with the rapid evolution of artificial intelligence (AI) and advanced large language models, chatbots effectively facilitate health care communication and linkage to care in various domains, including HIV prevention and PrEP care. Objective: Our study harnesses NPs’ holistic care capabilities and the power of AI through natural language processing algorithms, providing targeted, patient-centered facilitation for PrEP care. Our overarching goal is to create a nurse-led, stakeholder-inclusive, and AI-powered program to facilitate PrEP utilization among Black cisgender women, ultimately enhancing HIV prevention efforts in this vulnerable group in 3 phases. This project aims to mitigate health disparities and advance innovative, technology-based solutions. Methods: The study uses a mixed methods design involving semistructured interviews with key stakeholders, including 50 PrEP-eligible Black women, 10 NPs, and a community advisory board representing various socioeconomic backgrounds. The AI-powered chatbot is developed using HumanX technology and SmartBot360’s Health Insurance Portability and Accountability Act–compliant framework to ensure data privacy and security. The study spans 18 months and consists of 3 phases: exploration, development, and evaluation. Results: As of May 2024, the institutional review board protocol for phase 1 has been approved. We plan to start recruitment for Black cisgender women and NPs in September 2024, with the aim to collect information to understand their preferences regarding chatbot development. While institutional review board approval for phases 2 and 3 is still in progress, we have made significant strides in networking for participant recruitment. We plan to conduct data collection soon, and further updates on the recruitment and data collection progress will be provided as the study advances. Conclusions: The AI-powered chatbot offers a novel approach to improving PrEP care utilization among Black cisgender women, with opportunities to reduce barriers to care and facilitate a stigma-free environment. However, challenges remain regarding health equity and the digital divide, emphasizing the need for culturally competent design and robust data privacy protocols. The implications of this study extend beyond PrEP care, presenting a scalable model that can address broader health disparities. International Registered Report Identifier (IRRID): PRR1-10.2196/59975 %M 39137028 %R 10.2196/59975 %U https://www.researchprotocols.org/2024/1/e59975 %U https://doi.org/10.2196/59975 %U http://www.ncbi.nlm.nih.gov/pubmed/39137028 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52884 %T Creating a Culturally Safe Online Data Collection Instrument to Measure Vaccine Confidence Among Indigenous Youth: Indigenous Consensus Method %A Maar,Marion %A Bourdon,Caleigh %A Berti,Joahnna %A Bisaillon,Emma %A Boesch,Lisa %A Boston,Alicia %A Chapdelaine,Justin %A Humphrey,Alison %A Kumar,Sandeep %A Maar-Jackson,Benjamin %A Martell,Robert %A Naokwegijig,Bruce %A Preet Kaur,Davinder %A Rice,Sarah %A Rickaby,Barbara %A Sutherland,Mariette %A Reade,Maurianne %+ Human Sciences Division, Northern Ontario School of Medicine (NOSM) University, 935 Ramsey Lake Rd, Sudbury, ON, P3E 2C6, Canada, 1 705 662 7233, mmaar@nosm.ca %K ATKC consensus method %K community-based participatory research %K COVID-19 vaccines %K cultural competency %K electronic survey development %K Indigenous Peoples %K vaccine confidence %K vaccine hesitancy %K youth %D 2024 %7 12.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background:  Participating in surveys can shape the perception of participants related to the study topic. Administering a vaccine hesitancy questionnaire can have negative impacts on participants’ vaccine confidence. This is particularly true for online and cross-cultural data collection because culturally safe health education to correct misinformation is typically not provided after the administration of an electronic survey. Objective:  To create a culturally safe, online, COVID-19 vaccine confidence survey for Indigenous youth designed to collect authentic, culturally relevant data of their vaccine experiences, with a low risk of contributing to further vaccine confusion among participants. Methods:  Using the Aboriginal Telehealth Knowledge Circle consensus method, a team of academics, health care providers, policy makers, and community partners reviewed COVID-19 vaccine hesitancy surveys used in public health research, analyzed potential risks, and created a framework for electronic Indigenous vaccine confidence surveys as well as survey items. Results:  The framework for safer online survey items is based on 2 principles, a first do-no-harm approach and applying a strengths-based lens. Relevant survey domains identified in the process include sociodemographic information, participants’ connection to their community, preferred sources for health information, vaccination uptake among family members and peers, as well as personal attitudes toward vaccines. A total of 44 survey items were developed, including 5 open-ended items to improve the authenticity of the data and the analysis of the experiences of Indigenous youth. Conclusions:  Using an Indigenous consensus method, we have developed an online COVID-19 vaccine confidence survey with culturally relevant domains and reduced the risk of amplifying misinformation and negative impacts on vaccine confidence among Indigenous participants. Our approach can be adapted to other online survey development in collaboration with Indigenous communities. %M 39133917 %R 10.2196/52884 %U https://formative.jmir.org/2024/1/e52884 %U https://doi.org/10.2196/52884 %U http://www.ncbi.nlm.nih.gov/pubmed/39133917 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47100 %T Comparing Federal Communications Commission and Microsoft Estimates of Broadband Access for Mental Health Video Telemedicine Among Veterans: Retrospective Cohort Study %A O'Shea,Amy MJ %A Mulligan,Kailey %A Carter,Knute D %A Haraldsson,Bjarni %A Wray,Charlie M %A Shahnazi,Ariana %A Kaboli,Peter J %+ Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, 601 US Hwy 6, Iowa City, IA, 52246, United States, 1 3193380581, amy.oshea@va.gov %K broadband %K telemedicine %K Federal Communications Commission %K veterans %K United States Department of Veterans Affairs %K internet %K mental health care %K veteran health %K broadband access %K web-based %K digital %D 2024 %7 8.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic highlighted the importance of telemedicine in health care. However, video telemedicine requires adequate broadband internet speeds. As video-based telemedicine grows, variations in broadband access must be accurately measured and characterized. Objective: This study aims to compare the Federal Communications Commission (FCC) and Microsoft US broadband use data sources to measure county-level broadband access among veterans receiving mental health care from the Veterans Health Administration (VHA). Methods: Retrospective observational cohort study using administrative data to identify mental health visits from January 1, 2019, to December 31, 2020, among 1161 VHA mental health clinics. The exposure is county-level broadband percentages calculated as the percentage of the county population with access to adequate broadband speeds (ie, download >25 megabits per second) as measured by the FCC and Microsoft. All veterans receiving VHA mental health services during the study period were included and categorized based on their use of video mental health visits. Broadband access was compared between and within data sources, stratified by video versus no video telemedicine use. Results: Over the 2-year study period, 1,474,024 veterans with VHA mental health visits were identified. Average broadband percentages varied by source (FCC mean 91.3%, SD 12.5% vs Microsoft mean 48.2%, SD 18.1%; P<.001). Within each data source, broadband percentages generally increased from 2019 to 2020. Adjusted regression analyses estimated the change after pandemic onset versus before the pandemic in quarterly county-based mental health visit counts at prespecified broadband percentages. Using FCC model estimates, given all other covariates are constant and assuming an FCC percentage set at 70%, the incidence rate ratio (IRR) of county-level quarterly mental video visits during the COVID-19 pandemic was 6.81 times (95% CI 6.49-7.13) the rate before the pandemic. In comparison, the model using Microsoft data exhibited a stronger association (IRR 7.28; 95% CI 6.78-7.81). This relationship held across all broadband access levels assessed. Conclusions: This study found FCC broadband data estimated higher and less variable county-level broadband percentages compared to those estimated using Microsoft data. Regardless of the data source, veterans without mental health video visits lived in counties with lower broadband access, highlighting the need for accurate broadband speeds to prioritize infrastructure and intervention development based on the greatest community-level impacts. Future work should link broadband access to differences in clinical outcomes. %M 39116440 %R 10.2196/47100 %U https://www.jmir.org/2024/1/e47100 %U https://doi.org/10.2196/47100 %U http://www.ncbi.nlm.nih.gov/pubmed/39116440 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e48516 %T Measuring Relationship Influences on Romantic Couples’ Cancer-Related Behaviors During the COVID-19 Pandemic: Protocol for a Longitudinal Online Study of Dyads and Cancer Survivors %A Bowers,Jennifer M %A Huelsnitz,Chloe O %A Dwyer,Laura A %A Gibson,Laurel P %A Agurs-Collins,Tanya %A Ferrer,Rebecca A %A Acevedo,Amanda M %+ Behavioral Research Program, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD, 20850, United States, 1 2402765478, amanda.acevedo@nih.gov %K cancer prevention %K COVID-19 %K risk perceptions %K dyads %K romantic relationships %K cancer %K oncology %K survivor %K survivors %K dyad %K spouse %K spousal %K partner %K health behavior %K health behaviors %K cohabiting %K cohabit %K study design %K recruit %K recruitment %K methodology %K methods %K enrol %K enrolment %K enroll %K enrollment %D 2024 %7 31.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Research has established the effects of romantic relationships on individuals’ morbidity and mortality. However, the interplay between relationship functioning, affective processes, and health behaviors has been relatively understudied. During the COVID-19 pandemic, relational processes may influence novel health behaviors such as social distancing and masking. Objective: We describe the design, recruitment, and methods of the relationships, risk perceptions, and cancer-related behaviors during the COVID-19 pandemic study. This study was developed to understand how relational and affective processes influence romantic partners’ engagement in cancer prevention behaviors as well as health behaviors introduced or exacerbated by the COVID-19 pandemic. Methods: The relationships, risk perceptions, and cancer-related behaviors during the COVID-19 pandemic study used online survey methods to recruit and enroll 2 cohorts of individuals involved in cohabiting romantic relationships, including 1 cohort of dyads (n=223) and 1 cohort of cancer survivors (n=443). Survey assessments were completed over 2 time points that were 5.57 (SD 3.14) weeks apart on average. Health behaviors assessed included COVID-19 vaccination and social distancing, physical activity, diet, sleep, alcohol use, and smoking behavior. We also examined relationship factors, psychological distress, and household chaos. Results: Data collection occurred between October 2021 and August 2022. During that time, a total of 926 participants were enrolled, of which about two-thirds were from the United Kingdom (n=622, 67.8%) and one-third were from the United States (n=296, 32.2%); about two-thirds were married (n=608, 66.2%) and one-third were members of unmarried couples (n=294, 32%). In cohorts 1 and 2, the mean age was about 34 and 50, respectively. Out of 478 participants in cohort 1, 19 (4%) identified as Hispanic or Latino/a, 79 (17%) as non-Hispanic Asian, 40 (9%) as non-Hispanic Black or African American, and 306 (64%) as non-Hispanic White; 62 (13%) participants identified their sexual orientation as bisexual or pansexual, 359 (75.1%) as heterosexual or straight, and 53 (11%) as gay or lesbian. In cohort 2, out of 440 participants, 13 (3%) identified as Hispanic or Latino/a, 8 (2%) as non-Hispanic Asian, 5 (1%) as non-Hispanic Black or African American, and 398 (90.5%) as non-Hispanic White; 41 (9%) participants identified their sexual orientation as bisexual or pansexual, 384 (87.3%) as heterosexual or straight, and 13 (3%) as gay or lesbian. The overall enrollment rate for individuals was 66.14% and the overall completion rate was 80.08%. Conclusions: We discuss best practices for collecting online survey data for studies examining relationships and health, challenges related to the COVID-19 pandemic, recruitment of underrepresented populations, and enrollment of dyads. Recommendations include conducting pilot studies, allowing for extra time in the data collection timeline for marginalized or underserved populations, surplus screening to account for expected attrition within dyads, as well as planning dyad-specific data quality checks. International Registered Report Identifier (IRRID): DERR1-10.2196/48516 %M 39083795 %R 10.2196/48516 %U https://www.researchprotocols.org/2024/1/e48516 %U https://doi.org/10.2196/48516 %U http://www.ncbi.nlm.nih.gov/pubmed/39083795 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e44906 %T Intramural Health Care Through Video Consultations and the Need for Referrals and Hospital Admissions: Retrospective Quantitative Subanalysis of an Evaluation Study %A Schmalstieg-Bahr,Katharina %A Colombo,Miriam Giovanna %A Koch,Roland %A Szecsenyi,Joachim %A Völker,Friedrich %A Blozik,Eva Elisabeth %A Scherer,Martin %+ Department of General Practice and Primary Care, University Medical Center Eppendorf, Martinistrasse 52, Bldg. W37, 5th Fl, Hamburg, 20246, Germany, 49 40 7410 52400, k.schmalstieg-bahr@uke.de %K intramural health care %K prison %K telemedicine %K primary care %K family medicine %K referral %K hospital admission %K admission rate %K intramural %K penal %K video consult %K e-consult %K remote care %K virtual care %K health care delivery %K service delivery %K health care system %D 2024 %7 28.6.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: In comparison to the general population, prison inmates are at a higher risk for drug abuse and psychiatric, as well as infectious, diseases. Although intramural health care has to be equivalent to extramural services, prison inmates have less access to primary and secondary care. Furthermore, not every prison is constantly staffed with a physician. Since transportation to the nearest extramural medical facility is often resource-intensive, video consultations may offer cost-effective health care for prison inmates. Objective: This study aims to quantify the need for referrals to secondary care services and hospital admissions when video consultations with family physicians and psychiatrists are offered in prison. Methods: In 5 German prisons, a mixed methods evaluation study was conducted to assess feasibility, acceptance, and reasons for conducting video consultations with family physicians and psychiatrists. This analysis uses quantitative data from these consultations (June 2018 to February 2019) in addition to data from a sixth prison added in January 2019 focusing on referral and admission rates, as well as reasons for encounters. Results: At the initiation of the project, 2499 prisoners were detained in the 6 prisons. A total of 435 video consultations were conducted by 12 physicians (3 female and 7 male family physicians, and 2 male psychiatrists during the study period). The majority were scheduled consultations (341/435, 78%). In 68% (n=294) of all encounters, the patient was asked to consult a physician again if symptoms persisted or got worse. In 26% (n=115), a follow-up appointment with either the video consultant or prison physician was scheduled. A referral to other specialties, most often psychiatry, was necessary in 4% (n=17) of the cases. Only in 2% (n=8) of the consultations, a hospital admission was needed. Usually, hospital admissions were the result of unscheduled consultations, and the videoconferencing system was the method of communication in 88% (n=7) of these cases, while 12% (n=1) were carried out over the phone. Reasons for admissions were severe abdominal pain, hypotension, unstable angina or suspected myocardial infarction, or a suspected schizophrenic episode. Conclusions: Most scheduled and unscheduled consultations did not require subsequent patient transport to external health care providers. Using telemedicine services allowed a prompt patient-physician encounter with the possibility to refer patients to other specialties or to admit them to a hospital if necessary. %M 38941595 %R 10.2196/44906 %U https://www.i-jmr.org/2024/1/e44906 %U https://doi.org/10.2196/44906 %U http://www.ncbi.nlm.nih.gov/pubmed/38941595 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e44827 %T An Accessible Web-Based Survey to Monitor the Mental Health of People With Mild Intellectual Disability or Low Literacy Skills During the COVID-19 Pandemic: Comparative Data Analysis %A Koks-Leensen,Monique CJ %A Menko,Anouk %A Raaijmakers,Fieke %A Fransen-Kuppens,Gerdine AJ %A Bevelander,Kirsten E %+ Department of Primary and Community Care, Radboud university medical center, Geert Grooteplein 21, Nijmegen, 6525 EZ, Netherlands, 31 243618181, monique.koks-leensen@radboudumc.nl %K monitoring %K mental health %K intellectual disabilities %K low literacy %K COVID-19 %K web-based survey %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic and related control measures affected the mental health of all populations. Particular subgroups are underrepresented in mainstream surveys because they are hard to reach, and study measurements are not adapted to their skills. These subgroups include people with lower cognitive and literacy skills, such as people with mild intellectual disability (MID), who were considered vulnerable during the COVID-19 pandemic given their low socioeconomic status, small social networks, increased risks of health problems, and difficulties understanding health-related information. Objective: This study examines the impact of the COVID-19 pandemic on mental health among people with MID or low literacy skills compared with those predominantly represented in national surveys. Methods: A repeated cross-sectional study of people with MID or low literacy skills and a general population sample was conducted in the Netherlands. An easy-read web-based survey was co-designed with, and tested among, people with MID or low literacy skills and conducted in 3 rounds within 1 year of the COVID-19 pandemic (T1: November to December 2020, T2: March to April 2021, and T3: September to October 2021). The survey contained questions about demographics and 6 aspects of mental health: feeling happy, feeling energized, feeling stressed, worry, feeling lonely, and sleeping problems. Results: Our adapted survey and recruitment procedure enabled 1059 persons with MID or low literacy skills to participate (T1: n=412, 38.9%; T2: n=351, 33.1%; and T3: n=296, 28%). They were significantly younger, had a lower level of education, and more often than not were born outside the Netherlands compared to the general population sample (P<.001). Approximately half of them (604/1059, 57.03%) received professional care. They displayed poorer mental health scores than the general population sample. The percentages of people with MID or low literacy skills who reported more negative feelings in T1 ranged from 20.6% (85/412) reporting feeling lonely often or almost always to 57.8% (238/412) reporting feeling happy almost never or sometimes. The general population sample’s percentages were 5.4% (160/2930) and 32.2% (941/2918), respectively. Although scores improved over time in both populations, the disproportional effects remained. Conclusions: General COVID-19–related restrictions for the entire Dutch population affected people with MID or low literacy skills more negatively than the general population. Our study underscores the relevance of including these subpopulations in public health research because they are often overlooked in regular health data. An accessible web-based survey particularly targeted at this population enabled us to do so, and we reached a group of respondents significantly different from regular survey participants. This survey’s results provided insights into the health of people with MID or low literacy skills and gained knowledge to be used by care organizations and policy makers to reduce health disparities during a pandemic and in general. %M 38607229 %R 10.2196/44827 %U https://publichealth.jmir.org/2024/1/e44827 %U https://doi.org/10.2196/44827 %U http://www.ncbi.nlm.nih.gov/pubmed/38607229 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47017 %T The Challenges in Using eHealth Decision Resources for Surrogate Decision-Making in the Intensive Care Unit %A Sun,Wan-Na %A Kao,Chi-Yin %+ Department of Nursing, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 701, Taiwan, 886 6 2353535 ext 5843, chiyinkao@mail.ncku.edu.tw %K decision-making %K eHealth %K intensive care unit %K literacy %K surrogate %K mobile phone %D 2024 %7 1.4.2024 %9 Viewpoint %J J Med Internet Res %G English %X The mortality rate in intensive care units (ICUs) is notably high, with patients often relying on surrogates for critical medical decisions due to their compromised state. This paper provides a comprehensive overview of eHealth. The challenges of applying eHealth tools, including economic disparities and information inaccuracies are addressed. This study then introduces eHealth literacy and the assessment tools to evaluate users’ capability and literacy levels in using eHealth resources. A clinical scenario involving surrogate decision-making is presented. This simulated case involves a patient with a hemorrhagic stroke who has lost consciousness and requires medical procedures such as tracheostomy. However, due to the medical surrogate’s lack of familiarity with eHealth devices and limited literacy in using eHealth resources, difficulties arise in assisting the patient in making medical decisions. This scenario highlights challenges related to eHealth literacy and solution strategies are proposed. In conclusion, effective ICU decision-making with eHealth tools requires a careful balance between efficiency with inclusivity. Tailoring communication strategies and providing diverse materials are essential for effective eHealth decision resources in the ICU setting. Health professionals should adopt a patient-centered approach to enhance the decision-making experience, particularly for individuals with limited eHealth literacy. %M 38557504 %R 10.2196/47017 %U https://www.jmir.org/2024/1/e47017 %U https://doi.org/10.2196/47017 %U http://www.ncbi.nlm.nih.gov/pubmed/38557504 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46971 %T The Political Economy of Digital Health Equity: Structural Analysis %A Shaw,James %A Glover,Wiljeana %+ Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G1V7, Canada, 1 4169780315, jay.shaw@wchospital.ca %K digital health equity %K health equity %K health policy %K telemedicine %K digital care %K political economy %K race %K ethnicity %K socioeconomic %K policy %D 2024 %7 26.3.2024 %9 Viewpoint %J J Med Internet Res %G English %X Digital technologies have produced many innovations in care delivery and enabled continuity of care for many people when in-person care was impossible. However, a growing body of research suggests that digital health can also exacerbate health inequities for those excluded from its benefits for reasons of cost, digital literacy, and structural discrimination related to characteristics such as age, race, ethnicity, and socioeconomic status. In this paper, we draw on a political economy perspective to examine structural barriers to progress in advancing digital health equity at the policy level. Considering the incentive structures and investments of powerful actors in the field, we outline how characteristics of neoliberal capitalism in Western contexts produce and sustain digital health inequities by describing 6 structural challenges to the effort to promote health equity through digital health, as follows: (1) the revenue-first incentives of technology corporations, (2) the influence of venture capital, (3) inequitable access to the internet and digital devices, (4) underinvestment in digital health literacy, (5) uncertainty about future reimbursement of digital health, and (6) justified mistrust of digital health. Building on these important challenges, we propose future immediate and long-term directions for work to support meaningful change for digital health equity. %M 38530341 %R 10.2196/46971 %U https://www.jmir.org/2024/1/e46971 %U https://doi.org/10.2196/46971 %U http://www.ncbi.nlm.nih.gov/pubmed/38530341 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e41670 %T Extended Reality—New Opportunity for People With Disability? Practical and Ethical Considerations %A Stendal,Karen %A Bernabe,Rosemarie D L C %+ Department of Business, Marketing and Law, University of South-Eastern Norway, Bredalsveien 14, Honefoss, 3502, Norway, 47 31009477, karen.stendal@usn.no %K extended reality %K virtual worlds %K virtual reality %K disability %K practical %K ethical %K technology %K virtual %K reality %K development %K research %K challenges %D 2024 %7 13.2.2024 %9 Viewpoint %J J Med Internet Res %G English %X Since the introduction of virtual environments in the 70s, technologies have moved through virtual reality, mixed reality, and augmented reality into extended reality (XR). This development is promising for various groups. Previous research has shown people with disability benefiting from using technology in social and professional settings. Technology has offered people with disability the opportunity to communicate, interact, participate, and build new relationships. However, we do not know what impact XR has or will have and whether it will offer new opportunities for people with disability. This paper aims to indicate potential opportunities and challenges afforded by XR to people with disability. We offer reflections on the opportunities as well as the ethical considerations needed when introducing immersive technologies to a marginalized group. %M 38349731 %R 10.2196/41670 %U https://www.jmir.org/2024/1/e41670 %U https://doi.org/10.2196/41670 %U http://www.ncbi.nlm.nih.gov/pubmed/38349731 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e49881 %T Social Media, Public Health Research, and Vulnerability: Considerations to Advance Ethical Guidelines and Strengthen Future Research %A Massey,Philip M %A Murray,Regan M %A Chiang,Shawn C %A Russell,Alex M %A Yudell,Michael A %+ Department of Community Health Sciences, Fielding School of Public Health, UCLA, Box 951772, Suite 16-035 CHS, 650 Charles E. Young Dr. South, Los Angeles, CA, 90095, United States, 1 310 825 5308, pmassey@ucla.edu %K research ethics %K social