TY - JOUR AU - Harry, Christiana AU - Goodday, Sarah AU - Chapman, Carol AU - Karlin, Emma AU - Damian, Joy April AU - Brooks, Alexa AU - Boch, Adrien AU - Lugo, Nelly AU - McMillan, Rebecca AU - Tempero, Jonell AU - Swanson, Ella AU - Peabody, Shannon AU - McKenzie, Diane AU - Friend, Stephen PY - 2025/4/15 TI - Using Social Media to Engage and Enroll Underrepresented Populations: Longitudinal Digital Health Research JO - JMIR Form Res SP - e68093 VL - 9 KW - digital health research KW - digital health technology KW - recruitment KW - research subject KW - participant KW - pregnancy KW - maternal health KW - underrepresented populations KW - health equity KW - diversity KW - marginalized KW - advertisement KW - social media KW - retention KW - attrition KW - dropout N2 - Background: Emerging digital health research poses roadblocks to the inclusion of historically marginalized populations in research. Exclusion of underresourced communities in digital health research is a result of multiple factors (eg, limited technology access, decreased digital literacy, language barriers, and historical mistrust of research and research institutions). Alternative methods of access and engagement may aid in achieving long-term sustainability of diversified participation in digital health research, ensuring that developed technologies and research outcomes are effective and equitable. Objective: This study aims to (1) characterize socioeconomic and demographic differences in individuals who enrolled and engaged with different remote, digital, and traditional recruitment methods in a digital health pregnancy study and (2) determine whether social media outreach is an efficient way of recruiting and retaining specific underrepresented populations (URPs) in digital health research. Methods: The Better Understanding the Metamorphosis of Pregnancy (BUMP) study was used as a case example. This is a prospective, observational, cohort study using digital health technology to increase understanding of pregnancy among 524 women, aged 18-40 years, in the United States. The study used different recruitment strategies: patient portal for genetic testing results, paid/unpaid social media ads, and a community health organization providing care to pregnant women (Moses/Weitzman Health System). Results: Social media as a recruitment tool to engage URPs in a digital health study was overall effective, with a 23.6% (140/594) enrollment rate of those completing study interest forms across 25 weeks. Community-based partnerships were less successful, however, resulting in 53.3% (57/107) engagement with recruitment material and only 8.8% (5/57) ultimately enrolling in the study. Paid social media ads provided access to and enrollment of a diverse potential participant pool of race- or ethnicity-based URPs in comparison to other digital recruitment channels. Of those that engaged with study materials, paid recruitment had the highest percentage of non-White (non-Hispanic) respondents (85/321, 26.5%), in comparison to unpaid ads (Facebook and Reddit; 37/167, 22.2%). Of the enrolled participants, paid ads also had the highest percentage of non-White (non-Hispanic) participants (14/70, 20%), compared to unpaid ads (8/52, 15.4%) and genetic testing service subscribers (72/384, 18.8%). Recruitment completed via paid ads (Instagram) had the highest study retention rate (52/70, 74.3%) across outreach methods, whereas recruitment via community-based partnerships had the lowest (2/5, 40%). Retention of non-White (non-Hispanic) participants was low across recruitment methods: paid (8/52, 15.4%), unpaid (3/35, 14.3%), and genetic testing service subscribers (50/281, 17.8%). Conclusions: Social media recruitment (paid/unpaid) provides access to URPs and facilitates sustained retention similar to other methods, but with varying strengths and weaknesses. URPs showed lower retention rates than their White counterparts across outreach methods. Community-based recruitment showed lower engagement, enrollment, and retention. These findings highlight social media?s potential for URP engagement and enrollment, illuminate potential roadblocks of traditional methods, and underscore the need for tailored research to improve URP enrollment and retention. UR - https://formative.jmir.org/2025/1/e68093 UR - http://dx.doi.org/10.2196/68093 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68093 ER - TY - JOUR AU - Laestadius, Linnea AU - Hamad, Fridarose AU - Le, Leena AU - Buchtel, Rosemary AU - Campos-Castillo, Celeste PY - 2025/4/10 TI - Amplifying the Voices of Youth for Equity in Wellness and Technology Research: Reflections on the Midwest Youth Wellness Initiative on Technology (MYWIT) Youth Advisory Board JO - JMIR Public Health Surveill SP - e69013 VL - 11 KW - advisory boards KW - adolescents KW - social media KW - qualitative research KW - community engagement UR - https://publichealth.jmir.org/2025/1/e69013 UR - http://dx.doi.org/10.2196/69013 ID - info:doi/10.2196/69013 ER - TY - JOUR AU - Liu, Darren AU - Hu, Xiao AU - Xiao, Canhua AU - Bai, Jinbing AU - Barandouzi, A. Zahra AU - Lee, Stephanie AU - Webster, Caitlin AU - Brock, La-Urshalar AU - Lee, Lindsay AU - Bold, Delgersuren AU - Lin, Yufen PY - 2025/4/7 TI - Evaluation of Large Language Models in Tailoring Educational Content for Cancer Survivors and Their Caregivers: Quality Analysis JO - JMIR Cancer SP - e67914 VL - 11 KW - large language models KW - GPT-4 KW - cancer survivors KW - caregivers KW - education KW - health equity N2 - 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 UR - https://cancer.jmir.org/2025/1/e67914 UR - http://dx.doi.org/10.2196/67914 ID - info:doi/10.2196/67914 ER - TY - JOUR AU - Pettersson, Linda AU - Johansson, Stefan AU - Demmelmaier, Ingrid AU - von Koch, Lena AU - Gulliksen, Jan AU - Hedvall, Per-Olof AU - Gummesson, Karl AU - Gustavsson, Catharina PY - 2025/3/28 TI - Accessibility of eHealth Before and During the COVID-19 Pandemic Among People With and People Without Impairment: Repeated Cross-Sectional Survey JO - JMIR Public Health Surveill SP - e64707 VL - 11 KW - eHealth KW - impairment KW - accessibility KW - digital inclusion KW - universal design KW - disability KW - digital divide KW - electronic health KW - COVID-19 KW - pandemic KW - cross-sectional study KW - Sweden KW - online booking KW - digital identification KW - web portal KW - health information KW - control group KW - public health KW - digital health KW - digital literacy KW - health informatics KW - mobile phone N2 - Background: The adoption of eHealth accelerated during the COVID-19 pandemic. Inequalities in the adoption of eHealth during the COVID-19 pandemic have been reported, but there are few such studies among people with impairment. Objectives: This study aimed to investigate self-reported use and difficulty in the use of eHealth before the COVID-19 pandemic compared to during late social distancing restrictions in Sweden, among people with and without impairment, as well as between different types of impairment. Methods: A cross-sectional survey was distributed twice by snowball sampling to people with self-reported impairment and a general population matched by age, gender, and county. Use and difficulty in the use of six eHealth services were compared between groups using chi-square test and logistic regression with year interaction terms, reported as odds ratio adjusted (aOR) for gender and age with 95% CI. Results: The surveys included 1631 (in 2019) and 1410 (in 2021) participants with impairment, and 1084 (in 2019) and 1223 (in 2021) participants without. Participants with impairment, compared to those without impairment, reported less use and more difficulty in booking health care appointments online, digital identification, and the Swedish national web portal for health information and eHealth services (1177.se), both before and during the pandemic (P=.003 or lower). Video health care appointments were the exception to this disability digital divide in eHealth as video appointment adoption was the most likely among participants with attention, executive, and memory impairments (interaction term aOR 2.10, 95% CI 1.30?3.39). Nonuse and difficulty in the use of eHealth were consistently associated with language impairments and intellectual impairments. For example, language impairments were inversely associated with use of the logged-in eHealth services in 1177.se in 2021 (aOR 0.49, 95% CI 0.36?0.67) and were associated with difficulty in the use of 1177.se in 2019 (aOR 2.24, 95% CI 1.50?3.36) and the logged-in eHealth services in 1177.se in 2021 (aOR 1.89, 95% CI 1.32?2.70). Intellectual impairments were inversely associated with the use of the logged-in eHealth services in 1177.se in 2021 (aOR 0.19, 95% CI 0.13?0.27). Conclusions: This repeated cross-sectional survey study, including participants with diverse types of impairment and a control group without impairment, reveals persisting disability digital divides, despite an accelerated adoption of eHealth across the pandemic. eHealth services were not accessible to some groups of people who were identified as being at risk of severe disease during the COVID-19 pandemic. This implies that all people could not use eHealth as a measure of infection protection. UR - https://publichealth.jmir.org/2025/1/e64707 UR - http://dx.doi.org/10.2196/64707 ID - info:doi/10.2196/64707 ER - TY - JOUR AU - Yu, Yao AU - Liang, Zhenning AU - Zhou, Qingping AU - Tuersun, Yusupujiang AU - Liu, Siyuan AU - Wang, Chenxi AU - Xie, Yuying AU - Wang, Xinyu AU - Wu, Zhuotong AU - Qian, Yi PY - 2025/3/26 TI - Decomposition and Comparative Analysis of Urban-Rural Disparities in eHealth Literacy Among Chinese University Students: Cross-Sectional Study JO - J Med Internet Res SP - e63671 VL - 27 KW - university students KW - eHealth literacy KW - urban-rural disparities KW - Fairlie decomposition model KW - health equity N2 - Background: Mobile health care is rapidly expanding in China, making the enhancement of eHealth literacy a crucial strategy for improving public health. However, the persistent urban-rural divide may contribute to disparities in eHealth literacy between urban and rural university students, potentially affecting their health-related behaviors and outcomes. Objective: This study aims to examine disparities in eHealth literacy between university students in urban and rural China, identifying key influencing factors and their contributions. The findings will help bridge these gaps, promote social equity, enhance overall health and well-being, and inform future advancements in the digital health era. Methods: The eHealth Literacy Scale (eHEALS) was used to assess eHealth literacy levels among 7230 university students from diverse schools and majors across 10 regions, including Guangdong Province, Shanghai Municipality, and Jiangsu Province. Descriptive statistics summarized demographic, sociological, and lifestyle characteristics. Chi-square tests examined the distribution of eHealth literacy between urban and rural students. A binary logistic regression model identified key influencing factors, while a Fairlie decomposition model quantified their contributions to the observed disparities. Results: The average eHealth literacy score among Chinese university students was 29.22 (SD 6.68), with 4135 out of 7230 (57.19%) scoring below the passing mark. Rural students had a significantly higher proportion of inadequate eHealth literacy (2837/4510, 62.90%) compared with urban students (1298/2720, 47.72%; P<.001). The Fairlie decomposition analysis showed that 71.4% of the disparity in eHealth literacy was attributable to urban-rural factors and unobserved variables, while 28.6% resulted from observed factors. The primary contributors were monthly per capita household income (13.4%), exercise habits (11.7%), and 9-item Patient Health Questionnaire (PHQ-9) scores (2.1%). Conclusions: Rural university students exhibit lower eHealth literacy levels than their urban counterparts, a disparity influenced by differences in socioeconomic status, individual lifestyles, and personal health status. These findings highlight the need for targeted intervention strategies, including (1) improving access to eHealth resources in rural and underserved areas; (2) fostering an environment that encourages physical activity to promote healthy behaviors; (3) expanding school-based mental health services to enhance health information processing capacity; and (4) implementing systematic eHealth literacy training with ongoing evaluation. These strategies will support equitable access to and utilization of eHealth resources for all students, regardless of their geographic location. UR - https://www.jmir.org/2025/1/e63671 UR - http://dx.doi.org/10.2196/63671 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63671 ER - TY - JOUR AU - Ye, Qin AU - Wang, Wei AU - Zeng, Xuan AU - Kuang, Yuxian AU - Geng, Bingbing AU - Zhou, Song AU - Liu, Ning PY - 2025/3/25 TI - Development and Validation of the Digital Health Literacy Questionnaire for Stroke Survivors: Exploratory Sequential Mixed Methods Study JO - J Med Internet Res SP - e64591 VL - 27 KW - stroke survivors KW - digital health literacy KW - validation KW - reliability KW - mixed methods study N2 - Background: In China, there is limited research on digital health literacy (DHL) among patients with stroke. This is mainly due to the lack of validated tools, which hinders the precision and sustainability of our country?s digital transformation. Objective: This study aimed to develop and validate a DHL scale specifically for stroke survivors in China. Methods: We used a sequential, exploratory, mixed methods approach to develop a DHL questionnaire for stroke survivors. This study comprised 418 patients with stroke aged 18 years and older. To evaluate the questionnaire?s psychometric qualities, we randomly assigned individuals to 2 groups (subsample 1: n=118, subsample 2: n=300). Construct validity was evaluated through internal consistency analysis, exploratory and confirmatory factor analyses, hypothesis testing for structural validity, measurement invariance assessments using the eHealth Literacy Scale, and Rasch analyses to determine the questionnaire?s validity and reliability. Results: This study underwent 4 stages of systematic development. The initial pool of items contained 25 items, 5 of which were eliminated after content validity testing; 19 items were subsequently retained through cognitive interviews. After an interitem correlation analysis, 2 more items were excluded, leaving 17 items for exploratory factor analysis. Finally, 2 items were excluded by Rasch analysis, resulting in a final version of the questionnaire containing 15 items. The total score range of the scale was 15-75, with higher scores indicating greater DHL competence. Results showed that principal component analysis confirmed the theoretical structure of the questionnaire (69.212% explained variance). The factor model fit was good with ?24=1.669; root mean square error of approximation=0.047; Tucker-Lewis Index=0.973; and Comparative Fit Index=0.977. In addition, hypothesis-testing construct validity with the eHealth Literacy Scale revealed a strong correlation (r=0.853). The internal consistency (Cronbach ?) coefficient was 0.937. The retest reliability coefficient was 0.941. Rasch analysis demonstrated the item separation index was 3.81 (reliability 0.94) and the individual separation index was 2.91 (reliability 0.89). Conclusions: The DHL Questionnaire for Stroke Survivors is a reliable and valid measure to assess DHL among stroke survivors in China. UR - https://www.jmir.org/2025/1/e64591 UR - http://dx.doi.org/10.2196/64591 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64591 ER - TY - JOUR AU - Whittemore, Robin AU - Jeon, Sangchoon AU - Akyirem, Samuel AU - Chen, C. Helen N. AU - Lipson, Joanna AU - Minchala, Maritza AU - Wagner, Julie PY - 2025/3/25 TI - Multilevel Intervention to Increase Patient Portal Use in Adults With Type 2 Diabetes Who Access Health Care at Community Health Centers: Single Arm, Pre-Post Pilot Study JO - JMIR Form Res SP - e67293 VL - 9 KW - patient portal KW - mobile phone KW - diabetes KW - community health center KW - adults KW - diabetic KW - DM KW - diabetes mellitus KW - Type 2 diabetes KW - T2D KW - community health centers KW - CHCs KW - pilot study KW - feasibility KW - self-management KW - glycemic control KW - patient portals KW - social determinants of health KW - primary outcome KW - digital health KW - digital health literacy KW - health technology KW - health technologies KW - psychosocial KW - efficacy N2 - Background: Diabetes self-management education and support (DSMS) delivered via patient portals significantly improves glycemic control. Yet, disparities in patient portal use persist. Community health centers (CHCs) deliver care to anyone who needs it, regardless of income or insurance status. Objective: This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of a multilevel intervention to increase access and use of portals (MAP) among people with type 2 diabetes (T2D) receiving health care at CHCs. Methods: A within-subjects, pre-post design was used. Adults with T2D who were portal naive were recruited from 2 CHCs. After informed consent, participants met with a community health worker for referrals for social determinants of health, provision of a tablet with cell service, and individualized training on use of the tablet and portal. Next, a nurse met individually with participants to develop a DSMS plan and then communicated with patients via the portal at least twice weekly during the first 3 months and weekly for the latter 3 months. Data were collected at baseline, 3 months and 6 months. The primary outcome was patient activation and engagement with the portal. Secondary outcomes included technology attitudes, digital health literacy, health-related outcomes and psychosocial function. Results: In total, 26 patients were eligible, 23 received the intervention, and one was lost to follow up. The sample was predominately Latino or Hispanic (17/22, 77%) and reported low income (19/22, 86%< US $40,000/year), low education (13/22, 59% 2000 languages. Most technologies are in prototyping phases, with only one fully deployed chatbot addressing vaccine hesitancy. Evidence of measurable impact is limited, with 15% (8/54) studies attempting health-related evaluations and 4% (2/54) demonstrating positive public health outcomes, including improved participants? mood and increased vaccine intentions. Recommendations include expanding language coverage, targeting local health needs, enhancing trust, integrating solutions into health systems, and adopting participatory design approaches. The gray literature reveals industry- and nongovernmental organizations?led projects focused on deployable NLP applications. However, these projects tend to support only a few major languages and specific use cases, indicating a narrower scope than academic research. Conclusions: Despite growth in NLP research for public health, major gaps remain in deployment, linguistic inclusivity, and health outcome evaluation. Future research should prioritize cross-sectoral and needs-based approaches that engage local communities, align with African health systems, and incorporate rigorous evaluations to enhance public health outcomes. International Registered Report Identifier (IRRID): RR2-doi:10.1101/2024.07.02.24309815 UR - https://www.jmir.org/2025/1/e68720 UR - http://dx.doi.org/10.2196/68720 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053738 ID - info:doi/10.2196/68720 ER - TY - JOUR AU - Rinderknecht, Fatuma-Ayaan AU - Yang, B. Vivian AU - Tilahun, Mekaleya AU - Lester, C. Jenna PY - 2025/2/21 TI - Perspectives of Black, Latinx, Indigenous, and Asian Communities on Health Data Use and AI: Cross-Sectional Survey Study JO - J Med Internet Res SP - e50708 VL - 27 KW - augmented intelligence KW - artificial intelligence KW - health equity KW - dermatology KW - Black KW - Latinx KW - Indigenous KW - Asian KW - racial and ethnic minority communities KW - AI KW - health care KW - health data KW - survey KW - racism KW - large language model KW - LLM KW - diversity UR - https://www.jmir.org/2025/1/e50708 UR - http://dx.doi.org/10.2196/50708 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50708 ER - TY - JOUR AU - Wankah, Paul AU - Chandra, Shivani AU - Lofters, Aisha AU - Mohamednur, Nebila AU - Osei, Beverley AU - Makuwaza, Tutsirai AU - Sayani, Ambreen PY - 2025/2/19 TI - Improving Digital Cancer Care for Older Black Adults: Qualitative Study JO - J Med Internet Res SP - e63324 VL - 27 KW - digital care KW - cancer care KW - older Black adults KW - health equity KW - social determinants of health KW - access to care KW - health quality N2 - Background: Health systems are rapidly promoting digital cancer care models to improve cancer care of their populations. However, there is growing evidence that digital cancer care can exacerbate inequities in cancer care for communities experiencing social disadvantage, such as Black communities. Despite the increasing recognition that older Black adults face significant challenges in accessing and using health care services due to multiple socioeconomic and systemic factors, there is still limited evidence regarding how older Black adults? access and use digital cancer care. Objective: This study aims to better understand the digital cancer care experience of older Black adults, their caregivers, and health care providers to identify strategies that can better support patient-centered digital cancer care. Methods: A total of 6 focus group interviews were conducted with older Black adults living with cancer, caregivers, and health care providers (N=55 participants) across 10 Canadian provinces. Focus group interviews were recorded and transcribed. Through a theory-informed thematic analysis approach, experienced qualitative researchers used the Patient Centered Care model and the synergies of oppression conceptual lens to inductively and deductively code interview transcripts in order to develop key themes that captured the digital cancer care experiences of older Black adults. Results: In total, 5 overarching themes describe the experience of older Black adults, caregivers, and health care providers in accessing and using digital cancer care: (1) barriers to access and participation in digital care services, (2) shifting caregivers? dynamics, (3) autonomy of choice and choosing based on the purpose of care, (4) digital accessibility, and (5) effective digital communication. We identify 8 barriers and 6 facilitators to optimal digital cancer for older Black adults. Barriers include limited digital literacy, linguistic barriers in traditional African or Caribbean languages, and patient concerns of shifting power dynamics when supported by their children for digital cancer care; and facilitators include community-based cancer support groups, caregiver support, and key features of digital technologies. Conclusions: These findings revealed a multifaceted range of barriers and facilitators to digital cancer care for older Black adults. This means that a multipronged approach that simultaneously focuses on addressing barriers and leveraging community strengths can improve access and usage of digital cancer care. A redesign of digital cancer care programs, tailored to the needs of most structurally marginalized groups like older Black adults, can enhance the digital care experience for all population groups. Public policies and organizational practices that address issues like availability of internet in remote areas, resources to support linguistic barriers, or culturally sensitive training are important in responding to the complexity of access to digital l cancer care. These findings have implications for other structurally marginalized and underresourced communities that have suboptimal access and usage of digital care. UR - https://www.jmir.org/2025/1/e63324 UR - http://dx.doi.org/10.2196/63324 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63324 ER - TY - JOUR AU - Martínez-Alfonso, Julia AU - Sebastian-Valles, Fernando AU - Martinez-Vizcaino, Vicente AU - Jimenez-Olivas, Nuria AU - Cabrera-Majada, Antonio AU - De los Mozos-Hernando, Iván AU - Cekrezi, Shkelzen AU - Martínez-Martínez, Héctor AU - Mesas, Eumann Arthur PY - 2025/2/19 TI - Social Determinants of Health Screening Tools for Adults in Primary Care: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e68668 VL - 14 KW - social deprivation KW - social determinants of health KW - primary health care KW - social inequality KW - screening N2 - Background: Social determinants of health (SDH) have been shown to be predictors of health outcomes. Integrating SDH screening tools into primary care may help identify individuals or groups with a greater burden of social vulnerability and promote health equity. Objective: This study aimed (1) to identify the existing screening tools to assess social deprivation in adults in primary care settings; (2) to describe the characteristics of these tools and, where appropriate, their psychometric properties; (3) to describe their validity and reliability in those scales in which validation processes have been conducted; and (4) to identify evidence gaps and provide recommendations for future research. Methods: This study protocol was structured according to the Joanna Briggs Institute methodology for scoping reviews and reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Furthermore, since not all SDH assessment tools are published as scientific papers, we will use a slightly modified form of the scoping review framework to retrieve specific information about specific tools for screening SDH in primary care contexts. The following electronic databases will be searched by 2 reviewers: MEDLINE (via PubMed), CINAHL Plus, Web of Science, and Scopus. In addition, the following sources will also be searched for gray literature: DART-Europe E-thesis Portal, OpenGrey, and Google Scholar. After the revision of inclusion and exclusion criteria, the titles, abstracts, and full text of the included studies will be separately screened by 2 reviewers. A PRISMA-ScR flowchart will be used to depict the sources of evidence screened, and data charting will be used