media %K vulnerable populations %K public health %K ethical guidelines %K algorithms %K manipulation %D 2023 %7 29.12.2023 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The purpose of this article is to build upon prior work in social media research and ethics by highlighting an important and as yet underdeveloped research consideration: how should we consider vulnerability when conducting public health research in the social media environment? The use of social media in public health, both platforms and their data, has advanced the field dramatically over the past 2 decades. Applied public health research in the social media space has led to more robust surveillance tools and analytic strategies, more targeted recruitment activities, and more tailored health education. Ethical guidelines when using social media for public health research must also expand alongside these increasing capabilities and uses. Privacy, consent, and confidentiality have been hallmarks for ethical frameworks both in public health and social media research. To date, public health ethics scholarship has focused largely on practical guidelines and considerations for writing and reviewing social media research protocols. Such ethical guidelines have included collecting public data, reporting anonymized or aggregate results, and obtaining informed consent virtually. Our pursuit of the question related to vulnerability and public health research in the social media environment extends this foundational work in ethical guidelines and seeks to advance research in this field and to provide a solid ethical footing on which future research can thrive. %M 38157235 %R 10.2196/49881 %U https://publichealth.jmir.org/2023/1/e49881 %U https://doi.org/10.2196/49881 %U http://www.ncbi.nlm.nih.gov/pubmed/38157235 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e48150 %T Association Between Socioeconomic Status and Adherence to Fecal Occult Blood Tests in Colorectal Cancer Screening Programs: Systematic Review and Meta-Analysis of Observational Studies %A Luo,Zilin %A Dong,Xuesi %A Wang,Chenran %A Cao,Wei %A Zheng,Yadi %A Wu,Zheng %A Xu,Yongjie %A Zhao,Liang %A Wang,Fei %A Li,Jibin %A Ren,Jiansong %A Shi,Jufang %A Chen,Wanqing %A Li,Ni %+ Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China, 86 18201116334, nli@cicams.ac.cn %K adherence %K colorectal cancer %K fecal occult blood test %K screening %K socioeconomic status %D 2023 %7 31.10.2023 %9 Review %J JMIR Public Health Surveill %G English %X Background: Screening adherence is important in reducing colorectal cancer (CRC) incidence and mortality. Disparity in CRC screening adherence was observed in populations of different socioeconomic status (SES), but the direction and strength of the association remained unclear. Objective: We aimed to systematically review all the observational studies that have analyzed the association between SES and adherence to organized CRC screening based on fecal occult blood tests. Methods: We systematically reviewed the studies in PubMed, Embase, and Web of Science and reference lists of relevant reviews from the inception of the database up until June 7, 2023. Individual SES, neighborhood SES, and small-area SES were included, while any SES aggregated by geographic areas larger than neighbors were excluded. Studies assessing SES with any index or score combining indicators of income, education, deprivation, poverty, occupation, employment, marital status, cohabitation, and others were included. A random effect model meta-analysis was carried out for pooled odds ratios (ORs) and relative risks for adherence related to SES. Results: Overall, 10 studies, with a total of 3,542,379 participants and an overall adherence rate of 64.9%, were included. Compared with low SES, high SES was associated with higher adherence (unadjusted OR 1.73, 95% CI 1.42-2.10; adjusted OR 1.53, 95% CI 1.28-1.82). In the subgroup of nonindividual-level SES, the adjusted association was significant (OR 1.57, 95% CI 1.26-1.95). However, the adjusted association was insignificant in the subgroup of individual-level SES (OR 1.46, 95% CI 0.98-2.17). As for subgroups of the year of print, not only was the unadjusted association significantly stronger in the subgroup of early studies (OR 1.97, 95% CI 1.59-2.44) than in the subgroup of late studies (OR 1.43, 95% CI 1.31-1.56), but also the adjusted one was significantly stronger in the early group (OR 1.86, 95% CI 1.43-2.42) than in the late group (OR 1.26, 95% CI 1.14-1.39), which was consistent and robust. Despite being statistically insignificant, the strength of the association seemed lower in studies that did not adjust for race and ethnicity (OR 1.31, 95% CI 1.21-1.43) than the overall estimate (OR 1.53, 95% CI 1.28-1.82). Conclusions: The higher-SES population had higher adherence to fecal occult blood test–based organized CRC screening. Neighborhood SES, or small-area SES, was more competent than individual SES to be used to assess the association between SES and adherence. The disparity in adherence between the high SES and the low SES narrowed along with the development of interventions and the improvement of organized programs. Race and ethnicity were probably important confounding factors for the association. %M 37906212 %R 10.2196/48150 %U https://publichealth.jmir.org/2023/1/e48150 %U https://doi.org/10.2196/48150 %U http://www.ncbi.nlm.nih.gov/pubmed/37906212 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42483 %T The Digital Divide in Brazil and Barriers to Telehealth and Equal Digital Health Care: Analysis of Internet Access Using Publicly Available Data %A Nakayama,Luis Filipe %A Binotti,William Warr %A Link Woite,Naira %A Fernandes,Chrystinne Oliveira %A Alfonso,Pia Gabrielle %A Celi,Leo Anthony %A Regatieri,Caio Vinicius %+ Laboratory for Computational Physiology, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA, 02139, United States, 1 617 253 781, luisnaka@mit.edu %K digital divide %K digital health %K health equity %K internet access %K medical care %D 2023 %7 21.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has increased the use of digital solutions in medical care, especially for patients in remote areas and those requiring regular medical care. However, internet access is essential for the implementation of digital health care. The digital divide is the unequal distribution of access to digital technology, and the first level digital divide encompasses structural barriers. Brazil, a country with economic inequality and uneven population distribution, faces challenges in achieving internet access for all. Objective: This study aims to provide a comprehensive overview of the first-level digital divide in Brazil, estimate the relationship between variables, and identify the challenges and opportunities for digital health care implementation. Methods: Data were retrieved from the Brazilian Institute of Geography and Statistics National Continuous House survey database, including demographic, health, and internet-related variables. Statistical analysis included 2-tailed t tests, chi-square, and multivariate logistic regression to assess associations between variables. Results: Our analysis included 279,382 interviews throughout Brazil. The sample included more houses from the northeast (n=99,553) and fewer houses from the central west (n=30,804). A total of 223,386 (80.13%) of the interviewed population used the internet, with urban areas having higher internet access (187,671/212,109, 88.48%) than rural areas (35,715/67,077, 53.24%). Among the internet users, those interviewed who lived in urban houses, were women, were younger, and had higher income had a statistically higher prevalence (P<.001). Cell phones were the most common device used to access the internet (141,874/143,836, 98.63%). Reasons for not using the internet included lack of interest, knowledge, availability, and cost, with regional variations. The prevalence of internet access also varied among races, with 84,747 of 98,968 (85.63%) White respondents having access, compared to 22,234 of 28,272 (78.64%) Black respondents, 113,518 of 148,191 (76.6%) multiracial respondents, and 2887 of 3755 (76.88%) other respondents. In the southeast, central west, and south regions, the numbers of people with internet access were 49,790 of 56,298 (88.44%), 27,209 of 30,782 (88.39%), and 27,035 of 31,226 (86.58%), respectively, and in the north and northeast, 45,038 of 61,404 (73.35%) and 74,314 of 99,476 (74.7%). The income of internet users was twice the income of internet nonusers. Among those with diabetes-related limitations in daily activities, 945 of 2377 (39.75%) did not have internet access, and among those with daily activity restrictions, 1381 of 3644 (37.89%) did not have access. In a multivariate logistic regression analysis, women (odds ratio [OR] 1.147, 95% CI 0.118-0.156; P<.001), urban households (OR 6.743, 95% CI 1.888-1.929; P<.001), and those earning more than the minimum wage (OR 2.087, 95% CI 0.716-0.756; P<.01) had a positive association with internet access. Conclusions: Brazil’s diverse regions have different demographic distributions, house characteristics, and internet access levels, requiring targeted measures to address the first-level digital divide in rural areas and reduce inequalities in digital health solutions. Older people, poor, and rural populations face the greatest challenges in the first level digital divide in Brazil, highlighting the need to tackle the digital divide in order to promote equitable access to digital health care. %M 37477958 %R 10.2196/42483 %U https://www.jmir.org/2023/1/e42483 %U https://doi.org/10.2196/42483 %U http://www.ncbi.nlm.nih.gov/pubmed/37477958 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47851 %T Mobile Web App Intervention to Promote Breast Cancer Screening Among American Indian Women in the Northern Plains: Feasibility and Efficacy Study %A Roh,Soonhee %A Lee,Yeon-Shim %A Kenyon,DenYelle B %A Elliott,Amy J %A Petereit,Daniel G %A Gaba,Anu %A Lee,Hee Yun %+ Department of Social Work, University of South Dakota, 4801 N Career Ave, 145C, Sioux Falls, SD, 57107, United States, 1 6053571593, soonhee.roh@usd.edu %K American Indian women %K breast cancer %K mammogram %K mHealth %K mobile web app intervention %D 2023 %7 20.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Breast cancer is the most common cancer in the United States and the second leading cause of death for American Indian women. American Indian women have lower rates of breast cancer screening than other racial groups, and disparities in breast cancer mortality and survival rates persist among them. To address this critical need, a culturally appropriate, accessible, and personalized intervention is necessary to promote breast cancer screening among American Indian women. This study used mobile health principles to develop a mobile web app-based mammogram intervention (wMammogram) for American Indian women in a remote, rural community in the Northern Plains. Objective: This study aimed to assess the feasibility and efficacy of the wMammogram intervention, which was designed to motivate American Indian women to undergo breast cancer screening, as compared with the control group, who received an educational brochure. Methods: Using community-based participatory research (CBPR) principles and a multipronged recruitment strategy in a randomized controlled trial design, we developed the wMammogram intervention. This study involved 122 American Indian women aged between 40 and 70 years, who were randomly assigned to either the intervention group (n=62) or the control group (n=60). Those in the intervention group received personalized and culturally appropriate messages through a mobile web app, while those in the control group received an educational brochure. We measured outcomes such as mammogram receipt, intention to receive breast cancer screening after the intervention, and participants’ satisfaction with and acceptance of the intervention. Results: A significantly higher proportion of women who received the wMammogram intervention (26/62, 42%; P=.009) completed mammograms by the 6-month follow-up than the control group (12/60, 20%). The wMammogram intervention group, compared with the control group, reported significantly higher ratings on perceived effectiveness of the intervention (t120=−5.22; P<.001), increase in knowledge (t120=−4.75; P<.001), and satisfaction with the intervention (t120=−3.61; P<.001). Moreover, compared with the brochure group, the intervention group expressed greater intention to receive a mammogram in the future when it is due (62/62, 100% vs 51/60, 85%) and were more willing to recommend the intervention they received to their friends (61/62, 98.4% vs 54/60, 90%) with statistically significant differences. Conclusions: This study shows the feasibility and efficacy of the wMammogram intervention to promote breast cancer screening for American Indian women in a remote, rural community-based setting. Findings suggest that, with advancements in technology and the ubiquity of mobile devices, mobile web apps could serve as a valuable health intervention tool that builds upon low-cost technology and enhances accessibility and sustainability of preventive care to help reduce breast health disparities experienced in hard-to-reach American Indian populations. Trial Registration: ClinicalTrials.gov NCT05530603; https://clinicaltrials.gov/ct2/show/NCT05530603 %M 37471115 %R 10.2196/47851 %U https://formative.jmir.org/2023/1/e47851 %U https://doi.org/10.2196/47851 %U http://www.ncbi.nlm.nih.gov/pubmed/37471115 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e45162 %T Influencing Factors to mHealth Uptake With Indigenous Populations: Qualitative Systematic Review %A Goodman,Andrew %A Mahoney,Ray %A Spurling,Geoffrey %A Lawler,Sheleigh %+ School of Public Health, The University of Queensland, 266 Herston Road, Turrbal, Jagera Country, Herston, 4006, Australia, 61 733655393, Andrew.Goodman@csiro.au %K mHealth %K Indigenous %K Canada %K Australia %K New Zealand %K United States %K Papua New Guinea %K Samoa %K qualitative %K systematic review %K feasibility %K acceptability %K users %K design %K workflow %D 2023 %7 23.6.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The advancements and abundance of mobile phones and portable health devices have created an opportunity to use mobile health (mHealth) for population health systems. There is increasing evidence for the feasibility and acceptance of mHealth with Indigenous populations. Providing a synthesis of qualitative findings of mHealth with Indigenous populations will gain insights into the strengths and challenges to mHealth use in Indigenous populations. Objective: This review aimed to identify and synthesize qualitative data pertaining to the experiences and perceptions of mHealth from the perspectives of end users (patients and service providers) living in the colonial settler democracies of Canada, Australia, New Zealand, the United States, the Pacific Islands, and the Sápmi region of northern Europe. Methods: In May 2021, systematic searches of peer-reviewed, scientific papers were conducted across the 5 databases of PubMed, CINAHL, Embase, PsycINFO, and Web of Science. Qualitative or mixed method studies were included where a mHealth intervention was the primary focus for responding to health challenges with Indigenous populations. Two authors independently screened papers for eligibility and assessed the risk of bias using a modified version of the Critical Appraisal Skills Programme. A meta-aggregative approach was used to analyze the findings of included studies. Results: Seventeen papers met the eligibility criteria, 8 studies with patients, 7 studies with service providers, and 2 studies that included both patients and service providers. Studies were conducted in Australia (n=10), Canada (n=2), New Zealand (n=2), Papua New Guinea (n=1), the United States (n=1), and Samoa (n=1). Our interpretation of these qualitative findings shows commonalities between Indigenous patients’ and service providers’ perceptions of mHealth. We summarize our findings in six themes: (1) mHealth literacy, (2) mHealth as a facilitator for connection and support, (3) mHealth content needed to be culturally relevant, (4) mHealth security and confidentiality, (5) mHealth supporting rather than replacing service providers, and (6) workplace and organizational capacity. Conclusions: This research suggests that mHealth can meet the needs of both patients and service providers when the mHealth intervention is culturally relevant, accounts for digital and health literacy, incorporates interactive components, is supported by workplaces, fits into health provider workflows, and meets security and confidentiality standards. Future mHealth research with Indigenous populations should partner with key representatives (eg, patients, service providers, and executive leaders) in the mHealth design appropriate to the purpose, people, setting, and delivery. %M 37351947 %R 10.2196/45162 %U https://mhealth.jmir.org/2023/1/e45162 %U https://doi.org/10.2196/45162 %U http://www.ncbi.nlm.nih.gov/pubmed/37351947 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45502 %T Associations Between Frailty and the Increased Risk of Adverse Outcomes Among 38,950 UK Biobank Participants With Prediabetes: Prospective Cohort Study %A Cao,Xingqi %A Li,Xueqin %A Zhang,Jingyun %A Sun,Xiaoyi %A Yang,Gan %A Zhao,Yining %A Li,Shujuan %A Hoogendijk,Emiel O %A Wang,Xiaofeng %A Zhu,Yimin %A Allore,Heather %A Gill,Thomas M %A Liu,Zuyun %+ Center for Clinical Big Data and Analytics of the Second Affiliated Hospital, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Hangzhou, 310058, China, 86 057187077127, zuyunliu@zju.edu.cn %K frailty %K adverse outcomes %K diabetes %K prediabetes %K prospective study %D 2023 %7 18.5.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Compared with adults with normal glucose metabolism, those with prediabetes tend to be frail. However, it remains poorly understood whether frailty could identify adults who are most at risk of adverse outcomes related to prediabetes. Objective: We aimed to systematically evaluate the associations between frailty, a simple health indicator, and risks of multiple adverse outcomes including incident type 2 diabetes mellitus (T2DM), diabetes-related microvascular disease, cardiovascular disease (CVD), chronic kidney disease (CKD), eye disease, dementia, depression, and all-cause mortality in late life among middle-aged adults with prediabetes. Methods: We evaluated 38,950 adults aged 40 years to 64 years with prediabetes using the baseline survey from the UK Biobank. Frailty was assessed using the frailty phenotype (FP; range 0-5), and participants were grouped into nonfrail (FP=0), prefrail (1≤FP≤2), and frail (FP≥3). Multiple adverse outcomes (ie, T2DM, diabetes-related microvascular disease, CVD, CKD, eye disease, dementia, depression, and all-cause mortality) were ascertained during a median follow-up of 12 years. Cox proportional hazards regression models were used to estimate the associations. Several sensitivity analyses were performed to test the robustness of the results. Results: At baseline, 49.1% (19,122/38,950) and 5.9% (2289/38,950) of adults with prediabetes were identified as prefrail and frail, respectively. Both prefrailty and frailty were associated with higher risks of multiple adverse outcomes in adults with prediabetes (P for trend <.001). For instance, compared with their nonfrail counterparts, frail participants with prediabetes had a significantly higher risk (P<.001) of T2DM (hazard ratio [HR]=1.73, 95% CI 1.55-1.92), diabetes-related microvascular disease (HR=1.89, 95% CI 1.64-2.18), CVD (HR=1.66, 95% CI 1.44-1.91), CKD (HR=1.76, 95% CI 1.45-2.13), eye disease (HR=1.31, 95% CI 1.14-1.51), dementia (HR=2.03, 95% CI 1.33-3.09), depression (HR=3.01, 95% CI 2.47-3.67), and all-cause mortality (HR=1.81, 95% CI 1.51-2.16) in the multivariable-adjusted models. Furthermore, with each 1-point increase in FP score, the risk of these adverse outcomes increased by 10% to 42%. Robust results were generally observed in sensitivity analyses. Conclusions: In UK Biobank participants with prediabetes, both prefrailty and frailty are significantly associated with higher risks of multiple adverse outcomes, including T2DM, diabetes-related diseases, and all-cause mortality. Our findings suggest that frailty assessment should be incorporated into routine care for middle-aged adults with prediabetes, to improve the allocation of health care resources and reduce diabetes-related burden. %M 37200070 %R 10.2196/45502 %U https://publichealth.jmir.org/2023/1/e45502 %U https://doi.org/10.2196/45502 %U http://www.ncbi.nlm.nih.gov/pubmed/37200070 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45358 %T Racial/Ethnic Disparity in Association Between Fetal Alcohol Syndrome and Alcohol Intake During Pregnancy: Multisite Retrospective Cohort Study %A Oh,Sarah Soyeon %A Kang,Bada %A Park,Jewel %A Kim,SangMin %A Park,Eun-Cheol %A Lee,Seung Hee %A Kawachi,Ichiro %+ Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea, 82 2 2228 3283, bdkang@yuhs.ac %K fetal alcohol syndrome %K ethnic disparity %K alcohol intake %K pregnancy %K health disparity %K public health %K minority population %K vulnerable population %K women's health %K pediatrics %K fetal health %K pediatrics %D 2023 %7 21.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Alcohol consumption during pregnancy is associated with a range of adverse birth-related outcomes, including stillbirth, low birth weight, preterm birth, and fetal alcohol syndrome (FAS). With more than 10% of women consuming alcohol during pregnancy worldwide, it is increasingly important to understand how racial/ethnic variations affect FAS onset. However, whether race and ethnicity inform FAS risk assessment when daily ethanol intake is controlled for remains unknown. Objective: This study aimed to assess racial/ethnic disparities in FAS risk associated with alcohol consumption during pregnancy. Methods: We used data from a longitudinal cohort study (the Collaborative Initiative on Fetal Alcohol Spectrum Disorders) at 5 hospital sites around the United States of 595 women who consumed alcohol during pregnancy from 2007 to 2017. Questionnaires, in-person interviews, and reviews of medical, legal, and social service records were used to gather data on average alcoholic content (AAC) during pregnancy. Self-reports of maternal race (American Indian/Alaska Native [AI/AN], Asian, Native Hawaiian or other Pacific Islander, Black or African American, White, more than one race, and other) and ethnicity (Hispanic/Latino or not Hispanic/Latino), as well as FAS diagnoses based on standardized dysmorphological criteria, were used for analysis. Log-binomial regression was used to examine the risk of FAS associated with each 1-gram increase in ethanol consumption during pregnancy, stratified by race/ethnicity. Results: A total of 3.4% (20/595) of women who reported consuming alcohol during pregnancy gave birth to a baby with FAS. Women who gave birth to a baby with FAS had a mean AAC of 32.06 (SD 9.09) grams, which was higher than that of women who did not give birth to a baby with FAS (mean 12.07, SD 15.87 grams). AI/AN mothers with FAS babies had the highest AAC (mean 42.62, SD 8.35 grams), followed by White (mean 30.13, SD 4.88 grams) and Black mothers (mean 27.05, SD 12.78 grams). White (prevalence ratio [PR] 1.10, 95% CI 1.03-1.19), Black (PR 1.13, 95% CI 1.04-1.23), and AI/AN (PR 1.10, 95% CI 1.00-1.21) mothers had 10% to 13% increased odds of giving birth to a baby with FAS given the same exposure to alcohol during pregnancy. Regardless of race, a 1-gram increase in AAC resulted in a 4% increase (PR 1.04, 95% CI 1.02-1.07) in the chance of giving birth to a baby with ≥2 facial anomalies (ie, short palpebral fissures, thin vermilion border of the upper lip, and smooth philtrum) and a 4% increase (PR 1.04, 95% CI 1.01-1.07) in the chance of deficient brain growth. Conclusions: The risk of delivering a baby with FAS was comparable among White, Black, and AI/AN women at similar levels of drinking during pregnancy. Regardless of race, a 1-gram increase in AAC resulted in increased odds of giving birth to a baby with facial anomalies or deficient brain growth. %M 37083819 %R 10.2196/45358 %U https://publichealth.jmir.org/2023/1/e45358 %U https://doi.org/10.2196/45358 %U http://www.ncbi.nlm.nih.gov/pubmed/37083819 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44086 %T Methodological Challenges in Web-Based Qualitative Research With Medically Underserved Populations %A Jackson,Alexandra Malia %A Woo,Juhee %A Olson,Marley %A Dalisay,Francis %A Pokhrel,Pallav %A Muller,Clemma J %A Okamoto,Scott K %+ Public Health, Pacific University, 2043 College Way, Forest Grove, OR, 97116, United States, 1 503 352 3136, lexie.jackson@pacificu.edu %K data collection %K internet %K mischievous responders %K recruitment %K qualitative %K technology %D 2023 %7 30.3.2023 %9 Viewpoint %J J Med Internet Res %G English %X Internet- or web-based research is rapidly increasing, offering multiple benefits for researchers. However, various challenges in web-based data collection have been illustrated in prior research, particularly since the onset of the COVID-19 pandemic. To add to the literature on best practices for web-based qualitative data collection, we present 4 case studies in which each research team experienced challenges unique to web-based qualitative research and had to modify their research approaches to preserve data quality or integrity. The first 2 case examples describe issues with using social media to recruit hard-to-reach populations, the third example demonstrates the challenge in engaging adolescents in sensitive conversations on the web, and the final example discusses both the issues in recruitment and the use of different modalities in collecting data to accommodate the medical needs of study participants. Based on these experiences, we provide guidance and future directions for journals and researchers in collecting qualitative data on the web. %M 36995748 %R 10.2196/44086 %U https://www.jmir.org/2023/1/e44086 %U https://doi.org/10.2196/44086 %U http://www.ncbi.nlm.nih.gov/pubmed/36995748 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e39904 %T Regional Differences in Medical Costs of Chronic Kidney Disease in the South Korean Population: Marginalized Two-Part Model %A Park,Minah %A Yun,Choa %A Joo,Jae Hong %A Kang,Soo Hyun %A Jeong,Sung Hoon %A Nam,Chung-Mo %A Park,Eun-Cheol %A Han,Yoondae %A Jang,Sung In %+ Department of Preventive Medicine, College of Medicine, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 1863, jangsi@yuhs.ac %K chronic kidney disease %K cost analysis %K medical expenses %K medically vulnerable regions %K kidney %K public health %K cost %K economic %K chronic disease %K insurance %K regional %K longitudinal model %D 2023 %7 30.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: There are regional gaps in the access to medical services for patients with chronic kidney disease (CKD), and it is necessary to reduce those gaps, including the gaps involving medical costs. Objective: This study aimed to analyze regional differences in the medical costs associated with CKD in the South Korean population. Methods: This longitudinal cohort study included participants randomly sampled from the National Health Insurance Service-National Sample Cohort of South Korea. To select those who were newly diagnosed with CKD, we excluded those who were diagnosed in 2002-2003 and 2018-2019. A total of 5903 patients with CKD were finally included. We used a marginalized two-part longitudinal model to assess total medical costs. Results: Our cohort included 4775 (59.9%) men and 3191 (40.1%) women. Of these, 971 (12.2%) and 6995 (87.8%) lived in medically vulnerable and nonvulnerable regions, respectively. The postdiagnosis costs showed a significant difference between the regions (estimate: –0.0152, 95% confidence limit: –0.0171 to –0.0133). The difference in medical expenses between the vulnerable and nonvulnerable regions showed an increase each year after the diagnosis. Conclusions: Patients with CKD living in medically vulnerable regions are likely to have higher postdiagnostic medical expenses compared to those living in regions that are not medically vulnerable. Efforts to improve early diagnosis of CKD are needed. Relevant policies should be drafted to decrease the medical costs of patients with CKD disease living in medically deprived areas. %M 36995749 %R 10.2196/39904 %U https://publichealth.jmir.org/2023/1/e39904 %U https://doi.org/10.2196/39904 %U http://www.ncbi.nlm.nih.gov/pubmed/36995749 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 15 %N %P e38078 %T Co-design of the Transgender Health Information Resource: Web-Based Participatory Design %A Morse,Brad %A Soares,Andrey %A Ytell,Kate %A DeSanto,Kristen %A Allen,Marvyn %A Holliman,Brooke Dorsey %A Lee,Rita S %A Kwan,Bethany M %A Schilling,Lisa M %+ Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, 1890 North Revere Court | Mailstop F443, Aurora, CO, 80045, United States, 1 3037245138, brad.morse@cuanschutz.edu %K transgender %K gender diverse %K participatory design %K web-based design %K co-design %K health information resource %K smartphone %K app %K mobile phone %D 2023 %7 10.1.2023 %9 Original Paper %J J Particip Med %G English %X Background: There is an urgent and unmet need for accessible and credible health information within the transgender and gender-diverse (TGD) community. Currently, TGD individuals often seek and must find relevant resources by vetting social media posts. A resource that provides accessible and credible health-related resources and content via a mobile phone app may have a positive impact on and support the TGD population. Objective: COVID-19 stay-at-home orders forced a shift in the methods used in participatory design. In this paper, we aimed to describe the web-based participatory methods used to develop the Transgender Health Information Resource. We also described and characterized the web-based engagement that occurred during a single session of the overall design process. Methods: We planned and conducted web-based design sessions to replace the proposed in-person sessions. We used web-based collaborative tools, including Zoom (Zoom Video Communications), Mural (Mural), REDCap (Research Electronic Data Capture; Vanderbilt University), and Justinmind (Justinmind), to engage the participants in the design process. Zoom was used as an integrated platform for design activities. Mural was used to perform exercises, such as free listing, brainstorming, and grouping. REDCap allowed us to collect survey responses. Justinmind was used to create prototypes that were shared and discussed via Zoom. Recruitment was led by one of our community partners, One Colorado, who used private Facebook groups in which web-based flyers were dispersed. The design process took place in several workshops over a period of 10 months. We described and characterized engagement during a single design session by tracking the number of influential interactions among participants. We defined an influential interaction as communication, either verbal or web-based content manipulation, that advanced the design process. Results: We presented data from a single design session that lasted 1 hour and 48 minutes and included 4 participants. During the session, there were 301 influential interactions, consisting of 79 verbal comments and 222 web-based content manipulations. Conclusions: Web-based participatory design can elicit input and decisions from participants to develop a health information resource, such as a mobile app user interface. Overall, participants were highly engaged. This approach maintained the benefits and fidelity of traditional in-person design sessions, mitigated deficits, and exploited the previously unconsidered benefits of web-based methods, such as enhancing the ability to participate for those who live far from academic institutions. The web-based approach to participatory design was an efficient and feasible methodological design approach. %M 36626222 %R 10.2196/38078 %U https://jopm.jmir.org/2023/1/e38078 %U https://doi.org/10.2196/38078 %U http://www.ncbi.nlm.nih.gov/pubmed/36626222 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e37713 %T Dialogic Health Education to Reduce COVID-19 Disparities and Increase Health Literacy in Community and Correctional Settings: Protocol for a Two-Pronged Health Education Program %A Kader,Farah %A Kruchten,Stephanie %A Campo,Marc %A Collica-Cox,Kimberly %A Davidson,Charis %A Wald,Adrienne %A Hewlett Jr,Dial %+ Westchester County Department of Health, 148 Martine Ave, White Plains, NY, 10601, United States, 1 9149957731, fxkt@westchestergov.com %K community engagement %K dialogic learning %K training of trainers %K COVID-19 %K health literacy %K correctional facility health %K health equity %K racial disparities %K community participation %D 2022 %7 21.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: COVID-19 vaccines significantly reduce rates of hospitalization and death for those infected with the SARS-CoV-2 virus. Those facing social oppression, including people of color, experience heightened risk for COVID-19 and comorbidities, but are often mistrustful of governmental agencies and initiatives, contributing to low vaccine uptake and a reluctance to access vital health care services. Dialogue-based health literacy interventions may mitigate mistrust and increase access to health services and information, subsequently increasing rates of vaccination and other behaviors that reduce COVID-19 risk. Objective: To improve health literacy and reduce COVID-19 disparities, the Westchester County Department of Health, in partnership with two universities, community- and faith-based organizations, and the Westchester County Department of Correction, co-developed a health education program for community members, correctional officers, and incarcerated jail residents in Westchester, New York. Specific objectives are to increase preventative health behaviors, positive attitudes toward use of public health protocols, full vaccination or intentions to vaccinate, health care information understanding, health provider care access, clear communication with health care providers, and personal health care decision-making. Methods: Grounded in dialogic learning, the program entails training community-based “trusted messengers” and correctional officers to lead health information sessions in community and correctional settings. During the grant period, the program intends for 80 community-based trusted messengers to receive training from the Department of Health and will be expected to reach a goal of 100 members (N=8000) of their communities. Correctional staff with experience delivering educational programs will be trained to facilitate sessions among 400 correctional facility residents and 600 correctional staff. Results: Pre-post surveys will assess changes in health behaviors, attitudes, and perceptions. The program has been administered in the correctional facility since February 2022, with information sessions expected to cease for correctional staff and residents in June 2022 and November 2022, respectively. An initial cohort of community-based trusted messengers began training in February 2022, and information sessions have been scheduled in various virtual and community settings since March 2022. As of April 2022, the two-pronged health education program has reached 439 correctional officers, 98 jail residents, and 201 community members countywide. Program evaluation findings will be released in future publications after study implementation is complete. Conclusions: Few studies have evaluated the combined effects of training-of-trainers (ToT) and dialogical learning models on behavior and health literacy. As the first known COVID-19–specific dialogue-based health education program that applies a ToT model in the community-based, correctional, and virtual settings simultaneously, this study fills a gap in current knowledge about health literacy and health behavior in marginalized populations. Thus, this evidence-based framework can remedy COVID-19 disparities while also addressing risks for a host of health-related issues at the community level, potentially serving as a best-practice model for future health programs. International Registered Report Identifier (IRRID): PRR1-10.2196/37713 %M 36194870 %R 10.2196/37713 %U https://www.researchprotocols.org/2022/10/e37713 %U https://doi.org/10.2196/37713 %U http://www.ncbi.nlm.nih.gov/pubmed/36194870 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e37844 %T Cultural and Digital Health Literacy Appropriateness of App- and Web-Based Systems Designed for Pregnant Women With Gestational Diabetes Mellitus: Scoping Review %A Birati,Yosefa %A Yefet,Enav %A Perlitz,Yuri %A Shehadeh,Naim %A Spitzer,Sivan %+ The Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold Street, Safed, 1311502, Israel, 972 522684065, ebirati1@hotmail.com %K gestational diabetes mellitus %K maternal health %K mobile health %K mHealth %K mobile apps %K mobile phone %K telemedicine %K culture %K health literacy %K vulnerable populations %K pregnancy outcome %D 2022 %7 14.10.2022 %9 Review %J J Med Internet Res %G English %X Background: The prevalence of women diagnosed with gestational diabetes mellitus (GDM) is increasing dramatically. Mobile technologies to enhance patient self-management offer many advantages for women diagnosed with GDM. However, to our knowledge, although mobile health (mHealth) and telemedicine systems for GDM management exist, evidence on their cultural and digital health literacy appropriateness levels is limited. Objective: This review aimed to search and assess the literature on mHealth and telemedicine systems designed for women diagnosed with GDM. Our assessment of these technologies focused on their cultural and digital health literacy appropriateness as well as the systems’ effectiveness in improving glycemic control and maternal and infant outcomes. Methods: We conducted a scoping review using a framework adapted from Arksey and O’Malley. Four electronic databases were searched for relevant studies: PubMed, MEDLINE (EBSCO), Web of Science, and Scopus. The databases were searched between January 2010 and January 2022. The inclusion criteria were pregnant women diagnosed with GDM, use of telemedicine for monitoring and management, and vulnerable or disadvantaged patients. We used terms related to mobile apps and telemedicine: GDM, vulnerable populations, periphery, cultural appropriateness, and digital health literacy. Studies were screened and selected independently by 2 authors. We extracted the study data on a Microsoft Excel charting table and categorized them into final themes. The results were categorized according to the cultural and digital health literacy features presented. Results: We identified 17 studies that reported on 12 telemedicine and mHealth app interventions. We assessed the studies in three domains: cultural appropriateness, digital health literacy, and maternal and infant outcomes. In the literature, we found that existing digital technologies may improve glycemic control and diabetes self-management. However, there is a lack of assessment of cultural and digital health literacy appropriateness for pregnant women diagnosed with GDM. Considerations in app design regarding cultural appropriateness were found in only 12% (2/17) of the studies, and only 25% (3/12) of the interventions scored ≥3 out of 5 in our assessment of digital health literacy. Conclusions: mHealth and telemedicine can be an effective platform to improve the clinical management of women with GDM. Although studies published on the use of mHealth and telemedicine systems exist, there is a limited body of knowledge on the digital health literacy and cultural appropriateness of the systems designed for women diagnosed with GDM. In addition, as our study was restricted to the English language, relevant studies may have been excluded. Further research is needed to evaluate, design, and implement better tailored apps regarding cultural and digital literacy appropriateness for enhancing pregnant women’s self-management as well as the effectiveness of these apps in improving maternal and infant health outcomes. %M 36240008 %R 10.2196/37844 %U https://www.jmir.org/2022/10/e37844 %U https://doi.org/10.2196/37844 %U http://www.ncbi.nlm.nih.gov/pubmed/36240008 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e40568 %T Grocery Delivery to Support Healthy Weight Gain Among Pregnant Young Women With Low Income: Protocol for a Randomized Controlled Trial %A Waselewski,Marika %A Plegue,Melissa %A Sonneville,Kendrin %A Resnicow,Ken %A Ghumman,Aisha %A Ebbeling,Cara %A Mahmoudi,Elham %A Sen,Ananda %A Wolfson,Julia A %A Chang,Tammy %+ Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, United States, 1 734 998 7120, marikag@med.umich.edu %K pregnancy %K weight %K diet %K grocery delivery %D 2022 %7 5.8.2022 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Excessive weight gain during pregnancy is associated with complications for both the mother and her infant including gestational diabetes, hypertensive disorders, operative delivery, and long-term obesity. A healthy diet during pregnancy promotes healthy gestational weight gain and determines fetal epigenetic programming in infants that impacts risk for future chronic disease. Objective: This project will examine the impact of grocery delivery during pregnancy on the weight, diet, and health outcomes of young pregnant women and their infants. Methods: A three-arm randomized controlled trial design will be performed. A total of 855 young pregnant women, aged 14-24 years, from across the state of Michigan will be enrolled and randomized equally into the three study arms. Participants in arm one (control) will receive usual care from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); arm two will receive WIC plus biweekly grocery delivery; and arm three will receive WIC plus biweekly grocery and unsweetened beverage delivery. Weight will be assessed weekly during pregnancy, and total pregnancy weight gain will be categorized as above, below, or within guidelines. Additionally, dietary intake will be assessed at three time points (baseline, second trimester, and third trimester), and pregnancy outcomes will be extracted from medical records. The appropriateness of pregnancy weight gain, diet quality, and occurrence of poor outcomes will be compared between groups using standard practices for multinomial regression and confounder adjustment. Results: This study was funded in April 2021, data collection started in December 2021, and data collection is expected to be concluded in 2026. Conclusions: This study will test whether grocery delivery of healthy foods improves weight, diet, and pregnancy outcomes of young moms with low income. The findings will inform policies and practices that promote a healthy diet during pregnancy, which has multigenerational impacts on health. Trial Registration: ClinicalTrials.gov NCT05000645; https://clinicaltrials.gov/ct2/show/NCT05000645 International Registered Report Identifier (IRRID): DERR1-10.2196/40568 %M 35930351 %R 10.2196/40568 %U https://www.researchprotocols.org/2022/8/e40568 %U https://doi.org/10.2196/40568 %U http://www.ncbi.nlm.nih.gov/pubmed/35930351 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e38351 %T Knowledge, Attitude, Practices, and Vaccine Hesitancy Among the Latinx Community in Southern California Early in the COVID-19 Pandemic: Cross-sectional Survey %A Mehta,Shivani N %A Burger,Zoe C %A Meyers-Pantele,Stephanie A %A Garfein,Richard S %A Ortiz,Dayanna O %A Mudhar,Pavan K %A Kothari,Smit B %A Kothari,Jigna %A Meka,Meena %A Rodwell,Timothy %+ San Diego School Of Medicine, University of California, 9500 Gilman Dr #0039, La Jolla, CA, 92093, United States, 1 7146790080, s1mehta@ucsd.edu %K COVID-19 %K knowledge %K attitude %K practices %K KAP survey %K vaccine hesitancy %K Latinx %K Latinx cohort %K minority population %K primary care %K sociodemographic characteristic %K public health %K vulnerable population %K epidemiology %D 2022 %7 4.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The Latinx population in the United States has experienced high rates of infection, hospitalization, and death since the beginning of the COVID-19 pandemic. There is little data on the knowledge, attitude, and practices (KAP) specifically in Latinx communities in the United States. Objective: We aimed to assess COVID-19 KAP and vaccine hesitancy among a Latinx cohort in the early stages of the COVID-19 pandemic (from July 2020 to October 2020), at a unique time when a vaccine was not available.  Methods: Participants aged ≥18 years were recruited at a primary care clinic in Southern California and asked to self-report sociodemographic characteristics, KAP, and vaccine hesitancy. A subset of the participants answered the vaccine hesitancy assessment as it was added after the start of data collection. KAP items were summed to create composite scores, with higher scores reflecting increased COVID-19 knowledge, positive attitudes toward the COVID-19 pandemic, and disease prevention practices. Bivariate and multivariable regression models were fitted to test associations between sociodemographic characteristics and KAP scores. For our analysis, we only included patients who self-identified as Latinx. Results: Our final data set included 265 participants. The participants had a mean age of 49 (IQR 38.5-59) years, and 72.1% (n=191) were female, 77% (n=204) had at most a high school degree, 34.7% (n=92) had an annual income .99; current smoking, P=.37), and dyadic trust in family members living separately (P=.80). Further, in a multivariate regression analysis adjusted for confounding factors, such as educational history, age, gender, and job status, poor subjective health showed a prevalence odds ratio of less than 1 (OR 0.17, 95% CI 0.03-1.02). The HCS group showed significant positive relationships in the cohesion score with the neighborhood (P=.01; β=2.40, 95% CI 0.56-4.24), perceived social position (P=.03; β=1.17, 95% CI 0.11-2.23), and happiness score (P=.002; β=1.46, 95% CI 0.58-2.34) in the same multivariate regression models. Conclusions: This study suggested that people who frequently communicate with separated family members by taking advantage of various ICT tools can maintain a better mental state and better social relations among those who live alone and are separated from their families. %M 35921127 %R 10.2196/34949 %U https://formative.jmir.org/2022/8/e34949 %U https://doi.org/10.2196/34949 %U http://www.ncbi.nlm.nih.gov/pubmed/35921127 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e38905 %T An Integrated mHealth App for Smoking Cessation in Black Smokers With Anxiety: Protocol for a Randomized Controlled Trial %A Businelle,Michael S %A Garey,Lorra %A Gallagher,Matthew W %A Hébert,Emily T %A Vujanovic,Anka %A Alexander,Adam %A Kezbers,Krista %A Matoska,Cameron %A Robison,Jillian %A Montgomery,Audrey %A Zvolensky,Michael J %+ TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, United States, 1 405 271 8001 ext 50460, michael-businelle@ouhsc.edu %K smoking cessation %K treatment %K Black %K African American %K anxiety sensitivity %K mHealth %K just-in-time adaptive intervention %K mobile phone %D 2022 %7 30.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Black smokers have greater difficulty in quitting and higher rates of smoking-related diseases and disabilities than the general population. The smoking disparities experienced by this group are, in part, a consequence of multiple chronic life stressors (eg, racial discrimination) that engender increased exposure to interoceptive stress symptoms (eg, anxiety), which can ultimately lead to smoking as a means of immediate emotion regulation. Objective: This study aimed to culturally adapt and initially test a novel mobile intervention (ie, Mobile Anxiety Sensitivity Program for Smoking [MASP]) that targets anxiety sensitivity (AS; a proxy for difficulty and responsivity to interoceptive stress) among Black smokers. The MASP intervention is culturally informed to address interoceptive stress management difficulties among Black smokers and is thus hypothesized to facilitate smoking cessation. Methods: In phase 1, a total of 25 Black smokers with elevated AS will be administered MASP for 6 weeks. Following the completion of phase 1, we will further refine the MASP based on qualitative and quantitative data from participants to produce the final MASP iteration. In phase 2, a total of 200 Black smokers with elevated AS will be enrolled and randomly assigned to receive nicotine replacement therapy and either the smartphone-based National Cancer Institute QuitGuide app for standard mobile smoking cessation treatment or the MASP intervention. All participants in phases 1 and 2 will be enrolled remotely and will complete a web-based study screener; smartphone-based baseline assessment; daily smartphone-based ecological momentary assessments for 6 weeks; phone-based end-of-treatment qualitative interviews; and smartphone-based follow-up assessments at postbaseline weeks 1, 2 (quit date), 3, 4, 5, 6, 28, and 54 (weeks 28 and 54 follow-ups will be completed by phase 2 participants only). The MASP intervention is intended to offset barriers to treatment and encourage treatment engagement via smartphones. Results: This project was funded in September 2020. Phase 1 data collection began in January 2022. Phase 2 data collection is scheduled to begin in July 2022. Conclusions: If successful, data from this study will support culturally informed treatment approaches for Black smokers and, pending findings of efficacy, provide an evidence-based mobile intervention for smoking cessation that is ready for dissemination and implementation. Trial Registration: ClinicalTrials.gov NCT04838236; https://clinicaltrials.gov/ct2/show/NCT04838236 International Registered Report Identifier (IRRID): DERR1-10.2196/38905 %M 35635746 %R 10.2196/38905 %U https://www.researchprotocols.org/2022/5/e38905 %U https://doi.org/10.2196/38905 %U http://www.ncbi.nlm.nih.gov/pubmed/35635746 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e38348 %T Cardiovascular Disease Prevention Education Using a Virtual Environment in Sexual-Minority Men of Color With HIV: Protocol for a Sequential, Mixed Method, Waitlist Randomized Controlled Trial %A Ramos,S Raquel %A Johnson,Constance %A Melkus,Gail %A Kershaw,Trace %A Gwadz,Marya %A Reynolds,Harmony %A Vorderstrasse,Allison %+ School of Nursing, Yale University, 400 West Campus Drive, Orange, CT, 06477, United States, 1 203 737 2339, raquel.ramos@yale.edu %K virtual environment %K behavioral intervention %K consumer health informatics %K HIV %K cardiovascular disease %K sexual minority men %K prevention education %K gamification %K health communication %D 2022 %7 17.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: It is estimated that 70% of all deaths each year in the United States are due to chronic conditions. Cardiovascular disease (CVD), a chronic condition, is the leading cause of death in ethnic and racial minority males. It has been identified as the second most common cause of death in persons with HIV. By the year 2030, it is estimated that 78% of persons with HIV will be diagnosed with CVD. Objective: We propose the first technology-based virtual environment intervention to address behavioral, modifiable risk factors associated with cardiovascular and metabolic comorbidities in sexual-minority men of color with HIV. Methods: This study will be guided using social cognitive theory and the Technology Acceptance Model. A sequential, mixed method, waitlist controlled randomized control feasibility trial will be conducted. Aim 1 is to qualitatively explore perceptions of cardiovascular risk in 15 participants. Aim 2 is to conduct a waitlist controlled comparison to test if a virtual environment is feasible and acceptable for CVD prevention, based on web-based, self-assessed, behavioral, and psychosocial outcomes in 80 sexual-minority men of color with HIV. Results: The study was approved by the New York University Institutional Review Board in 2019, University of Texas Health Science Center at Houston in 2020, and by the Yale University Institutional Review Board in February 2022. As of April 2022, aim 1 data collection is 87% completed. We expect to complete data collection for aim 1 by April 30, 2022. Recruitment for aim 2 will begin mid-May 2022. Conclusions: This study will be the first online virtual environment intervention for CVD prevention in sexual-minority men of color with HIV. We anticipate that the intervention will be beneficial for CVD prevention education and building peer social supports, resulting in change or modification over time in risk behaviors for CVD. Trial Registration: ClinicalTrials.gov NCT05242952; https://clinicaltrials.gov/ct2/show/NCT05242952 International Registered Report Identifier (IRRID): PRR1-10.2196/38348 %M 35579928 %R 10.2196/38348 %U https://www.researchprotocols.org/2022/5/e38348 %U https://doi.org/10.2196/38348 %U http://www.ncbi.nlm.nih.gov/pubmed/35579928 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e34508 %T Technology-Based Interventions in Substance Use Treatment to Promote Health Equity Among People Who Identify as African American/Black, Hispanic/Latinx, and American Indian/Alaskan Native: Protocol for a Scoping Review %A Hichborn,Emily G %A Moore,Sarah K %A Gauthier,Phoebe R %A Agosti,Nico O %A Bell,Kathleen D %A Boggis,Jesse S %A Lambert-Harris,Chantal A %A Saunders,Elizabeth C %A Turner,Avery M %A McLeman,Bethany M %A Marsch,Lisa A %+ Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH, 03766, United States, 1 603 646 7081, Emily.G.Hichborn@Dartmouth.Edu %K health disparities %K scoping review %K social determinants of health %K substance use %K treatment %K technology-based interventions %K underrepresented %D 2022 %7 17.