to gain in-depth knowledge. The findings of the scoping review will be presented in both narrative and tabular formats, summarizing the existing literature on tools used for SDH in primary care settings. A critical analysis will be undertaken to address the variability in tool validation, cultural adaptability, and integration into different health care systems. Finally, key gaps in the existing evidence will be explored, and research priorities will be proposed, emphasizing the need for screening tools that are culturally sensitive, scalable, and easily integrated into primary care workflows. This critically appraised information may be useful for implementing SDH screening tools in primary care settings and may contribute to future research addressing feasibility and validation studies in different primary health care systems. Results: The study began in July 2024. Data collection is expected to be completed in April 2025, with publication expected in October 2025. Conclusions: This scoping review will provide a comprehensive and critical description of the available tools aimed at screening SDH in primary care settings. Incorporating these tools into routine care has been recognized as a key strategy for addressing health inequalities, given the growing evidence base on the influence of SDH on health outcomes. International Registered Report Identifier (IRRID): PRR1-10.2196/68668 UR - https://www.researchprotocols.org/2025/1/e68668 UR - http://dx.doi.org/10.2196/68668 UR - http://www.ncbi.nlm.nih.gov/pubmed/39969980 ID - info:doi/10.2196/68668 ER - TY - JOUR AU - Shin, Jiyoung AU - Kang, Hun AU - Choi, Seongmi AU - Chu, Hui Sang AU - Choi, JiYeon PY - 2025/2/19 TI - Identifying Profiles of Digital Literacy Among Community-Dwelling Korean Older Adults: Latent Profile Analysis JO - J Med Internet Res SP - e57122 VL - 27 KW - digital literacy KW - digital divide KW - older adults KW - South Korea KW - latent profile analysis N2 - Background: The digital divide is apparent not only between older and younger generations but also within the older adult population itself. Identifying digital literacy profiles among older adults is crucial for developing targeted strategies to narrow this divide. Objective: This study aimed to identify profiles of digital literacy among community-dwelling older adults and to examine factors associated with these profiles. Methods: Data were collected from community-dwelling older adults in South Korea through a nationwide cross-sectional survey that assessed digital literacy and related factors. Digital literacy was evaluated across 3 domains: information and communication (9 items), content creation and management (4 items), and safety and security (9 items). Latent profile analysis was used to identify profiles of digital literacy among community-dwelling older adults, and multinomial logistic regression was used to identify predictors of profile membership. Results: A total of 1016 older adults completed structured questionnaires (average age 68, SD 6.5 years; 486/1016, 47.8% men). Three digital literacy profiles were identified (P<.001): ?low level? (346/1016, 34.1%), ?middle level? (374/1016, 36.8%), and ?high level? (296/1016, 29.1%). With the ?middle-level? digital literacy group as the reference group, older adult participants (odds ratio [OR] 1.11, 95% CI 1.07-1.15) with less than a middle school education (vs with a college degree or higher; OR 7.22, 95% CI 2.31-22.54), who needed help with one of the 10 instrumental daily activities (vs ?2 activities; OR 3.06, 95% CI 1.11-8.40) and who did not engage in in-person social activities (OR 1.81, 95% CI 1.07-3.07), were more likely to be in the ?low-level? group. Women were less likely to be in the ?high-level? digital literacy group than men (OR 0.45, 95% CI 0.25-0.80). Participants with less than a college education were also less likely to be in the ?high-level? group, with those having less than a middle school education showing the lowest OR (OR 0.17, 95% CI 0.07-0.41). Those who had never worked (OR 0.23, 95% CI 0.06-0.90) and those not engaging in regular physical exercise (OR 0.58, 95% CI 0.40-0.84) were also less likely to be in the ?high-level? digital literacy group. Participants with greater social support were more likely to be in the ?high-level? digital literacy group (OR 1.70, 95% CI 1.22-2.37). Conclusions: These findings underscore the characteristics linked to lower digital literacy and suggest a tailored approach to meet the needs of diverse groups of older adults in a digitalizing society. To promote digital literacy among older adults, potential strategies include improving access to and guidance for using digital devices, specifically designed for this demographic, as well as promoting social support and encouraging participation in social activities. UR - https://www.jmir.org/2025/1/e57122 UR - http://dx.doi.org/10.2196/57122 UR - http://www.ncbi.nlm.nih.gov/pubmed/39969960 ID - info:doi/10.2196/57122 ER - TY - JOUR AU - Stiles-Shields, Colleen AU - Bobadilla, Gabriella AU - Reyes, Karen AU - Gustafson, L. Erika AU - Lowther, Matthew AU - Smith, L. Dale AU - Frisbie, Charles AU - Antognini, Camilla AU - Dyer, Grace AU - MacCarthy, Rae AU - Martinengo, Nicolò AU - Morris, Guy AU - Touranachun, Alissa AU - Wilkens, M. Kimberlee AU - Julion, A. Wrenetha AU - Karnik, S. Niranjan PY - 2025/2/18 TI - Digital Mental Health Screening, Feedback, and Referral System for Teens With Socially Complex Needs: Protocol for a Randomized Controlled Trial Integrating the Teen Assess, Check, and Heal System into Pediatric Primary Care JO - JMIR Res Protoc SP - e65245 VL - 14 KW - teens KW - primary care KW - digital mental health KW - low intensity treatments KW - disparities N2 - Background: Teens with socially complex needs?those who face multiple and potentially overlapping adversities?are disproportionately affected by several barriers to mental health screening and treatment. Pediatric primary care (PPC) is a typically low-stigmatized setting for teens that is visited at least annually. As such, implementing digital mental health tools (DMH), as low-intensity treatments in PPCs may increase the reach of such tools for teens with socially complex needs. Objective: This study aimed to evaluate the Teen Assess, Check, and Heal (TeACH) System in comparison to a control condition while integrated into PPCs at 2 Medical Centers serving teen patients in Chicago, Illinois. Through collaboration with key players throughout the design and implementation planning phases, the TeACH System is hypothesized to increase teen patient self-reported engagement with DMH and address specific individual-level barriers to mental health care, compared with a digital psychoeducation control condition. Methods: Eligible participants will be recruited through PPC clinics housed within the University of Illinois Chicago (UIC) and Rush University Medical Center (RUSH). Recruitment involves invitations from research staff members and primary care clinicians and staff members, as well as posting flyers with QR codes at the specified clinics. All participants complete a brief demographic survey, baseline survey, and Kiddie-Computerized Adaptive Tests Anxiety Module. Participants are randomized to receive either the control condition (digital evidence-based workbook) or the intervention (TeACH System Feedback and Resources). All randomized participants will then be invited to complete an immediate and 1-week follow-up survey. The primary outcomes assess changes in engagement with DMH (ie, likelihood to use DMH for anxiety and actual DMH use) and individual-level barriers to mental health care (ie, symptom understanding and confidence to act). Descriptive analyses will be conducted to characterize the sample and usability ratings of the TeACH System. Linear or generalized linear mixed effects regression models will examine differences in primary outcomes over time. Results: Recruitment began in July 2024 and data collection is expected to be completed by August 2025. To date, 122 teens have assented to complete study activities, 80 have been randomized (an additional 24 teens have had subthreshold anxiety symptoms and were therefore not randomized), and 42 teens have completed the 1-week follow-up assessment. Conclusions: This study will provide preliminary feasibility data that may inform how the TeACH System and other DMH low-intensity treatments might better engage and support teens with socially complex needs. Trial Registration: ClinicalTrials.gov NCT05466929; https://clinicaltrials.gov/study/NCT05466929 International Registered Report Identifier (IRRID): DERR1-10.2196/65245 UR - https://www.researchprotocols.org/2025/1/e65245 UR - http://dx.doi.org/10.2196/65245 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65245 ER - TY - JOUR AU - Clifford, Namuun AU - Tunis, Rachel AU - Ariyo, Adetimilehin AU - Yu, Haoxiang AU - Rhee, Hyekyun AU - Radhakrishnan, Kavita PY - 2025/2/10 TI - Trends and Gaps in Digital Precision Hypertension Management: Scoping Review JO - J Med Internet Res SP - e59841 VL - 27 KW - precision health KW - hypertension KW - digital health KW - prediction models KW - personalization KW - phenotyping KW - machine learning KW - algorithms KW - mobile apps KW - mobile health N2 - Background: Hypertension (HTN) is the leading cause of cardiovascular disease morbidity and mortality worldwide. Despite effective treatments, most people with HTN do not have their blood pressure under control. Precision health strategies emphasizing predictive, preventive, and personalized care through digital tools offer notable opportunities to optimize the management of HTN. Objective: This scoping review aimed to fill a research gap in understanding the current state of precision health research using digital tools for the management of HTN in adults. Methods: This study used a scoping review framework to systematically search for articles in 5 databases published between 2013 and 2023. The included articles were thematically analyzed based on their precision health focus: personalized interventions, prediction models, and phenotyping. Data were extracted and summarized for study and sample characteristics, precision health focus, digital health technology, disciplines involved, and characteristics of personalized interventions. Results: After screening 883 articles, 46 were included; most studies had a precision health focus on personalized digital interventions (34/46, 74%), followed by prediction models (8/46, 17%) and phenotyping (4/46, 9%). Most studies (38/46, 82%) were conducted in or used data from North America or Europe, and 63% (29/46) of the studies came exclusively from the medical and health sciences, with 33% (15/46) of studies involving 2 or more disciplines. The most commonly used digital technologies were mobile phones (33/46, 72%), blood pressure monitors (18/46, 39%), and machine learning algorithms (11/46, 24%). In total, 45% (21/46) of the studies either did not report race or ethnicity data (14/46, 30%) or partially reported this information (7/46, 15%). For personalized intervention studies, nearly half (14/30, 47%) used 2 or less types of data for personalization, with only 7% (2/30) of the studies using social determinants of health data and no studies using physical environment or digital literacy data. Personalization characteristics of studies varied, with 43% (13/30) of studies using fully automated personalization approaches, 33% (10/30) using human-driven personalization, and 23% (7/30) using a hybrid approach. Conclusions: This scoping review provides a comprehensive mapping of the literature on the current trends and gaps in digital precision health research for the management of HTN in adults. Personalized digital interventions were the primary focus of most studies; however, the review highlighted the need for more precise definitions of personalization and the integration of more diverse data sources to improve the tailoring of interventions and promotion of health equity. In addition, there were significant gaps in the reporting of race and ethnicity data of participants, underuse of wearable devices for passive data collection, and the need for greater interdisciplinary collaboration to advance precision health research in digital HTN management. Trial Registration: OSF Registries osf.io/yuzf8; https://osf.io/yuzf8 UR - https://www.jmir.org/2025/1/e59841 UR - http://dx.doi.org/10.2196/59841 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59841 ER - TY - JOUR AU - He, Jinyu AU - Li, Yanjun AU - Zeng, Huatang AU - Sun, Haoran AU - Wu, Liqun AU - Zhu, Zhenzhen AU - Zhang, Ning AU - Liang, Wannian PY - 2025/2/10 TI - Health Equity of Hypertension Management Between Local Residents and Internal Migrants in Shenzhen, China: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e65548 VL - 11 KW - health equity KW - hypertension management KW - immigrant population KW - hypertension KW - China KW - global health KW - public health KW - health disparities KW - medical record KW - community health care KW - native population KW - immigrant KW - socioeconomic KW - disease burden KW - well-being KW - chronic disease KW - community health center N2 - Background: With hypertension emerging as a global public health concern, taking measures to alleviate its burden is urgently needed. The hypertension management program (HMP) in China is a standardized policy to help people with hypertension to improve their health levels and reduce health inequalities. However, studies focusing on details regarding participation in this program remain scarce. Objective: This study aims to investigate the participation rates in HMPs in China and examine the health disparities in hypertension management between local residents and internal migrants in Shenzhen. Methods: This study used the medical record of Shenzhen, Guangdong, China. We included adults with new-onset diagnosis of hypertension after 2017 and focused on patients who have a record in the community health center. We described the basic characteristics of people diagnosed with hypertension, including age, gender, marital status, occupation, education level, and health insurance type. Enrolled rate, follow-up rate, and adherence rate were used to measure the engagement with this program at the city, district, and community levels. Results: Of the 1,160,214 hypertensive patients, 29.70% (344,526/1,160,214) were local residents, while 70.3% (815,688/1,160,214) were internal migrants. In addition, 55.36% (642,250/1,160,214) were enrolled in the HMP. Of those, 57.52% (369,439/642,25) were followed up. In addition, 62.59% (231,217/369,439) of followed up individuals were adherents. Internal migrants demonstrated a significantly higher participation in the HMP, especially for the enrolled rate (local residents: 156,085/344,526, 45.30% vs internal migrants: 486,165/815,688, 59.60%) and adherence rate (local residents: 44,044/84,635, 52.04% vs internal migrants: 187,173/284,804, 65.72%). Apart from that, local, single, and younger individuals had lower rates compared to their counterparts. There also existed within-district and within-community variation among enrolled, follow-up, and adherence rates. Conclusions: Based on our research, individuals with different demographic and socioeconomic characteristics and in different regions had different enrolled, follow-up, and adherence rates. Internal migrants in Shenzhen showed a significantly higher participation in the HMP. Given these findings, there exists the potential to enhance the outreach and engagement of local, single, and younger populations through targeted promotional strategies. UR - https://publichealth.jmir.org/2025/1/e65548 UR - http://dx.doi.org/10.2196/65548 ID - info:doi/10.2196/65548 ER - TY - JOUR AU - Yang, Lu AU - Lynch, Chris AU - Lee, Tayu John AU - Oldenburg, Brian AU - Haregu, Tilahun PY - 2025/2/10 TI - Understanding the Association Between Home Broadband Connection and Well-Being Among Middle-Aged and Older Adults in China: Nationally Representative Panel Data Study JO - J Med Internet Res SP - e59023 VL - 27 KW - digital divide KW - health inequity KW - China KW - longitudinal study KW - broadband KW - internet connection KW - internet KW - well-being KW - psychosocial KW - middle age KW - older adult KW - inequality KW - digital connectivity KW - logistic regression KW - questionnaire KW - survey KW - panel data approach N2 - Background: Access to digital technology is among the major social determinants of health, and digital divide impacts health inequality. Yet, the impact of digital connectivity on the well-being and psychosocial outcomes in adults has not been fully studied. Objective: The aim of this study was to investigate the association of home broadband connection with health and well-being of middle-aged adults and adults older than 45 years in China. Methods: A panel data study design of the national sample of China Health and Retirement Longitudinal Study (CHARLS) was conducted in 2015, 2018, and 2020. This study included 16,185 participants older than 45 years. The associations between digital connectivity (home broadband connection), loneliness, social participation, and life satisfaction were assessed using mixed effects logistic regression models, adjusting for socioeconomic factors, behavioral factors, and locality. Broadband internet connectivity, feelings of loneliness, social participation, and satisfaction with life were measured using the self-reported CHARLS questionnaire. Results: We observed a substantial increase in digital connectivity from 29.5% in 2015 to 59.8% in 2020. Broadband internet connection at home was positively correlated with social participation (adjusted odds ratio [AOR] 1.34, 95% CI 1.28-1.41) and life satisfaction (AOR 1.30, 95% CI 1.20-1.40), after adjusting for confounding factors, while the absence of broadband internet connection was associated with increased loneliness (AOR 0.81, 95% CI 0.77-0.86). These associations were consistent across age, gender, socioeconomic groups, and geographic areas. Conclusions: This study highlights the potential additional health benefits of digital connectivity beyond the known advantages. Our results suggest the importance of expanding broadband access to enhance social inclusion and life satisfaction. Further research is needed to understand the broader implications and digital determinants of health associated with digital connectivity. UR - https://www.jmir.org/2025/1/e59023 UR - http://dx.doi.org/10.2196/59023 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59023 ER - TY - JOUR AU - Jung, Hyein AU - Lee, Hocheol AU - Nam, Woo Eun PY - 2025/2/6 TI - Mediating Effect of Social Capital on the Association Between Digital Literacy and Life Satisfaction Among Older Adults in South Korea: Cross-Sectional Study JO - JMIR Form Res SP - e68163 VL - 9 KW - digital literacy KW - digital access KW - digital competency KW - digital utilization KW - life satisfaction KW - older adults KW - social capital KW - mediating effect KW - aging N2 - Background: As Korea rapidly transforms into a super-aged society, research indicates that digital literacy among older adults enhances their life satisfaction. Digital literacy refers to the ability to efficiently use digital technologies, encompassing access, competency, and utilization. It reflects the capacity to navigate and benefit from digital environments effectively. Furthermore, social capital positively influences the quality of life, and digital literacy facilitates social capital formation. However, since most studies have only focused on the direct relationship between digital literacy and life satisfaction, research on the mediating role of social capital remains limited. Objective: To analyze the effect of digital literacy on the life satisfaction of older adults in South Korea and to verify whether social capital acts as a mediating factor in this process. Methods: This descriptive cross-sectional study used data from the 2023 Report on the Digital Divide?an annual survey conducted by the Korean Ministry of Science and Information and Communications Technology. The study targeted individuals aged 65 years or older. Descriptive statistics, the Pearson correlation analyses, and the 3-step multiple regression analysis proposed by Baron and Kenny were performed. The bootstrap method was employed, and all analyses were conducted using R, version 4.4.1. Results: The study included 869 participants. Digital literacy had a significant positive effect on their life satisfaction (?=0.103; P=.008). Social capital was also positively associated with life satisfaction (?=0.337; P<.001). Mediation analysis showed that digital literacy influenced life satisfaction both directly (?=0.103; P=.006) and indirectly through social capital (?=0.037; P=.03). Bootstrapping confirmed the significance of the indirect effect (?=0.037, 95% CI 0.005?0.070; P=.03). The total effect of digital literacy on life satisfaction was also significant (?=0.140, 95% CI 0.058?0.230; P=.002). Conclusions: This study analyzed the association between digital literacy, social capital, and life satisfaction among older adults in Korea. We identified that social capital mediates the association between digital literacy and life satisfaction among older adults. These findings indicate that tailored digital literacy programs and support policies that promote social capital formation could help bridge the digital divide and foster social inclusion. These measures would enable older adults to access essential services, reduce social isolation, and enhance health and well-being, ultimately improving the overall quality of life. UR - https://formative.jmir.org/2025/1/e68163 UR - http://dx.doi.org/10.2196/68163 ID - info:doi/10.2196/68163 ER - TY - JOUR AU - Kraft, A. Stephanie AU - Chopra, Shaan AU - Duran, C. Miriana AU - Rojina, A. Janet AU - Beretta, Abril AU - López, I. Katherine AU - Javan, Russell AU - Wilfond, S. Benjamin AU - Rosenfeld, Margaret AU - Fogarty, James AU - Ko, K. Linda PY - 2025/2/6 TI - Perspectives of Hispanic and Latinx Community Members on AI-Enabled mHealth Tools: Qualitative Focus Group Study JO - J Med Internet Res SP - e59817 VL - 27 KW - wearable electronic devices KW - qualitative research KW - mobile health KW - mHealth KW - digital health KW - privacy KW - data sharing KW - artificial intelligence KW - AI KW - community KW - chronic conditions KW - chronic disease N2 - Background: Mobile health (mHealth) tools have the potential to reduce the burden of chronic conditions that disproportionately affect Hispanic and Latinx communities; however, digital divides in the access to and use of health technology suggest that mHealth has the potential to exacerbate, rather than reduce, these disparities. Objective: A key step toward developing health technology that is accessible and usable is to understand community member perspectives and needs so that technology is culturally relevant and appropriately contextualized. In this study, we aimed to examine the perspectives of Hispanic and Latinx community members in Washington State about mHealth. Methods: We recruited English- and Spanish-speaking Hispanic or Latinx adults to participate in web-based focus groups through existing community-based networks across rural and urban regions of Washington State. Focus groups included a presentation of narrative slideshow materials developed by the research team depicting mHealth use case examples of asthma in children and fall risk in older adults. Focus group questions asked participants to respond to the case examples and to further explore mHealth use preferences, benefits, barriers, and concerns. Focus group recordings were professionally transcribed, and Spanish transcripts were translated into English. We developed a qualitative codebook using deductive and inductive methods and then coded deidentified transcripts using the constant comparison method. The analysis team proposed themes based on review of coded data, which were validated through member checking with a community advisory board serving Latino individuals in the region and finalized through discussion with the entire research team. Results: Between May and September 2023, we conducted 8 focus groups in English or Spanish with 48 participants. Focus groups were stratified by language and region and included the following: 3 (n=18, 38% participants) Spanish urban groups, 2 (n=14, 29% participants) Spanish rural groups, 1 (n=6, 13% participants) English urban group, and 2 (n=10, 21% participants) English rural groups. We identified the following seven themes: (1) mHealth is seen as beneficial for promoting health and peace of mind; (2) some are unaware of, unfamiliar with, or uncomfortable with technology and may benefit from individualized support; (3) financial barriers limit access to mHealth; (4) practical considerations create barriers to using mHealth in daily life; (5) mHealth raises concern for overreliance on technology; (6) automated mHealth features are perceived as valuable but fallible, requiring human input to ensure accuracy; and (7) data sharing is seen as valuable for limited uses but raises privacy concerns. These themes illustrate key barriers to the benefits of mHealth that communities may face, provide insights into the role of mHealth within families, and examine the appropriate balance of data sharing and privacy protections. Conclusions: These findings offer important insights that can help advance the development of mHealth that responds to community values and priorities. UR - https://www.jmir.org/2025/1/e59817 UR - http://dx.doi.org/10.2196/59817 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59817 ER - TY - JOUR AU - Tong, Chau AU - Margolin, Drew AU - Niederdeppe, Jeff AU - Chunara, Rumi AU - Liu, Jiawei AU - Jih-Vieira, Lea AU - King, J. Andy PY - 2025/2/3 TI - Colorectal Cancer Racial Equity Post Volume, Content, and Exposure: Observational Study Using Twitter Data JO - J Med Internet Res SP - e63864 VL - 27 KW - racial equity information KW - information exposure KW - health disparities KW - colorectal cancer KW - cancer communication KW - Twitter KW - X N2 - Background: Racial inequity in health outcomes, particularly in colorectal cancer (CRC), remains one of the most