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Technology-based interventions (TBIs; ie, web-based and mobile interventions) have the potential to promote health equity in substance use treatment (SUTx) for underrepresented groups (people who identify as African American/Black, Hispanic/Latinx, and American Indian/Alaskan Native) by removing barriers and increasing access to culturally relevant effective treatments. However, technologies (emergent and more long-standing) may have unintended consequences that could perpetuate health care disparities among people who identify as a member of one of the underrepresented groups. Health care research, and SUTx research specifically, is infrequently conducted with people who identify with these groups as the main focus. Therefore, an improved understanding of the literature at the intersection of SUTx, TBIs, and underrepresented groups is warranted to avoid exacerbating inequities and to promote health equity. Objective: This study aims to explore peer-reviewed literature (January 2000-March 2021) that includes people who identify as a member of one of the underrepresented groups in SUTx research using TBIs. We further seek to explore whether this subset of research is race/ethnicity conscious (does the research consider members of underrepresented groups beyond their inclusion as study participants in the introduction, methods, results, or discussion). Methods: Five electronic databases (MEDLINE, Scopus, Cochrane Library, CINAHL, and PsycInfo) were searched to identify SUTx research using TBIs, and studies were screened for eligibility at the title/abstract and full-text levels. Studies were included if their sample comprised of people who identify as a member of one of the underrepresented groups at 50% or more when combined. Results: Title/abstract and full-text reviews were completed in 2021. These efforts netted a sample of 185 studies that appear to meet inclusionary criteria. Due to the uniqueness of tobacco relative to other substances in the SUTx space, as well as the large number of studies netted, we plan to separately publish a scoping review on tobacco-focused studies that meet all other criteria. Filtering for tobacco-focused studies (n=31) netted a final full-text sample for a main scoping review of 154 studies. The tobacco-focused scoping review manuscript is expected to be submitted for peer review in Spring 2022. The main scoping review data extraction and data validation to confirm the accuracy and consistency of data extraction across records was completed in March 2022. We expect to publish the main scoping review findings by the end of 2022. Conclusions: Research is needed to increase our understanding of the range and nature of TBIs being used in SUTx research studies with members of underrepresented groups. The planned scoping review will highlight research at this intersection to promote health equity. International Registered Report Identifier (IRRID): DERR1-10.2196/34508 %M 35579930 %R 10.2196/34508 %U https://www.researchprotocols.org/2022/5/e34508 %U https://doi.org/10.2196/34508 %U http://www.ncbi.nlm.nih.gov/pubmed/35579930 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e34013 %T Exploring the Equity Impact of Current Digital Health Design Practices: Protocol for a Scoping Review %A Evans,Laura %A Evans,Jay %A Pagliari,Claudia %A Källander,Karin %+ Usher Institute, University of Edinburgh, Old College, South Bridge Edinburgh, Edinburgh, EH8 9AG, United Kingdom, 44 0131 651 4138, v1levan6@exseed.ed.ac.uk %K digital health %K health equity %K design %K human-centered design %D 2022 %7 17.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The field of digital health has grown rapidly in part due to digital health tools’ potential to reduce health inequities. However, such potential has not always been realized. The design approaches used in digital health are one of the known aspects that have an impact on health equity. Objective: The aim of our scoping review will be to understand how design approaches in digital health have an impact on health equity. Methods: A scoping review of studies that describe how design practices for digital health have an impact on health equity will be carried out. The scoping review will follow the methodologies laid out by Arksey and O’Malley, the Joanna Briggs Institute, and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The PubMed, Embase, Web of Science, and ACM Digital Library databases will be searched for peer-reviewed papers. The ProQuest Dissertations and Theses and Global Index Medicus databases will be searched for gray literature. The results will be screened against our inclusion and exclusion criteria. Subsequently, the data extracted from the included studies will be analyzed. Results: As of March 2022, a preliminary search of the peer-reviewed databases has yielded over 4900 studies, and more are anticipated when gray literature databases are searched. We expect that after duplicates are removed and screening is completed, a much smaller number of studies will meet all of our inclusion criteria. Conclusions: Although there has been much discussion about the importance of design for lowering barriers to digital health participation, the evidence base demonstrating its impacts on health equity is less obvious. We hope that our findings will contribute to a better understanding of the impact that design in digital health has on health equity and that these findings will translate into action that leads to stronger, more equitable health care systems. %M 35579918 %R 10.2196/34013 %U https://www.researchprotocols.org/2022/5/e34013 %U https://doi.org/10.2196/34013 %U http://www.ncbi.nlm.nih.gov/pubmed/35579918 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 2 %P e33240 %T Barriers to Clinical Trial Participation: Comparative Study Between Rural and Urban Participants %A Mudaranthakam,Dinesh Pal %A Gajewski,Byron %A Krebill,Hope %A Coulter,James %A Springer,Michelle %A Calhoun,Elizabeth %A Hughes,Dorothy %A Mayo,Matthew %A Doolittle,Gary %+ University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66085, United States, 1 9139456922, dmudaranthakam@kumc.edu %K rural residents %K clinical trials %K screening %K cancer %K patients %K lung cancer %K health policy epidemiology %K cancer patients %K electronic screening logs %K electronic screening %D 2022 %7 21.4.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: The National Clinical Trials Network program conducts phase 2 or phase 3 treatment trials across all National Cancer Institute’s designated cancer centers. Participant accrual across these clinical trials is a critical factor in deciding their success. Cancer centers that cater to rural populations, such as The University of Kansas Cancer Center, have an additional responsibility to ensure rural residents have access and are well represented across these studies. Objective: There are scant data available regarding the factors that act as barriers to the accrual of rural residents in these clinical trials. This study aims to use electronic screening logs that were used to gather patient data at several participating sites in The Kansas University of Cancer Center’s Catchment area. Methods: Screening log data were used to assess what clinical trial participation barriers are faced by these patients. Additionally, the differences in clinical trial participation barriers were compared between rural and urban participating sites. Results: Analysis revealed that the hospital location rural urban category, defined as whether the hospital was in an urban or rural setting, had a medium effect on enrolment of patients in breast cancer and lung cancer trials (Cohen d=0.7). Additionally, the hospital location category had a medium effect on the proportion of recurrent lung cancer cases at the time of screening (d=0.6). Conclusions: In consideration of the financially hostile nature of cancer treatment as well as geographical and transportation barriers, clinical trials extended to rural communities are uniquely positioned to alleviate the burden of nonmedical costs in trial participation. However, these options can be far less feasible for patients in rural settings. Since the number of patients with cancer who are eligible for a clinical trial is already limited by the stringent eligibility criteria required of such a complex disease, improving accessibility for rural patients should be a greater focus in health policy. %M 35451964 %R 10.2196/33240 %U https://cancer.jmir.org/2022/2/e33240 %U https://doi.org/10.2196/33240 %U http://www.ncbi.nlm.nih.gov/pubmed/35451964 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e35196 %T App-Based Mindfulness Meditation for People of Color Who Experience Race-Related Stress: Protocol for a Randomized Controlled Trial %A Ramos,Giovanni %A Aguilera,Adrian %A Montoya,Amanda %A Lau,Anna %A Wen,Chu Yin %A Cruz Torres,Victor %A Chavira,Denise %+ Department of Psychology, University of California, Los Angeles, 502 Portola Plaza, Los Angeles, CA, 90095, United States, 1 786 564 2448, gioramos@ucla.edu %K race-related stress %K discrimination %K mindfulness %K meditation %K mental health %K app %K digital mental health intervention %K racial and ethnic minority %K people of color %K BIPOC %D 2022 %7 14.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: People of color (POC) who experience race-related stress are at risk of developing mental health problems, including high levels of stress, anxiety, and depression. Mindfulness meditation may be especially well suited to help POC cope, given its emphasis on gaining awareness and acceptance of emotions associated with discriminatory treatment. However, mindfulness meditation rarely reaches POC, and digital approaches could reduce this treatment gap by addressing traditional barriers to care. Objective: This study will test the effectiveness of a self-directed app-based mindfulness meditation program among POC who experience elevated levels of race-related stress. Implementation outcomes such as treatment acceptability, adherence, and satisfaction will be examined. Methods: Participants (n=80) will be recruited online by posting recruitment materials on social media and sending emails to relevant groups. In-person recruitment will consist of posting flyers in communities with significant POC representation. Eligible participants will be block randomized to either the intervention group (n=40) that will complete a self-directed 4-week mindfulness meditation program or a wait-list control condition (n=40) that will receive access to the app after study completion. All participants will complete measures at baseline, midtreatment, and posttreatment. Primary outcomes include changes in stress, anxiety, and depression, and secondary outcomes constitute changes in mindfulness, self-compassion, rumination, emotion suppression, and experiential avoidance. Exploratory analyses will examine whether changes in the secondary outcomes mediate changes in primary outcomes. Finally, treatment acceptability, adherence, and satisfaction will be examined descriptively. Results: Recruitment began in October 2021. Data will be analyzed using multilevel modeling, a statistical methodology that accounts for the dependence among repeated observations. Considering attrition issues in self-directed digital interventions and their potential effects on statistical significance and treatment effect sizes, we will examine data using both intention-to-treat and per-protocol analyses. Conclusions: To our knowledge, this will be the first study to provide data on the effectiveness of a self-directed app-based mindfulness meditation program for POC recruited based on elevated race-related stress, a high-risk population. Similarly, meaningful clinical targets for POC affected by stressors related to race will be examined. Findings will provide important information regarding whether this type of intervention is an acceptable treatment among these marginalized groups. Trial Registration: ClinicalTrials.gov NCT05027113; https://clinicaltrials.gov/ct2/show/NCT05027113 International Registered Report Identifier (IRRID): DERR1-10.2196/35196 %M 35436228 %R 10.2196/35196 %U https://www.researchprotocols.org/2022/4/e35196 %U https://doi.org/10.2196/35196 %U http://www.ncbi.nlm.nih.gov/pubmed/35436228 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e32325 %T The Impact of COVID-19 on the Delivery of Educational Programs in Native American Communities: Qualitative Study %A Sacca,Lea %A Markham,Christine %A Hernandez,Belinda %A Shegog,Ross %A Peskin,Melissa %A Craig Rushing,Stephanie %A Warren,Hannah %A Tsosie,Monique %+ Center for Health Promotion and Disease Prevention, University of Texas Health Science Center Houston, 7000 Fannin Street, Houston, TX, 77030, United States, 1 (713) 500 9050, lea.sacca@uth.tmc.edu %K online sexual health programs %K COVID-19 %K COVID-19 pandemic %K AI/AN youth %K sexual health educators %K culturally responsive adaptation %K program implementation %K sexual health %K implementation %K Native communities %K American Indian youth %K Alaskan youth %K education %K tribal communities %K online %K virtual %D 2022 %7 11.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the availability of culturally responsive sexual health educational programs for American Indian and Alaska Native (AI/AN) youth, barriers to their uptake and utilization persist in tribal communities. These challenges were exacerbated by the COVID-19 pandemic, which required flexible program delivery using both in-person and virtual classrooms. Objective: This exploratory study provides a preliminary understanding of the extent to which pre-existing challenges impact the delivery of culturally responsive sexual health education programs in Native communities and to what extent they were exacerbated by the COVID-19 pandemic. It also highlights the challenges faced by adolescent health advocates when adapting culturally responsive health curricula to online platforms. Finally, this study discloses major socioeconomic, health, and mental challenges experienced by AI/AN youth during the pandemic. Methods: An exploratory, descriptive, qualitative design approach was adopted to carry out 5 individual and 1 collective in-depth key informant interviews. A total of 8 Native and non-Native sexual health educators served as key informants and shared their personal experiences with the delivery of sexual health education programs for youth during the COVID-19 pandemic. The interviews were conducted virtually from October to November 2020 using Zoom to reach participants dispersed across different regions of the United States. We followed the consolidated criteria for reporting qualitative research (COREQ) as a reference for the study methodology. We also used the Braun and Clarke framework (2006) to conduct a thematic analysis. Results: Experts’ opinions were structured according to 5 main themes: (1) competing community priorities during COVID-19; (2) moving to web-based programming: skills, training, support; (3) recruiting youth; and (4) challenges for implementation in a household environment; and (5) recommendations to overcome implementation challenges. These themes are complementary, connected, and should be considered holistically for the development, dissemination, and implementation of online sexual health programs for AI/AN youth, specifically during the COVID-19 pandemic. The results raised the following points for discussion: (1) Building partnerships with schools and community organizations facilitates program adaptation and implementation, (2) there is a need to adopt a holistic approach when addressing youth sexual health in AI/AN communities, (3) a systematic and culturally responsive adaptation approach ensures effective virtual program delivery, and (4) community and youth engagement is essential for the success of virtual sexual health programs. Conclusions: Findings can provide recommendations on actions to be taken by sexual health educators and guidelines to follow to ensure cultural sensitivity, effective adaptation, and successful implementation when setting out to advocate for online sexual health programs for AI/AN youth. %M 35348464 %R 10.2196/32325 %U https://formative.jmir.org/2022/4/e32325 %U https://doi.org/10.2196/32325 %U http://www.ncbi.nlm.nih.gov/pubmed/35348464 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e34544 %T The Evaluation of a Social Media Campaign to Increase COVID-19 Testing in Migrant Groups: Cluster Randomized Trial %A Elgersma,Ingeborg Hess %A Fretheim,Atle %A Indseth,Thor %A Munch,Anita Thorolvsen %A Johannessen,Live Bøe %A Hansen,Christine Engh %+ Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Postboks 222, Skøyen, Oslo, 0213, Norway, 47 91584782, ingeborghess.elgersma@fhi.no %K COVID-19 %K SARS-CoV-2 %K social media %K campaign %K cluster randomized trial %K nonpharmaceutical interventions %K migrant %K intervention %K testing %K strategy %K public health %K Facebook %K communication %D 2022 %7 24.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: A low test positivity rate is key to keeping the COVID-19 pandemic under control. Throughout the pandemic, several migrant groups in Norway have seen higher rates of confirmed COVID-19 and related hospitalizations, while test positivity has remained high in the same groups. The Norwegian government has used several platforms for communication, and targeted social media advertisements have in particular been an important part of the communication strategy to reach these groups. Objective: In this study, we aimed to investigate whether such a targeted Facebook campaign increased the rate of COVID-19 tests performed in certain migrant groups. Methods: We randomly assigned 386 Norwegian municipalities and city districts to intervention or control groups. Individuals born in Eritrea, Iraq, Pakistan, Poland, Russia, Somalia, Syria, and Turkey residing in intervention areas were targeted with a social media campaign aiming at increasing the COVID-19 test rate. The campaign message was in a simple language and conveyed in the users’ main language or in English. Results: During the 2-week follow-up period, the predicted probability of having a COVID-19 test taken was 4.82% (95% CI 4.47%-5.18%) in the control group, and 5.58% (95% CI 5.20%-5.99%) in the intervention group (P=.004). Conclusions: Our targeted social media intervention led to a modest increase in test rates among certain migrant groups in Norway. Trial Registration: ClinicalTrials.gov NCT04866589; https://clinicaltrials.gov/ct2/show/NCT04866589 %M 35285811 %R 10.2196/34544 %U https://www.jmir.org/2022/3/e34544 %U https://doi.org/10.2196/34544 %U http://www.ncbi.nlm.nih.gov/pubmed/35285811 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e35182 %T PriSUD-Nordic—Diagnosing and Treating Substance Use Disorders in the Prison Population: Protocol for a Mixed Methods Study %A Bukten,Anne %A Lokdam,Nicoline Toresen %A Skjærvø,Ingeborg %A Ugelvik,Thomas %A Skurtveit,Svetlana %A Gabrhelík,Roman %A Skardhamar,Torbjørn %A Lund,Ingunn Olea %A Havnes,Ingrid Amalia %A Rognli,Eline Borger %A Chang,Zheng %A Fazel,Seena %A Friestad,Christine %A Hesse,Morten %A Lothe,Johan %A Ploeg,Gerhard %A Dirkzwager,Anja J E %A Clausen,Thomas %A Tjagvad,Christian %A Stavseth,Marianne Riksheim %+ Norwegian Centre for Addiction Research, University of Oslo, Kirkeveien 166, Oslo, 0407, Norway, 47 23368971, anne.bukten@medisin.uio.no %K substance use disorders %K prison %K criminal justice %K epidemiology %K mixed methods %K harm reduction %K treatment %D 2022 %7 23.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: A large proportion of the prison population experiences substance use disorders (SUDs), which are associated with poor physical and mental health, social marginalization, and economic disadvantage. Despite the global situation characterized by the incarceration of large numbers of people with SUD and the health problems associated with SUD, people in prison are underrepresented in public health research. Objective: The overall objective of the PriSUD (Diagnosing and Treating Substance Use Disorders in Prison)-Nordic project is to develop new knowledge that will contribute to better mental and physical health, improved quality of life, and better life expectancies among people with SUD in prison. Methods: PriSUD-Nordic is based on a multidisciplinary mixed method approach, including the methodological perspectives of both quantitative and qualitative methods. The qualitative part includes ethnographic fieldwork and semistructured interviews. The quantitative part is a registry-based cohort study including national registry data from Norway, Denmark, and Sweden. The national prison cohorts will comprise approximately 500,000 individuals and include all people imprisoned in Norway, Sweden, and Demark during the period from 2000 to 2019. The project will investigate the prison population during three different time periods: before imprisonment, during imprisonment, and after release. Results: PriSUD-Nordic was funded by The Research Council of Norway in December 2019, and funding started in 2020. Data collection is ongoing and will be completed in the first quarter of 2022. Data will be analyzed in spring 2022 and the results will be disseminated in 2022-2023. The PriSUD-Nordic project has formal ethical approval related to all work packages. Conclusions: PriSUD-Nordic will be the first research project to investigate the epidemiology and the lived experiences of people with SUD in the Nordic prison population. Successful research in this field will have the potential to identify significant areas of benefit and will have important implications for ongoing policy related to interventions for SUD in the prison population. International Registered Report Identifier (IRRID): DERR1-10.2196/35182 %M 35320114 %R 10.2196/35182 %U https://www.researchprotocols.org/2022/3/e35182 %U https://doi.org/10.2196/35182 %U http://www.ncbi.nlm.nih.gov/pubmed/35320114 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e27890 %T Demographic and Psychosocial Characteristics Associated With Use of a Prostate Cancer Survivorship Website: Implications From a Multisite Randomized Controlled Trial %A Marziliano,Allison %A Diefenbach,Michael A %A Hudson,Shawna V %A Tagai,Erin K %A Handorf,Elizabeth A %A Bator,Alicja %A Miller,Suzanne M %+ Cancer Prevention and Control, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Avenue, Philadelphia, PA, 19111, United States, 1 1 215 728 4069, Suzanne.Miller@fccc.edu %K prostate cancer %K cancer survivorship %K web-based resource %K monitoring style of coping %K cancer %K survivorship %K eHealth %K emotions %K interpersonal %D 2022 %7 21.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Many prostate cancer (PC) survivors experience disease and treatment-related symptomatology in both the physical and psychosocial domains. Although the benefits and barriers to using web-based resources for cancer patients are well-documented, less research has focused on the personal characteristics important for efficient tailoring and targeting of information that are associated with usage. Objective: We used the Cognitive-Social Health Information Processing (C-SHIP) framework to guide our exploration of personal characteristics associated with use of PROGRESS, an informational PC survivorship website that addresses physical, emotional, interpersonal, and practical concerns relevant for PC survivors. Methods: PC survivors (N=217) were randomized to the intervention arm (PROGRESS) of a randomized controlled trial. Of those randomized to the intervention arm, 84 used PROGRESS, and 133 did not use PROGRESS. Multivariable analyses evaluated demographic and psychosocial characteristics (eg, style of coping, health literacy, self-efficacy, affective states of depression, anxiety, and fatigue) associated with website use. Results: A larger proportion of non-Hispanic White (68/160, 42.5%), compared with non-Hispanic Black (9/40, 23%), participants used PROGRESS (P<.001). Further, PROGRESS users were older in age (P<.001), had a monitoring style of coping (P=.01), and were less depressed (P=.004), anxious (P=.02), and fatigued (P<.001) than nonusers. Education, income, health literacy, blunting style of coping, self-efficacy, and treatment type (radiation therapy or surgery) were not significantly related to use. On multivariable analyses, race (OR 0.28, P<.001), age (OR 1.05, P<.001), monitoring style of coping (OR 1.27, P=.02), and overall mood (OR 0.98, P<.001) remained significant. Conclusions: A combination of monitoring and low levels of negative affect were associated with website use. Additionally, users were older, non-Hispanic White survivors. To ensure that important survivorship-relevant information reaches users, future efforts need to focus on enhancing patient engagement. Trial Registration: ClinicalTrials.gov NCT02224482; https://clinicaltrials.gov/ct2/show/NCT02224482 %M 35311678 %R 10.2196/27890 %U https://www.jmir.org/2022/3/e27890 %U https://doi.org/10.2196/27890 %U http://www.ncbi.nlm.nih.gov/pubmed/35311678 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 1 %P e23844 %T Small Practices, Big (QI) Dreams: Customizing Quality Improvement (QI) Efforts for Under-Resourced Primary Care Practices to Improve Diabetes Disparities %A Lim,Sahnah %A Islam,Nadia S %+ Department of Population Health, Grossman School of Medicine, New York University, 180 Madison Avenue 8-12, New York, NY, 10016, United States, 1 6465013485, sahnah.lim@nyulangone.org %K electronic health record %K quality improvement %K health equity %K clinical practice guidelines %K diabetes %D 2022 %7 18.3.2022 %9 Viewpoint %J JMIR Diabetes %G English %X Electronic health record quality improvement (QI) initiatives hold great promise in improving adoption of clinical practice guidelines, including those related to diabetes. QI initiatives implemented in under-resourced primary care settings that primarily serve racial/ethnic minority populations have potential to improve quality of care and ultimately improve diabetes disparities. The “Screen at 23” campaign was launched in 2011 to increase screening for prediabetes and diabetes at lower BMI thresholds (ie, 23 kg/m2) for Asian Americans, in line with the new guidelines put forth by the American Diabetes Association. Here, we describe the implementation of a customized electronic health record QI initiative in under-resourced practices that primarily serve low-income South Asian populations in New York City, designed to increase diabetes screening using updated BMI guidelines and in alignment with the “Screen at 23” campaign. The customization involved the implementation of an innovative, semi-manual alternate solution to automated clinical decision support system (CDSS) alerts in order to address the restrictions on customizing CDSS alerts in electronic health record platforms used in small practice settings. We also discuss challenges and strategies with this customized QI effort. Our experience suggests that multisector partnership engagement, user-centered approaches, and informal strategies for relationship building are even more critical in under-resourced, small practice settings. Relatively simple technological solutions can be greatly beneficial in enhancing small practice capacity to engage in larger-scale QI initiatives. Tailored, context-driven approaches for implementation of equity-focused QI initiatives such as the one we describe can increase adoption of clinical practice guidelines, improve diabetes-related outcomes, and improve health disparities among underserved populations.International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3711-y %M 35302500 %R 10.2196/23844 %U https://diabetes.jmir.org/2022/1/e23844 %U https://doi.org/10.2196/23844 %U http://www.ncbi.nlm.nih.gov/pubmed/35302500 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e36201 %T Linking Electronic Health Records and In-Depth Interviews to Inform Efforts to Integrate Social Determinants of Health Into Health Care Delivery: Protocol for a Qualitative Research Study %A Hirsch,Annemarie %A Durden,T Elizabeth %A Silva,Jennifer %+ Department of Population Health Sciences, Geisinger, 100 N. Academy Avenue, Danville, PA, 17822, United States, 1 267 626 8110, aghirsch@geisinger.edu %K electronic health records %K social determinants of health %K poverty %K rural %K qualitative %K health system %D 2022 %7 11.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health systems are attempting to capture social determinants of health (SDoH) in electronic health records (EHR) and use these data to adjust care plans. To date, however, methods for identifying social needs, which are the SDoH prioritized by patients, have been underexplored, and there is little guidance as to how clinicians should act on SDoH data when caring for patients. Moreover, the unintended consequences of collecting and responding to SDoH are poorly understood. Objective: The objective of this study is to use two data sources, EHR data and patient interviews, to describe divergences between the EHR and patient experiences that could help identify gaps in the documentation of SDoH in the EHR; highlight potential missed opportunities for addressing social needs, and identify unintended consequences of efforts to integrate SDoH into clinical care. Methods: We are conducting a qualitative study that merges discrete and free-text data from EHRs with in-depth interviews with women residing in rural, socioeconomically deprived communities in the Mid-Atlantic region of the United States. Participants had to confirm that they had at least one visit with the large health system that serves the region. Interviews with the women included questions regarding health, interaction with the health system, and social needs. Next, with consent, we extracted discrete data (eg, diagnoses and medication orders) for each participant and free-text clinician notes from this health system’s EHRs between 1996 and the year of the interview. We used a standardized protocol to create an EHR narrative, a free-text summary of the EHR data. We used NVivo to identify themes in the interviews and the EHR narratives. Results: To date, we have interviewed 88 women, including 51 White women, 19 Black women, 14 Latina women, 2 mixed Black and Latina women, and 2 Asian Pacific women. We have completed the EHR narratives on 66 women. The women range in age from 18 to 90 years. We found corresponding EHR data on all but 4 of the interview participants. Participants had contact with a wide range of clinical departments (eg, psychiatry, neurology, and infectious disease) and received care in various clinical settings (eg, primary care clinics, emergency departments, and inpatient hospitalizations). A preliminary review of the EHR narratives revealed that the clinician notes were a source of data on a range of SDoH but did not always reflect the social needs that participants described in the interviews. Conclusions: This study will provide unique insight into the demands and consequences of integrating SDoH into clinical care. This work comes at a pivotal point in time, as health systems, payors, and policymakers accelerate attempts to deliver care within the context of social needs. International Registered Report Identifier (IRRID): DERR1-10.2196/36201 %M 35275090 %R 10.2196/36201 %U https://www.researchprotocols.org/2022/3/e36201 %U https://doi.org/10.2196/36201 %U http://www.ncbi.nlm.nih.gov/pubmed/35275090 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e35402 %T Developing a Smartphone-Based Adjunct Intervention to Reduce Cannabis Use Among Juvenile Justice-Involved Adolescents: Protocol for a Multiphase Study %A Helseth,Sarah A %A Guigayoma,John %A Price,Dayna %A Spirito,Anthony %A Clark,Melissa A %A Barnett,Nancy P %A Becker,Sara J %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 5th Floor, Providence, RI, , United States, 1 401 863 6881, sarah_helseth@brown.edu %K mobile intervention %K juvenile justice %K justice %K court %K adolescent %K teenager %K substance use %K cannabis %K youth %K adolescence %K protocol %K mHealth %K mobile health %K substance use %K user design %K behavioral app %K health app %K development %K pilot %K prototype %K feasibility %K acceptability %K smartphone app %K marijuana %K mobile phone %D 2022 %7 11.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescents involved in the juvenile justice system who use cannabis are at an increased risk of future substance use disorders and rearrest. Many court-involved, nonincarcerated (CINI) youth are referred for services in the community and often encounter multiple barriers to care, highlighting the need for minimally burdensome services that can be delivered in justice settings. Digital health interventions are accessible, easy to implement, and can provide ongoing support but have not been developed to address the unique needs of CINI youth who use cannabis. Objective: This multiphase study will aim to develop, implement, and pilot test a novel smartphone app, Teen Empowerment through Computerized Health (TECH), to reduce cannabis and other substance use among CINI youth. TECH is conceptualized as a digital adjunct to a brief computerized intervention delivered by our family court partner. Methods: Following the principles of user-centered design, phase I interviews with CINI youth aged 14-18 years (n=14-18), their caregivers (n=6-8), and behavioral health app developers (n=6-8) will guide the TECH design decisions. Next, in phase II, CINI youth (n=10) will beta test the TECH app prototype for 1 month; their feedback regarding feasibility and acceptability will directly inform the app refinement process. Finally, in phase III, CINI youth (n=60) will participate in a pilot randomized controlled trial for 6 months, comparing the preliminary effectiveness of the adjunctive TECH app on cannabis use outcomes. Results: Phase I data collection began in September 2020 and was completed in December 2021; 14 CINI youth, 8 caregivers, and 11 behavioral health app developers participated in the study. Phases II and III will occur in 2022 and 2023 and 2023 and 2025, respectively. Conclusions: This body of work will provide insight into the feasibility and acceptability of a smartphone-based adjunctive intervention designed for CINI youth. Phase III results will offer a preliminary indication of the effectiveness of the TECH app in reducing cannabis use among CINI youth. International Registered Report Identifier (IRRID): DERR1-10.2196/35402 %M 35275086 %R 10.2196/35402 %U https://www.researchprotocols.org/2022/3/e35402 %U https://doi.org/10.2196/35402 %U http://www.ncbi.nlm.nih.gov/pubmed/35275086 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e28704 %T Lessons Learned From Beta-Testing a Facebook Group Prototype to Promote Treatment Use in the “Connecting Alaska Native People to Quit Smoking” (CAN Quit) Study %A Sinicrope,Pamela S %A Young,Colleen D %A Resnicow,Ken %A Merritt,Zoe T %A McConnell,Clara R %A Hughes,Christine A %A Koller,Kathryn R %A Bock,Martha J %A Decker,Paul A %A Flanagan,Christie A %A Meade,Crystal D %A Thomas,Timothy K %A Prochaska,Judith J %A Patten,Christi A %+ Behavioral Health Research Program, Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, United States, 1 507 284 2511, Sinicrope.Pamela@mayo.edu %K Web 2.0 %K social media %K Facebook %K Alaska Native %K American Indian %K Alaska %K smoking %K cessation %K cancer prevention %K Quitline %K mobile phone %D 2022 %7 17.2.2022 %9 Viewpoint %J J Med Internet Res %G English %X Social media provides an effective tool to reach, engage, and connect smokers in cessation efforts. Our team developed a Facebook group, CAN Quit (Connecting Alaska Native People to Quit smoking), to promote use of evidence-based smoking cessation resources for Alaska Native people living in Alaska, which are underused despite their effectiveness. Often separated by geography and climate, Alaska Native people prefer group-based approaches for tobacco cessation that support their culture and values. Such preferences make Alaska Native people candidates for social media–based interventions that promote connection. This viewpoint discusses the steps involved and lessons learned in building and beta-testing our Facebook group prototype, which will then be evaluated in a pilot randomized controlled trial. We describe the process of training moderators to facilitate group engagement and foster community, and we describe how we developed and tested our intervention prototype and Facebook group. All parts of the prototype were designed to facilitate use of evidence-based cessation treatments. We include recommendations for best practices with the hope that lessons learned from the CAN Quit prototype could provide a model for others to create similar platforms that benefit Alaska Native and American Indian people in the context of smoking cessation. %M 35175208 %R 10.2196/28704 %U https://www.jmir.org/2022/2/e28704 %U https://doi.org/10.2196/28704 %U http://www.ncbi.nlm.nih.gov/pubmed/35175208 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e31928 %T Defining the Pre-exposure Prophylaxis Care Continuum Among Recently Incarcerated Men at High Risk for HIV Infection: Protocol for a Prospective Cohort Study %A Murphy,Matthew %A Sosnowy,Collette %A Rogers,Brooke %A Napoleon,Siena %A Galipeau,Drew %A Scott,Ty %A Tao,Jun %A Berk,Justin %A Clarke,Jennifer %A Nunn,Amy %A Chan,Philip A %+ Brown University, Open Door Health, 7 Central Street, Providence, RI, 02907, United States, 1 401 648 4700, matthew_murphy@brown.edu %K HIV %K PrEP %K criminal justice system %K incarceration %K criminal justice %K pre-exposure prophylaxis %K prison system %D 2022 %7 10.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: HIV disproportionately impacts criminal justice–involved individuals, including men who experience incarceration. Men make up the vast majority of those experiencing incarceration as well as those newly diagnosed with HIV infection. Pre-exposure prophylaxis (PrEP) is a highly effective biomedical intervention that significantly reduces the risk of HIV acquisition. However, implementation in criminal justice systems is limited. Little is known about effective PrEP implementation and use in this unique public health context. Objective: The aim of this study is to characterize the experience of implementing PrEP clinical care in a criminal justice setting for men vulnerable to HIV acquisition. Methods: This article describes a PrEP care continuum for men experiencing incarceration who are at increased risk of HIV acquisition, which can help conceptualize approaches to evaluating PrEP implementation. Results: The outlined study will enroll 100 men experiencing incarceration at high risk for HIV acquisition prior to release into the community. The goal is to initiate PrEP prior to release and link individuals to PrEP providers in the community, capturing barriers and facilitators to PrEP use during this uniquely vulnerable time period for HIV acquisition. Conclusions: Based on the proposed care continuum and what is known about HIV risk and prevention efforts in the criminal justice context, we outline key future research efforts to better understand effective approaches to preventing HIV infection among this vulnerable population. The described approach presents a powerful public health opportunity to help end the HIV epidemic. International Registered Report Identifier (IRRID): DERR1-10.2196/31928 %M 35142633 %R 10.2196/31928 %U https://www.researchprotocols.org/2022/2/e31928 %U https://doi.org/10.2196/31928 %U http://www.ncbi.nlm.nih.gov/pubmed/35142633 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e28798 %T Identifying Ethical and Culturally Responsive Research Activities to Build Trust and Improve Participation of Black Sexual Minority Men in Pre-Exposure Prophylaxis Telehealth Clinical Trials: Qualitative Study %A Dangerfield II,Derek T %A Wylie,Charleen %+ Johns Hopkins School of Nursing, 525 N Wolfe St, Baltimore, MD, 21205, United States, 1 4439839283, ddanger2@jhu.edu %K HIV %K sexual health %K stigma %K medical mistrust %K PrEP %K telehealth %K medication adherence %K minorities %K focus groups %K sexual minorities %K mobile phone %D 2022 %7 7.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Telehealth interventions could improve pre-exposure prophylaxis (PrEP) initiation and adherence in high HIV incidence groups such as young Black sexual minority men (BSMM). However, young BSMM remain distrustful of and underrepresented in clinical trials. Therefore, ethical and culturally responsive ways are needed to build trust and improve their participation in PrEP telehealth clinical trials. Objective: To bridge this gap, this study identified ethical and culturally responsive activities to build trust and improve participation of young BSMM in PrEP telehealth clinical trials. Methods: We obtained data from 7 virtual, synchronous focus groups that were conducted from April to August 2020 and consisted of 28 BSMM aged 18-34 years. Focus groups included a brief survey distributed online via Qualtrics followed by a virtual, synchronous focus group conducted via Zoom that lasted between 50 and 75 minutes. Focus groups were stratified by age (18- to 24-year-old participants and 25- to 34-year-old participants), outlined the components of an example PrEP telehealth randomized controlled trial, and included questions on domains of the study design—research motivations, study funding, recruitment activities, informed consent details, randomization, follow-up, and end of study activities. Participants were asked targeted questions regarding the ethics and trustworthiness of the study and ways in which researchers could gain their trust through the protocol used in the PrEP telehealth clinical trial. Results: The focus groups included 2 groups of 18- to 24-year-old participants and 5 groups of 25- to 34-year-old participants. The mean age of participants was 27.2 years (SD 4.4 years). Of the 28 participants, 10 (36%) reported a bachelor’s degree to be their highest completed education level and 6 (21%) reported some graduate degree or higher to be their highest completed education level. Most participants (16/28, 57%) reported that they worked full-time and that they were single or not in a committed relationship (21/28, 75%). Most participants (24/28, 86%) reported that they used at least one drug before sex in the 6 months prior to the study. All participants reported that they heard about PrEP and 36% (10/28) were current PrEP users. Overall, the focus groups yielded themes related to the impact of researcher intentions, study funding, recruitment activities, informed consent details, randomization, and study team interactions during and after the study on trust and participation in the clinical trial. Conclusions: Medical and research mistrust persists among BSMM. This study identified several ethical and culturally responsive activities to build trust and improve participation of young BSMM in PrEP telehealth clinical trials. Future studies should assess the relative impact of implementing these findings on research participation in a PrEP telehealth clinical trial. %M 35129448 %R 10.2196/28798 %U https://humanfactors.jmir.org/2022/1/e28798 %U https://doi.org/10.2196/28798 %U http://www.ncbi.nlm.nih.gov/pubmed/35129448 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e28137 %T Approaches to Determine and Manage Sexual Consent Abilities for People With Cognitive Disabilities: Systematic Review %A Esmail,Shaniff %A Concannon,Brendan %+ Department of Occupational Therapy, University of Alberta, Corbett Hall, 8205 - 114St 2-64, Edmonton, AB, T6G 2G4, Canada, 1 (780) 492 0397, shaniff.esmail@ualberta.ca %K sexual consent %K capacity %K disability %K sexual expression %K dementia %K ethics %K long-term care %D 2022 %7 4.2.2022 %9 Review %J Interact J Med Res %G English %X Background: This review focused on how sexual consent ability was determined, managed, and enhanced in people with cognitive disabilities, with the aim of better understanding the recurring themes influencing the design and implementation of these approaches. If a person’s consensual ability becomes compromised, owing to either an early or late-onset cognitive disability, the formal systems involved must establish plans to balance the individual’s rights and restrictions on sexual expression. This review identified these plans, focusing on how they promoted the intimacy rights of the individual. Objective: This study aims to identify approaches that determine sexual consent ability in people with cognitive disabilities, identify the means of managing and enhancing sexual consent ability in people with cognitive disabilities, and note the recurring themes that influence how these approaches and management systems are designed and implemented. Methods: A systematic literature review was performed using EBSCOhost (Social Gerontology, CINAHL Plus, MEDLINE, and SocINDEX), Embase, PsyInfo, and Scopus to locate reports on terms expanded on sexual consent and cognitive disability. Results: In all, 47 articles were identified, featuring assessment practices, legal case studies, and clinical standards for managing sexual consent capacity in people with cognitive disabilities. A total of 8 studies (5/8, 63% qualitative and 3/8, 38% quantitative) were included out of the 47 articles identified. Approaches for determining sexual consent included functional capacity and person-centered, integrated, and contextual approaches. Management of sexual consent ability included education, attitude, and advanced directives and support networks. The recurring themes that influenced these approaches included the 3 legal criteria of consent, American Bar Association and American Psychological Association Model, Lichtenberg and Strzepek Instrument, Ames and Samowitz Instrument, Lyden approach, Mental Capacity Act of 2005, and Vancouver Coastal Health Authority of 2009. Conclusions: Determining sexual consent takes a holistic approach, with individuals judged in terms of their adaptive abilities, capacities, and human rights. The attitudes of those using this holistic approach need to be balanced; otherwise, the sexual rights of assessed people could be moved either in favor or against them. The ideal outcome, after person-centered considerations of those living with cognitive disabilities includes the people themselves being involved in the process of personalizing these approaches used to facilitate healthy intimate relationships. %M 35119371 %R 10.2196/28137 %U https://www.i-jmr.org/2022/1/e28137 %U https://doi.org/10.2196/28137 %U http://www.ncbi.nlm.nih.gov/pubmed/35119371 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e32112 %T Adoption of the Website and Mobile App of a Preventive Health Program Across Neighborhoods With Different Socioeconomic Conditions in the Netherlands: Longitudinal Study %A Agachi,Elena %A Bijmolt,Tammo H A %A Mierau,Jochen O %A van Ittersum,Koert %+ Department of Marketing, Faculty of Economics and Business, University of Groningen, PO Box 800, Groningen, 9700 AV, Netherlands, 31 50 363 3686, e.agachi@rug.nl %K eHealth %K mHealth %K mobile health %K mobile app %K internet %K preventive health program %K health disparities %K NSES %K program adoption %K survival analysis %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Socioeconomic disparities in the adoption of preventive health programs represent a well-known challenge, with programs delivered via the web serving as a potential solution. The preventive health program examined in this study is a large-scale, open-access web-based platform operating in the Netherlands, which aims to improve the health behaviors and wellness of its participants. Objective: This study aims to examine the differences in the adoption of the website and mobile app of a web-based preventive health program across socioeconomic groups. Methods: The 83,466 participants in this longitudinal, nonexperimental study were individuals who had signed up for the health program between July 2012 and September 2019. The rate of program adoption per delivery means was estimated using the Prentice, Williams, and Peterson Gap–Time model, with the measure of neighborhood socioeconomic status (NSES) used to distinguish between population segments with different socioeconomic characteristics. Registration to the health program was voluntary and free, and not within a controlled study setting, allowing the observation of the true rate of adoption. Results: The estimation results indicate that program adoption across socioeconomic groups varies depending on the program’s delivery means. For the website, higher NSES groups have a higher likelihood of program adoption compared with the lowest NSES group (hazard ratio 1.03, 95% CI 1.01-1.05). For the mobile app, the opposite holds: higher NSES groups have a lower likelihood of program adoption compared with the lowest NSES group (hazard ratio 0.94, 95% CI 0.91-0.97). Conclusions: Promoting preventive health programs using mobile apps can help to increase program adoption among the lowest socioeconomic segments. Given the increasing use of mobile phones among disadvantaged population groups, structuring future health interventions to include mobile apps as means of delivery can support the stride toward diminishing health disparities. %M 35107433 %R 10.2196/32112 %U https://humanfactors.jmir.org/2022/1/e32112 %U https://doi.org/10.2196/32112 %U http://www.ncbi.nlm.nih.gov/pubmed/35107433 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e27355 %T Mobile Device Ownership, Current Use, and Interest in Mobile Health Interventions Among Low-Income Older Chinese Immigrants With Type 2 Diabetes: Cross-sectional Survey Study %A Hu,Lu %A Trinh-Shevrin,Chau %A Islam,Nadia %A Wu,Bei %A Cao,Shimin %A Freeman,Jincong %A Sevick,Mary Ann %+ Center for Healthful Behavior Change, Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, 180 Madison Ave, New York, NY, 10016, United States, 1 6465013438, lu.hu@nyumc.org %K technology use %K Chinese immigrants %K type 2 diabetes %K mHealth %K health disparities %K immigrant health %K diabetes %K mobile health %K intervention %K smartphone %K immigrant %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Chinese immigrants suffer a disproportionately high type 2 diabetes (T2D) burden and tend to have poorly controlled disease. Mobile health (mHealth) interventions have been shown to increase access to care and improve chronic disease management in minority populations. However, such interventions have not been developed for or tested in Chinese immigrants with T2D. Objective: This study aims to examine mobile device ownership, current use, and interest in mHealth interventions among Chinese immigrants with T2D. Methods: In a cross-sectional survey, Chinese immigrants with T2D were recruited from Chinese community centers in New York City. Sociodemographic characteristics, mobile device ownership, current use of social media software applications, current use of technology for health-related purposes, and interest in using mHealth for T2D management were assessed. Surveys were administered face-to-face by bilingual study staff in the participant’s preferred language. Descriptive statistics were used to characterize the study sample and summarize technology use. Results: The sample (N=91) was predominantly female (n=57, 63%), married (n=68, 75%), and had a high school education or less (n=58, 64%); most participants had an annual household income of less than US $25,000 (n=63, 69%) and had limited English proficiency (n=78, 86%). The sample had a mean age of 70 (SD 11) years. Almost all (90/91, 99%) participants had a mobile device (eg, basic cell phones, smart devices), and the majority (n=83, 91%) reported owning a smart device (eg, smartphone or tablet). WeChat was the most commonly used social media platform (65/91, 71%). When asked about their top source for diabetes-related information, 63 of the 91 participants (69%) reported health care providers, followed by 13 who reported the internet (14%), and 10 who reported family, friends, and coworkers (11%). Less than one-quarter (21/91, 23%) of the sample reported using the internet to search for diabetes-related information in the past 12 months. About one-third of the sample (34/91, 37%) reported that they had watched a health-related video on their cell phone or computer in the past 12 months. The majority (69/91, 76%) of participants reported interest in receiving an mHealth intervention in the future to help with T2D management. Conclusions: Despite high mobile device ownership, the current use of technology for health-related issues remained low in older Chinese immigrants with T2D. Given the strong interest in future mHealth interventions and high levels of social media use (eg, WeChat), future studies should consider how to leverage these existing low-cost platforms and deliver tailored mHealth interventions to this fast-growing minority group. %M 35107426 %R 10.2196/27355 %U https://aging.jmir.org/2022/1/e27355 %U https://doi.org/10.2196/27355 %U http://www.ncbi.nlm.nih.gov/pubmed/35107426 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 1 %P e26049 %T FOCUS mHealth Intervention for Veterans With Serious Mental Illness in an Outpatient Department of Veterans Affairs Setting: Feasibility, Acceptability, and Usability Study %A Buck,Benjamin %A Nguyen,Janelle %A Porter,Shelan %A Ben-Zeev,Dror %A Reger,Greg M %+ Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, United States, 1 206 221 8518, buckbe@uw.edu %K mHealth %K veterans %K schizophrenia %K serious mental illness %K mobile phone %D 2022 %7 28.1.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Veterans with serious mental illnesses (SMIs) face barriers to accessing in-person evidence-based interventions that improve illness management. Mobile health (mHealth) has been demonstrated to be feasible, acceptable, effective, and engaging among individuals with SMIs in community mental health settings. mHealth for SMIs has not been tested within the Department of Veterans Affairs (VA). Objective: This study examines the feasibility, acceptability, and preliminary effectiveness of an mHealth intervention for SMI in the context of VA outpatient care. Methods: A total of 17 veterans with SMIs were enrolled in a 1-month pilot trial of FOCUS, a smartphone-based self-management intervention for SMI. At baseline and posttest, they completed measures examining symptoms and functional recovery. The participants provided qualitative feedback related to the usability and acceptability of the intervention. Results: Veterans completed on an average of 85.0 (SD 96.1) interactions with FOCUS over the 1-month intervention period. They reported high satisfaction, usability, and acceptability, with nearly all participants (16/17, 94%) reporting that they would recommend the intervention to a fellow veteran. Clinicians consistently reported finding mHealth-related updates useful for informing their care. Qualitative feedback indicated that veterans thought mHealth complemented their existing VA services well and described potential opportunities to adapt FOCUS to specific subpopulations (eg, combat veterans) as well as specific delivery modalities (eg, groups). In the 1-month period, the participants experienced small improvements in self-assessed recovery, auditory hallucinations, and quality of life. Conclusions: The FOCUS mHealth intervention is feasible, acceptable, and usable among veterans. Future work should develop and examine VA-specific implementation approaches of FOCUS for this population. %M 35089151 %R 10.2196/26049 %U https://mental.jmir.org/2022/1/e26049 %U https://doi.org/10.2196/26049 %U http://www.ncbi.nlm.nih.gov/pubmed/35089151 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e31123 %T Assessment of Glycemic Control at St. Luke’s Free Medical Clinic: Retrospective Chart Review %A Hopper,Wade %A Fox,Justin %A Dimucci-Ward,JuliSu %+ Department of Surgery, Edward Via College of Osteopathic Medicine - Carolinas, 350 Howard St, Spartanburg, SC, 29303, United States, 1 8643279800, whopper@carolinas.vcom.edu %K free clinic %K glycemic control %K underserved %K uninsured %K diabetes %K health care delivery %K treatment program %D 2022 %7 24.1.