pressing issues in cancer communication and public health. Social media platforms like Twitter (now X) provide opportunities to disseminate health equity information widely, yet little is known about the availability, content, and reach of racial health equity information related to CRC on these platforms. Addressing this gap is essential to leveraging social media for equitable health communication. Objective: This study aims to analyze the volume, content, and exposure of CRC racial health equity tweets from identified CRC equity disseminator accounts on Twitter. These accounts were defined as those actively sharing information related to racial equity in CRC outcomes. By examining the behavior and impact of these disseminators, this study provides insights into how health equity content is shared and received on social media. Methods: We identified accounts that posted CRC-related content on Twitter between 2019 and 2021. Accounts were classified as CRC equity disseminators (n=798) if they followed at least 2 CRC racial equity organization accounts. We analyzed the volume and content of racial equity?related CRC tweets (n=1134) from these accounts and categorized them by account type (experts vs nonexperts). Additionally, we evaluated exposure by analyzing follower reach (n=6,266,269) and the role of broker accounts?accounts serving as unique sources of CRC racial equity information to their followers. Results: Among 19,559 tweets posted by 798 CRC equity disseminators, only 5.8% (n=1134) mentioned racially and ethnically minoritized groups. Most of these tweets (641/1134, 57%) addressed disparities in outcomes, while fewer emphasized actionable content, such as symptoms (11/1134, 1%) or screening procedures (159/1134, 14%). Expert accounts (n=479; 716 tweets) were more likely to post CRC equity tweets compared with nonexpert accounts (n=319; 418 tweets). Broker accounts (n=500), or those with a substantial portion of followers relying on them for equity-related information, demonstrated the highest capacity for exposing followers to CRC equity content, thereby extending the reach of these critical messages to underserved communities. Conclusions: This study emphasizes the critical roles played by expert and broker accounts in disseminating CRC racial equity information on social media. Despite the limited volume of equity-focused content, broker accounts were crucial in reaching otherwise unexposed audiences. Public health practitioners should focus on encouraging equity disseminators to share more actionable information, such as symptoms and screening benefits, and implement measures to amplify the reach of such content on social media. Strengthening these efforts could help bridge disparities in cancer outcomes among racially minoritized groups. UR - https://www.jmir.org/2025/1/e63864 UR - http://dx.doi.org/10.2196/63864 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63864 ER - TY - JOUR AU - Figueroa, A. Caroline AU - Torkamaan, Helma AU - Bhattacharjee, Ananya AU - Hauptmann, Hanna AU - Guan, W. Kathleen AU - Sedrakyan, Gayane PY - 2025/1/30 TI - Designing Health Recommender Systems to Promote Health Equity: A Socioecological Perspective JO - J Med Internet Res SP - e60138 VL - 27 KW - digital health KW - health promotion KW - health recommender systems KW - artificial intelligence KW - health equity KW - AI KW - digital devices KW - socioecological KW - health inequities KW - health behavior KW - health behaviors KW - patient centric KW - digital health intervention UR - https://www.jmir.org/2025/1/e60138 UR - http://dx.doi.org/10.2196/60138 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60138 ER - TY - JOUR AU - Karasek, Deborah AU - Williams, C. Jazzmin AU - Taylor, A. Michaela AU - De La Cruz, M. Monica AU - Arteaga, Stephanie AU - Bell, Sabra AU - Castillo, Esperanza AU - Chand, A. Maile AU - Coats, Anjeanette AU - Hubbard, M. Erin AU - Love-Goodlett, Latriece AU - Powell, Breezy AU - Spellen, Solaire AU - Malawa, Zea AU - Gomez, Manchikanti Anu PY - 2025/1/27 TI - Designing the First Pregnancy Guaranteed Income Program in the United States: Qualitative Needs Assessment and Human-Centered Design to Develop the Abundant Birth Project JO - JMIR Form Res SP - e60829 VL - 9 KW - maternal and child health KW - economics KW - public health KW - qualitative research methods KW - programs (evaluation and funding) KW - community-centered KW - pregnancy KW - first pregnancy KW - behavioral interventions KW - racial health KW - financial stress KW - Abundant Birth Project KW - infant health KW - infant KW - Black N2 - 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. UR - https://formative.jmir.org/2025/1/e60829 UR - http://dx.doi.org/10.2196/60829 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60829 ER - TY - JOUR AU - Marcolino, Soriano Milena AU - Oliveira, Ramos Lucca Fagundes AU - Valle, Rocha Lucas AU - Rosa, Santa Luiza Marinho Motta AU - Reis, Nogueira Zilma Silveira AU - Soares, Castro Thiago Barbabela de AU - Bernardino, Almeida Elidéa Lúcia AU - Cordeiro, Almeida Raniere Alislan AU - Prates, Oliveira Raquel AU - Campos, Montenegro Mario Fernando PY - 2025/1/23 TI - Sign Language Recognition System for Deaf Patients: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e55427 VL - 14 KW - computer neural networks KW - artificial intelligence KW - biomedical technology KW - communication aids for disabled KW - computer vision KW - sign language KW - hearing loss KW - deaf people KW - communication barriers KW - gestures N2 - Background: Individuals with hearing impairments may face hindrances in health care assistance, which may significantly impact the prognosis and the incidence of complications and iatrogenic events. Therefore, the development of automatic communication systems to assist the interaction between this population and health care workers is paramount. Objective: This study aims to systematically review the evidence on communication systems using human-computer interaction techniques developed for deaf people who communicate through sign language that are already in use or proposed for use in health care contexts and have been tested with human users or videos of human users. Methods: A systematic review will be performed based on a literature search in MEDLINE, Web of Science, ACM, and IEEE Xplore as well as top-tiered conferences in the area to identify relevant studies. The inclusion criteria are the description of the development of a sign language recognition system in a health care context and the testing with human users. Independent investigators (LFRO, LRV, and LMMSR) will screen eligible studies, and disagreements will be solved by a senior researcher (MSM). The included papers will undergo full-text screening. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flow diagram will be presented to visually summarize the screening process, ensuring clarity and transparency in presenting the results. Additionally, a comprehensive chart table will be constructed to consolidate essential data related to the key variables extracted from the studies. These results will be meticulously analyzed and presented descriptively, offering insightful interpretations of the information encapsulated within the table. Results: A preliminary search was performed in April 2024. Researchers concluded the study selection by July 2024. Data extraction, synthesis, report, and recommendations are expected to be finished by February 2025. Conclusions: This systematic review will identify human-machine systems that enable communication in health services involving deaf patients, presenting the framework that includes usability and application in human contexts. We will present a comprehensive panel of findings, highlighting systems used to tackle communication barriers and offer a narrative comparison of current implementation practices. International Registered Report Identifier (IRRID): PRR1-10.2196/55427 UR - https://www.researchprotocols.org/2025/1/e55427 UR - http://dx.doi.org/10.2196/55427 UR - http://www.ncbi.nlm.nih.gov/pubmed/39847417 ID - info:doi/10.2196/55427 ER - TY - JOUR AU - Weidinger, Florian AU - Dietzel, Nikolas AU - Graessel, Elmar AU - Prokosch, Hans-Ulrich AU - Kolominsky-Rabas, Peter PY - 2025/1/15 TI - Using Health Information Resources for People With Cognitive Impairment (digiDEM Bayern): Registry-Based Cohort Study JO - JMIR Form Res SP - e54460 VL - 9 KW - dementia KW - mild cognitive impairment KW - cognitive impairment KW - information sources KW - health information KW - health information?seeking behavior KW - Digital Dementia Registry Bavaria KW - digiDEM N2 - Background: Dementia is a growing global health challenge with significant economic and social implications. Underdiagnosis of dementia is prevalent due to a lack of knowledge and understanding among the general population. Enhancing dementia literacy through improved health information?seeking behavior is crucial for the self-determined management of the disease by those affected. Understanding the relationship between dementia literacy, health information?seeking behavior, and the use of various information sources among individuals with cognitive impairment is of high importance in this context. Objective: The aim of this study was to analyze the relevance of different sources of health information from the perspective of people with cognitive impairment, while also evaluating differences based on age, gender, and disease progression. Methods: This study is part of the ongoing project ?Digital Dementia Registry Bavaria ? digiDEM Bayern.? The Digital Dementia Registry Bavaria is a multicenter, prospective, longitudinal register study in Bavaria, Germany. People with cognitive impairment rated several information sources by using Likert scales with the values unimportant (1) to very important (5). Data were analyzed descriptively, and multiple 2-sample, 2-tailed t tests were used to evaluate differences by cognitive status and gender and using multiple one-way ANOVA to evaluate differences by age group. Results: Data of 924 people with cognitive impairment (531 with dementia, 393 with mild cognitive impairment) were evaluated. The most relevant health information sources were ?Personal visit to a medical professional? (mean 3.9, SD 1.1) and ?Family / Friends? (mean 3.9, SD 1.2). ?Internet? was 1 of the 2 lowest-rated information sources by people with cognitive impairment (mean 1.6, SD 1.1), with nearly three-quarters (684/924, 74%) of the participants rating the source as unimportant. The age-specific analyses showed significant differences for the sources ?Internet? (F2,921=61.23; P<.001), ?Courses / Lectures? (F2,921=18.88; P<.001), and ?Family / Friends? (F2,921=6.27; P=.002) for the 3 defined age groups. There were several significant differences between people with mild cognitive impairment and dementia whereby the first group evaluated most sources higher, such as ?Internet? (mean difference=0.6; t640=7.52; P<.001). The only sources rated higher by the dementia group were ?TV / Radio? and ?Family / Friends,? with none of them showing significant differences. Gender-specific analyses showed women with cognitive impairment valuing every evaluated source higher than men apart from ?Internet? (mean difference=0.4; t685=4.97; P<.001). Conclusions: To enhance health and dementia literacy, the best way to communicate health information to people with cognitive impairment is through interpersonal contact with medical professionals and their friends and family. Slight changes in valuation should be considered as the medical condition progresses, along with variations by age and gender. In particular, the evaluation and use of the internet are dependent on these factors. Further research is needed to capture potential changes in the valuation of the internet as a health information source. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-043473 UR - https://formative.jmir.org/2025/1/e54460 UR - http://dx.doi.org/10.2196/54460 ID - info:doi/10.2196/54460 ER - TY - JOUR AU - Wu, Mengqiu AU - Xue, Yongxi AU - Ma, Chengyu PY - 2025/1/15 TI - The Association Between the Digital Divide and Health Inequalities Among Older Adults in China: Nationally Representative Cross-Sectional Survey JO - J Med Internet Res SP - e62645 VL - 27 KW - older adults KW - digital divide KW - internet use KW - internet access KW - health inequalities N2 - Background: Health inequalities among older adults become increasingly pronounced as aging progresses. In the digital era, some researchers argue that access to and use of digital technologies may contribute to or exacerbate these existing health inequalities. Conversely, other researchers believe that digital technologies can help mitigate these disparities. Objective: This study aimed to investigate the relationship between the digital divide and health inequality among older adults and to offer recommendations for promoting health equity. Methods: Data were obtained from the 2018 and 2020 waves of the China Health and Retirement Longitudinal Study. Physical, mental, and subjective health were assessed using the Activities of Daily Living (ADL) scale, the Instrumental Activities of Daily Living scale, the Mini-Mental State Examination scale, and a 5-point self-rated health scale, respectively. The chi-square and rank sum tests were used to explore whether internet use and access were associated with health inequality status. After controlling for confounders, multiple linear regression models were used to further determine this association. Sensitivity analysis was conducted using propensity score matching, and heterogeneity was analyzed for different influencing factors. Results: The 2018 analysis highlighted widening health disparities among older adults due to internet access and use, with statistically significant increases in inequalities in self-rated health (3.9%), ADL score (5.8%), and cognition (7.5%). Similarly, internet use widened gaps in self-rated health (7.5%) and cognition (7.6%). Conversely, the 2020 analysis demonstrated that internet access improved health disparities among older adults, reducing gaps in self-rated health (3.8%), ADL score (2.1%), instrumental ADL score (3.5%), and cognition (7.5%), with significant results, except for ADL. Internet use also narrowed disparities, with significant effects on self-rated health (4.8%) and cognition (12.8%). The robustness of the results was confirmed through propensity score?matching paired tests. In addition, the study found heterogeneity in the effects of internet access and use on health inequalities among older adults, depending on sex, age, education, and region. Conclusions: The impact of internet access and use on health inequalities among older adults showed different trends in 2018 and 2020. These findings underscore the importance of addressing the challenges and barriers to internet use among older adults, particularly during the early stages of digital adoption. It is recommended to promote equitable access to the health benefits of the internet through policy interventions, social support, and technological advancements. UR - https://www.jmir.org/2025/1/e62645 UR - http://dx.doi.org/10.2196/62645 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62645 ER - TY - JOUR AU - Choi, Ki Seul AU - Marshall, Jaclyn AU - Sexton Topper, Patrina AU - Pregnall, Andrew AU - Bauermeister, José PY - 2025/1/9 TI - Impact of a Virtual Care Navigation Service on Member-Reported Outcomes Among Lesbian, Gay, Bisexual, Transgender, and Queer Populations: Case Study JO - JMIR Form Res SP - e64137 VL - 9 KW - health care navigation KW - LGBTQ+ KW - lesbian KW - gay KW - bisexual KW - transgender KW - queer KW - access to care KW - care avoidance KW - identity-affirming care KW - minority KW - stress KW - stigma KW - health outcomes N2 - Background: While the significance of care navigation in facilitating access to health care within the lesbian, gay, bisexual, transgender, queer, and other (LGBTQ+) communities has been acknowledged, there is limited research examining how care navigation influences an individual?s ability to understand and access the care they need in real-world settings. By analyzing private sector data, we can bridge the gap between theoretical research findings and practical applications, ultimately informing both business strategies and public policy with evidence grounded in real-world efficacy. Objective: The objective of this study was to evaluate the impact of specialized virtual care navigation services on LGBTQ+ individuals? ability to comprehend and access necessary care within a national cohort of commercially insured members. Methods: This case study is based on the experience of commercially insured members, aged 18 or older, who used the LGBTQ+ Health Care Navigation (LGBTQ+ Navigation) service by Included Health between January 26 and July 31, 2023. Care coordinators assisted members by connecting them with vetted identity-affirming in-network providers, helping them navigate and understand their LGBTQ+ health benefits, and providing education and advocacy for clinical and nonclinical needs. We examined the impact of navigation on 5 member-reported outcomes. In addition to reporting the proportion who agreed or strongly agreed, we calculated an impact score that averaged assigned numerical values to all 5 question responses (1=strongly disagree to 5=strongly agree) for each respondent. We used ANOVA with Tukey post hoc tests and t tests to explore the relationships between the impact score and member characteristics, including optional self-reported demographics. Results: Out of 4703 LGBTQ+ Navigation cases, 7.53% (n=354) had member-reported outcomes. A large majority of LGBTQ+ members agreed or strongly agreed that care navigation resulted in less stress (315/354, 89%), less care avoidance (305/354, 86.2%), higher confidence in finding an identity-affirming provider (327/354, 92.4%), improved ability to comprehend health care information (312/354, 88.1%), and improved ability to engage with providers (308/354, 87%). The average impact score was 4.44 (SD 0.69), with statistically significant differences by gender identity (P=.003), race (P=.01), ethnicity (P=.008), and pronouns (P=.02). The scores were highest for members with multiple gender identities (mean 4.56, SD 0.37), and members who did not provide their race, ethnicity, or their pronouns (mean 4.55, SD 0.64). Impact scores were lowest for transgender members (mean 4.11, SD 0.95). Conclusions: The LGBTQ+ Navigation service, by enhancing members? comprehension and use of necessary care, demonstrates potential public health utility and value. Continuous evaluation of navigation services can serve as a supplementary tool for employers seeking to promote health equity and improve belonging among employees. This is particularly important as discrimination and stigma against LGBTQ+ communities persist in the United States. Therefore, scalable and system-level changes that use navigation services are essential to reach a larger proportion of the LGBTQ+ population. UR - https://formative.jmir.org/2025/1/e64137 UR - http://dx.doi.org/10.2196/64137 ID - info:doi/10.2196/64137 ER - TY - JOUR AU - Valla, Guido Luca AU - Rossi, Michele AU - Gaia, Alessandra AU - Guaita, Antonio AU - Rolandi, Elena PY - 2025/1/9 TI - The Impact of the COVID-19 Pandemic on Oldest-Old Social Capital and Health and the Role of Digital Inequalities: Longitudinal Cohort Study JO - J Med Internet Res SP - e62824 VL - 27 KW - older adults KW - information and communication technology KW - ICT KW - ICT use KW - COVID-19 KW - social capital KW - health KW - mental health KW - digital divide N2 - Background: During the COVID-19 pandemic, information and communication technology (ICT) became crucial for staying connected with loved ones and accessing health services. In this scenario, disparities in ICT use may have exacerbated other forms of inequality, especially among older adults who were less familiar with technology and more vulnerable to severe COVID-19 health consequences. Objective: This study investigated changes in ICT use, psychological and physical health, and social capital before and after the pandemic among the oldest old population (aged 80 years or older after the pandemic) and explored how internet use influenced these changes. Methods: We leveraged data from the InveCe.Ab study, a population-based longitudinal cohort of people born between 1935 and 1939 and living in Abbiategrasso, a municipality on the outskirts of Milan, Italy. Participants underwent multidimensional assessment at baseline (2010) and after 2, 4, 8, and 12 years. We restricted our analysis to cohort members who participated in the last wave (ie, 2022) and who did not have a diagnosis of dementia (n=391). We used linear mixed models to assess the impact of COVID-19 and time on changes in social capital, physical and psychological health, and ICT use in a discontinuity regression design while controlling for age, sex, education, and income satisfaction. Then, we assessed the influence of internet use and its interaction with COVID-19 on these changes. Results: COVID-19 had a significant impact on social relationships (?=?4.35, 95% CI 6.38 to ?2.32; P<.001), cultural activities (?=?.55, 95% CI ?0.75 to ?0.35; P<.001), cognitive functioning (?=?1.00, 95% CI ?1.28 to ?0.72; P<.001), depressive symptoms (?=.42, 95% CI 0.10-0.74; P=.009), physical health (?=.07, 95% CI 0.04-0.10; P<.001), and ICT use (?=?.11, 95% CI ?0.18 to ?0.03; P=.008). Internet use predicts reduced depressive symptoms (?=?.56, 95% CI ?1.07 to ?0.06; P=.03) over time. The interaction between internet use and COVID-19 was significant for cultural activities (?=?.73, 95% CI ?1.22 to ?0.24; P=.003) and cognitive functioning (?=1.36, 95% CI 0.67-2.05; P<.001). Conclusions: The pandemic had adverse effects on older adults? health and social capital. Contrary to expectations, even ICT use dropped significantly after the pandemic. Internet users maintained higher psychological health regardless of time and COVID-19 status. However, COVID-19 was associated with a steeper decline in cognitive functioning among internet nonusers. Policy makers may develop initiatives to encourage ICT adoption among older adults or strengthen their digital skills. Trial Registration: ClinicalTrials.gov NCT01345110; https://clinicaltrials.gov/study/NCT01345110 UR - https://www.jmir.org/2025/1/e62824 UR - http://dx.doi.org/10.2196/62824 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62824 ER - TY - JOUR AU - DeLange Martinez, Pauline AU - Tancredi, Daniel AU - Pavel, Misha AU - Garcia, Lorena AU - Young, M. Heather PY - 2025/1/8 TI - Adapting the Technology Acceptance Model to Examine the Use of Information Communication Technologies and Loneliness Among Low-Income, Older Asian Americans: Cross-Sectional Survey Analysis JO - JMIR Aging SP - e63856 VL - 8 KW - social isolation KW - loneliness KW - aged KW - older adults KW - Asian American KW - immigrant KW - vulnerable populations KW - internet KW - information and communication technologies KW - ICTs KW - digital divide KW - technology acceptance model KW - mobile phone N2 - Background: Loneliness is a significant issue among older Asian Americans, exacerbated by the COVID-19 pandemic. Older age, lower income, limited education, and immigrant status heighten loneliness risk. Information communication technologies (ICTs) have been associated with decreased loneliness among older adults. However, older Asian Americans are less likely to use ICTs, particularly if they are immigrants, have limited English proficiency, or are low income. The Technology Acceptance Model posits that perceived usefulness (PU), and perceived ease of use (PEOU) are key factors in predicting technology use. Objective: This study aimed to examine associations between PU, PEOU, ICT use, and loneliness among low-income, older Asian Americans. Methods: Cross-sectional survey data were gathered from predominately older Asian Americans in affordable senior housing (N=401). Using exploratory factor analysis and Horn parallel analysis, we examined 12 survey items to identify factors accounting for variance in ICT use. We deployed structural equation modeling to explore relationships among the latent factors and loneliness, adjusting for demographic and cognitive factors. Results: Exploratory factor analysis and Horn parallel analysis revealed 3 factors that accounted for 56.48% (6.78/12) total variance. PEOU combined items from validated subscales of tech anxiety and comfort, accounting for a 28.44% (3.41/12) variance. ICT use combined years of technological experience, computer, tablet, and smartphone use frequency, accounting for 15.59% (1.87/12) variance. PU combined 2 items assessing the usefulness of technology for social connection and learning and accounted for a 12.44% (1.49/12) variance. The 3-factor structural equation modeling revealed reasonable fit indexes (?2133=345.132; P<.001, chi-square minimum (CMIN)/df = 2595, comparative fit index (CFI)=0.93, Tucker-Lewis Index (TLI)=0.88). PEOU was positively associated with PU (?=.15; P=.01); PEOU and PU were positive predictors of ICT use (PEOU ?=.26, P<.001; PU ?=.18, P=.01); and ICT use was negatively associated with loneliness (?=?.28, P<.001). Demographic and health covariates also significantly influenced PU, PEOU, ICT use, and loneliness. English proficiency and education positively predicted PEOU (r=0.25, P<.001; r=0.26, P<.001) and ICT use (?=1.66, P=.03; ?=.21, P<.001), while subjective cognitive decline and Asian ethnicity were positively associated with loneliness (?=.31, P<.001; ?