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: A free clinic is a health care delivery model that provides primary care and pharmaceutical services exclusively to uninsured patients. With a multidisciplinary volunteer clinical staff, which includes physicians, social workers, dieticians, and osteopathic medical students, St. Luke’s Free Medical Clinic (SLFMC) cares for over 1700 patients annually in Spartanburg, South Carolina. Objective: This study aims to measure the change, over time, in patient hemoglobin A1c measurements at the SLFMC to quantify the success of the clinic’s diabetes treatment program. Methods: A prospective-retrospective chart review of patients (n=140) enrolled at the SLFMC between January 1, 2018, and January 1, 2021, was performed. Patients were stratified as having controlled (hemoglobin A1c<7.0, n=53) or uncontrolled (hemoglobin A1c≥7.0, n=87) diabetes relative to a therapeutic hemoglobin A1c target of 7.0, which is recommended by the American Diabetes Association. For both controlled and uncontrolled groups, baseline hemoglobin A1c values were compared to subsequent readings using a Wilcoxon matched-pairs signed rank test. Results from the SLFMC population were compared to the published literature on hemoglobin A1c from other free clinics. Results: Patients with uncontrolled diabetes experienced significant reductions in median hemoglobin A1c at both 6 months (P=.006) and 1 year (P=.002) from baseline. Patients with controlled diabetes showed no significant changes. Black and Hispanic patients with uncontrolled diabetes experienced a 1.0% mean improvement in hemoglobin A1c over the study window. The SLFMC’s wholly uninsured patient population showed a population rate of controlled diabetes (42%), which was similar to recent nationwide averages for adults with diabetes (51% to 56%), as reported by the National Health and Nutrition Examination Survey. The clinic’s Hispanic population (n=47) showed the greatest average improvement in hemoglobin A1c of any ethnic group from baseline. Additionally, 61% of the SLFMC’s Black population (n=33) achieved a hemoglobin A1c of <7.0 by the end of the study window, which surpassed the nationwide averages for glycemic control. Conclusions: We present free clinic hemoglobin A1c outcomes obtained through a retrospective chart review. Uninsured patients treated for diabetes at the SLFMC show a reduction in hemoglobin A1c, which is comparable to nationwide standards, although average hemoglobin A1c levels in this study were higher than nationwide averages. Black and Hispanic patients with uncontrolled diabetes showed a mean 1% improvement in hemoglobin A1c levels. These results represent some of the first in the literature emerging from a free clinic that is not affiliated with a major medical school. %M 35072636 %R 10.2196/31123 %U https://www.i-jmr.org/2022/1/e31123 %U https://doi.org/10.2196/31123 %U http://www.ncbi.nlm.nih.gov/pubmed/35072636 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 1 %P e32818 %T Social Determinants of Health Screening by Preclinical Medical Students During the COVID-19 Pandemic: Service-Based Learning Case Study %A Herrera,Tara %A Fiori,Kevin P %A Archer-Dyer,Heather %A Lounsbury,David W %A Wylie-Rosett,Judith %+ Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1310 Belfer Building, 1300 Morris Park Avenue, Bronx, NY, 10461, United States, 1 516 737 4345, judith.wylie-rosett@einsteinmed.edu %K social determinants of health %K service-based learning %K telehealth %K preclinical education %K screening %K referral %K community health workers %K determinant %K medical student %K case study %K service %K preparation %K pilot %K feasibility %K training %K assessment %K needs %K electronic health record %K questionnaire %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: The inclusion of social determinants of health is mandated for undergraduate medical education. However, little is known about how to prepare preclinical students for real-world screening and referrals for addressing social determinants of health. Objective: This pilot project’s objective was to evaluate the feasibility of using a real-world, service-based learning approach for training preclinical students to assess social needs and make relevant referrals via the electronic medical record during the COVID-19 pandemic (May to June 2020). Methods: This project was designed to address an acute community service need and to teach preclinical, second-year medical student volunteers (n=11) how to assess social needs and make referrals by using the 10-item Social Determinants of Health Screening Questionnaire in the electronic health record (EHR; Epic platform; Epic Systems Corporation). Third-year medical student volunteers (n=3), who had completed 6 clinical rotations, led the 2-hour skills development orientation and were available for ongoing mentoring and peer support. All student-patient communication was conducted by telephone, and bilingual (English and Spanish) students called the patients who preferred to communicate in Spanish. We analyzed EHR data extracted from Epic to evaluate screening and data extracted from REDCap (Research Electronic Data Capture; Vanderbilt University) to evaluate community health workers’ notes. We elicited feedback from the participating preclinical students to evaluate the future use of this community-based service learning approach in our preclinical curriculum. Results: The preclinical students completed 45 screening interviews. Of the 45 screened patients, 20 (44%) screened positive for at least 1 social need. Almost all of these patients (19/20, 95%) were referred to the community health worker. Half (8/16, 50%) of the patients who had consultations with the community health worker were connected with a relevant social service resource. The preclinical students indicated that project participation increased their ability to assess social needs and make needed EHR referrals. Food insecurity was the most common social need. Conclusions: Practical exposure to social needs assessment has the potential to help preclinical medical students develop the ability to address social concerns prior to entering clinical clerkships in their third year of medical school. The students can also become familiar with the EHR prior to entering third-year clerkships. Physicians, who are aware of social needs and have the electronic medical record tools and staff resources needed to act, can create workflows to make social needs assessments and services integral components of health care. Research studies and quality improvement initiatives need to investigate how to integrate screening for social needs and connecting patients to the appropriate social services into routine primary care procedures. %M 35037885 %R 10.2196/32818 %U https://mededu.jmir.org/2022/1/e32818 %U https://doi.org/10.2196/32818 %U http://www.ncbi.nlm.nih.gov/pubmed/35037885 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e32442 %T COVID-19’s Influence on Information and Communication Technologies in Long-Term Care: Results From a Web-Based Survey With Long-Term Care Administrators %A Schuster,Amy M %A Cotten,Shelia R %+ Department of Sociology, Anthropology, and Criminal Justice, Clemson University, 132 Brackett Hall, Clemson, SC, 29634, United States, 1 904 294 7893, amschus@clemson.edu %K COVID-19 %K pandemic %K socioemotional needs %K long-term care %K nursing home facility %K assisted living facility %K elderly %K older adults %K information and communication technologies %K support %K emotion %K needs %K access %K connection %K communication %K engagement %D 2022 %7 12.1.2022 %9 Original Paper %J JMIR Aging %G English %X Background: The prevalence of COVID-19 in the United States led to mandated lockdowns for long-term care (LTC) facilities, resulting in loss of in-person contact with social ties for LTC residents. Though information and communication technologies (ICTs) can be used by LTC residents to support their socioemotional needs, residents must have access to ICTs to use them. Objective: This study explored ICT access and use in LTC facilities and how LTC facilities adapted to try to enhance social connections for their residents during the COVID-19 pandemic. Methods: LTC administrators in South Carolina (United States) were invited to complete a web-based survey exploring ICT access and use in LTC facilities and whether access and use changed as a result of the COVID-19 pandemic. Results: LTC administrators (N=70, 12 nursing homes [NHs], and 58 assisted living facilities [ALFs]) completed the web-based survey. Since March 2020, a total of 53% (37/70) of the LTC facilities have purchased ICTs for residents’ use. ICTs have mainly been used for videoconferencing with family members (31/36, 86%), friends (25/36, 69%), and health care providers (26/36, 72%). NHs were 10.23 times more likely to purchase ICTs for residents’ use during the COVID-19 pandemic than ALFs (odds ratio 11.23, 95% CI 1.12-113.02; P=.04). Benefits of ICT use included residents feeling connected to their family members, friends, and other residents. Barriers to ICT use included staff not having time to assist residents with using the technology, nonfunctional technology, and residents who do not want to share technology. Conclusions: Our results suggest that over half of the LTC facilities in this study were able to acquire ICTs for their residents to use during the COVID-19 pandemic. Additional research is needed to explore how residents adapted to using the ICTs and whether LTC facilities developed and adopted technology integration plans, which could help them be prepared for future situations that may affect LTC residents’ engagement and communication opportunities, such as another pandemic. %M 34878989 %R 10.2196/32442 %U https://aging.jmir.org/2022/1/e32442 %U https://doi.org/10.2196/32442 %U http://www.ncbi.nlm.nih.gov/pubmed/34878989 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e30749 %T Determining the Prevalence and Incidence of SARS-CoV-2 Infection in Prisons in England: Protocol for a Repeated Panel Survey and Enhanced Outbreak Study %A Plugge,Emma %A Burke,Danielle %A Czachorowski,Maciej %A Gutridge,Kerry %A Maxwell,Fiona %A McGrath,Nuala %A O'Mara,Oscar %A O'Moore,Eamonn %A Parkes,Julie %+ University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, United Kingdom, 44 07789033336, emma.plugge@phe.gov.uk %K COVID-19 %K epidemiology %K prison %K outbreak %K testing %K health inequalities %K SARS-CoV-2 %D 2022 %7 12.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: There are over 80,000 people imprisoned in England and Wales in 117 prisons. The management of the COVID-19 pandemic presents particular challenges in this setting where confined, crowded, and poorly ventilated conditions facilitate the rapid spread of infectious diseases. Objective: The COVID-19 in Prison Study aims to examine the epidemiology of SARS-CoV-2 in prisons in England in order to inform public health policy and practice during the pandemic and recovery. The primary objective is to estimate the proportion of positive tests of SARS-CoV-2 infection among residents and staff within selected prisons. The secondary objectives include estimating the incidence rate of SARS-CoV-2 infection and examining how the proportion of positive tests and the incidence rate vary among individual, institutional, and system level factors. Methods: Phase 1 comprises a repeated panel survey of prison residents and staff in a representative sample of 28 prisons across England. All residents and staff in the study prisons are eligible for inclusion. Participants will be tested for SARS-CoV-2 using a nasopharyngeal swab twice (6 weeks apart). Staff will also be tested for antibodies to SARS-CoV-2. Phase 2 focuses on SARS-CoV-2 infection in prisons with recognized COVID-19 outbreaks. Any prison in England will be eligible to participate if an outbreak is declared. In 3 outbreak prisons, all participating staff and residents will be tested for SARS-CoV-2 antigens at the following 3 timepoints: as soon as possible after the outbreak is declared (day 0), 7 days later (day 7), and at day 28. They will be swabbed twice (a nasal swab for lateral flow device testing and a nasopharyngeal swab for polymerase chain reaction testing). Testing will be done by external contractors. Data will also be collected on individual, prison level, and community factors. Data will be stored and handled at the University of Southampton and Public Health England. Summary statistics will summarize the prison and participant characteristics. For the primary objective, simple proportions of individuals testing positive for SARS-CoV-2 and incidence rates will be calculated. Linear regression will examine the individual, institutional, system, and community factors associated with SARS-CoV-2 infection within prisons. Results: The UK Government’s Department for Health and Social Care funds the study. Data collection started on July 20, 2020, and will end on May 31, 2021. As of May 2021, we had enrolled 4192 staff members and 6496 imprisoned people in the study. Data analysis has started, and we expect to publish the initial findings in summer/autumn 2021. The main ethical consideration is the inclusion of prisoners, who are vulnerable participants. Conclusions: This study will provide unique data to inform the public health management of SARS-CoV-2 in prisons. Its findings will be of relevance to health policy makers and practitioners working in prisons. International Registered Report Identifier (IRRID): DERR1-10.2196/30749 %M 34751157 %R 10.2196/30749 %U https://www.researchprotocols.org/2022/1/e30749 %U https://doi.org/10.2196/30749 %U http://www.ncbi.nlm.nih.gov/pubmed/34751157 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e25419 %T Designing Effective eHealth Interventions for Underserved Groups: Five Lessons From a Decade of eHealth Intervention Design and Deployment %A Lee,Edmund WJ %A McCloud,Rachel F %A Viswanath,Kasisomayajula %+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, 31 Nanyang Link, Wee Kim Wee School of Communication and Information Building, Singapore, 637718, Singapore, 65 69083429, elwj88@gmail.com %K eHealth %K mobile health %K communication inequalities %K health disparities %K health informatics %K mobile phone %D 2022 %7 7.1.2022 %9 Viewpoint %J J Med Internet Res %G English %X Despite the proliferation of eHealth interventions, such as web portals, for health information dissemination or the use of mobile apps and wearables for health monitoring, research has shown that underserved groups do not benefit proportionately from these eHealth interventions. This is largely because of usability issues and the lack of attention to the broader structural, physical, and psychosocial barriers to technology adoption and use. The objective of this paper is to draw lessons from a decade of experience in designing different user-centered eHealth interventions (eg, web portals and health apps) to inform future work in leveraging technology to address health disparities. We draw these lessons from a series of interventions from the work we have done over 15 years in the Viswanath laboratory at the Dana-Farber Cancer Institute and Harvard TH Chan School of Public Health, focusing on three projects that used web portals and health apps targeted toward underserved groups. The projects were the following: Click to Connect, which was a community-based eHealth intervention that aimed to improve internet skills and health literacy among underserved groups by providing home access to high-speed internet, computer, and internet training classes, as well as a dedicated health web portal with ongoing technical support; PLANET MassCONECT, which was a knowledge translation project that built capacity among community-based organizations in Boston, Lawrence, and Worcester in Massachusetts to adopt evidence-based health promotion programs; and Smartphone App for Public Health, which was a mobile health research that facilitated both participatory (eg, surveys) and passive data (eg, geolocations and web-browsing behaviors) collection for the purpose of understanding tobacco message exposure in individuals’ built environment. Through our work, we distilled five key principles for researchers aiming to design eHealth interventions for underserved groups. They are as follows: develop a strategic road map to address communication inequalities (ie, a concrete action plan to identify the barriers faced by underserved groups and customize specific solutions to each of them), engage multiple stakeholders from the beginning for the long haul, design with usability—readability and navigability—in mind, build privacy safeguards into eHealth interventions and communicate privacy–utility tradeoffs in simplicity, and strive for an optimal balance between open science aspirations and protection of underserved groups. %M 34994700 %R 10.2196/25419 %U https://www.jmir.org/2022/1/e25419 %U https://doi.org/10.2196/25419 %U http://www.ncbi.nlm.nih.gov/pubmed/34994700 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e29872 %T COVID-19 Vaccine Hesitancy and Acceptance Among Individuals With Cancer, Autoimmune Diseases, or Other Serious Comorbid Conditions: Cross-sectional, Internet-Based Survey %A Tsai,Richard %A Hervey,John %A Hoffman,Kathleen %A Wood,Jessica %A Johnson,Jennifer %A Deighton,Dana %A Clermont,Donald %A Loew,Brian %A Goldberg,Stuart L %+ Inspire, 3101 Wilson Boulevard, Suite 220, Arlington, VA, 22201, United States, 1 800 945 0381, richard@inspire.com %K COVID-19 %K vaccine %K hesitancy %K cancer %K autoimmune diseases %K vaccination %K comorbidities %K SARS-CoV-2 %K survey %K cross-sectional %K survey %K incidence %K safety %K vulnerable %K perception %K attitude %D 2022 %7 5.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Individuals with comorbid conditions have been disproportionately affected by COVID-19. Since regulatory trials of COVID-19 vaccines excluded those with immunocompromising conditions, few patients with cancer and autoimmune diseases were enrolled. With limited vaccine safety data available, vulnerable populations may have conflicted vaccine attitudes. Objective: We assessed the prevalence and independent predictors of COVID-19 vaccine hesitancy and acceptance among individuals with serious comorbidities and assessed self-reported side effects among those who had been vaccinated. Methods: We conducted a cross-sectional, 55-item, online survey, fielded January 15, 2021 through February 22, 2021, among a random sample of members of Inspire, an online health community of over 2.2 million individuals with comorbid conditions. Multivariable regression analysis was utilized to determine factors independently associated with vaccine hesitancy and acceptance. Results: Of the 996,500 members of the Inspire health community invited to participate, responses were received from 21,943 individuals (2.2%). Respondents resided in 123 countries (United States: 16,277/21,943, 74.2%), had a median age range of 56-65 years, were highly educated (college or postgraduate degree: 10,198/17,298, 58.9%), and had diverse political leanings. All respondents self-reported at least one comorbidity: cancer, 27.3% (5459/19,980); autoimmune diseases, 23.2% (4946/21,294); chronic lung diseases: 35.4% (7544/21,294). COVID-19 vaccine hesitancy was identified in 18.6% (3960/21,294), with 10.3% (2190/21,294) declaring that they would not, 3.5% (742/21,294) stating that they probably would not, and 4.8% (1028/21,294) not sure whether they would agree to be vaccinated. Hesitancy was expressed by the following patients: cancer, 13.4% (731/5459); autoimmune diseases, 19.4% (962/4947); chronic lung diseases: 17.8% (1344/7544). Positive predictors of vaccine acceptance included routine influenza vaccination (odds ratio [OR] 1.53), trust in responsible vaccine development (OR 14.04), residing in the United States (OR 1.31), and never smoked (OR 1.06). Hesitancy increased with a history of prior COVID-19 (OR 0.86), conservative political leaning (OR 0.93), younger age (OR 0.83), and lower education level (OR 0.90). One-quarter (5501/21,294, 25.8%) had received at least one COVID-19 vaccine injection, and 6.5% (1390/21,294) completed a 2-dose series. Following the first injection, 69.0% (3796/5501) self-reported local reactions, and 40.0% (2200/5501) self-reported systemic reactions, which increased following the second injection to 77.0% (1070/1390) and 67.0% (931/1390), respectively. Conclusions: In this survey of individuals with serious comorbid conditions, significant vaccine hesitancy remained. Assumptions that the most vulnerable would automatically accept COVID-19 vaccination are erroneous and thus call for health care team members to initiate discussions focusing on the impact of the vaccine on an individual’s underlying condition. Early self-reported side effect experiences among those who had already been vaccinated, as expressed by our population, should be reassuring and might be utilized to alleviate vaccine fears. Health care–related social media forums that rapidly disseminate accurate information about the COVID-19 vaccine may play an important role. %M 34709184 %R 10.2196/29872 %U https://publichealth.jmir.org/2022/1/e29872 %U https://doi.org/10.2196/29872 %U http://www.ncbi.nlm.nih.gov/pubmed/34709184 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e25586 %T Dose–Response Effects of Patient Engagement on Health Outcomes in an mHealth Intervention: Secondary Analysis of a Randomized Controlled Trial %A Li,Yiran %A Guo,Yan %A Hong,Y Alicia %A Zeng,Yu %A Monroe-Wise,Aliza %A Zeng,Chengbo %A Zhu,Mengting %A Zhang,Hanxi %A Qiao,Jiaying %A Xu,Zhimeng %A Cai,Weiping %A Li,Linghua %A Liu,Cong %+ Department of Medical Statistics, School of Public Health, 74 Zhongshan 2nd Road, Guangzhou, 510080, China, 86 020 87333239, Yan.Guo1@umassmed.edu %K mHealth %K patient engagement %K dose–response relationship %K long-term effect %K generalized linear mixed effects model %D 2022 %7 4.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The dose–response relationship between patient engagement and long-term intervention effects in mobile health (mHealth) interventions are understudied. Studies exploring long-term and potentially changing relationships between patient engagement and health outcomes in mHealth interventions are needed. Objective: This study aims to examine dose–response relationships between patient engagement and 3 psychosocial outcomes in an mHealth intervention, Run4Love, using repeated measurements of outcomes at baseline and 3, 6, and 9 months. Methods: This study is a secondary analysis using longitudinal data from the Run4Love trial, a randomized controlled trial with 300 people living with HIV and elevated depressive symptoms to examine the effects of a 3-month mHealth intervention on reducing depressive symptoms and improving quality of life (QOL). We examined the relationships between patient engagement and depressive symptoms, QOL, and perceived stress in the intervention group (N=150) using 4–time-point outcome measurements. Patient engagement was assessed using the completion rate of course assignments and frequency of items completed. Cluster analysis was used to categorize patients into high- and low-engagement groups. Generalized linear mixed effects models were conducted to investigate the dose–response relationships between patient engagement and outcomes. Results: The cluster analysis identified 2 clusters that were distinctively different from each other. The first cluster comprised 72 participants with good compliance to the intervention, completing an average of 74% (53/72) of intervention items (IQR 0.22). The second cluster comprised 78 participants with low compliance to the intervention, completing an average of 15% (11/72) of intervention items (IQR 0.23). Results of the generalized linear mixed effects models showed that, compared with the low-engagement group, the high-engagement group had a significant reduction in more depressive symptoms (β=−1.93; P=.008) and perceived stress (β=−1.72; P<.001) and an improved QOL (β=2.41; P=.01) over 9 months. From baseline to 3, 6, and 9 months, the differences in depressive symptoms between the 2 engagement groups were 0.8, 1.6, 2.3, and 3.7 points, respectively, indicating widening between-group differences over time. Similarly, between-group differences in QOL and perceived stress increased over time (group differences in QOL: 0.9, 1.9, 4.7, and 5.1 points, respectively; group differences in the Perceived Stress Scale: 0.9, 1.4, 2.3, and 3.0 points, respectively). Conclusions: This study revealed a positive long-term dose–response relationship between patient engagement and 3 psychosocial outcomes among people living with HIV and elevated depressive symptoms in an mHealth intervention over 9 months using 4 time-point repeat measurement data. The high- and low-engagement groups showed significant and widening differences in depressive symptoms, QOL, and perceived stress at the 3-, 6-, and 9-month follow-ups. Future mHealth interventions should improve patient engagement to achieve long-term and sustained intervention effects. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://www.chictr.org.cn/showproj.aspx?proj=21019 %M 34982724 %R 10.2196/25586 %U https://mhealth.jmir.org/2022/1/e25586 %U https://doi.org/10.2196/25586 %U http://www.ncbi.nlm.nih.gov/pubmed/34982724 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e27696 %T A Mobile Intervention to Link Young Female Entertainment Workers in Cambodia to Health and Gender-Based Violence Services: Randomized Controlled Trial %A Brody,Carinne %A Chhoun,Pheak %A Tuot,Sovannary %A Fehrenbacher,Anne E %A Moran,Alexander %A Swendeman,Dallas %A Yi,Siyan %+ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore, 65 87533823, siyan@nus.edu.sg %K mHealth %K female sex workers %K HIV %K sexually transmitted infection %K linkage to services %K sexual and reproductive health %K gender-based violence %K low- and middle-income countries %D 2022 %7 4.