=.25, P<.001). Conclusions: This study suggests that targeted interventions enhancing PU or PEOU could increase ICT acceptance and reduce loneliness among low-income Asian Americans. Findings also underscore the importance of considering limited English proficiency and subjective cognitive decline when designing interventions and in future research. UR - https://aging.jmir.org/2025/1/e63856 UR - http://dx.doi.org/10.2196/63856 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63856 ER - TY - JOUR AU - Standaar, Lucille AU - van Tuyl, Lilian AU - Suijkerbuijk, Anita AU - Brabers, Anne AU - Friele, Roland PY - 2025/1/7 TI - Differences in eHealth Access, Use, and Perceived Benefit Between Different Socioeconomic Groups in the Dutch Context: Secondary Cross-Sectional Study JO - JMIR Form Res SP - e49585 VL - 9 KW - eHealth KW - digital divide KW - socioeconomic factors KW - education KW - income KW - neighborhood KW - health disparities KW - cross-sectional studies KW - digital health care KW - health equity KW - Netherlands N2 - Background: There is a growing concern that digital health care may exacerbate existing health disparities. Digital health care or eHealth encompasses the digital apps that are used in health care. Differences in access, use, and perceived benefits of digital technology among socioeconomic groups are commonly referred to as the digital divide. Current research shows that people in lower socioeconomic positions (SEPs) use eHealth less frequently. Objective: This study aims to (1) investigate the association between SEP and eHealth access to, use of, and perceived benefit within the adult Dutch population and (2) evaluate disparities in eHealth access, use, and perceived benefit through three socioeconomic variables?education, standardized income, and the socioeconomic status of the neighborhood. Methods: A secondary analysis was conducted on data from the Nivel Dutch Health Care Consumer Panel (response rate 57%, 849/1500), to assess access to, use of, and perceived benefits from eHealth. These data were collected to monitor eHealth developments in the Netherlands. eHealth was examined through two concepts: (1) eHealth in general and (2) websites, apps, and wearables. Results were stratified into 9 SEP populations based on 3 indicators?education, standardized income, and socioeconomic status level of the neighborhood. Logistic regression analyses were performed to evaluate whether the outcomes varied significantly across different SEP groups. Age was included as a covariate to control for confounding. Results: This study confirms the association between eHealth and SEP and shows that low SEP respondents have less access (odds ratio [OR] 5.72, 95% CI 3.06-10.72) and use (OR 4.96, 95% CI 2.66-9.24) of eHealth compared to medium or high SEP respondents. Differences were most profound when stratifying for levels of education. Conclusions: The access to and use of eHealth has a socioeconomic gradient and emphasizes that SEP indicators cannot be used interchangeably to assess eHealth access and use. The results underline the importance of activities and policies aimed at improving eHealth accessibility and usage among low SEP groups to mitigate disparities in health between different socioeconomic groups. UR - https://formative.jmir.org/2025/1/e49585 UR - http://dx.doi.org/10.2196/49585 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49585 ER - TY - JOUR AU - Isaac, Mohsen Sarah AU - Dawes, Mark AU - Howell, Ruth Emily AU - Oladipo, Francis Antonia PY - 2025/1/6 TI - Gender-Inclusive Language in Public-Facing Labor and Delivery Web Pages in the New York Tristate Area: Cross-Sectional Study JO - JMIR Hum Factors SP - e53057 VL - 12 KW - OBGYN KW - transgender KW - nonbinary KW - pregnancy KW - maternity KW - transmasculine KW - observational study KW - gestational KW - perinatal care KW - communication KW - labor KW - USA KW - United States KW - New York City KW - sexual orientation KW - inclusion KW - parents KW - obstetrician gynecologist KW - delivery N2 - Background: Transgender and nonbinary (TGNB) individuals are increasingly intentionally becoming pregnant to raise children, and hospital websites should reflect these trends. For prospective TGNB parents, a hospital website is the only way they can assess their safety from discrimination while receiving perinatal care. Cisnormativity enforced by communication gaps between medical institutions and TGNB patients can and has caused delays in receiving urgent care during their pregnancy. Objective: The aim of this study was to evaluate the current prevalence of gender-inclusive terminology among labor and delivery services in the New York tristate area. Methods: The labor and delivery web pages of 189 hospitals from New York, New Jersey, and Connecticut were examined for gender-inclusive language. ?Fully inclusive? websites explicitly acknowledged lesbian, gay, bisexual, transgender, queer, intersex, and asexual plus other gender- and sexual-oriented (LGBTQIA+) parents, ?inclusive? websites did not use gendered terminology for parents, and ?noninclusive? websites used gendered terms at least once in the text reviewed. The hospitals? web pages were further stratified by Healthcare Equality Index scores and population classifications defined by the 2013 National Center for Health Statistics Urban-Rural classification given to the county that each hospital was located in. Results: Of the 300 hospital websites reviewed, only 189 websites met the criteria for inclusion. Overall, only 6.3% (n=12) of labor and delivery web pages were ?inclusive? or ?fully inclusive.? No geographic areas (P=.61) or Healthcare Equality Index scores (P=.81) were associated with inclusive or fully inclusive language. Conclusions: Hospitals need to use inclusive language to help TGNB people identify hospitals where their existence and needs are acknowledged and thus feel more comfortable in their transition to parenthood. UR - https://humanfactors.jmir.org/2025/1/e53057 UR - http://dx.doi.org/10.2196/53057 ID - info:doi/10.2196/53057 ER - TY - JOUR AU - Tartaglia, Julia AU - Jaghab, Brendan AU - Ismail, Mohamed AU - Hänsel, Katrin AU - Meter, Van Anna AU - Kirschenbaum, Michael AU - Sobolev, Michael AU - Kane, M. John AU - Tang, X. Sunny PY - 2024/12/30 TI - Assessing Health Technology Literacy and Attitudes of Patients in an Urban Outpatient Psychiatry Clinic: Cross-Sectional Survey Study JO - JMIR Ment Health SP - e63034 VL - 11 KW - digital literacy KW - attitudes KW - mental health KW - digital health technology KW - cluster analysis KW - psychiatry KW - mobile phone N2 - Background: Digital health technologies are increasingly being integrated into mental health care. However, the adoption of these technologies can be influenced by patients? digital literacy and attitudes, which may vary based on sociodemographic factors. This variability necessitates a better understanding of patient digital literacy and attitudes to prevent a digital divide, which can worsen existing health care disparities. Objective: This study aimed to assess digital literacy and attitudes toward digital health technologies among a diverse psychiatric outpatient population. In addition, the study sought to identify clusters of patients based on their digital literacy and attitudes, and to compare sociodemographic characteristics among these clusters. Methods: A survey was distributed to adult psychiatric patients with various diagnoses in an urban outpatient psychiatry program. The survey included a demographic questionnaire, a digital literacy questionnaire, and a digital health attitudes questionnaire. Multiple linear regression analyses were used to identify predictors of digital literacy and attitudes. Cluster analysis was performed to categorize patients based on their responses. Pairwise comparisons and one-way ANOVA were conducted to analyze differences between clusters. Results: A total of 256 patients were included in the analysis. The mean age of participants was 32 (SD 12.6, range 16-70) years. The sample was racially and ethnically diverse: White (100/256, 38.9%), Black (39/256, 15.2%), Latinx (44/256, 17.2%), Asian (59/256, 23%), and other races and ethnicities (15/256, 5.7%). Digital literacy was high for technologies such as smartphones, videoconferencing, and social media (items with >75%, 193/256 of participants reporting at least some use) but lower for health apps, mental health apps, wearables, and virtual reality (items with <42%, 108/256 reporting at least some use). Attitudes toward using technology in clinical care were generally positive (9 out of 10 items received >75% positive score), particularly for communication with providers and health data sharing. Older age (P<.001) and lower educational attainment (P<.001) negatively predicted digital literacy scores, but no demographic variables predicted attitude scores. Cluster analysis identified 3 patient groups. Relative to the other clusters, cluster 1 (n=30) had lower digital literacy and intermediate acceptance of digital technology. Cluster 2 (n=50) had higher literacy and lower acceptance. Cluster 3 (n=176) displayed both higher literacy and acceptance. Significant between-cluster differences were observed in mean age and education level between clusters (P<.001), with cluster 1 participants being older and having lower levels of formal education. Conclusions: High digital literacy and acceptance of digital technologies were observed among our patients, indicating a generally positive outlook for digital health clinics. Our results also found that patients of older age and lower formal levels of educational attainment had lower digital literacy, highlighting the need for targeted interventions to support those who may struggle with adopting digital health tools. UR - https://mental.jmir.org/2024/1/e63034 UR - http://dx.doi.org/10.2196/63034 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63034 ER - TY - JOUR AU - Chadwick, Helen AU - Laverty, Louise AU - Finnigan, Robert AU - Elias, Robert AU - Farrington, Ken AU - Caskey, J. Fergus AU - van der Veer, N. Sabine PY - 2024/12/26 TI - Engagement With Digital Health Technologies Among Older People Living in Socially Deprived Areas: Qualitative Study of Influencing Factors JO - JMIR Form Res SP - e60483 VL - 8 KW - aged KW - digital health KW - health equity KW - intersectionality, qualitative research KW - social deprivation N2 - Background: The potential benefits of incorporating digital technologies into health care are well documented. For example, they can improve access for patients living in remote or underresourced locations. However, despite often having the greatest health needs, people who are older or living in more socially deprived areas may be less likely to have access to these technologies and often lack the skills to use them. This puts them at risk of experiencing further health inequities. In addition, we know that digital health inequities associated with older age may be compounded by lower socioeconomic status. Yet, there is limited research on the intersectional barriers and facilitators for engagement with digital health technology by older people who are particularly marginalized. Objective: This study aimed to explore factors influencing engagement with digital health technologies among people at the intersection of being older and socially deprived. Methods: We conducted semistructured interviews with people who were 70 years or older, living in a socially deprived area, or both. Chronic kidney disease was our clinical context. We thematically analyzed interview transcripts using the Unified Theory of Acceptance and Use of Technology as a theoretical framework. Results: We interviewed 26 people. The majority were White British (n=20) and had moderate health and digital literacy levels (n=10 and n=11, respectively). A total of 13 participants were 70 years of age or older and living in a socially deprived area. Across participants, we identified 2 main themes from the interview data. The first showed that some individuals did not use digital health technologies due to a lack of engagement with digital technology in general. The second theme indicated that people felt that digital health technologies were ?not for them.? We identified the following key engagement factors, with the first 2 particularly impacting participants who were both older and socially deprived: lack of opportunities in the workplace to become digitally proficient; lack of appropriate support from family and friends; negative perceptions of age-related social norms about technology use; and reduced intrinsic motivation to engage with digital health technology because of a perceived lack of relevant benefits. Participants on the intersection of older age and social deprivation also felt significant anxiety around using digital technology and reported a sense of distrust toward digital health care. Conclusions: We identified factors that may have a more pronounced negative impact on the health equity of older people living in socially deprived areas compared with their counterparts who only have one of these characteristics. Successful implementation of digital health interventions therefore warrants dedicated strategies for managing the digital health equity impact on this group. Future studies should further develop these strategies and investigate their effectiveness, as well as explore the influence of related characteristics, such as educational attainment and ethnicity. UR - https://formative.jmir.org/2024/1/e60483 UR - http://dx.doi.org/10.2196/60483 ID - info:doi/10.2196/60483 ER - TY - JOUR AU - Ahmed, Nisar AU - Hall, Alex AU - Poku, Brenda AU - McDermott, Jane AU - Astbury, Jayne AU - Todd, Chris PY - 2024/12/18 TI - Experiences and Views of Older Adults of South Asian, Black African, and Caribbean Backgrounds About the Digitalization of Primary Care Services Since the COVID-19 Pandemic: Qualitative Focus Group Study JO - JMIR Form Res SP - e57580 VL - 8 KW - digital health and primary care services KW - digital exclusion KW - digital divide KW - health inequalities KW - older adults KW - South Asian KW - Black African KW - Caribbean KW - COVID-19 pandemic KW - qualitative focus group study N2 - Background: The COVID-19 pandemic from 2020 to 2022 prompted governments worldwide to enforce lockdowns and social restrictions, alongside the rapid adoption of digital health and care services. However, there are concerns about the potential exclusion of older adults, who face barriers to digital inclusion, such as age, socioeconomic status, literacy level, and ethnicity. Objective: This study aims to explore the experiences of older adults from the 3 largest minoritized ethnic groups in England and Wales?people of South Asian, Black African, and Caribbean backgrounds?in the use of digitalized primary care services since the beginning of the COVID-19 pandemic. Methods: In total, 27 individuals participated in 4 focus groups (April and May 2023) either in person or via online videoconferencing. Patient and public involvement and engagement were sought through collaboration with community organizations for focus group recruitment and feedback on the topic guide. Data were analyzed using framework analysis. Results: This paper summarizes the perspectives of 27 older adults from these 3 minoritized ethnic groups and identifies four key themes: (1) service accessibility through digital health (participants faced difficulties accessing digital health care services through online platforms, primarily due to language barriers and limited digital skills, with reliance on younger family members or community organizations for assistance; the lack of digital literacy among older community members was a prominent concern, and digital health care services were felt to be tailored for English speakers, with minimal consultation during the development phase), (2) importance of face-to-face (in-person) appointments for patient-clinician interactions (in-person appointments were strongly preferred, emphasizing the value of physical interaction and connection with health care professionals; video consultations were seen as an acceptable alternative), (3) stressors caused by the shift to remote access (the transition to remote digital access caused stress, fear, and anxiety; participants felt that digital health solutions were imposed without sufficient explanation or consent; and Black African and Caribbean participants reported experiences of racial discrimination within the health care system), and (4) digital solutions (evaluating technology acceptance; participants acknowledged the importance of digitalization but cautioned against viewing it as a one-size-fits-all solution; they advocated for offline alternatives and a hybrid approach, emphasizing the need for choice and a well-staffed clinical workforce). Conclusions: Digital health initiatives should address the digital divide, health inequalities, and the specific challenges faced by older adults, particularly those from minoritized ethnic backgrounds, ensuring accessibility, choice, and privacy. Overcoming language barriers involves more than mere translation. Maintaining in-person options for consultations, addressing sensitive issues, and implementing support systems at the practice level to support those struggling to access services are vital. This study recommends that policy makers ensure the inclusivity of older adults from diverse backgrounds in the design and implementation of digital health and social care services. UR - https://formative.jmir.org/2024/1/e57580 UR - http://dx.doi.org/10.2196/57580 UR - http://www.ncbi.nlm.nih.gov/pubmed/39693146 ID - info:doi/10.2196/57580 ER - TY - JOUR AU - Pathak, R. Priya AU - Stockwell, S. Melissa AU - Lane, M. Mariellen AU - Robbins-Milne, Laura AU - Friedman, Suzanne AU - Pethe, Kalpana AU - Krause, C. Margaret AU - Soren, Karen AU - Matiz, Adriana Luz AU - Solomon, B. Lauren AU - Burke, E. Maria AU - Bracho-Sanchez, Edith PY - 2024/12/17 TI - Access to Primary Care Telemedicine and Visit Characterization in a Pediatric, Low-Income, Primarily Latino Population: Retrospective Study JO - JMIR Pediatr Parent SP - e57702 VL - 7 KW - telemedicine KW - telehealth KW - pediatric primary care KW - COVID-19 pandemic KW - disparities KW - primary care KW - pediatrics KW - portals KW - access KW - accessibility KW - accessible KW - use KW - demographics KW - low income KW - Latino KW - Hispanic KW - Spanish KW - mobile phone N2 - Background: Since the COVID-19 pandemic, telemedicine has been widely integrated into primary care pediatrics. While initial studies showed some concern for disparities in telemedicine use, telemedicine uptake for pediatric patients in a low-income, primarily Latino community over a sustained period has yet to be described. Objective: We aimed to assess the relationship between demographics, patient portal activation, and telemedicine visits, as well as characterize diagnoses addressed in telemedicine, in a low-income, primarily Latino population over time. Methods: A multidisciplinary team conducted outreach for telemedicine and patient portal activation with the adoption of a new electronic health record. Data were collected on all in-person and telemedicine visits from February 2020 through April 2021 for 4 community-based pediatric practices. The outcomes included patient portal activation, telemedicine use, and reason for telemedicine visits. Bivariate tests and multivariate regression analyses were conducted to assess the independent effects of demographics on the likelihood of portal activation and having a telemedicine visit. Telemedicine diagnoses were categorized, and subanalyses were conducted to explore variations by age and month. Results: There were 12,377 unique patients and 7127 telemedicine visits. Latino patients made up 83.4% (n=8959) of the population. Nearly all patients (n=10,830, 87.5%) had an activated portal, and 33.8% (n=4169) had at least 1 telemedicine visit. Portal activation decreased with age >2 years (2-4 years: adjusted odds ratio [aOR] 0.62, 95% CI 0.51-0.76; 5-11 years: aOR 0.28, 95% CI 0.23-0.32; 12-14 years: aOR 0.29, 95% CI 0.23-0.35; and 15-17 years: aOR 0.46, 95% CI 0.36-0.58). Spanish-speaking (aOR 0.52, 95% CI 0.45-0.59) and non-Latino patients (aOR 0.64, 95% CI 0.54-0.76) had decreased odds of activation and having a telemedicine visit (aOR 0.81, 95% CI 0.74-0.89 and aOR 0.71, 95% CI 0.62-0.81, respectively). The top 5 diagnostic categories for telemedicine were infectious disease (n=1749, 26.1%), dermatology (n=1287, 19.5%), gastrointestinal (n=771, 11.7%), well and follow-up care (n=459, 7%), and other specialty-related care (n=415, 6.3%). Infectious disease showed the most variation over time. Age-based patterns included a decrease in the proportion of infectious disease diagnoses by increasing age group and a higher proportion of well and follow-up care in older ages. Additional telemedicine diagnoses included common infant concerns for patients younger than 2 years of age; pulmonary, asthma, and allergy concerns for toddler or school-age children; behavioral health concerns for younger adolescents; and genitourinary and gynecologic concerns for older adolescents. Conclusions: The high engagement across demographics suggests feasibility and interest in telemedicine in this low-income, primarily Latino population, which may be attributable to the strength of outreach. Language-based disparities were still present. Telemedicine was used for a wide range of diagnoses. As telemedicine remains a vital component of pediatric health care, targeted interventions may enhance engagement to serve diverse pediatric patient populations. UR - https://pediatrics.jmir.org/2024/1/e57702 UR - http://dx.doi.org/10.2196/57702 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57702 ER - TY - JOUR AU - Dobson, Rosie AU - Whittaker, Robyn AU - Abroms, C. Lorien AU - Bramley, Dale AU - Free, Caroline AU - McRobbie, Hayden AU - Stowell, Melanie AU - Rodgers, Anthony PY - 2024/12/17 TI - Don?t Forget the Humble Text Message: 25 Years of Text Messaging in Health JO - J Med Internet Res SP - e59888 VL - 26 KW - text messaging KW - messaging KW - SMS KW - texting KW - mHealth KW - mobile health UR - https://www.jmir.org/2024/1/e59888 UR - http://dx.doi.org/10.2196/59888 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59888 ER - TY - JOUR AU - Fernandez, Diana Isabel AU - Yang, Yu-Ching AU - Chang, Wonkyung AU - Kautz, Amber AU - Farchaus Stein, Karen PY - 2024/12/13 TI - Developing Components of an Integrated mHealth Dietary Intervention for Mexican Immigrant Farmworkers: Feasibility Usability Study of a Food Photography Protocol for Dietary Assessment JO - JMIR Form Res SP - e54664 VL - 8 KW - Mexican immigrant farmworker KW - diet-related noncommunicable diseases KW - mHealth KW - dietary assessment KW - image-based KW - healthcare disparities KW - minority KW - feasibility study KW - food photography KW - rural health KW - health literacy KW - culutural adaptation KW - women KW - technology acceptance KW - mobile health N2 - 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. UR - https://formative.jmir.org/2024/1/e54664 UR - http://dx.doi.org/10.2196/54664 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54664 ER - TY - JOUR AU - Mora Pinzon, Maria AU - Hills, Ornella AU - Levy, George AU - James, T. Taryn AU - Benitez, Ashley AU - Lawrence, Sacheen AU - Ellis, Tiffany AU - Washington, Venus AU - Solorzano, Lizbeth AU - Tellez-Giron, Patricia AU - Cano Ospina, Fernando AU - Metoxen, F. Melissa AU - Gleason, E. Carey PY - 2024/12/10 TI - Implementation of a Social Media Strategy for Public Health Promotion in Black, American Indian or Alaska Native, and Hispanic or Latino Communities During the COVID-19 Pandemic: Cross-Sectional Study JO - J Med Internet Res SP - e58581 VL - 26 KW - health communications KW - social media KW - Hispanic KW - Latino KW - Black KW - American Indian KW - Alaska Native KW - minority health KW - health disparities KW - COVID-19 N2 - Background: Individuals identifying as Black, American Indian or Alaska Native, or Hispanic or Latino lack access to culturally appropriate accurate information and are the target of disinformation campaigns, which create doubt in science and health care providers and might play a role in sustaining health disparities related to the COVID-19 pandemic. Objective: This study aims to create and disseminate culturally and medically appropriate social media messages for Black, Latino, and American Indian or Alaska Native communities in Wisconsin and evaluate their reach and effectiveness in addressing the information needs of these communities. Methods: Our team identified relevant COVID-19 topics based on feedback from their respective community, developed lay format materials, and translated materials into culturally appropriate social media messages that community advocates delivered across their respective communities. Social media metrics (reach, engagement, and impressions) were collected using Sprout Social and Facebook Analytics. We hosted 9 focus groups with community members to learn about their social media use. These data were analyzed using an inductive approach, using NVivo software (release 1.7) to code content. Results: Between August 2021 and January 2023, we created 980 unique social media posts that reached 88,790 individuals and gathered >6700 engagements. Average reach per post was similar across the 3 communities, despite differences in the number of posts and followers on each page: 119.46 (Latino individuals), 111.74 (Black individuals), and 113.11 (Oneida Nation members). The type of posts that had higher engagement rate per reached person (ERR) varied across communities and platforms, with the highest being live videos for the Latino community on Facebook (ERR 9.4%), videos for the Black community on Facebook (ERR 19.53%), and social media messages for the Oneida Nation community (ERR 59.01%). Conclusions: Our project presents a unique and effective model for health messages and highlights the need for tailoring social media messages and approaches for minoritized audiences (eg, age, gender, race, and ethnicity). Further research studies are needed to explore how specific types of information affect the dissemination of information and the implications for health communications. UR - https://www.jmir.org/2024/1/e58581 UR - http://dx.doi.org/10.2196/58581 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58581 ER - TY - JOUR AU - Bosco, Cristina AU - Shojaei, Fereshtehossadat AU - Theisz, Andrew Alec AU - Osorio Torres, John AU - Cureton, Bianca AU - Himes, K. Anna AU - Jessup, M. Nenette AU - Barnes, A. Priscilla AU - Lu, Yvonne AU - Hendrie, C. Hugh AU - Hill, V. Carl AU - Shih, C. Patrick PY - 2024/12/9 TI - Testing 3 Modalities (Voice Assistant, Chatbot, and Mobile App) to Assist Older African American and Black Adults in Seeking Information