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Female entertainment workers (FEWs) in Cambodia experience a greater prevalence of human immunodeficiency virus (HIV), other sexually transmitted infections (STIs), psychological distress, substance abuse, and gender-based violence (GBV) than the general female population. Reaching FEWs with health education and linking them to services has been difficult because of their hidden and stigmatized status. Objective: This study evaluated the efficacy of the Mobile Link intervention in improving FEWs’ health by engaging and connecting them to existing HIV, sexual and reproductive health, and GBV services. Methods: A randomized controlled trial was conducted between March 2018 and June 2019 in the capital city and 3 other provinces in Cambodia. FEWs in the intervention arm received automated twice-weekly Short Message Service messages and voice messages with health information and direct links to outreach workers. The control group received the existing standard care, including free HIV and STI counseling and testing and a toll-free helpline staffed by trained counselors. We used a stratified random sampling method to select participants from 5 study sites in the 4 selected provinces. Initially, we randomly selected 600 participants from a list of 4000 FEWs by age group (18-24 and 25-30 years) and study site using a random number generator and enrolled them in person. The primary outcome measures included self-reported HIV and STI testing, condom use, and contraceptive use assessed through a face-to-face structured interview. We also measured secondary outcomes, including contact with outreach workers, escorted referral service use, forced drinking, and GBV experiences. Intervention effects were modeled using repeated measures, multilevel mixed-effects logistic regression. Results: A total of 1118 participants were recruited and enrolled in the study. We included 218 FEWs in the intervention arm and 170 FEWs in the control arm in the per protocol analyses after removing 730 dropouts. Evidence of positive intervention effects was detected for the following secondary outcomes: contacting an outreach worker (at 30 weeks: adjusted odds ratio [AOR] 3.29, 95% CI 1.28-8.47), receiving an escorted referral (at 30 weeks: AOR 2.86, 95% CI 1.09-7.52; at 60 weeks: AOR 8.15, 95% CI 1.65-40.25), and never being forced to drink at work (at 60 weeks: AOR 3.95, 95% CI 1.62-9.60). Over time, no significant differences between intervention and control groups were observed for any primary outcomes in the fully adjusted models. Conclusions: The Mobile Link intervention effectively connected FEWs with outreach workers and escorted referrals but did not show an effect on primary outcomes. Reduced forced drinking at work was also significantly more extensive in the intervention group than in the control group. Longer-term messaging may increase access to services and impact FEWs’ health outcomes in the future. Trial Registration: Clinicaltrials.gov NCT03117842; https://clinicaltrials.gov/ct2/show/NCT03117842 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2614-7 %M 34982716 %R 10.2196/27696 %U https://www.jmir.org/2022/1/e27696 %U https://doi.org/10.2196/27696 %U http://www.ncbi.nlm.nih.gov/pubmed/34982716 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31665 %T Digital Interventions to Improve Health Literacy Among Parents of Children Aged 0 to 12 Years With a Health Condition: Systematic Review %A Mörelius,Evalotte %A Robinson,Suzanne %A Arabiat,Diana %A Whitehead,Lisa %+ School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia, 61 8 6304 2272, e.morelius@ecu.edu.au %K child %K child health services %K digital technology %K health literacy %K infant %K internet-based intervention %K parents %K patient compliance %K pediatric hospitals %D 2021 %7 22.12.2021 %9 Review %J J Med Internet Res %G English %X Background: Parental health literacy is associated with child health outcomes. Parents are increasingly turning to the internet to obtain health information. In response, health care providers are using digital interventions to communicate information to assist parents in managing their child’s health conditions. Despite the emergence of interventions to improve parental health literacy, to date, no systematic evaluation of the effectiveness of the interventions has been undertaken. Objective: The aim of this review is to examine the effect of digital health interventions on health literacy among parents of children aged 0-12 years with a health condition. This includes evaluating parents’ engagement (use and satisfaction) with digital health interventions, the effect of these interventions on parental health knowledge and health behavior, and the subsequent impact on child health outcomes. Methods: This systematic review was registered a priori on PROSPERO (International Prospective Register of Systematic Reviews) and developed according to the Joanna Briggs Institute methodology for systematic reviews. The databases CINAHL, MEDLINE, and PsycINFO were searched for relevant literature published between January 2010 and April 2021. Studies were included if they were written in English. A total of 2 authors independently assessed the search results and performed a critical appraisal of the studies. Results: Following the review of 1351 abstracts, 31 (2.29%) studies were selected for full-text review. Of the 31 studies, 6 (19%) studies met the inclusion criteria. Of the 6 studies, 1 (17%) was excluded following the critical appraisal, and the 5 (83%) remaining studies were quantitative in design and included digital health interventions using web-based portals to improve parents’ health knowledge and health behavior. Owing to heterogeneity in the reported outcomes, meta-analysis was not possible, and the findings were presented in narrative form. Of the 5 studies, satisfaction was measured in 3 (60%) studies, and all the studies reported high satisfaction with the digital intervention. All the studies reported improvement in parental health literacy at postintervention as either increase in disease-specific knowledge or changes in health behavior. Of the 5 studies, only 1 (20%) study included child health outcomes, and this study reported significant improvements related to increased parental health knowledge. Conclusions: In response to a pandemic such as COVID-19, there is an increased need for evidence-based digital health interventions for families of children living with health conditions. This review has shown the potential of digital health interventions to improve health knowledge and behavior among parents of young children with a health condition. However, few digital health interventions have been developed and evaluated for this population. Future studies with robust research designs are needed and should include the potential benefits of increased parent health literacy for the child. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020192386; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=192386 %M 34941559 %R 10.2196/31665 %U https://www.jmir.org/2021/12/e31665 %U https://doi.org/10.2196/31665 %U http://www.ncbi.nlm.nih.gov/pubmed/34941559 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e28305 %T Anti-Asian Sentiments During the COVID-19 Pandemic Across 20 Countries: Analysis of a 12-Billion-Word News Media Database %A Ng,Reuben %+ Lee Kuan Yew School of Public Policy, National University of Singapore, 469C Bukit Timah Rd, Singapore, 259772, Singapore, 65 66015229, spprng@nus.edu.sg %K racism %K COVID-19 %K anti-Asian sentiments %K psychomics %K quantitative social science %K culture %K text as data %K xenophobia %K digital humanities %D 2021 %7 8.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: US president Joe Biden signed an executive action directing federal agencies to combat hate crimes and racism against Asians, which have percolated during the COVID-19 pandemic. This is one of the first known empirical studies to dynamically test whether global societal sentiments toward Asians have become more negative during the COVID-19 pandemic. Objective: This study aimed to investigate whether global societal sentiments toward Asians across 20 countries have become more negative, month by month, from before the pandemic (October 2019) to May 2020, along with the pandemic (incidence and mortality rates) and cultural (Hofstede’s cultural dimensions) predictors of this trend. Methods: We leveraged a 12-billion-word web-based media database, with over 30 million newspaper and magazine articles taken from over 7000 sites across 20 countries, and identified 6 synonyms of “Asian” that are related to the coronavirus. We compiled their most frequently used descriptors (collocates) from October 2019 to May 2020 across 20 countries, culminating in 85,827 collocates that were rated by 2 independent researchers to provide a Cumulative Asian Sentiment Score (CASS) per month. This allowed us to track significant shifts in societal sentiments toward Asians from a baseline period (October to December 2019) to the onset of the pandemic (January to May 2020). We tested the competing predictors of this trend: pandemic variables of incidence and mortality rates measured monthly for all 20 countries taken from the Oxford COVID-19 Government Response Tracker, and Hofstede’s Cultural Dimensions of Individualism, Power Distance, Uncertainty Avoidance, and Masculinity for the 20 countries. Results: Before the pandemic in December 2019, Jamaica and New Zealand evidenced the most negative societal sentiments toward Asians; when news about the coronavirus was released in January 2020, the United States and Nigeria evidenced the most negative sentiments toward Asians among 20 countries. Globally, sentiments of Asians became more negative—a significant linear decline during the COVID-19 pandemic. CASS trended neutral before the pandemic during the baseline period of October to November 2019 and then plummeted in February 2020. CASS were, ironically, not predicted by COVID-19’s incidence and mortality rates, but rather by Hofstede’s cultural dimensions: individualism, power distance, and uncertainty avoidance—as shown by mixed models (N=28,494). Specifically, higher power distance, individualism, and uncertainty avoidance were associated with negative societal sentiments toward Asians. Conclusions: Racism, in the form of Anti-Asian sentiments, are deep-seated, and predicated on structural undercurrents of culture. The COVID-19 pandemic may have indirectly and inadvertently exacerbated societal tendencies for racism. Our study lays the important groundwork to design interventions and policy communications to ameliorate Anti-Asian racism, which are culturally nuanced and contextually appropriate. %M 34678754 %R 10.2196/28305 %U https://www.jmir.org/2021/12/e28305 %U https://doi.org/10.2196/28305 %U http://www.ncbi.nlm.nih.gov/pubmed/34678754 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e28503 %T Early Patient-Centered Outcomes Research Experience With the Use of Telehealth to Address Disparities: Scoping Review %A Bailey,James E %A Gurgol,Cathy %A Pan,Eric %A Njie,Shirilyn %A Emmett,Susan %A Gatwood,Justin %A Gauthier,Lynne %A Rosas,Lisa G %A Kearney,Shannon M %A Robler,Samantha Kleindienst %A Lawrence,Raymona H %A Margolis,Karen L %A Osunkwo,Ifeyinwa %A Wilfley,Denise %A Shah,Vallabh O %+ Tennessee Population Health Consortium, University of Tennessee Health Science Center, Coleman Building, Suite D222, 956 Court Avenue, Memphis, TN, 38163, United States, 1 9014482475, jeb@uthsc.edu %K telehealth %K scoping review %K disparities %K implementation science %D 2021 %7 7.12.2021 %9 Review %J J Med Internet Res %G English %X Background: Health systems and providers across America are increasingly employing telehealth technologies to better serve medically underserved low-income, minority, and rural populations at the highest risk for health disparities. The Patient-Centered Outcomes Research Institute (PCORI) has invested US $386 million in comparative effectiveness research in telehealth, yet little is known about the key early lessons garnered from this research regarding the best practices in using telehealth to address disparities. Objective: This paper describes preliminary lessons from the body of research using study findings and case studies drawn from PCORI seminal patient-centered outcomes research (PCOR) initiatives. The primary purpose was to identify common barriers and facilitators to implementing telehealth technologies in populations at risk for disparities. Methods: A systematic scoping review of telehealth studies addressing disparities was performed. It was guided by the Arksey and O’Malley Scoping Review Framework and focused on PCORI’s active portfolio of telehealth studies and key PCOR identified by study investigators. We drew on this broad literature using illustrative examples from early PCOR experience and published literature to assess barriers and facilitators to implementing telehealth in populations at risk for disparities, using the active implementation framework to extract data. Major themes regarding how telehealth interventions can overcome barriers to telehealth adoption and implementation were identified through this review using an iterative Delphi process to achieve consensus among the PCORI investigators participating in the study. Results: PCORI has funded 89 comparative effectiveness studies in telehealth, of which 41 assessed the use of telehealth to improve outcomes for populations at risk for health disparities. These 41 studies employed various overlapping modalities including mobile devices (29/41, 71%), web-based interventions (30/41, 73%), real-time videoconferencing (15/41, 37%), remote patient monitoring (8/41, 20%), and store-and-forward (ie, asynchronous electronic transmission) interventions (4/41, 10%). The studies targeted one or more of PCORI’s priority populations, including racial and ethnic minorities (31/41, 41%), people living in rural areas, and those with low income/low socioeconomic status, low health literacy, or disabilities. Major themes identified across these studies included the importance of patient-centered design, cultural tailoring of telehealth solutions, delivering telehealth through trusted intermediaries, partnering with payers to expand telehealth reimbursement, and ensuring confidential sharing of private information. Conclusions: Early PCOR evidence suggests that the most effective health system- and provider-level telehealth implementation solutions to address disparities employ patient-centered and culturally tailored telehealth solutions whose development is actively guided by the patients themselves to meet the needs of specific communities and populations. Further, this evidence shows that the best practices in telehealth implementation include delivery of telehealth through trusted intermediaries, close partnership with payers to facilitate reimbursement and sustainability, and safeguards to ensure patient-guided confidential sharing of personal health information. %M 34878986 %R 10.2196/28503 %U https://www.jmir.org/2021/12/e28503 %U https://doi.org/10.2196/28503 %U http://www.ncbi.nlm.nih.gov/pubmed/34878986 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e31657 %T Comparing Social Media and In-Person Recruitment: Lessons Learned From Recruiting Substance-Using, Sexual and Gender Minority Adolescents and Young Adults for a Randomized Control Trial %A Parker,Jayelin N %A Hunter,Alexis S %A Bauermeister,Jose A %A Bonar,Erin E %A Carrico,Adam %A Stephenson,Rob %+ Center for Sexuality and Health Disparities, University of Michigan, 400 N Ingalls, Room 3340, Ann Arbor, MI, 48109, United States, 1 2488609446, jayelinp@umich.edu %K HIV testing %K substance use %K recruitment %K sexual and gender minorities %K youth %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Recruiting large samples of diverse sexual and gender minority adolescent and young adults (AYAs) into HIV intervention research is critical to the development and later dissemination of interventions that address the risk factors for HIV transmission among substance-using, sexual and gender minority AYAs. Objective: This paper aimed to describe the characteristics of the samples recruited via social media and in-person methods and makes recommendations for strategies to recruit substance-using, sexual and gender minority AYAs, a hardly reached population that is a priority for HIV prevention research. Methods: Using data from a randomized control trial of an HIV and substance use intervention with sexual and gender minority AYAs, aged 15 to 29 years in southeastern Michigan (n=414), we examined demographic and behavioral characteristics associated with successful recruitment from a range of virtual and physical venues. Results: We found that paid advertisements on Facebook, Instagram, and Grindr offered the largest quantity of eligible participants willing to enroll in the trial. Instagram offered the largest proportion of transgender masculine participants, and Grindr offered the largest proportion of Black/African American individuals. Although we attempted venue-based recruitment at clubs, bars, community centers, and AIDS service organizations, we found it to be unsuccessful for this specific hardly reached population. Social media and geobased dating applications offered the largest pool of eligible participants. Conclusions: Understanding factors associated with successful recruitment has the potential to inform effective and efficient strategies for HIV prevention research with substance-using, sexual and gender AYAs. Trial Registration: ClinicalTrials.gov NCT02945436; https://clinicaltrials.gov/ct2/show/NCT02945436 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.9414 %M 34855613 %R 10.2196/31657 %U https://publichealth.jmir.org/2021/12/e31657 %U https://doi.org/10.2196/31657 %U http://www.ncbi.nlm.nih.gov/pubmed/34855613 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 13 %N 3 %P e29945 %T Developing Graphic Messages for Vaping Prevention Among Black and Latino Adolescents: Participatory Research Approach %A Cartujano-Barrera,Francisco %A Azogini,Chiamaka %A McIntosh,Scott %A Bansal-Travers,Maansi %A Ossip,Deborah J %A Cupertino,Ana Paula %+ Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd, Box 420644, Rochester, NY, 14642, United States, 1 585 298 2031, Francisco_cartujano@urmc.rochester.edu %K vaping %K electronic cigarettes %K adolescents %K Latino %K Black %D 2021 %7 23.11.2021 %9 Original Paper %J J Particip Med %G English %X Background: As an important transition stage in human development, adolescence is a critical window for vaping prevention. There is a substantial gap in communication research on vaping prevention among racial and ethnic minority groups. Their representation is essential to develop, implement, and disseminate innovative and effective interventions for vaping prevention. Objective: The aim of this study is to describe the participatory research (PR) procedures used with Black and Latino adolescents to develop culturally and linguistically appropriate graphic messages for vaping prevention. Methods: This PR study used a qualitative, user-centered design method. We conducted a series of focus groups with 16 Black and Latino adolescents to develop culturally and linguistically appropriate graphic messages for vaping prevention. The biobehavioral model of nicotine addiction provided a framework for the development of the graphic messages. Participants met 4 times to provide iterative feedback on the graphic messages until they reached a consensus on overall quality and content. Results: At baseline, the participants’ mean age was 15.4 years (SD 1.4). Of the participants, 50% (8/16) were female, 88% (14/16) were heterosexual, 56% (9/16) were Black/African American, and 44% (7/16) were Hispanic/Latino. A total of 12 of the 16 participants (75%) chose to participate in the English sessions. Participants decided to create four types of graphic messages: (1) financial reward, (2) health reward, (3) social norms, and (4) self-efficacy. Meeting 4 times with the 4 groups provided sufficient opportunities for iterative feedback on the graphic messages to reach a consensus on overall quality and content. Conclusions: It is feasible and practical to build PR among Black and Latino adolescents focused on vaping prevention. Adolescents added innovation and creativity to the development of culturally and linguistically appropriate graphic messages for vaping prevention. Appropriate staffing, funding, and approaches are key for successful PR efforts among Black and Latino adolescents. Future research is needed to evaluate the impact of the graphic messages on vaping prevention. %M 34812734 %R 10.2196/29945 %U https://jopm.jmir.org/2021/3/e29945 %U https://doi.org/10.2196/29945 %U http://www.ncbi.nlm.nih.gov/pubmed/34812734 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e32591 %T Exploring Online Health Reviews to Monitor COVID-19 Public Health Responses in Alabama State Department of Corrections: Case Example %A Valera,Pamela %A Carmona,David %A Malarkey,Sarah %A Sinangil,Noah %A Owens,Madelyn %A Lefebre,Asia %+ Department of Urban-Global Public Health, Rutgers School of Public Health, 1 Riverfront Plaza, 10th Floor, Newark, NJ, 07102, United States, 1 9739726555, pv181@sph.rutgers.edu %K Alabama %K correctional facilities %K COVID-19 %K online health reviews %K review %K monitoring %K public health %K policy %K response %K prison %K United States %K case study %K formative %K feasibility %K acceptability %K survey %D 2021 %7 10.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19, caused by SARS-CoV-2, has devastated incarcerated people throughout the United States. Objective: The purpose of this study was to test the feasibility and acceptability of a COVID-19 Health Review for Correctional Facilities. Methods: The COVID-19 Health Review survey for the Department of Corrections was developed in Qualtrics to assess the following: (1) COVID-19 testing, (2) providing personal protective equipment, (3) vaccination procedures, (4) quarantine procedures, (5) COVID-19 mortality rates for inmates, (6) COVID-19 mortality rates for correctional officers and prison staff, (7) COVID-19 infection rates for inmates, (8) COVID-19 infection rates for correctional officers and prison staff, and (9) uptake of COVID-19 vaccines. The estimated time to review the Alabama State Department of Corrections COVID-19 responses on their website and complete the survey items was 45 minutes to 1 hour. Results: Of the 21 participants who completed the COVID-19 Health Review for Correctional Facilities survey, 48% (n=10) identified as female, 43% (n=9) identified as male, and 10% (n=2) identified as transgender. For race, 29% (n=6) self-identified as Black or African American, 24% (n=5) Asian, 24% (n=5) White, 5% (n=1) Pacific Islander or Native Hawaiian, and 19% (n=4) Other. In addition, 5 respondents self-identified as returning citizens. For COVID-19 review questions, the majority concluded that information on personal protective equipment was “poor” and “very poor,” information on COVID-19 testing was “fair” and above, information on COVID-19 death/infection rates between inmates and staff was “good” and “very good,” and information on vaccinations was “good” and “very good.” There was a significant difference observed (P=.03) between nonreturning citizens and returning citizens regarding the health grade review with respect to available information on COVID-19 infection rates. Conclusions: COVID-19 health reviews may provide an opportunity for the public to review the COVID-19 responses in correctional settings. %M 34609313 %R 10.2196/32591 %U https://formative.jmir.org/2021/11/e32591 %U https://doi.org/10.2196/32591 %U http://www.ncbi.nlm.nih.gov/pubmed/34609313 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e29155 %T Sources of Health Information, Technology Access, and Use Among Non–English-Speaking Immigrant Women: Descriptive Correlational Study %A Chae,Steve %A Lee,Yoon-Jae %A Han,Hae-Ra %+ Johns Hopkins University School of Nursing, 525 N Wolfe St, Room 533, Baltimore, MD, 21205, United States, 1 310 614 2669, hhan3@jhu.edu %K technology use %K internet %K text messaging %K health literacy %K English proficiency %K immigrant %K health disparities %K Korean American %K women %K mobile phone %D 2021 %7 29.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: As the world is becoming increasingly connected by the World Wide Web, the internet is becoming the main source of health information. With the novel COVID-19 pandemic, ubiquitous use of the internet has changed the daily lives of individuals, from working from home to seeking and meeting with health care providers through web-based sites. Such heavy reliance on internet-based technologies raises concerns regarding the accessibility of the internet for minority populations who are likely to already face barriers when seeking health information. Objective: This study aims to examine the level of technology access and common modes of technology used by Korean American women and to investigate how key psychosocial determinants of health such as age, education, English proficiency, and health literacy are correlated with sources of health information used by Korean American women and by their use of the internet. Methods: We used data from a subsample of Korean American women (N=157) who participated in a community-based randomized trial designed to test a health literacy–focused cancer screening intervention. In addition to descriptive statistics to summarize Korean American women’s internet access and common modes of technology use, we conducted backward stepwise logistic regression analyses to substantiate the association between the psychosocial determinants of health and internet use. Results: Approximately two-thirds (103/157, 65.6%) of the sample had access to the internet, and nearly all had access to a mobile phone. The internet was the most commonly used channel to obtain health information 63% (99/157), and 70% (110/157) of the sample used text messaging. Nevertheless, only approximately 38.8% (40/103) of the sample were very confident in using the internet, and only 29.9% (47/157) were very confident in using text messaging. Multivariate analyses revealed that older age (>50 years) was associated with 79% lower odds of using the internet to seek health information (adjusted odds ratio [AOR] 0.21, 95% CI 0.10-0.46). The higher health literacy group (19+ on Rapid Estimate of Adult Literacy in Medicine) had 56% lower odds of using the internet to acquire health information (AOR 0.44, 95% CI 1.13-11.18). Higher education (college+) was associated with both internet use (AOR 4.42, 95% CI 1.88-9.21) and text messaging (AOR 3.42, 95% CI 1.55-7.54). Finally, English proficiency was associated with text messaging (AOR 4.20, 95% CI 1.44-12.24). Conclusions: The differences in modes of technology access, use, and confidence by some of the key psychosocial determinants, as observed in our study sample, have important implications when health care teams develop dissemination plans. %M 34714249 %R 10.2196/29155 %U https://www.jmir.org/2021/10/e29155 %U https://doi.org/10.2196/29155 %U http://www.ncbi.nlm.nih.gov/pubmed/34714249 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e24272 %T Increasing Testing Options for Key Populations in Burundi Through Peer-Assisted HIV Self-Testing: Descriptive Analysis of Routine Programmatic Data %A Lillie,Tiffany %A Boyee,Dorica %A Kamariza,Gloriose %A Nkunzimana,Alphonse %A Gashobotse,Dismas %A Persaud,Navindra %+ Family Health International 360, 1825 Connecticut Avenue, Suite 800, Washington, DC, 20009, United States, 1 202 884 8000, tlillie@fhi360.org %K HIV %K HIV self-testing %K key populations %K case finding %K ART initiation %K Burundi %D 2021 %7 30.