on Alzheimer Disease and Related Dementias: Wizard of Oz Usability Study JO - JMIR Form Res SP - e60650 VL - 8 KW - older African American and Black adults KW - Alzheimer disease and related dementias KW - health literacy KW - Wizard of Oz KW - voice assistant KW - chatbot KW - mobile app KW - dementia KW - geriatric KW - aging KW - Alzheimer disease KW - artificial intelligence KW - AI KW - mHealth KW - digital tools N2 - Background: Older African American and Black adults are twice as likely to develop Alzheimer disease and related dementias (ADRD) and have the lowest level of ADRD health literacy compared to any other ethnic group in the United States. Low health literacy concerning ADRD negatively impacts African American and Black people in accessing adequate health care. Objective: This study explored how 3 technological modalities?voice assistants, chatbots, and mobile apps?can assist older African American and Black adults in accessing ADRD information to improve ADRD health literacy. By testing each modality independently, the focus could be kept on understanding the unique needs and challenges of this population concerning the use of each modality when accessing ADRD-related information. Methods: Using the Wizard of Oz usability testing method, we assessed the 3 modalities with a sample of 15 older African American and Black adults aged >55 years. The 15 participants were asked to interact with the 3 modalities to search for information on local events happening in their geographical area and search for ADRD-related health information. Results: Our findings revealed that, across the 3 modalities, the content should avoid convoluted and complex language and give the possibility to save, store, and share it to be fully accessible by this population. In addition, content should come from credible sources, including information tailored to the participants? cultural values, as it has to be culturally relevant for African American and Black communities. Finally, the interaction with the tool must be time efficient, and it should be adapted to the user?s needs to foster a sense of control and representation. Conclusions: We conclude that, when designing ADRD-related interventions for African American and Black older adults, it proves to be crucial to tailor the content provided by the technology to the community?s values and construct an interaction with the technology that is built on African American and Black communities? needs and demands. UR - https://formative.jmir.org/2024/1/e60650 UR - http://dx.doi.org/10.2196/60650 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60650 ER - TY - JOUR AU - Sebo, Paul PY - 2024/12/9 TI - Use of ChatGPT to Explore Gender and Geographic Disparities in Scientific Peer Review JO - J Med Internet Res SP - e57667 VL - 26 KW - Africa KW - artificial intelligence KW - discrimination KW - peer review KW - sentiment analysis KW - ChatGPT KW - disparity KW - gender KW - geographic KW - global south KW - inequality KW - woman KW - assessment KW - researcher KW - communication KW - consultation KW - gender bias N2 - Background: In the realm of scientific research, peer review serves as a cornerstone for ensuring the quality and integrity of scholarly papers. Recent trends in promoting transparency and accountability has led some journals to publish peer-review reports alongside papers. Objective: ChatGPT-4 (OpenAI) was used to quantitatively assess sentiment and politeness in peer-review reports from high-impact medical journals. The objective was to explore gender and geographical disparities to enhance inclusivity within the peer-review process. Methods: All 9 general medical journals with an impact factor >2 that publish peer-review reports were identified. A total of 12 research papers per journal were randomly selected, all published in 2023. The names of the first and last authors along with the first author?s country of affiliation were collected, and the gender of both the first and last authors was determined. For each review, ChatGPT-4 was asked to evaluate the ?sentiment score,? ranging from ?100 (negative) to 0 (neutral) to +100 (positive), and the ?politeness score,? ranging from ?100 (rude) to 0 (neutral) to +100 (polite). The measurements were repeated 5 times and the minimum and maximum values were removed. The mean sentiment and politeness scores for each review were computed and then summarized using the median and interquartile range. Statistical analyses included Wilcoxon rank-sum tests, Kruskal-Wallis rank tests, and negative binomial regressions. Results: Analysis of 291 peer-review reports corresponding to 108 papers unveiled notable regional disparities. Papers from the Middle East, Latin America, or Africa exhibited lower sentiment and politeness scores compared to those from North America, Europe, or Pacific and Asia (sentiment scores: 27 vs 60 and 62 respectively; politeness scores: 43.5 vs 67 and 65 respectively, adjusted P=.02). No significant differences based on authors? gender were observed (all P>.05). Conclusions: Notable regional disparities were found, with papers from the Middle East, Latin America, and Africa demonstrating significantly lower scores, while no discernible differences were observed based on authors? gender. The absence of gender-based differences suggests that gender biases may not manifest as prominently as other forms of bias within the context of peer review. The study underscores the need for targeted interventions to address regional disparities in peer review and advocates for ongoing efforts to promote equity and inclusivity in scholarly communication. UR - https://www.jmir.org/2024/1/e57667 UR - http://dx.doi.org/10.2196/57667 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57667 ER - TY - JOUR AU - Moore, K. Sarah AU - Boggis, S. Jesse AU - Gauthier, R. Phoebe AU - Lambert-Harris, A. Chantal AU - Hichborn, G. Emily AU - Bell, D. Kathleen AU - Saunders, C. Elizabeth AU - Montgomery, LaTrice AU - Murphy, I. Eilis AU - Turner, M. Avery AU - Agosti, Nico AU - McLeman, M. Bethany AU - Marsch, A. Lisa PY - 2024/12/3 TI - Technology-Based Interventions for Substance Use Treatment Among People Who Identify as African American or Black, Hispanic or Latino, and American Indian or Alaska Native: Scoping Review JO - J Med Internet Res SP - e53685 VL - 26 KW - technology-based interventions KW - substance use KW - treatment KW - health equity KW - underrepresented KW - scoping review KW - mobile phone N2 - Background: In the United States, racial and ethnic disparities in substance use treatment outcomes are persistent, especially among underrepresented minority (URM) populations. Technology-based interventions (TBIs) for substance use treatment show promise in reducing barriers to evidence-based treatment, yet no studies have described how TBIs may impact racial or ethnic health equity. Objective: This study explored whether TBIs in substance use treatment research promote health equity among people who identify as African American or Black, Hispanic or Latino, and American Indian or Alaska Native through their inclusion in research. We explored whether research that includes the aforementioned groups consciously considers race and/or ethnicity beyond including these populations as participants. Methods: We conducted a scoping review of 5 electronic databases to identify TBIs in substance use treatment studies published in English between January 2000 and March 2021. Studies were included if ?50% of participants identified as African American or Black, Hispanic or Latino, or American Indian or Alaska Native when combined. Included studies were evaluated for conscious consideration of race and ethnicity in at least one manuscript section. Finally, we conducted a critical appraisal of each study?s potential to facilitate insights into the impact of a TBI for members of specific URM groups. Results: Of 6897 titles and abstracts screened and 1158 full-text articles assessed for eligibility, nearly half (532/1158, 45.9%) of the full-text articles were excluded due to the absence of data on race, ethnicity, or not meeting the aforementioned demographic eligibility criteria. Overall, 110 studies met the inclusion criteria. Study designs included 39.1% (43/110) randomized trials, and 35.5% (39/110) feasibility studies. In total, 47.3% (52/110) of studies used computer-based interventions, including electronic screening, brief interventions, and referrals to treatment, whereas 33.6% (37/110) used interactive voice response, ecological momentary assessment or interventions, or SMS text messaging via mobile phones. Studies focused on the following substances: alcohol or drugs (45/110, 40.9%), alcohol alone (26/110, 23.6%), opioids (8/110, 7.3%), cannabis (6/110, 5.5%), cocaine (4/110, 3.6%), and methamphetamines (3/110, 2.7%). Of the studies that consciously considered race or ethnicity (29/110, 26.4%), 6.4% (7/110) explicitly considered race or ethnicity in all manuscript sections. Overall, 28.2% (31/110) of the studies were critically appraised as having a high confidence in the interpretability of the findings for specific URM groups. Conclusions: While the prevalence of TBIs in substance use treatment has increased recently, studies that include and consciously consider URM groups are rare, especially for American Indian or Alaska Native and Hispanic or Latino groups. This review highlights the limited research on TBIs in substance use treatment that promotes racial and ethnic health equity and provides context, insights, and direction for researchers working to develop and evaluate digital technology substance use interventions while promoting health equity. UR - https://www.jmir.org/2024/1/e53685 UR - http://dx.doi.org/10.2196/53685 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53685 ER - TY - JOUR AU - DeLange Martinez, Pauline AU - Tancredi, Daniel AU - Pavel, Misha AU - Garcia, Lorena AU - Young, M. Heather PY - 2024/12/3 TI - The Role of Health in the Technology Acceptance Model Among Low-Income Asian American Older Adults: Cross-Sectional Survey Analysis JO - JMIR Form Res SP - e57009 VL - 8 KW - aged KW - older adults KW - Asian American KW - immigrant KW - vulnerable populations KW - internet KW - information and communications technology KW - ICT KW - digital divide KW - technology acceptance model KW - mobile phone N2 - Background: Self-rated health is associated with information and communications technology (ICT) use among older adults. Non?US born, older Asian American individuals are more inclined to rate their health as fair or poor compared to individuals from other racial and ethnic backgrounds. This population is also less likely to use ICTs as compared to White older Americans. Furthermore, cognitive decline may impact technology acceptance. In a previous adaptation of the technology acceptance model for low-income, Asian American older adults, perceived usefulness (PU), perceived ease of use (PEOU), age, educational attainment, ethnicity, and English proficiency were significant predictors of ICT use. However, the association between health and technology acceptance has not been explored among Asian American older adults. Objective: This study examined the role of self-rated health and subjective cognitive decline in the acceptance and use of ICTs among low-income, Asian American older adults. Methods: This cross-sectional survey included Asian American individuals aged ?62 years living in affordable housing for older adults (N=392). Using hierarchical multiple regression, we explored the association between self-rated health and ICT use and technology acceptance model mediators (PU and PEOU) while adjusting for demographics, English proficiency, and subjective cognitive decline. Contrast statements were used to estimate contrasts of interest. To further examine the separate and joint association between age and subjective cognitive decline and the dependent variables, we examined scatterplots with locally estimated scatterplot smoothing lines, revealing that the relationship between subjective cognitive decline and ICT use varied in 3 age segments, which led to updating our analysis to estimate differences in ICT use among age categories with and without subjective cognitive decline. Results: Self-rated health was not significantly associated with ICT use (?=.087; P=.13), PU (?=.106; P=.10), or PEOU (?=.062; P=.31). However, the interaction terms of subjective cognitive decline and age significantly improved the model fit for ICT use (?R2=0.011; P=.04). In reviewing scatterplots, we determined that, in the youngest age group (62-74 years), ICT use increased with subjective cognitive decline, whereas in the older age groups (75-84 and ?85 years), ICT use decreased with subjective cognitive decline, more so in the oldest age category. Through regression analysis, among participants with subjective cognitive decline, ICT use significantly decreased in the middle and older age groups as compared to the youngest age group. However, among participants without subjective cognitive decline, the difference in use among age groups was not significant. Conclusions: This study contributes to the understanding of the complex relationship between health and ICT acceptance among low-income, Asian American older adults and suggests the need for tailored interventions to promote digital engagement and quality of life for this population. UR - https://formative.jmir.org/2024/1/e57009 UR - http://dx.doi.org/10.2196/57009 UR - http://www.ncbi.nlm.nih.gov/pubmed/39625744 ID - info:doi/10.2196/57009 ER - TY - JOUR AU - Narayan, Shawna AU - Gooderham, Ellie AU - Spencer, Sarah AU - McCracken, K. Rita AU - Hedden, Lindsay PY - 2024/12/2 TI - Virtual Primary Care for People With Opioid Use Disorder: Scoping Review of Current Strategies, Benefits, and Challenges JO - J Med Internet Res SP - e54015 VL - 26 KW - telehealth KW - virtual care KW - primary care KW - opioid use disorder KW - opioid agonist therapy KW - COVID-19 KW - mobile phone N2 - Background: There is a pressing need to understand the implications of the rapid adoption of virtual primary care for people with opioid use disorder. Potential impacts, including disruptions to opiate agonist therapies, and the prospect of improved service accessibility remain underexplored. Objective: This scoping review synthesized current literature on virtual primary care for people with opioid use disorder with a specific focus on benefits, challenges, and strategies. Methods: We followed the Joanna Briggs Institute methodological approach for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist for reporting our findings. We conducted searches in MEDLINE, Web of Science, CINAHL Complete, and Embase using our developed search strategy with no date restrictions. We incorporated all study types that included the 3 concepts (ie, virtual care, primary care, and people with opioid use disorder). We excluded research on minors, asynchronous virtual modalities, and care not provided in a primary care setting. We used Covidence to screen and extract data, pulling information on study characteristics, health system features, patient outcomes, and challenges and benefits of virtual primary care. We conducted inductive content analysis and calculated descriptive statistics. We appraised the quality of the studies using the Quality Assessment With Diverse Studies tool and categorized the findings using the Consolidated Framework for Implementation Research. Results: Our search identified 1474 studies. We removed 36.36% (536/1474) of these as duplicates, leaving 938 studies for title and abstract screening. After a double review process, we retained 3% (28/938) of the studies for extraction. Only 14% (4/28) of the studies were conducted before the COVID-19 pandemic, and most (15/28, 54%) used quantitative methodologies. We summarized objectives and results, finding that most studies (18/28, 64%) described virtual primary care delivered via phone rather than video and that many studies (16/28, 57%) reported changes in appointment modality. Through content analysis, we identified that policies and regulations could either facilitate (11/28, 39%) or impede (7/28, 25%) the provision of care virtually. In addition, clinicians? perceptions of patient stability (5/28, 18%) and the heightened risks associated with virtual care (10/28, 36%) can serve as a barrier to offering virtual services. For people with opioid use disorder, increased health care accessibility was a noteworthy benefit (13/28, 46%) to the adoption of virtual visits, whereas issues regarding access to technology and digital literacy stood out as the most prominent challenge (12/28, 43%). Conclusions: The available studies highlight the potential for enhancing accessibility and continuous access to care for people with opioid use disorder using virtual modalities. Future research and policies must focus on bridging gaps to ensure that virtual primary care does not exacerbate or entrench health inequities. UR - https://www.jmir.org/2024/1/e54015 UR - http://dx.doi.org/10.2196/54015 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54015 ER - TY - JOUR AU - Smith, C. Lisa AU - Johnson, George AU - Jadhav, Snehal AU - Kabayundo, Josiane AU - Ahuja, Muskan AU - Wang, Hongmei AU - Ratnapradipa, L. Kendra PY - 2024/11/28 TI - Ever Use of Telehealth in Nebraska by March 2021: Cross-Sectional Analysis JO - J Med Internet Res SP - e53320 VL - 26 KW - COVID-19 KW - digital divide KW - health care access KW - telehealth KW - cross-sectional study KW - Nevada KW - United States KW - adult KW - medical care KW - geographical area KW - disparity KW - accessibility KW - utilization KW - survey KW - chi-square test KW - regression model KW - socioeconomic KW - demographic KW - health condition KW - digital health N2 - Background: Nationally, COVID-19 spurred the uptake of telehealth to facilitate patients? access to medical care, especially among individuals living in geographically isolated areas. Despite the potential benefits of telehealth to address health care access barriers and enhance health outcomes, there are still disparities in the accessibility and utilization of telehealth services. Hence, identifying facilitators and barriers to telehealth should be prioritized to ensure that disparities are mitigated rather than exacerbated. Objective: This study aims to identify factors associated with ever use of telehealth in Nebraska, a primarily rural state with a significant portion of its population living in nonmetropolitan areas. Methods: A stratified random sample of Nebraska households (n=5300), with oversampling of census tracts with at least 30% African American, Hispanic, or Native American populations, received a mailed survey (English and Spanish) with web-based response options about social determinants of health and health care access (October 2020-March 2021). Survey weights were used for all calculations. Chi-square tests were used to compare telehealth use (yes or no) by participant sociodemographic, health, and access variables. Robust Poisson regression models were used to compute prevalence odds ratios (POR) with 95% CIs of telehealth use after controlling for socioeconomic, demographic, and health conditions. Results: The overall response rate was 20.8% (1101/5300). About 25.5% of Nebraska adults had ever used telehealth (urban 26.4%, rural 20.8%), despite 97% of respondents reporting internet access (98.3% urban, 90.5% rural). In the chi-square analysis, telehealth use was statistically significantly more common (P<.05) among those who are aged <45 years (32.4%), female (30.7%), and non-Hispanic (25.9%); with at least a bachelor?s degree (32.6%); who had a routine checkup (30.2%) or health care visit other than a routine checkup (34.2%); and with any chronic health conditions (29.6%) but did not differ (P?.05) by race, marital status, income, insurance, having a primary care provider, or 1-way travel time for medical visits. In univariate models, internet access, age, sex, ethnicity, education, any health care visit in the past year, and no chronic health condition were significant (P<.05). When adjusted, education (POR 1.87, 95% CI 0.33-10.63) and sex (1.38, 0.93-2.04) were not significant, but internet access (5.43, 1.62-18.16), age <45 (5.33, 2.22-12.81) and 45-64 years (9.05, 2.37-34.62), non-Hispanic ethnicity (7.40, 2.39-22.90), any health care visit (2.43, 1.23-4.79), and any chronic condition (1.73, 1.09-2.76) were significantly associated with having ever used telehealth. Conclusions: This study highlights disparities in telehealth use. Despite high coverage, internet access was a significant predictor of telehealth use, highlighting the role of the digital divide in telehealth access and use. Telehealth use was significantly less prevalent among older adults, people without chronic health conditions, and Hispanic individuals. Targeted interventions that address barriers to telehealth use and improve health care access are warranted. UR - https://www.jmir.org/2024/1/e53320 UR - http://dx.doi.org/10.2196/53320 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53320 ER - TY - JOUR AU - Tisdale, Lauren Rebecca AU - Purmal, Colin AU - Kalwani, Neil AU - Sandhu, Alexander AU - Heidenreich, Paul AU - Zulman, Donna AU - Hussain, Tanvir PY - 2024/11/28 TI - Opportunities to Address Specialty Care Deserts and the Digital Divide through the Veterans Health Administration?s Telehealth Hub-and-Spoke Cardiology Clinic: Retrospective Cohort Study JO - J Med Internet Res SP - e53932 VL - 26 KW - telehealth KW - specialty care KW - cardiovascular disease KW - telemedicine KW - cardiology KW - veterans KW - low income KW - digital divide KW - access KW - Veterans Health Administration KW - VA KW - VHA KW - rural KW - clinical resource hub KW - CRH N2 - Background: To address geographic barriers to specialty care access for services such as cardiology, the Veterans Health Administration (VA) has implemented a novel, regionalized telehealth care hub. The Clinical Resource Hub (CRH) model extends care, including cardiology services, to individuals in low-access communities across the region. Little is known, however, about the reach of such programs. Objective: This study aimed to describe the initial CRH program implementation in terms of growth in users and clinical encounters, as well as the association between user characteristics and the use of CRH cardiology care, in VA?s Sierra Pacific region (Northern California, Nevada, and the Pacific Islands). Methods: We compared patients who used CRH cardiology services (CRH users) to those using non-CRH cardiology services (CRH nonusers) in the Sierra Pacific region between July 15, 2021, and March 31, 2023. After characterizing changes in the numbers of CRH users and nonusers and clinical encounters over the study period, we used multivariable logistic regression to estimate the association between patient-level factors and the odds of being a CRH user. Results: There were 804 CRH users over the study period, with 1961 CRH encounters concentrated at 3 main CRH sites. The CRH program comprised a minority of cardiology users and encounters in the region, with 19,583 CRH nonusers with 83,489 encounters. The numbers of CRH patients and encounters both increased at a steady-to-increasing rate over the study period, with increases of 37% (n=292 vs n=213) in users and 64% (n=584 vs n=356) in encounters in the first quarter of 2023 compared with the last quarter of 2022. Among CRH users, 8.3% (67/804) were female and 41.4% (333/804) were aged ?75 years, compared with 4.3% (840/19,583) and 49% (9600/19,583), respectively, among CRH nonusers. The proportions of rural (users: 205/804, 25.5%; nonusers: 4936/19,583, 25.2%), highly disabled (users: 387/804, 48.1%; nonusers: 9246/19,583, 47.2%), and low-income (users: 165/804, 20.5%; nonusers: 3941/19,583, 20.1%) veterans in both groups were similar. In multivariable logistic models, adjusted odds ratios of using CRH were higher for female veterans (1.70, 95% CI 1.29-2.24) and lower for older veterans (aged ?75 years; 0.33, 95% CI 0.23-0.47). Rural veterans also had a higher adjusted odds ratio of using CRH (1.19, 95% CI 1.00-1.42; P=.046). Conclusions: The VA?s Sierra Pacific CRH cardiology program grew substantially in its first 2 years of operation, serving disproportionately more female and rural veterans and similar proportions of highly disabled and low-income veterans compared to conventional VA care. This model appears to be effective for overcoming specialty care access barriers for certain individuals, although targeted efforts may be required to reach older veterans. While this study focuses on a single region, specialty, and health care system, lessons from implementing regionalized telehealth hub models may be applicable to other settings. UR - https://www.jmir.org/2024/1/e53932 UR - http://dx.doi.org/10.2196/53932 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53932 ER - TY - JOUR AU - O'Malley, Andrew AU - Veenhuizen, Miriam AU - Ahmed, Ayla PY - 2024/11/27 TI - Ensuring Appropriate Representation in Artificial Intelligence?Generated Medical Imagery: Protocol for a Methodological Approach to Address Skin Tone Bias JO - JMIR AI SP - e58275 VL - 3 KW - artificial intelligence KW - generative AI KW - AI images KW - dermatology KW - anatomy KW - medical education KW - medical imaging KW - skin KW - skin tone KW - United States KW - educational material KW - psoriasis KW - digital imagery N2 - Background: In medical education, particularly in anatomy and dermatology, generative artificial intelligence (AI) can be used to create customized illustrations. However, the underrepresentation of darker skin tones in medical textbooks and elsewhere, which serve as training data for AI, poses a significant challenge in ensuring diverse and inclusive educational materials. Objective: This study aims to evaluate the extent of skin tone diversity in AI-generated medical images and to test whether the representation of skin tones can be improved by modifying AI prompts to better reflect the demographic makeup of the US population. Methods: In total, 2 standard AI models (Dall-E [OpenAI] and Midjourney [Midjourney Inc]) each generated 100 images of people with psoriasis. In addition, a custom model was developed that incorporated a prompt injection aimed at ?forcing? the AI (Dall-E 3) to reflect the skin tone distribution of the US population according to the 2012 American National Election Survey. This custom model generated another set of 100 images. The skin tones in these images were assessed by 3 researchers using the New Immigrant Survey skin tone scale, with the median value representing each image. A chi-square goodness of fit analysis compared the skin tone distributions from each set of images to that of the US population. Results: The standard AI models (Dalle-3 and Midjourney) demonstrated a significant difference between the expected skin tones of the US population and the observed tones in the generated images (P<.001). Both standard AI models overrepresented lighter skin. Conversely, the custom model with the modified prompt yielded a distribution of skin tones that closely matched the expected demographic representation, showing no significant difference (P=.04). Conclusions: This study reveals a notable bias in AI-generated medical images, predominantly underrepresenting darker skin tones. This bias can be effectively addressed by modifying AI prompts to incorporate real-life demographic distributions. The findings emphasize the need for conscious efforts in AI development to ensure diverse and representative outputs, particularly in educational and medical contexts. Users of generative AI tools should be aware that these biases exist, and that similar tendencies may also exist in other types of generative AI (eg, large language models) and in other characteristics (eg, sex, gender, culture, and ethnicity). Injecting demographic data into AI prompts may effectively counteract these biases, ensuring a more accurate representation of the general population. UR - https://ai.jmir.org/2024/1/e58275 UR - http://dx.doi.org/10.2196/58275 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58275 ER - TY - JOUR AU - Al-Hamad, Areej AU - Yasin, Mohammad Yasin AU - Metersky, Kateryna AU - Guruge, Sepali AU - Jung, Grace AU - Mahsud, Khadija PY - 2024/11/25 TI - Homestay Hosting Dynamics and Refugee Well-Being: Scoping Review JO - Interact J Med Res SP - e58613 VL - 13 KW - homestay KW - host-guest relationship KW - hospitality KW - hosting KW - well-being KW - homestay accommodation KW - host-refugee relation KW - refugee KW - scoping review KW - review N2 - Background: Homestay accommodations aim to support a smoother transition for refugees; yet, the intricate nature of relationships between refugees and their hosting families can make this process complex, which, in turn, can affect their health and well-being. It is crucial to grasp the experiences of both refugees and their host families in order to foster effective settlement, integration, and well-being. Objective: The purpose of this scoping review is to explore the dynamics of homestay or hosting with a focus on understanding the experiences of both refugees and their hosting families to identify gaps in the literature and propose directions for future research. Methods: We used the Joanna Briggs Institute methodology and followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist to guide this scoping review. Searches were conducted in MEDLINE via EBSCO, Scopus via OVID, CINAHL, SOCIndex, Web of Science Core Collection, ProQuest Dissertations and Theses, the SciELO Citation Index, and APA PsycInfo. Literature written in English and published from 2011 to 2024 that focused on homestay hosting contexts for refugees was included. Results: The results of this review illuminate the multifaceted and dynamic nature of homestay hosting for refugees. The findings include motivations and barriers for homestay hosting, factors influencing host-refugee relations, and psychological and social outcomes of homestay hosting. Conclusions: The results of this scoping review demonstrated the need for tailored support for refugees to improve homestay programs for the benefit of both refugees and host families and highlighted the need of more inclusive, supportive, and effective strategies for the hosting, resettlement, and integration of refugees. International Registered Report Identifier (IRRID): RR2-10.2196/56242 UR - https://www.i-jmr.org/2024/1/e58613 UR - http://dx.doi.org/10.2196/58613 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58613 ER - TY - JOUR AU - DeLange Martinez, Pauline AU - Tancredi, Daniel AU - Pavel, Misha AU - Garcia, Lorena AU - Young, M. Heather PY - 2024/11/22 TI - Technology Acceptance Among Low-Income Asian American Older Adults: Cross-Sectional Survey Analysis JO - J Med Internet Res SP - e52498 VL - 26 KW - aged KW - older adults KW - Asian American KW - immigrant KW - vulnerable populations KW - internet KW - information and communications technology KW - ICT KW - digital divide KW - technology acceptance model KW - mobile phone N2 - Background: Studies show that the use of information and communications technologies (ICTs), including smartphones, tablets, computers, and the internet, varies by demographic factors such as age, gender, and educational attainment. However, the connections between ICT use and factors such as ethnicity and English proficiency, especially among Asian American older adults, remain less explored. The technology acceptance model (TAM) suggests that 2 key attitudinal factors, perceived usefulness (PU) and perceived ease of use (PEOU), influence technology acceptance. While the TAM has been adapted for older adults in China, Taiwan, Singapore, and Korea, it has not been tested among Asian American older adults, a population that is heterogeneous and experiences language barriers in the United States. Objective: This study aims to examine the relationships among demographics (age, gender, educational attainment, ethnicity, and English proficiency), PU, PEOU, and ICT use among low-income Asian American older adults. Two outcomes were examined: smartphone use and ICT use, each measured by years of experience and current frequency of use. Methods: This was a secondary data analysis from a cross-sectional baseline survey of the Lighthouse Project, which provided free broadband, ICT devices, and digital literacy training to residents living in 8 affordable senior housing communities across California. This analysis focused on Asian participants aged ?62 years (N=392), specifically those of Korean, Chinese, Vietnamese, Filipino, and other Asian ethnicities (eg, Hmong and Japanese). Hypotheses were examined using descriptive statistics, correlation analysis, and hierarchical regression analysis. Results: Younger age, higher education, and greater English proficiency were positively associated with smartphone use (age: ?=?.202; P<.001; education: ?=.210; P<.001; and English proficiency: ?=.124; P=.048) and ICT use (age: ?=?.157; P=.002; education: ?=.215; P<.001; and English proficiency: ?=.152; P=.01). Male gender was positively associated with PEOU (?=.111; P=.047) but not with PU (?=?.031; P=.59), smartphone use (?=.023; P=.67), or ICT use (?=.078; P=.16). Ethnicity was a significant predictor of PU (F4,333=5.046; P<.001), PEOU (F4,345=4.299; P=.002), and ICT use (F4,350=3.177; P=.01), with Chinese participants reporting higher levels than Korean participants, who were the reference group (?=.143; P=.007). PU and PEOU were positively correlated with each other (r=0.139, 95% CI=0.037-0.237; P=.007), and both were significant predictors of smartphone use (PU: ?=.158; P=.002 and PEOU: ?=.166; P=.002) and ICT use (PU: ?=.117; P=.02 and PEOU: ?=0.22; P<.001), even when controlling for demographic variables. Conclusions: The findings support the use of the TAM among low-income Asian American older adults. In addition, ethnicity and English proficiency are significant predictors of smartphone and ICT use among this population. Future interventions should consider heterogeneity and language barriers of this population to increase technology acceptance and use. UR - https://www.jmir.org/2024/1/e52498 UR - http://dx.doi.org/10.2196/52498 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52498 ER - TY - JOUR AU - Maaß, Laura AU - Badino, Manuel AU - Iyamu, Ihoghosa AU - Holl, Felix PY - 2024/11/20 TI - Assessing the Digital Advancement of Public Health Systems Using Indicators Published in Gray Literature: Narrative Review JO - JMIR Public Health Surveill SP - e63031 VL - 10 KW - digital public health KW - health system KW - indicator KW - interdisciplinary KW - information and communications technology KW - maturity assessment KW - readiness assessment KW - narrative review KW - gray literature KW - digital health KW - mobile phone N2 - Background: Revealing the full potential of digital public health (DiPH) systems requires a wide-ranging tool to assess their maturity and readiness for emerging technologies. Although a variety of indices exist to assess digital health systems, questions arise about the inclusion of indicators of information and communications technology maturity and readiness, digital (health) literacy, and interest in DiPH tools by the society and workforce, as well as the maturity of the legal framework and the readiness of digitalized health systems. Existing tools frequently target one of these domains while overlooking the others. In addition, no review has yet holistically investigated the available national DiPH system maturity and readiness indicators using a multidisciplinary lens. Objective: We used a narrative review to map the landscape of DiPH system maturity and readiness indicators published in the gray literature. Methods: As original indicators were not published in scientific databases, we applied predefined search strings to the DuckDuckGo and Google search engines for 11 countries from all continents that had reached level 4 of 5 in the latest Global Digital Health Monitor evaluation. In addition, we searched the literature published by 19 international organizations for maturity and readiness indicators concerning DiPH. Results: Of the 1484 identified references, 137 were included, and they yielded 15,806 indicators. We deemed 286 indicators from 90 references relevant for DiPH system maturity and readiness assessments. The majority of these indicators (133/286, 46.5%) had legal relevance (targeting big data and artificial intelligence regulation, cybersecurity, national DiPH strategies, or health data governance), and the smallest number of indicators (37/286, 12.9%) were related to social domains (focusing on internet use and access, digital literacy and digital health literacy, or the use of DiPH tools, smartphones, and computers). Another 14.3% (41/286) of indicators analyzed the information and communications technology infrastructure (such as workforce, electricity, internet, and smartphone availability or interoperability standards). The remaining 26.2% (75/286) of indicators described the degree to which DiPH was applied (including health data architecture, storage, and access; the implementation of DiPH interventions; or the existence of interventions promoting health literacy and digital inclusion). Conclusions: Our work is the first to conduct a multidisciplinary analysis of the gray literature on DiPH maturity and readiness assessments. Although new methods for systematically researching gray literature are needed, our study holds the potential to develop more comprehensive tools for DiPH system assessments. We contributed toward a more holistic understanding of DiPH. Further examination is required to analyze the suitability and applicability of all identified indicators in diverse health care settings. By developing a standardized method to assess DiPH system maturity and readiness, we aim to foster informed decision-making among health care planners and practitioners to improve resource distribution and continue to drive innovation in health care delivery. UR - https://publichealth.jmir.org/2024/1/e63031 UR - http://dx.doi.org/10.2196/63031 UR - http://www.ncbi.nlm.nih.gov/pubmed/39566910 ID - info:doi/10.2196/63031 ER - TY - JOUR AU - Abbasgholizadeh Rahimi, Samira AU - Shrivastava, Richa AU - Brown-Johnson, Anita AU - Caidor, Pascale AU - Davies, Claire AU - Idrissi Janati, Amal AU - Kengne Talla, Pascaline AU - Madathil, Sreenath AU - Willie, M. Bettina AU - Emami, Elham PY - 2024/11/15 TI - EDAI Framework for Integrating Equity, Diversity, and Inclusion Throughout the Lifecycle of AI to Improve Health and Oral Health Care: Qualitative Study JO - J Med Internet Res SP - e63356 VL - 26 KW - equity, diversity, and inclusion KW - EDI KW - health care KW - oral health care KW - machine learning KW - artificial intelligence KW - AI N2 - Background: Recent studies have identified significant gaps in equity, diversity, and inclusion (EDI) considerations within the lifecycle of artificial intelligence (AI), spanning from data collection and problem definition to implementation stages. Despite the recognized need for integrating EDI principles, there is currently no existing guideline or framework to support this integration in the AI lifecycle. Objective: This study aimed to address this gap by identifying EDI principles and indicators to be integrated into the AI lifecycle. The goal was to develop a comprehensive guiding framework to guide the development and implementation of future AI systems. Methods: This study was conducted in 3 phases. In phase 1, a comprehensive systematic scoping review explored how EDI principles have been integrated into AI in health and oral health care settings. In phase 2, a multidisciplinary team was established, and two 2-day, in-person international workshops with over 60 representatives from diverse backgrounds, expertise, and communities were conducted. The workshops included plenary presentations, round table discussions, and focused group discussions. In phase 3, based on the workshops? insights, the EDAI framework was developed and refined through iterative feedback from participants. The results of the initial systematic scoping review have been published separately, and this paper focuses on subsequent phases of the project, which is related to framework development. Results: In this study, we developed the EDAI framework, a comprehensive guideline that integrates EDI principles and indicators throughout the entire AI lifecycle. This framework addresses existing gaps at various stages, from data collection to implementation, and focuses on individual, organizational, and systemic levels. Additionally, we identified both the facilitators and barriers to integrating EDI within the AI lifecycle in health and oral health care. Conclusions: The developed EDAI framework provides a comprehensive, actionable guideline for integrating EDI principles into AI development and deployment. By facilitating the systematic incorporation of these principles, the framework supports the creation and implementation of AI systems that are not only technologically advanced but also sensitive to EDI principles. UR - https://www.jmir.org/2024/1/e63356 UR - http://dx.doi.org/10.2196/63356 UR - http://www.ncbi.nlm.nih.gov/pubmed/39546793 ID - info:doi/10.2196/63356 ER - TY - JOUR AU - Kang, Jin Soo AU - Oh, Hye-Kyung AU - Han, Hae-Ra PY - 2024/11/13 TI - Developing and Validating the Health Literacy Scale for Migrant Workers: Instrument Development and Validation Study JO - JMIR Public Health Surveill SP - e59293 VL - 10 KW - transients and migrants KW - psychometrics KW - scale development KW - health literacy KW - validation study KW - Rasch model N2 - Background: Research concerning health literacy among migrant workers in South Korea has been limited, especially given the lack of validated instruments and the lack of focus on the cultural diversity of migrant workers. Objective: This study aimed to develop and validate a health literacy scale for unskilled migrant workers (HLS-MW) in South Korea. Methods: We first generated a pool of potential items based on a literature review and in-depth interviews with 23 migrant workers. Subsequently, we reviewed empirical referents from the first step to select relevant medical terminologies and passages, ultimately choosing 709 words. The study team initially generated 35 items with 709 health-related terms through empirical referent reviews. After content validity testing by an expert panel, 28 items comprising 89 terms on the 2 subscales of prose and documents were selected for psychometric testing. Overall, 402 unskilled migrant workers in South Korea completed a web-based survey between August and September 2021, with 334 responses included in the final analysis. We used multiple analytic approaches, including exploratory factor analysis, Rasch analysis (item response theory), and descriptive analysis, to examine the new scale?s validity and reliability. Results: The final sample primarily included young male workers from South Asian countries. The HLS-MW yielded 2 factors: prose and documents. The item difficulty scores ranged from ?1.36 to 2.56. The scale was reduced to 13 items (10 prose and 3 document items), with the final version exhibiting good internal reliability (Kuder-Richardson index=0.88; intraclass correlation coefficient=0.94, 95% CI 0.93?0.95) and test-retest reliability (r=0.74, 95% CI 0.57?0.92). HLS-MW scores differed significantly by Korean language proficiency (F2,331=3.54, P=.004). Conclusions: The HLS-MW is a reliable and valid measure to assess health literacy among migrant workers in South Korea. Further studies are needed to test the psychometric properties of the HLS-MW in diverse migrant groups in South Korea while also establishing cutoffs to help identify those in need of health literacy support. UR - https://publichealth.jmir.org/2024/1/e59293 UR - http://dx.doi.org/10.2196/59293 ID - info:doi/10.2196/59293 ER - TY - JOUR AU - Nowels, Aideen Molly AU - McDarby, Meghan AU - Brody, Lilla AU - Kleiman, Evan AU - Sagui Henson, Sara AU - Castro Sweet, Cynthia AU - Kozlov, Elissa PY - 2024/11/7 TI - Predictors of Engagement in Multiple Modalities of Digital Mental Health Treatments: Longitudinal Study JO - J Med Internet Res SP - e48696 VL - 26 KW - digital health KW - mental health KW - health care benefit KW - prediction KW - technology KW - digital mental health KW - employer-based KW - teletherapy KW - coaching KW - utilization KW - mobile phone N2 - Background: Technology-enhanced mental health platforms may serve as a pathway to accessible and scalable mental health care; specifically, those that leverage stepped care models have the potential to address many barriers to patient care, including low mental health literacy, mental health provider shortages, perceived acceptability of care, and equitable access to evidence-based treatment. Driving meaningful engagement in care through these platforms remains a challenge. Objective: This study aimed to examine predictors of engagement in self-directed digital mental health services offered as part of an employer-based mental health benefit that uses a technology-enabled care platform. Methods: Using a prospective, longitudinal design, we examined usage data from employees who had access to an employer-sponsored mental health care benefit. Participants had access to a digital library of mental health resources, which they could use at any time, including daily exercises, interactive programs, podcasts, and mindfulness exercises. Coaching and teletherapy were also available to. The outcome was engagement with the self-directed digital mental health resources, measured by the number of interactions. Poisson regression models included sociodemographic characteristics, patient activation, mental health literacy, well-being, PHQ-9 and GAD-7 scores at baseline, primary concern for engaging in treatment, and the use of coaching or teletherapy sessions. Results: In total 950 individuals enrolled in the study, with 38% using any self-directed digital mental health resources. Approximately 44% of the sample did not use the app during the study period. Those using both self-directed digital and 1:1 modalities made up about one-quarter of the sample (235/950, 24.7%). Those using only coaching or therapy (170/950, 17.9%) and those using only self-directed digital mental health resources (126/950, 13.3%) make up the rest. At baseline, these groups statistically significantly differed on age, PHQ-9, GAD-7, MHLS, and primary concern. Receipt of coaching and teletherapy was associated with the number of self-directed digital mental health resources interactions in adjusted Poisson regression modeling. Use of any coach visit was associated with 82% (rate ratio [RR] 1.82, 95% CI 1.63-2.03) more self-directed digital mental health resource interactions while use of any teletherapy session was associated with 80% (RR 1.80, 95% CI 1.55-2.07) more digital mental health resources interactions (both P<.001). Each additional year of age was associated with increased digital mental health resources interactions (RR 1.04, 95% CI (1.03-1.05), and women had 23% more self-directed digital resources interactions than men (RR 1.23, 95% CI 1.09-1.39). Conclusions: Our key finding was that the use of coaching or teletherapy was associated with increased self-directed digital mental health resource use. Higher self-directed digital resource engagement among those receiving coaching or therapy may be a result of provider encouragement. On the other hand, when a participant engages with 1 modality in the platform, they may be more likely to begin engaging with others, becoming ?super users? of all resources. UR - https://www.jmir.org/2024/1/e48696 UR - http://dx.doi.org/10.2196/48696 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/48696 ER - TY - JOUR AU - Chandrasekaran, Ranganathan AU - Sadiq T, Muhammed AU - Moustakas, Evangelos PY - 2024/11/6 TI - Racial and Demographic Disparities in Susceptibility to Health Misinformation on Social Media: National Survey-Based Analysis JO - J Med Internet Res SP - e55086 VL - 26 KW - health misinformation KW - digital divide KW - racial disparities KW - social media KW - national survey-based analysis KW - health information KW - interventions N2 - Background: Social media platforms have transformed the dissemination of health information, allowing for rapid and widespread sharing of content. However, alongside valuable medical knowledge, these platforms have also become channels for the spread of health misinformation, including false claims and misleading advice, which can lead to significant public health risks. Susceptibility to health misinformation varies and is influenced by individuals? cultural, social, and personal backgrounds, further complicating efforts to combat its spread. Objective: This study aimed to examine the extent to which individuals report encountering health-related misinformation on social media and to assess how racial, ethnic, and sociodemographic factors influence susceptibility to such misinformation. Methods: Data from the Health Information National Trends Survey (HINTS; Cycle 6), conducted by the National Cancer Institute with 5041 US adults between March and November 2022, was used to explore associations between racial and sociodemographic factors (age, gender, race/ethnicity, annual household income, marital status, and location) and susceptibility variables, including encounters with misleading health information on social media, difficulty in assessing information truthfulness, discussions with health providers, and making health decisions based on such information. Results: Over 35.61% (1740/4959) of respondents reported encountering ?a lot? of misleading health information on social media, with an additional 45% (2256/4959) reporting seeing ?some? amount of health misinformation. Racial disparities were evident in comparison with Whites, with non-Hispanic Black (odds ratio [OR] 0.45, 95% CI 0.33-0.6, P<.01) and Hispanic (OR 0.54, 95% CI 0.41-0.71, P<.01) individuals reporting lower odds of finding deceptive information, while Hispanic (OR 1.68, 95% CI 1.48-1.98, P<.05) and non-Hispanic Asian (OR 1.96, 95% CI 1.21-3.18, P<.01) individuals exhibited higher odds in having difficulties in assessing the veracity of health information found on social media. Hispanic and Asian individuals were more likely to discuss with providers and make health decisions based on social media information. Older adults aged ?75 years exhibited challenges in assessing health information on social media (OR 0.63, 95% CI 0.43-0.93, P<.01), while younger adults (18-34) showed increased vulnerability to health misinformation. In addition, income levels were linked to higher exposure to health misinformation on social media: individuals with annual household incomes between US $50,000 and US $75,000 (OR 1.74, 95% CI 1.14-2.68, P<.01), and greater than US $75,000 (OR 1.78, 95% CI 1.20-2.66, P<.01) exhibited greater odds, revealing complexities in decision-making and information access. Conclusions: This study highlights the pervasive presence of health misinformation on social media, revealing vulnerabilities across racial, age, and income groups, underscoring the need for tailored interventions. UR - https://www.jmir.org/2024/1/e55086 UR - http://dx.doi.org/10.2196/55086 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55086 ER - TY - JOUR AU - Menschik, Christian AU - Kunze, Christophe AU - Renner, Gregor AU - Etges, Theresa PY - 2024/11/5 TI - Mainstream Technologies in Facilities for People With Intellectual Disabilities: Multiple-Methods Study Using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability Framework JO - JMIR Rehabil Assist Technol SP - e59360 VL - 11 KW - intellectual disabilities KW - mainstream technology KW - technology adoption KW - technology implementation KW - NASSS KW - digital competencies KW - facility for people with disabilities KW - mobile phone N2 - Background: People with intellectual disabilities in residential or outpatient facilities for people with disabilities run the risk of being digitally excluded by not having opportunities for taking advantage of digitalization possibilities. Objective: We aimed to investigate how disability caregivers and managers describe barriers and facilitating factors to implement and adopt mainstream technology for people with intellectual disabilities in residential or outpatient facilities and