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In Burundi, given the low testing numbers among key populations (KPs), peer-assisted HIV self-testing (HIVST) was initiated for female sex workers (FSWs), men who have sex with men (MSM), and transgender people to provide another testing option. HIVST was provided by existing peer outreach workers who were trained to provide support before, during, and after the administration of the test. People who screened reactive were referred and actively linked to confirmatory testing, and those confirmed positive were linked to treatment. Standard testing included HIV testing by clinical staff either at mobile clinics in the community or in facilities. Objective: This study aims to improve access to HIV testing for underserved KPs, improve diagnoses of HIV serostatus among key populations, and link those who were confirmed HIV positive to life-saving treatment for epidemic control. Methods: A descriptive analysis was conducted using routine programmatic data that were collected during a 9-month implementation period (June 2018 to March 2019) for peer-assisted HIVST among FSWs, MSM, and transgender people in 6 provinces where the US Agency for International Development–and US President’s Emergency Plan for AIDS Relief–funded LINKAGES (Linkage across the Continuum of HIV Services for KP Affected by HIV) Burundi project was being implemented. Chi-square tests were used to compare case-finding rates among individuals who were tested through HIVST versus standard testing. Multivariable logistic regression was performed to assess factors that were independently associated with HIV seropositivity among FSWs and MSM who used HIVST kits. Results: A total of 2198 HIVST kits were administered (FSWs: 1791/2198, 81.48%; MSM: 363/2198, 16.52%; transgender people: 44/2198, 2%). HIV seropositivity rates from HIVST were significantly higher than those from standard testing for FSWs and MEM and nonsignificantly higher than those from standard testing for transgender people (FSWs: 257/1791, 14.35% vs 890/9609, 9.26%; P<.001; MSM: 47/363, 12.95% vs 90/2431, 3.7%; P<.001; transgender people: 10/44, 23% vs 6/36, 17%; P=.50). Antiretroviral therapy initiation rates were significantly lower among MSM who were confirmed to be HIV positive through HIVST compared to those among MSM who were confirmed to be HIV positive through standard testing (40/47, 85% vs 89/90, 99%; P<.001). No significant differences in antiretroviral therapy initiation rates were found between the FSW and transgender groups. Multivariable analyses among FSWs who used HIVST kits showed that being aged ≥25 years (adjusted odds ratio 1.9, 95% CI 1.4-2.6) and having >8 clients per week (adjusted odds ratio 1.3, 95% CI 1.0-1.8) were independently associated with HIV seropositivity. Conclusions: The results demonstrate the potential effectiveness of HIVST in newly diagnosing underserved KPs and linking them to treatment. %M 34591018 %R 10.2196/24272 %U https://publichealth.jmir.org/2021/9/e24272 %U https://doi.org/10.2196/24272 %U http://www.ncbi.nlm.nih.gov/pubmed/34591018 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26623 %T Barriers and Facilitators to the Implementation of Virtual Reality as a Pain Management Modality in Academic, Community, and Safety-Net Settings: Qualitative Analysis %A Sarkar,Urmimala %A Lee,Jane E %A Nguyen,Kim H %A Lisker,Sarah %A Lyles,Courtney R %+ Department of Medicine, University of California San Francisco, 1001 Potrero Avenue, Box 1364, San Francisco, CA, 94143, United States, 1 6282064273, urmimala.sarkar@ucsf.edu %K virtual reality %K medical informatics %K information technology %K implementation science %K qualitative research %D 2021 %7 22.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Prior studies have shown that virtual reality (VR) is an efficacious treatment modality for opioid-sparing pain management. However, the majority of these studies were conducted among primarily White, relatively advantaged populations and in well-resourced settings. Objective: We conducted a qualitative, theory-informed implementation science study to assess the readiness for VR in safety-net settings. Methods: Using the theoretical lens of the Consolidated Framework for Implementation Research (CFIR) framework, we conducted semistructured interviews with current VR users and nonusers based in safety-net health systems (n=15). We investigated barriers and facilitators to a commercially available, previously validated VR technology platform AppliedVR (Los Angeles, CA, USA). We used deductive qualitative analysis using the overarching domains of the CFIR framework and performed open, inductive coding to identify specific themes within each domain. Results: Interviewees deemed the VR intervention to be useful, scalable, and an appealing alternative to existing pain management approaches. Both users and nonusers identified a lack of reimbursement for VR as a significant challenge for adoption. Current users cited positive patient feedback, but safety-net stakeholders voiced concern that existing VR content may not be relevant or appealing to diverse patients. All respondents acknowledged the challenge of integrating and maintaining VR in current pain management workflows across a range of clinical settings, and this adoption challenge was particularly acute, given resource and staffing constraints in safety-net settings. Conclusions: VR for pain management holds interest for frontline pain management clinicians and leadership in safety-net health settings but will require significant tailoring and adaption to address the needs of diverse populations. Integration into complex workflows for pain management is a significant barrier to adoption, and participants cited structural cost and reimbursement concerns as impediments to initial implementation and scaling of VR use. %M 34550074 %R 10.2196/26623 %U https://www.jmir.org/2021/9/e26623 %U https://doi.org/10.2196/26623 %U http://www.ncbi.nlm.nih.gov/pubmed/34550074 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29085 %T Public Adoption of and Trust in the NHS COVID-19 Contact Tracing App in the United Kingdom: Quantitative Online Survey Study %A Dowthwaite,Liz %A Fischer,Joel %A Perez Vallejos,Elvira %A Portillo,Virginia %A Nichele,Elena %A Goulden,Murray %A McAuley,Derek %+ Horizon Digital Economy Research, University of Nottingham, Innovation Park, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 07943583035, liz.dowthwaite@gmail.com %K trust %K technology adoption %K COVID-19 %K digital contact tracing %K coronavirus %K vulnerable populations %K attitudes %K SARS-CoV-2 %K digital proximity tracing %K compliance %D 2021 %7 17.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital contact tracing is employed to monitor and manage the spread of COVID-19. However, to be effective the system must be adopted by a substantial proportion of the population. Studies of mostly hypothetical contact tracing apps show generally high acceptance, but little is known about the drivers and barriers to adoption of deployed systems. Objective: The aim of this study was to investigate adoption of and attitudes toward the NHS (National Health Service) COVID-19 smartphone app, the digital contact tracing solution in the United Kingdom. Methods: An online survey based on the extended Technology Acceptance Model with the added factor of trust was carried out with a representative sample of the UK population. Statistical analysis showed adoption rates, attitudes toward and trust in the app, and compliance with self-isolation advice and highlighted differences for vulnerable populations (ie, older adults aged 65 years and over and members of Black, Asian, and minority ethnic [BAME] communities). Results: A total of 1001 participants took part in the study. Around half of the participants who had heard of the NHS COVID-19 mobile phone app (490/963, 50.9%; 95% CI 47.8%-54.0%) had downloaded and kept the app, but more than one-third (345/963, 35.8%; 95% CI 32.8%-38.8%) either did not intend to download it or had deleted it. Significantly more BAME respondents than White respondents had deleted the app (16/115, 13.9%; 95% CI 11.8%-16.0%, vs 65/876, 7.4%; 95% CI 5.8%-9.0%), and significantly more older adults 65 years and over than those under 65 years did not intend to download it (44/127, 34.6%; 95% CI 31.7%-37.5%, vs 220/874, 25.2%; 95% CI 22.5%-27.9%). Broadly, one of the reasons for uptake was to help the NHS and other people, especially among older adults, although significantly fewer BAME participants agreed that they did so to help the NHS. Reported compliance with received notifications to self-isolate was high but was significantly lower than reported intended compliance without received notifications. Only one-fifth (136/699, 19.5%; 95% CI 17.0%-22.0%) of participants understood that the decision to send self-isolation notifications was automated by the app. There were a range of significantly more negative views among BAME participants, including lower trust in the NHS, while older adults were often significantly more positive. Respondents without the app reported significantly lower trust and more negative views toward the app and were less likely to report that they understood how the app works. Conclusions: While compliance on the part of the approximately 50% of participants who had the app was fairly high, there were issues surrounding trust and understanding that hindered adoption and, therefore, the effectiveness of digital contact tracing, particularly among BAME communities. This study highlights that more needs to be done to improve adoption among groups who are more vulnerable to the effects of the virus in order to enhance uptake and acceptance of contact tracing apps. %M 34406960 %R 10.2196/29085 %U https://www.jmir.org/2021/9/e29085 %U https://doi.org/10.2196/29085 %U http://www.ncbi.nlm.nih.gov/pubmed/34406960 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e27799 %T Health Equity in Artificial Intelligence and Primary Care Research: Protocol for a Scoping Review %A Wang,Jonathan Xin %A Somani,Sulaiman %A Chen,Jonathan H %A Murray,Sara %A Sarkar,Urmimala %+ Center for Vulnerable Populations at San Francisco General Hospital, University of California San Francisco, 2789 25th St, Suite 350, San Francisco, CA, United States, 1 651 285 3335, jonxwang@alumni.stanford.edu %K artificial intelligence %K health information technology %K health informatics %K electronic health records %K big data %K data mining %K primary care %K family medicine %K decision support %K diagnosis %K treatment %K scoping review %K health equity %K health disparity %D 2021 %7 17.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Though artificial intelligence (AI) has the potential to augment the patient-physician relationship in primary care, bias in intelligent health care systems has the potential to differentially impact vulnerable patient populations. Objective: The purpose of this scoping review is to summarize the extent to which AI systems in primary care examine the inherent bias toward or against vulnerable populations and appraise how these systems have mitigated the impact of such biases during their development. Methods: We will conduct a search update from an existing scoping review to identify studies on AI and primary care in the following databases: Medline-OVID, Embase, CINAHL, Cochrane Library, Web of Science, Scopus, IEEE Xplore, ACM Digital Library, MathSciNet, AAAI, and arXiv. Two screeners will independently review all abstracts, titles, and full-text articles. The team will extract data using a structured data extraction form and synthesize the results in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Results: This review will provide an assessment of the current state of health care equity within AI for primary care. Specifically, we will identify the degree to which vulnerable patients have been included, assess how bias is interpreted and documented, and understand the extent to which harmful biases are addressed. As of October 2020, the scoping review is in the title- and abstract-screening stage. The results are expected to be submitted for publication in fall 2021. Conclusions: AI applications in primary care are becoming an increasingly common tool in health care delivery and in preventative care efforts for underserved populations. This scoping review would potentially show the extent to which studies on AI in primary care employ a health equity lens and take steps to mitigate bias. International Registered Report Identifier (IRRID): PRR1-10.2196/27799 %M 34533458 %R 10.2196/27799 %U https://www.researchprotocols.org/2021/9/e27799 %U https://doi.org/10.2196/27799 %U http://www.ncbi.nlm.nih.gov/pubmed/34533458 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e28728 %T COVID-19 Health Crisis and Chronic Illness: Protocol for a Qualitative Study %A Ricadat,Élise %A Béliard,Aude %A Citrini,Marie %A Craus,Yann %A Gabarro,Céline %A Mamzer,Marie-France %A Marques,Ana %A Sannié,Thomas %A Teixeira,Maria %A Tocilovac,Marko %A Velpry,Livia %A Villa,François %A Virole,Louise %A Lefève,Céline %+ Institut La Personne en Médecine, Université de Paris, 5 rue Thomas Mann, Paris, 75013, France, 33 0157275249, louise.virole@sciencespo.fr %K chronic illness %K care %K prevention %K vulnerability %K health democracy %K COVID %K qualitative study %K COVID-19 %K pandemic %K risk %D 2021 %7 9.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The acute nature of the COVID-19 pandemic has put a strain on health resources that are usually dedicated to chronic illnesses. Resulting changes in care practices and networks have had major repercussions on the experience of people with chronic disorders. Objective: This paper presents the protocol of the Parcours, Associations, Réseau, Chronicité, Organisation, Usagers, Retour d’expérience, Soins (PARCOURS)-COVID study. The aim of this study is to evaluate the effects of reorganization of the health system on the usual care network of patients with chronic illness, which fosters and qualifies the quality and continuum of care provided. The first objective of this study is to document these patients’ experiences through transformations and adaptations of their network, both in the practical dimension (ie, daily life and care) and subjective dimension (ie, psychosocial experience of illness and relationship to the health system). The second objective of the study is to understand and acknowledge these reorganizations during the COVID-19 lockdown and postlockdown periods. The third objective is to produce better adapted recommendations for patients with chronic illness and value their experience for the management of future health crisis. Methods: The PARCOURS-COVID study is a qualitative and participatory research involving patient organizations as research partners and members of these organizations as part of the research team. Three group of chronic diseases have been selected regarding the specificities of the care network they mobilize: (1) cystic fibrosis and kidney disease, (2) hemophilia, and (3) mental health disorders. Four consecutive phases will be conducted, including (1) preparatory interviews with medical or associative actors of each pathology field; (2) in-depth individual interviews with patients of each pathology, analyzed using the qualitative method of thematic analysis; (3) results of both these phases will then be triangulated through interviews with members of each patient’s care ecosystem; and finally, (4) focus groups will be organized to discuss the results with research participants (ie, representatives of chronic disease associations; patients; and actors of the medical, psychosocial, and family care network) in a research-action framework. Results: The protocol study has undergone a peer review by the French National Research Agency’s scientific committee and has been approved by the research ethical committee of the University of Paris (registration number: IRB 00012020-59, June 28, 2020). The project received funding from August 2020 through April 2021. Expected results will be disseminated in 2021 and 2022. Conclusions: Our findings will better inform the stakes of the current health crisis on the management of patients with chronic illness and, more broadly, any future crisis for a population deemed to be at risk. They will also improve health democracy by supporting better transferability of knowledge between the scientific and citizen communities. International Registered Report Identifier (IRRID): DERR1-10.2196/28728 %M 34460413 %R 10.2196/28728 %U https://www.researchprotocols.org/2021/9/e28728 %U https://doi.org/10.2196/28728 %U http://www.ncbi.nlm.nih.gov/pubmed/34460413 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e26871 %T A Home-Based eHealth Intervention for an Older Adult Population With Food Insecurity: Feasibility and Acceptability Study %A Gomes,Luís Antunes %A Gregório,Maria João %A Iakovleva,Tatiana A %A Sousa,Rute Dinis de %A Bessant,John %A Oliveira,Pedro %A Branco,Jaime C %A Canhão,Helena %A Rodrigues,Ana Maria %+ Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Pólo de Investigação, NMS, UNL. Edifício Amarelo, Piso 2. Rua do Instituto Bacteriológico, nº5, Lisbon, Portugal, 351 218 803 000, ana.m.rodrigues@nms.unl.pt %K food insecurity %K eHealth %K television app %K elderly people %K vulnerable population %K cognitive behavioral strategy %K health innovation %K multidisciplinary program %D 2021 %7 31.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Food insecurity is a global public health challenge, affecting predominately the most vulnerable people in society, including older adults. For this population, eHealth interventions represent an opportunity for promoting healthy lifestyle habits, thus mitigating the consequences of food insecurity. However, before their widespread dissemination, it is essential to evaluate the feasibility and acceptability of these interventions among end users. Objective: This study aims to explore the feasibility and acceptability of a home-based eHealth intervention focused on improving dietary and physical activity through an interactive television (TV) app among older adults with food insecurity. Methods: A pilot noncontrolled quasi-experimental study was designed with baseline and 3-month follow-up assessments. Older adult participants with food insecurity were recruited from 17 primary health care centers in Portugal. A home-based intervention program using an interactive TV app aimed at promoting healthy lifestyle behaviors was implemented over 12 weeks. Primary outcomes were feasibility (self-reported use and interest in eHealth) and acceptability (affective attitude, burden, ethicality, perceived effectiveness, and self-efficacy), which were evaluated using a structured questionnaire with a 7-point Likert scale. Secondary outcomes were changes in food insecurity (Household Food Insecurity Scale), quality of life (European Quality of Life Questionnaire with five dimensions and three levels and Functional Assessment of Chronic Illness Therapy-Fatigue), physical function (Health Assessment Questionnaire, Elderly Mobility Scale, grip strength, and regularity of exercise), and nutritional status (adherence to the Mediterranean diet). Results: A sample of 31 older adult individuals with food insecurity was enrolled in the 12-week intervention program with no dropouts. A total of 10 participants self-reported low use of the TV app. After the intervention, participants were significantly more interested in using eHealth to improve food insecurity (baseline median 1.0, IQR 3.0; 3-month median 5.0, IQR 5.0; P=.01) and for other purposes (baseline median 1.0, IQR 2.0; 3-month median 6.0, IQR 2.0; P=.03). High levels of acceptability were found both before and after (median range 7.0-7.0, IQR 2.0-0.0 and 5.0-7.0, IQR 2.0-2.0, respectively) the intervention, with no significant changes for most constructs. Clinically, there was a reduction of 40% in food insecurity (P=.001), decreased fatigue (mean −3.82, SD 8.27; P=.02), and improved physical function (Health Assessment Questionnaire: mean −0.22, SD 0.38; P=.01; Elderly Mobility Scale: mean −1.50, SD 1.08; P=.01; regularity of exercise: baseline 10/31, 32%; 3 months 18/31, 58%; P=.02). No differences were found for the European Quality of Life Questionnaire with five dimensions and three levels, grip strength, or adherence to the Mediterranean diet. Conclusions: The home-based eHealth intervention was feasible and highly acceptable by participants, thus supporting a future full-scale trial. The intervention program not only reduced the proportion of older adults with food insecurity but also improved participants’ fatigue and physical function. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.6626 %M 34463638 %R 10.2196/26871 %U https://www.jmir.org/2021/8/e26871 %U https://doi.org/10.2196/26871 %U http://www.ncbi.nlm.nih.gov/pubmed/34463638 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 3 %P e25873 %T Analysis of Social Determinants and the Utilization of Pediatric Tele–Urgent Care During the COVID-19 Pandemic: Cross-sectional Study %A Khairat,Saif %A McDaniel,Phillip %A Jansen,Matthew %A Francis,Tia %A Edson,Barbara %A Gianforcaro,Robert %+ Cecil G. Sheps Center for Health Services Research, 725 M.L.K. Jr Blvd, Chapel Hill, NC, 27516, United States, 1 9198435413, saif@unc.edu %K telehealth %K pediatrics %K social %K determinants %K COVID-19 %K use %K children %K infant %K consultation %K telemedicine %K urgent care %K vulnerable population %K cross-sectional %K minority %D 2021 %7 30.8.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Telehealth is increasingly used to provide specialty consultations to infants and children receiving care. However, there is uncertainty if the COVID-19 pandemic has influenced the use of telehealth among vulnerable populations. Objective: This research aims to compare the overall use of tele–urgent care visits for pediatric patients before and after the pandemic, especially among vulnerable populations. Methods: We conducted a cross-sectional analysis of pediatric tele–urgent care visits at a virtual care center at a southeastern health care center. The main outcome of this study was the use of pediatrics tele–urgent visits across geographical regions with different levels of social disparities and between 2019 and 2020. Results: Of 584 tele–urgent care visits, 388 (66.4%) visits occurred in 2020 during the pandemic compared to 196 (33.6%) visits in 2019. Among 808 North Carolina zip codes, 181 (22%) consisted of a high concentration of vulnerable populations, where 17.7% (56/317) of the tele–urgent care visits originated from. The majority (215/317, 67.8%) of tele–urgent care visits originated from zip codes with a low concentration of vulnerable populations. There was a significant association between the rate of COVID-19 cases and the concentration level of social factors in a given Zip Code Tabulation Area. Conclusions: The use of tele–urgent care visits for pediatric care doubled during the COVID-19 pandemic. The majority of the tele–urgent care visits after COVID-19 originated from regions where there is a low presence of vulnerable populations. In addition, our geospatial analysis found that geographic regions with a high concentration of vulnerable populations had a significantly higher rate of COVID-19–confirmed cases and deaths compared to regions with a low concentration of vulnerable populations. %M 34459742 %R 10.2196/25873 %U https://pediatrics.jmir.org/2021/3/e25873 %U https://doi.org/10.2196/25873 %U http://www.ncbi.nlm.nih.gov/pubmed/34459742 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e12813 %T Profiling Clinical Research Activity at an Academic Medical Center by Using Institutional Databases: Content Analysis %A Langford,Aisha %A Sherman,Scott %A Thornton,Rachel %A Nightingale,Kira %A Kwon,Simona %A Chavis-Keeling,Deborah %A Link,Nathan %A Cronstein,Bruce %A Hochman,Judith %A Trachtman,Howard %+ New York University Langone Health, 403 E34th St, New York, NY, 10016, United States, 1 914 563 1580, howard.trachtman@nyulangone.org %K database %K clinical studies as topic %K vulnerable populations %K pediatrics %K geriatrics %D 2020 %7 24.8.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: It is important to monitor the scope of clinical research of all types, to involve participants of all ages and subgroups in studies that are appropriate to their condition, and to ensure equal access and broad validity of the findings. Objective: We conducted a review of clinical research performed at New York University with the following objectives: (1) to determine the utility of institutional administrative data to characterize clinical research activity; (2) to assess the inclusion of special populations; and (3) to determine if the type, initiation, and completion of the study differed by age. Methods: Data for all studies that were institutional review board–approved between January 1, 2014, and November 2, 2016, were obtained from the research navigator system, which was launched in November 2013. One module provided details about the study protocol, and another module provided the characteristics of individual participants. Research studies were classified as observational or interventional. Descriptive statistics were used to assess the characteristics of clinical studies across the lifespan, by type, and over time. Results: A total of 22%-24% of studies included children (minimum age <18 years) and 4%-5% focused exclusively on pediatrics. Similarly, 64%-72% of studies included older patients (maximum age >65 years) but only 5%-12% focused exclusively on geriatrics. Approximately 85% of the studies included both male and female participants. Of the remaining studies, those open only to girls or women were approximately 3 times as common as those confined to boys or men. A total of 56%-58% of projects focused on nonvulnerable patients. Among the special populations studied, children (12%-15%) were the most common. Noninterventional trial types included research on human data sets (24%), observational research (22%), survey research (16%), and biospecimen research (8%). The percentage of projects designed to test an intervention in a vulnerable population increased from 17% in 2014 to 21% in 2015. Conclusions: Pediatric participants were the special population that was most often studied based on the number of registered projects that included children and adolescents. However, they were much less likely to be successfully enrolled in research studies compared with adults older than 65 years. Only 20% of the studies were interventional, and 20%-35% of participants in this category were from vulnerable populations. More studies are exclusively devoted to women’s health issues compared with men’s health issues. %M 32831180 %R 10.2196/12813 %U http://publichealth.jmir.org/2020/3/e12813/ %U https://doi.org/10.2196/12813 %U http://www.ncbi.nlm.nih.gov/pubmed/32831180