how the competencies and capabilities of the caregivers are assessed in the process. Methods: For this reason, we conducted a multiple-methods study applying the nonadoption, abandonment, scale-up, spread, and sustainability framework. Results: As a result, we identified barriers and facilitators across the nonadoption, abandonment, scale-up, spread, and sustainability framework domains: (1) condition?people with intellectual disabilities are a diverse group, where the individual condition of the person and, for example, their communication skills were seen as a prerequisite for implementing mainstream technologies; (2) technology?the extent to which mainstream technology fits the individual needs and demands contributed to the implementation process; (3) value proposition?communication was seen as a life area where mainstream technology can add value; (4) adopters?the caregivers needed competencies and capabilities to accompany their care recipients? technology use; (5) organization?missing legal regulations and lack of personnel resources were described as barriers; (6) wider context?funding opportunities were seen as unclear in disability services as mainstream technologies could not be financed as participation benefits; (7) embedding and adaptation over time?the COVID-19 pandemic forced facilities to become digitalized to some extent. Conclusions: The disability services investigated were still in need of standardized procedures to promote the digital participation of their residents. UR - https://rehab.jmir.org/2024/1/e59360 UR - http://dx.doi.org/10.2196/59360 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59360 ER - TY - JOUR AU - Robertson, Noah AU - Syed, J. Maryam AU - Song, Bowen AU - Kaur, Arshdeep AU - Patel, G. Janaki AU - Marawar, Rohit AU - Basha, Maysaa AU - Zutshi, Deepti PY - 2024/10/30 TI - Self-Reported Patient and Provider Satisfaction With Neurology Telemedicine Visits After Rapid Telemedicine Implementation in an Urban Academic Center: Cross-Sectional Survey JO - JMIR Form Res SP - e53491 VL - 8 KW - telemedicine KW - telehealth KW - neurology KW - eHealth KW - teleneurology KW - patient experience KW - patient satisfaction N2 - Background: Many clinics and health systems implemented telemedicine appointment services out of necessity due to the COVID-19 pandemic. Objective: Our objective was to evaluate patient and general provider satisfaction with neurology telemedicine implementation at an urban academic medical center. Methods: Patients who had completed 1 or more teleneurology visits from April 1 to December 31, 2020, were asked to complete a survey regarding their demographic information and satisfaction with teleneurology visits. Providers of all specialties within the same hospital system were given a different survey to gather their experiences of providing telemedicine care. Results: Of the estimated 1500 patients who had completed a teleneurology visit within the given timeframe, 117 (7.8%) consented to complete the survey. Of these 117 respondents, most appointments were regarding epilepsy (n=59, 50.4%), followed by multiple sclerosis (n=33, 28.2%) and neuroimmunology (n=7, 6%). Overall, 74.4% (n=87) of patients rated their experience as 8 out of 10 or higher, with 10 being the highest satisfaction. Furthermore, 75.2% (n=88) of patients reported missing an appointment in the previous year due to transportation issues and thought telemedicine was more convenient instead. A significant relationship between racial or ethnic group and comfort sharing private information was found (P<.001), with 52% (26/50) of Black patients reporting that an office visit is better, compared to 25% (14/52) of non-Black patients. The provider survey gathered 40 responses, with 75% (n=30) of providers agreeing that virtual visits are a valuable tool for patient care and 80% (n=32) reporting few to no technical issues. The majority of provider respondents were physicians on faculty or staff (n=21, 52%), followed by residents or fellows (n=15, 38%) and nurse practitioners or physician assistants (n=4, 10%). Of the specialties represented, 15 (38%) of the providers were in neurology. Conclusions: Our study found adequate satisfaction among patients and providers regarding telemedicine implementation and its utility for patient care in a diverse urban population. Additionally, while access to technology and technology literacy are barriers to telemedical care, a substantial majority of patients who responded to the survey had access to devices (101/117, 86.3%) and were able to connect with few to no technological difficulties (84/117, 71.8%). One area identified by patients in need of improvement was comfortability in communicating via telemedicine with their providers. Furthermore, while providers agreed that telemedicine is a useful tool for patient care, it limits their ability to perform physical exams. More research and quality studies are needed to further appreciate and support the expansion of telemedical care into underserved and rural populations, especially in the area of subspecialty neurological care. UR - https://formative.jmir.org/2024/1/e53491 UR - http://dx.doi.org/10.2196/53491 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53491 ER - TY - JOUR AU - Jayamini, Darsha Widana Kankanamge AU - Mirza, Farhaan AU - Bidois-Putt, Marie-Claire AU - Naeem, Asif M. AU - Chan, Yan Amy Hai PY - 2024/10/30 TI - Perceptions Toward Using Artificial Intelligence and Technology for Asthma Attack Risk Prediction: Qualitative Exploration of M?ori Views JO - JMIR Form Res SP - e59811 VL - 8 KW - asthma risk prediction KW - artificial intelligence KW - machine learning KW - m?ori perceptions KW - health system development KW - mobile phone N2 - Background: Asthma is a significant global health issue, impacting over 500,000 individuals in New Zealand and disproportionately affecting M?ori communities in New Zealand, who experience worse asthma symptoms and attacks. Digital technologies, including artificial intelligence (AI) and machine learning (ML) models, are increasingly popular for asthma risk prediction. However, these AI models may underrepresent minority ethnic groups and introduce bias, potentially exacerbating disparities. Objective: This study aimed to explore the views and perceptions that M?ori have toward using AI and ML technologies for asthma self-management, identify key considerations for developing asthma attack risk prediction models, and ensure M?ori are represented in ML models without worsening existing health inequities. Methods: Semistructured interviews were conducted with 20 M?ori participants with asthma, 3 male and 17 female, aged 18-76 years. All the interviews were conducted one-on-one, except for 1 interview, which was conducted with 2 participants. Altogether, 10 web-based interviews were conducted, while the rest were kanohi ki te kanohi (face-to-face). A thematic analysis was conducted to identify the themes. Further, sentiment analysis was carried out to identify the sentiments using a pretrained Bidirectional Encoder Representations from Transformers model. Results: We identified four key themes: (1) concerns about AI use, (2) interest in using technology to support asthma, (3) desired characteristics of AI-based systems, and (4) experience with asthma management and opportunities for technology to improve care. AI was relatively unfamiliar to many participants, and some of them expressed concerns about whether AI technology could be trusted, kanohi ki te kanohi interaction, and inadequate knowledge of AI and technology. These concerns are exacerbated by the M?ori experience of colonization. Most of the participants were interested in using technology to support their asthma management, and we gained insights into user preferences regarding computer-based health care applications. Participants discussed their experiences, highlighting problems with health care quality and limited access to resources. They also mentioned the factors that trigger their asthma control level. Conclusions: The exploration revealed that there is a need for greater information about AI and technology for M?ori communities and a need to address trust issues relating to the use of technology. Expectations in relation to computer-based applications for health purposes were expressed. The research outcomes will inform future investigations on AI and technology to enhance the health of people with asthma, in particular those designed for Indigenous populations in New Zealand. UR - https://formative.jmir.org/2024/1/e59811 UR - http://dx.doi.org/10.2196/59811 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59811 ER - TY - JOUR AU - Rousaki, Anastasia AU - Zamani, D. Efpraxia AU - Sbaffi, Laura AU - Hamblin, Kate AU - Black, Rachael PY - 2024/10/24 TI - The Digitalization of Social Care in England and Implications for Older, Unpaid Carers: Constructionist Thematic Analysis JO - J Med Internet Res SP - e60056 VL - 26 KW - social care KW - England KW - digitalization KW - digital transformation KW - unpaid care KW - mobile phone N2 - Background: Globally, populations are aging, generating concerns about the sustainability of health and social care provision. In terms of the public provision of social care in particular, unpaid carers provide much of the support to people with disabilities and older people. In addition, there is an increased onus in many countries on digital transformation projects, in the hope that the digitalization of services can create efficiencies and savings in both costs and care labor. In England, the focus of this paper, the shift to digital services is also framed as a means to enhance choice and control for older unpaid carers, while being part of a broader offering that includes nondigital alternatives and support to mitigate digital exclusion. Objective: This study examines the impact of digitalization on older, unpaid carers?a group more likely to be both expected to engage digitally with services and at risk of digital exclusion?in England, focusing on their lived experiences in terms of caring and access to social care. Methods: We used a constructionist approach to thematic analysis, where data from 48 older unpaid carers collected through focus groups were analyzed using thematic analysis, resulting in 4 prevailing themes. Results: Our findings indicated that while unpaid carers largely acknowledge the benefits of digitalization, they also highlight several points of failure, whereby engagement with digital spaces is experienced as coercive and exacerbates feelings of exclusion. These are further worsened by government failures to address issues of connectivity, imposing additional financial burdens and complicating tasks such as benefit applications. Conclusions: In this study, we have highlighted the need for greater involvement in shaping both policy and technological solutions, which in turn will be more inclusive and aligned to the aspirations and circumstances of older carers. UR - https://www.jmir.org/2024/1/e60056 UR - http://dx.doi.org/10.2196/60056 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60056 ER - TY - JOUR AU - Ramasawmy, Mel AU - Roland Persson, Dan AU - Sunkersing, David AU - Gill, Paramjit AU - Khunti, Kamlesh AU - Poole, Lydia AU - Hanif, Wasim AU - Blandford, Ann AU - Sajid, Madiha AU - Stevenson, Fiona AU - Khan, Nushrat AU - Banerjee, Amitava PY - 2024/10/24 TI - Uptake of Digital Health Interventions for Cardiometabolic Disease in British South Asian Individuals: Think Aloud Study JO - JMIR Hum Factors SP - e57338 VL - 11 KW - digital health KW - cardiometabolic disease KW - cardiology KW - cardiovascular risk KW - health inequality KW - health disparity KW - usability KW - user experience KW - think aloud KW - cultural barriers KW - digital divide KW - digital literacy N2 - Background: Digital health interventions (DHIs) could support prevention and management of cardiometabolic disease. However, those who may benefit most often experience barriers to awareness and adoption of these interventions. Objective: Among South Asian individuals, we evaluated user experience of DHIs for prevention and management of cardiometabolic disease, aiming to understand barriers and facilitators to initial and ongoing use. Methods: Among South Asian individuals recruited via primary care, community organizations, and snowball methods (n=18), we conducted ?think-aloud? interviews using a reflective and reactive approach. Participants included nonusers, as well as those that used a range of DHIs as part of monitoring and improving their health. Participants were asked to think aloud while completing a task they routinely do in a familiar DHI, as well as while setting up and completing a search task in a novel DHI; they were encouraged to behave as if unobserved. Results: Lack of cultural specificity was highlighted as reducing relevance and usability, particularly relating to dietary change. Preferred features reflected individual health beliefs and behaviors, digital skills, and trust in DHIs. For example, tracking blood glucose was considered by some to be positive, while for others it caused distress and anxiety. Similarly, some users found the novel DHI to be extremely simple to set up and use, and others grew frustrated navigating through initial interfaces. Many participants raised concerns about data privacy and needing to agree to terms and conditions that they did not understand. Participants expressed that with information and support from trusted sources, they would be interested in using DHIs as part of self-management. Conclusions: DHIs may support South Asians to prevent and manage cardiometabolic disease, but it is important to consider the needs of specific user groups in DHI development, design, and implementation. Despite motivation to make health changes, digital barriers are common. Cultural appropriateness and trusted sources (such as health care providers and community organizations) have roles in increasing awareness and enabling individuals to access and use DHIs. UR - https://humanfactors.jmir.org/2024/1/e57338 UR - http://dx.doi.org/10.2196/57338 ID - info:doi/10.2196/57338 ER - TY - JOUR AU - Kang, Jeemin AU - Szeto, D. Mindy AU - Suh, Lois AU - Olayinka, T. Jadesola AU - Dellavalle, P. Robert PY - 2024/10/18 TI - Popular Skin-of-Color Dermatology Social Media Hashtags on TikTok From 2021 to 2022: Content Analysis JO - JMIR Dermatol SP - e50408 VL - 7 KW - dermatology KW - dermatologist KW - social media KW - TikTok KW - skin of color KW - hashtag KW - content analysis KW - education KW - influencers KW - diversity KW - inclusion KW - disparities UR - https://derma.jmir.org/2024/1/e50408 UR - http://dx.doi.org/10.2196/50408 ID - info:doi/10.2196/50408 ER - TY - JOUR AU - Sabben, Gaëlle AU - Telfort, Courtney AU - Morales, Marissa AU - Zhang, Stella Wenjia AU - Espinoza, C. Juan AU - Pasquel, J. Francisco AU - Winskell, Kate PY - 2024/10/15 TI - Technology and Continuous Glucose Monitoring Access, Literacy, and Use Among Patients at the Diabetes Center of an Inner-City Safety-Net Hospital: Mixed Methods Study JO - JMIR Diabetes SP - e54223 VL - 9 KW - diabetes mellitus KW - type 1 KW - type 2 KW - digital health KW - continuous glucose monitoring KW - mobile phone N2 - Background: Despite the existence of an increasing array of digital technologies and tools for diabetes management, there are disparities in access to and uptake and use of continuous glucose monitoring (CGM) devices, particularly for those most at risk of poor diabetes outcomes. Objective: This study aims to assess communication technology and CGM access, literacy, and use among patients receiving treatment for diabetes at an inner-city safety-net hospital. Methods: A survey on digital technology ownership and use was self-administered by 75 adults with type 1 and type 2 diabetes at the diabetes clinic of Grady Memorial Hospital in Atlanta, Georgia. In-depth interviews were conducted with 16% (12/75) of these patient participants and 6 health care providers (HCPs) to obtain additional insights into the use of communication technology and CGM to support diabetes self-management. Results: Most participants were African American (66/75, 88%), over half (39/75, 52%) were unemployed or working part time, and 29% (22/75) had no health insurance coverage, while 61% (46/75) had federal coverage. Smartphone ownership and use were near universal; texting and email use were common (63/75, 84% in both cases). Ownership and use of tablets and computers and use and daily use of various forms of media were more prevalent among younger participants and those with type 1 diabetes, who also rated them as easier to use. Technology use specifically for diabetes and health management was low. Participants were supportive of a potential smartphone app for diabetes management, with a high interest in such an app helping them track blood sugar levels and communicate with their care teams. Younger participants showed higher levels of interest, perceived value, and self-efficacy for using an app with these capabilities. History of CGM use was reported by 56% (42/75) of the participants, although half (20/42, 48%) had discontinued use, above all due to the cost of the device and issues with its adhesive. Nonuse was primarily due to not being offered CGM by their HCP. Reasons given for continued use included convenience, improved blood glucose control, and better tracking of blood glucose. The in-depth interviews (n=18) revealed high levels of satisfaction with CGM by users and supported the survey findings regarding reasons for continued use. They also highlighted the value of CGM data to enhance communication between patients and HCPs. Conclusions: Smartphone ownership was near universal among patients receiving care at an inner-city hospital. Alongside the need to address barriers to CGM access and continued use, there is an opportunity to leverage increased access to communication technology in combination with CGM to improve diabetes outcomes among underresourced populations. UR - https://diabetes.jmir.org/2024/1/e54223 UR - http://dx.doi.org/10.2196/54223 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54223 ER - TY - JOUR AU - Hichborn, Emily AU - Turner, Avery AU - Moore, Sarah AU - Gauthier, Phoebe AU - Bell, Kathleen AU - Montgomery, LaTrice AU - Boggis, Jesse AU - Lambert-Harris, Chantal AU - Saunders, Elizabeth AU - Dallery, Jesse AU - McLeman, Bethany AU - Marsch, Lisa PY - 2024/10/10 TI - Technology-Based Interventions in Tobacco Use Treatment Among People Who Identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native: Scoping Review JO - J Med Internet Res SP - e50748 VL - 26 KW - health disparities KW - underrepresented KW - social determinants of health KW - tobacco use KW - technology-based interventions KW - scoping review KW - mobile phone N2 - Background: Although tobacco use has significantly declined in the general population, traditional tobacco use treatment uptake and success rates remain disproportionately low among people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native. Technology-based interventions (TBIs) for tobacco use are promising alternatives to traditional tobacco use treatments. Objective: This scoping review aims to investigate the extent to which the use of digital TBIs in tobacco use treatment research promotes health equity among people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native. Methods: This scoping review identifies US-based studies (between January 2000 and March 2021) that enlist TBIs for tobacco use treatment and include people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native at ?50% of the sample when combined; features studies that are also race and ethnicity conscious; and highlights health equity?promoting insights from included studies. Results: In 85% (22/26) of the studies, the largest proportion of the sample was African American/Black, most participants had low socioeconomic status, and recruitment was most commonly from medical settings. In total, 58% (15/26) of the studies were race and ethnicity conscious, and 67% (10/15) of these studies sought to partner with potential end users. An array of TBIs were represented; however, SMS text messaging was most prevalent. Most TBIs were combined with other evidence-based intervention components (eg, nicotine replacement therapy). Approximately one-third of the studies (8/26, 31%) required participants to have their own device or internet access. The majority were underpowered to detect substantial differences. Conclusions: The modest number of studies, particularly for persons who identify as Hispanic/Latina/o and American Indian/Alaska Native, demonstrates the limited application of TBIs for tobacco use and that additional research is needed to determine the extent to which TBIs for tobacco use promote health equity among these populations. International Registered Report Identifier (IRRID): RR2-10.2196/34508 UR - https://www.jmir.org/2024/1/e50748 UR - http://dx.doi.org/10.2196/50748 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50748 ER - TY - JOUR AU - Hong, Minji AU - Rajaguru, Vasuki AU - Kim, KyungYi AU - Jang, Suk-Yong AU - Lee, Gyu Sang PY - 2024/10/10 TI - Menstrual Cycle Management and Period Tracker App Use in Millennial and Generation Z Individuals: Mixed Methods Study JO - J Med Internet Res SP - e53146 VL - 26 KW - menstruation KW - dysmenorrhea KW - period tracker app, menstrual cycle management, health care application, millennial KW - Gen Z KW - mobile phone N2 - Background: Menstruation is a physical symptom that occurs in women of reproductive age. It has a significant impact on the daily life and health of women when their academic and social activities are most active. Since many women experience difficulties in daily life because of premenstrual syndrome and dysmenorrhea, it is important to identify, prepare for, and manage the menstrual cycle in advance. Objective: This study aimed to investigate the relationship between menstruation-related experiences and the use of mobile-based period tracker apps by millennial and generation Z (gen Z) individuals. The objectives of this study are to investigate (1) menstrual cycle management, (2) factors affecting app usage (3) factors affecting cycle management, and (4) motivators and barriers to using period tracker apps, in millennial and gen Z women. Methods: A mixed methods design was used for this study. The participants were young women aged 20-39 years and recruited via the Ovey application. Data were collected through surveys and focus group interviews. The survey was conducted among 700 women, and 8 of them participated in the focus group interviews. Results: In total, 431 (62.3%) participants used period tracker apps primarily to predict their next menstrual cycle. Factors affecting app usage included childbirth experience (odds ratio [OR] 0.475, P<.05), number of dysmenorrhea symptoms (OR 1.136, P<.05), and cycle management level (OR 2.279, P<.001). Additionally, education level (OR 1.122, P<.05 [university level compared high school level]) and the number of dysmenorrhea symptoms (OR 1.024, P<.05) showed a positive association with the cycle management level. However, childbirth experience (OR 0.902, P<.05) and period irregularity (OR 0.929, P<.001) were negatively associated with the cycle management level. Conclusions: Period tracker apps are becoming the new normal among millennials and gen Z individuals for managing their menstrual cycles. The use of a period tracker app empowers women by helping them gain a better understanding of their bodies, ultimately enhancing their social, academic, and health-related lives. Improving the accuracy and literacy of the app is an ongoing task for period-tracking apps, and it is important to provide added value tailored to users? needs. Therefore, the findings of this study should be considered when designing or upgrading period tracker apps to facilitate the adoption of digital technology among young women, thereby promoting their overall well-being and reproductive health. UR - https://www.jmir.org/2024/1/e53146 UR - http://dx.doi.org/10.2196/53146 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53146 ER - TY - JOUR AU - Bober, Timothy AU - Rollman, L. Bruce AU - Handler, Steven AU - Watson, Andrew AU - Nelson, A. Lyndsay AU - Faieta, Julie AU - Rosland, Ann-Marie PY - 2024/10/9 TI - Digital Health Readiness: Making Digital Health Care More Inclusive JO - JMIR Mhealth Uhealth SP - e58035 VL - 12 KW - digital health KW - digital health literacy KW - informatics KW - digital disparities KW - digital health readiness KW - inclusivity KW - digital health tool KW - literacy KW - patient support KW - health system UR - https://mhealth.jmir.org/2024/1/e58035 UR - http://dx.doi.org/10.2196/58035 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58035 ER - TY - JOUR AU - Bozkurt, Selen AU - Fereydooni, Soraya AU - Kar, Irem AU - Diop Chalmers, Catherine AU - Leslie, L. Sharon AU - Pathak, Ravi AU - Walling, Anne AU - Lindvall, Charlotta AU - Lorenz, Karl AU - Quest, Tammie AU - Giannitrapani, Karleen AU - Kavalieratos, Dio PY - 2024/10/8 TI - Investigating Data Diversity and Model Robustness of AI Applications in Palliative Care and Hospice: Protocol for Scoping Review JO - JMIR Res Protoc SP - e56353 VL - 13 KW - palliative care KW - artificial intelligence KW - ethical frameworks KW - AI KW - data diversity KW - model robustness KW - decision support KW - clinical settings KW - end-of-life care KW - hospice environments KW - hospice KW - methodology KW - thematic analysis KW - dissemination N2 - Background: Artificial intelligence (AI) has become a pivotal element in health care, leading to significant advancements across various medical domains, including palliative care and hospice services. These services focus on improving the quality of life for patients with life-limiting illnesses, and AI?s ability to process complex datasets can enhance decision-making and personalize care in these sensitive settings. However, incorporating AI into palliative and hospice care requires careful examination to ensure it reflects the multifaceted nature of these settings. Objective: This scoping review aims to systematically map the landscape of AI in palliative care and hospice settings, focusing on the data diversity and model robustness. The goal is to understand AI?s role, its clinical integration, and the transparency of its development, ultimately providing a foundation for developing AI applications that adhere to established ethical guidelines and principles. Methods: Our scoping review involves six stages: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; (5) collating, summarizing, and reporting the results; and (6) consulting with stakeholders. Searches were conducted across databases including MEDLINE through PubMed, Embase.com, IEEE Xplore, ClinicalTrials.gov, and Web of Science Core Collection, covering studies from the inception of each database up to November 1, 2023. We used a comprehensive set of search terms to capture relevant studies, and non-English records were excluded if their abstracts were not in English. Data extraction will follow a systematic approach, and stakeholder consultations will refine the findings. Results: The electronic database searches conducted in November 2023 resulted in 4614 studies. After removing duplicates, 330 studies were selected for full-text review to determine their eligibility based on predefined criteria. The extracted data will be organized into a table to aid in crafting a narrative summary. The review is expected to be completed by May 2025. Conclusions: This scoping review will advance the understanding of AI in palliative care and hospice, focusing on data diversity and model robustness. It will identify gaps and guide future research, contributing to the development of ethically responsible and effective AI applications in these settings. International Registered Report Identifier (IRRID): DERR1-10.2196/56353 UR - https://www.researchprotocols.org/2024/1/e56353 UR - http://dx.doi.org/10.2196/56353 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56353 ER - TY - JOUR AU - Aguilera, Adrian AU - Arévalo Avalos, Marvyn AU - Xu, Jing AU - Chakraborty, Bibhas AU - Figueroa, Caroline AU - Garcia, Faviola AU - Rosales, Karina AU - Hernandez-Ramos, Rosa AU - Karr, Chris AU - Williams, Joseph AU - Ochoa-Frongia, Lisa AU - Sarkar, Urmimala AU - Yom-Tov, Elad AU - Lyles, Courtney PY - 2024/10/8 TI - Effectiveness of a Digital Health Intervention Leveraging Reinforcement Learning: Results From the Diabetes and Mental Health Adaptive Notification Tracking and Evaluation (DIAMANTE) Randomized Clinical Trial JO - J Med Internet Res SP - e60834 VL - 26 KW - digital health KW - physical activity KW - mobile phone KW - text messages KW - SMS KW - steps KW - walking KW - diabetes KW - depression KW - reinforcement learning KW - exercise KW - machine learning N2 - Background: Digital and mobile health interventions using personalization via reinforcement learning algorithms have the potential to reach large number of people to support physical activity and help manage diabetes and depression in daily life. Objective: The Diabetes and Mental Health Adaptive Notification and Tracking Evaluation (DIAMANTE) study tested whether a digital physical activity intervention using personalized text messaging via reinforcement learning algorithms could increase step counts in a diverse, multilingual sample of people with diabetes and depression symptoms. Methods: From January 2020 to June 2022, participants were recruited from 4 San Francisco, California?based public primary care clinics and through web-based platforms to participate in the 24-week randomized controlled trial. Eligibility criteria included English or Spanish language preference and a documented diagnosis of diabetes and elevated depression symptoms. The trial had 3 arms: a Control group receiving a weekly mood monitoring message, a Random messaging group receiving randomly selected feedback and motivational text messages daily, and an Adaptive messaging group receiving text messages selected by a reinforcement learning algorithm daily. Randomization was performed with a 1:1:1 allocation. The primary outcome, changes in daily step counts, was passively collected via a mobile app. The primary analysis assessed changes in daily step count using a linear mixed-effects model. An a priori subanalysis compared the primary step count outcome within recruitment samples. Results: In total, 168 participants were analyzed, including those with 24% (40/168) Spanish language preference and 37.5% (63/168) from clinic-based recruitment. The results of the linear mixed-effects model indicated that participants in the Adaptive arm cumulatively gained an average of 3.6 steps each day (95% CI 2.45-4.78; P<.001) over the 24-week intervention (average of 608 total steps), whereas both the Control and Random arm participants had significantly decreased rates of change. Postintervention estimates suggest that participants in the Adaptive messaging arm showed a significant step count increase of 19% (606/3197; P<.001), in contrast to 1.6% (59/3698) and 3.9% (136/3480) step count increase in the Random and Control arms, respectively. Intervention effectiveness differences were observed between participants recruited from the San Francisco clinics and those recruited via web-based platforms, with the significant step count trend persisting across both samples for participants in the Adaptive group. Conclusions: Our study supports the use of reinforcement learning algorithms for personalizing text messaging interventions to increase physical activity in a diverse sample of people with diabetes and depression. It is the first to test this approach in a large, diverse, and multilingual sample. Trial Registration: ClinicalTrials.gov NCT03490253; https://clinicaltrials.gov/study/NCT03490253 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-034723 UR - https://www.jmir.org/2024/1/e60834 UR - http://dx.doi.org/10.2196/60834 UR - http://www.ncbi.nlm.nih.gov/pubmed/39378080 ID - info:doi/10.2196/60834 ER - TY - JOUR AU - Doueiri, Nadeem Zakaria AU - Bajra, Rika AU - Srinivasan, Malathi AU - Schillinger, Erika AU - Cuan, Nancy PY - 2024/10/1 TI - Bridging the Telehealth Digital Divide With Collegiate Navigators: Mixed Methods Evaluation Study of a Service-Learning Health Disparities Course JO - JMIR Med Educ SP - e57077 VL - 10 KW - service learning KW - medical education KW - access to care KW - telehealth KW - telemedicine KW - health disparities KW - social determinants of health KW - digital literacy KW - vulnerable populations KW - community engagement KW - value-added medical education KW - digital health KW - digital divide KW - health equity KW - collegiate navigator KW - experimental KW - education KW - student KW - qualitative analysis KW - technology KW - mobile phone N2 - Background: Limited digital literacy is a barrier for vulnerable patients accessing health care. Objective: The Stanford Technology Access Resource Team (START), a service-learning course created to bridge the telehealth digital divide, trained undergraduate and graduate students to provide hands-on patient support to improve access to electronic medical records (EMRs) and video visits while learning about social determinants of health. Methods: START students reached out to 1185 patients (n=711, 60% from primary care clinics of a large academic medical center and n=474, 40% from a federally qualified health center). Registries consisted of patients without an EMR account (at primary care clinics) or patients with a scheduled telehealth visit (at a federally qualified health center). Patient outcomes were evaluated by successful EMR enrollments and video visit setups. Student outcomes were assessed by reflections coded for thematic content. Results: Over 6 academic quarters, 57 students reached out to 1185 registry patients. Of the 229 patients contacted, 141 desired technical support. START students successfully established EMR accounts and set up video visits for 78.7% (111/141) of patients. After program completion, we reached out to 13.5% (19/141) of patients to collect perspectives on program utility. The majority (18/19, 94.7%) reported that START students were helpful, and 73.7% (14/19) reported that they had successfully connected with their health care provider in a digital visit. Inability to establish access included a lack of Wi-Fi or device access, the absence of an interpreter, and a disability that precluded the use of video visits. Qualitative analysis of student reflections showed an impact on future career goals and improved awareness of health disparities of technology access. Conclusions: Of the patients who desired telehealth access, START improved access for 78.7% (111/141) of patients. Students found that START broadened their understanding of health disparities and social determinants of health and influenced their future career goals. UR - https://mededu.jmir.org/2024/1/e57077 UR - http://dx.doi.org/10.2196/57077 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57077 ER - TY - JOUR AU - Donawa, Alyssa AU - Powell, Christian AU - Wang, Rong AU - Chih, Ming-Yuan AU - Patel, Reema AU - Zinner, Ralph AU - Aronoff-Spencer, Eliah AU - Baker, E. Corey PY - 2024/9/26 TI - Designing Survey-Based Mobile Interfaces for Rural Patients With Cancer Using Apple?s ResearchKit and CareKit: Usability Study JO - JMIR Form Res SP - e57801 VL - 8 KW - usability KW - usability testing KW - digital literacy KW - ehealth literacy KW - digital divide KW - mobile health KW - mHealth KW - patients with cancer KW - rural health KW - distress KW - apps KW - ehealth adoption KW - HealthKit KW - CareKit N2 - Background: Despite the increased accessibility and availability of technology in recent years, equality and access to health-related technology remain limited to some demographics. In particular, patients who are older or from rural communities represent a large segment of people who are currently underusing mobile health (mHealth) solutions. System usability continues to hinder mHealth adoption among users with nontraditional digital literacy. Objective: This study aims to investigate if state-of-the-art mobile app interfaces from open-source libraries provide sufficient usability for rural patients with cancer, with minimal design changes and forgoing the co-design process. Methods: We developed Assuage (Network Reconnaissance Lab) as a research platform for any mHealth study. We conducted a pilot study using Assuage to assess the usability of 4 mobile user interfaces (UIs) based on open-source libraries from Apple?s ResearchKit and CareKit. These UIs varied in complexity for reporting distress symptoms. Patients with cancer were recruited at the Markey Cancer Center, and all research procedures were conducted in person. Participants completed the distress assessment using a randomly selected UI in Assuage with little to no assistance. Data were collected on participant age, location, mobile app use, and familiarity with mHealth apps. Participants rated usability with the System Usability Scale (SUS), and usability issues were documented and compared. A one-way ANOVA was used to compare the effect of the UIs on the SUS scores. Results: We recruited 30 current or postsurgery patients with cancer for this pilot study. Most participants were aged >50 years (24/30, 80%), from rural areas (25/30, 83%), had up to a high school education (19/30, 63%), and were unfamiliar with mHealth apps (21/30, 70%). General mobile app use was split, with 43% (14/30) of the patients not regularly using mobile apps. The mean SUS score across the UIs was 75.8 (SD 22.2), with UI 3 and UI 4 achieving an SUS score ?80, meeting the industry standard for good usability of 80. Critical usability issues were related to data input and navigation with touch devices, such as scale-format questions, vertical scrolling, and traversing multiple screens. Conclusions: The findings from this study show that most patients with cancer (20/30, 67%) who participated in this study rated the different interfaces of Assuage as above-average usability (SUS score >68). This suggests that Apple?s ResearchKit and CareKit libraries can provide usable UIs for older and rural users with minimal interface alterations. When resources are limited, the design stage can be simplified by omitting the co-design process while preserving suitable usability for users with nontraditional technical proficiency. Usability comparable to industry standards can be achieved by considering heuristics for interface and electronic survey design, specifically how to segment and navigate surveys, present important interface elements, and signal gestural interactions. UR - https://formative.jmir.org/2024/1/e57801 UR - http://dx.doi.org/10.2196/57801 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57801 ER - TY - JOUR AU - Savage, C. Leah AU - Soto-Cossio, Estefhany Luz AU - Minardi, Francesca AU - Beyrouty, Matthew AU - Schoonover, Julie AU - Musella, Jay AU - Frazier, Michaela AU - Villagra, N. Cristina AU - Sly, R. Jamilia AU - Erblich, Joel AU - Itzkowitz, H. Steven AU - Jandorf, H. Lina AU - Calman, S. Neil AU - Atreja, Ashish AU - Miller, J. Sarah PY - 2024/9/25 TI - The Development of a Digital Patient Navigation Tool to Increase Colorectal Cancer Screening Among Federally Qualified Health Center Patients: Acceptability and Usability Testing JO - JMIR Form Res SP - e53224 VL - 8 KW - digital navigation KW - digital health KW - Federally Qualified Health Center KW - colorectal cancer KW - cancer screening KW - mobile phone N2 - Background: Federally Qualified Health Centers (FQHCs) are an essential place for historically underserved patients to access health care, including screening for colorectal cancer (CRC), one of the leading causes of cancer death in the United States. Novel interventions aimed at increasing CRC screening completion rates at FQHCs are crucial. Objective: This study conducts user testing of a digital patient navigation tool, called eNav, designed to support FQHC patients in preparing for, requesting, and completing CRC screening tests. Methods: We recruited English- and Spanish-speaking patients (N=20) at an FQHC in New York City to user-test the eNav website (2 user tests; n=10 participants per user test). In each user test, participants engaged in a ?think aloud? exercise and a qualitative interview to summarize and review their feedback. They also completed a baseline questionnaire gathering data about demographics, technology and internet use, medical history, and health literacy, and completed surveys to assess the website?s acceptability and usability. Based on participant feedback from the first user test, we modified the eNav website for a second round of testing. Then, feedback from the second user test was used to modify and finalize the eNav website. Results: Survey results supported the overall usability and acceptability of the website. The average System Usability Scale score for our first user test was 75.25; for the second, it was 75.28. The average Acceptability E-scale score for our first user test was 28.3; for the second, it was 29.2. These scores meet suggested benchmarks for usability and acceptability. During qualitative think-aloud exercises, in both user tests, many participants favorably perceived the website as motivating, interesting, informative, and user-friendly. Respondents also gave suggestions on how to improve the website?s content, usability, accessibility, and appeal. We found that some participants did not have the digital devices or internet access needed to interact with the eNav website at home. Conclusions: Based on participant feedback on the eNav website and reported limitations to digital access across both user tests, we made modifications to the content and design of the website. We also designed alternative methods of engagement with eNav to increase the tool?s usability, accessibility, and impact for patients with diverse needs, including those with limited access to devices or the internet at home. Next, we will test the eNav intervention in a randomized controlled trial to evaluate the efficacy of the eNav website for improving CRC screening uptake among patients treated at FQHCs. UR - https://formative.jmir.org/2024/1/e53224 UR - http://dx.doi.org/10.2196/53224 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53224 ER - TY - JOUR AU - Robinson, Athena AU - Flom, Megan AU - Forman-Hoffman, L. Valerie AU - Histon, Trina AU - Levy, Monique AU - Darcy, Alison AU - Ajayi, Toluwalase AU - Mohr, C. David AU - Wicks, Paul AU - Greene, Carolyn AU - Montgomery, M. Robert PY - 2024/9/24 TI - Equity in Digital Mental Health Interventions in the United States: Where to Next? JO - J Med Internet Res SP - e59939 VL - 26 KW - Digital Mental Health Interventions KW - mental health KW - health equity KW - access to health care KW - health plan implementations UR - https://www.jmir.org/2024/1/e59939 UR - http://dx.doi.org/10.2196/59939 UR - http://www.ncbi.nlm.nih.gov/pubmed/39316436 ID - info:doi/10.2196/59939 ER - TY - JOUR AU - Yun, Byungyoon AU - Park, Heejoo AU - Choi, Jaesung AU - Oh, Juyeon AU - Sim, Juho AU - Kim, Yangwook AU - Lee, Jongmin AU - Yoon, Jin-Ha PY - 2024/9/20 TI - Inequality in Mortality and Cardiovascular Risk Among Young, Low-Income, Self-Employed Workers: Nationwide Retrospective Cohort Study JO - JMIR Public Health Surveill SP - e48047 VL - 10 KW - self-employed KW - employee KW - all-cause mortality KW - cardiovascular disease KW - mental illness KW - socioeconomic status KW - nationwide study KW - inequality KW - effect modification KW - health checkups N2 - 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. UR - https://publichealth.jmir.org/2024/1/e48047 UR - http://dx.doi.org/10.2196/48047 ID - info:doi/10.2196/48047 ER - TY - JOUR AU - Tuitert, Inge AU - Marinus, D. Jesse AU - Dalenberg, R. Jelle AU - van 't Veer, TB Job PY - 2024/9/13 TI - Digital Health Technology Use Across Socioeconomic Groups Prior to and During the COVID-19 Pandemic: Panel Study JO - JMIR Public Health Surveill SP - e55384 VL - 10 KW - digital divide KW - vulnerable groups KW - digital health apps KW - adoption KW - socioeconomics KW - health technology KW - digital health KW - longitudinal KW - surveys KW - technology use N2 - Background: Digital technologies have become more important in the health care sector in the past decades. This transition from conventional to digital health care has been accelerated by the impact of the COVID-19 pandemic, which poses the risk of creating a ?digital divide,? inadvertently placing those who are older, economically disadvantaged, and have a lower level of education at a disadvantage. Objective: This study focuses on the influence of socioeconomic factors on the adoption of digital health technology in the Frisian population and how this relation is affected by the COVID-19 pandemic. Methods: In 2019 and 2020, a panel study was conducted on digital health in the Frisian population in the Netherlands. In the survey, the use of digital health technology was operationalized in a broad sense, going beyond the care context by also including preventative health-promoting solutions generally available on the consumer market, such as wearables and lifestyle apps. First, to assess the influence of socioeconomic factors on the total use of digital health apps, a generalized linear model was fitted with use of digital health app as the dependent variable and socioeconomic factors as between-subject factors on the 2019 data. Second, to analyze whether the use of separate health apps increased from 2019 to 2020, we conducted chi-square tests on different digital health app types. Third, to examine the influence of COVID-19 on the use of digital health apps, a generalized linear mixed model was fitted with the use of digital health apps as the dependent variable, COVID-19 as the within-subject variable, and socioeconomic factors as between-subject factors. Results: The results indicated that prior to the COVID-19 pandemic, digital health technology use was higher in women, younger people, and those who are well educated and economically more privileged. Moreover, the percentage of people who reported using digital health technology rose from 70% (1580/2258) to 82.5% (1812/2197) due to the COVID-19 pandemic. This increase was significant for all separate types of digital health technology (all P<.001). In addition, we found the interaction effects of COVID-19 with age and education attainment, indicating that the lower total use among older people and people with lower education attainment became slightly less apparent from 2019 to 2020. Conclusions: These findings on the influence of the COVID-19 pandemic on the digital divide indicated that the use of all types of digital health apps increased and that older individuals and people with a lower level of education caught up a little during COVID-19. Future research should gain more insight into this effect and examine whether it persists beyond the COVID-19 pandemic. Additionally, future endeavors should focus on vulnerable groups, ensuring they receive adequate attention to guarantee access to health care, preventative health-promoting solutions, and social services. UR - https://publichealth.jmir.org/2024/1/e55384 UR - http://dx.doi.org/10.2196/55384 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55384 ER - TY - JOUR AU - Fari?, Nu?a AU - Potts, WW Henry AU - Heilman, M. James PY - 2024/9/12 TI - Quality of Male and Female Medical Content on English-Language Wikipedia: Quantitative Content Analysis JO - J Med Internet Res SP - e47562 VL - 26 KW - Wikipedia KW - wikis KW - writing KW - internet KW - health information KW - sex KW - sex bias KW - consumer health information KW - health communication KW - public education KW - social media N2 - Background: Wikipedia is the largest free online encyclopedia and the seventh most visited website worldwide, containing >45,000 freely accessible English-language medical articles accessed nearly 1.6 billion times annually. Concerns have been expressed about the balance of content related to biological sex on Wikipedia. Objective: This study aims to categorize the top 1000 most-read (most popular) English-language Wikipedia health articles for June 2019 according to the relevance of the article topic to each sex and quality. Methods: In the first step, Wikipedia articles were identified using WikiProject Medicine Popular Pages. These were analyzed on 13 factors, including total views, article quality, and total number of references. In the second step, 2 general medical textbooks were used as comparators to assess whether Wikipedia?s spread of articles was typical compared to the general medical coverage. According to the article?s content, we proposed criteria with 5 categories: 1=?exclusively female,? 2=?predominantly female but can also affect male individuals,? 3=?not sex specific or neutral,? 4=predominantly male but can affect female individuals,? and 5=?exclusively male.? Results: Of the 1000 Wikipedia health articles, 933 (93.3%) were not sex specific and 67 (6.7%) were sex specific. There was no statistically significant difference in the number of reads per month between the sex-specific and non?sex-specific articles (P=.29). Coverage of female topics was higher (50/1000, 5%) than male topics (17/1000, 1.7%; this difference was also observed for the 2 medical textbooks, in which 90.2% (2330/2584) of content was not sex specific, female topics accounted for 8.1% (209/2584), and male topics for accounted for 1.7% (45/2584; statistically significant difference; Fisher exact test P=.03). Female-category articles were ranked higher on the Wikipedia medical topic importance list (top, high, or mid importance) than male-category articles (borderline statistical significance; Fisher exact test P=.05). Female articles had a higher number of total and unique references; a slightly higher number of page watchers, pictures, and available languages; and lower number of edits than male articles (all were statistically nonsignificant). Conclusions: Across several metrics, a sample of popular Wikipedia health-related articles for both sexes had comparable quality. Wikipedia had a lower number of female articles and a higher number of neutral articles relative to the 2 medical textbooks. These differences were small, but statistically significant. Higher exclusively female coverage, compared to exclusively male coverage, in Wikipedia articles was similar to the 2 medical textbooks and can be explained by inclusion of sections on obstetrics and gynecology. This is unlike the imbalance seen among biographies of living people, in which approximately 77.6% pertain to male individuals. Although this study included a small sample of articles, the spread of Wikipedia articles may reflect the readership and the population?s content consumption at a given time. Further study of a larger sample of Wikipedia articles would be valuable. UR - https://www.jmir.org/2024/1/e47562 UR - http://dx.doi.org/10.2196/47562 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/47562 ER - TY - JOUR AU - Guo, Ying AU - Hong, Zixuan AU - Cao, Chenglin AU - Cao, Wenwen AU - Chen, Ren AU - Yan, Jing AU - Hu, Zhi AU - Bai, Zhongliang PY - 2024/9/11 TI - Urban-Rural Differences in the Association of eHealth Literacy With Medication Adherence Among Older People With Frailty and Prefrailty: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e54467 VL - 10 KW - eHealth literacy KW - medication adherence KW - frailty KW - older people KW - China N2 - Background: With advances in science and technology and improvements in health literacy, more studies have focused on frailty prevention by promoting medication adherence, emphasizing the role of eHealth literacy. However, the association between eHealth literacy and medication adherence in frail older adults has not been well studied, and it is unknown whether urban-rural differences exist in this relationship. Objective: This study aims to examine the relationship between eHealth literacy and medication adherence in older people with different frailty statuses, emphasizing variations between rural and urban areas. Methods: Between November and December 2020, a total of 4218 urban and rural community members (aged ?60 years) in China were recruited as participants using a multistage random sampling method. A face-to-face structured questionnaire survey was conducted to collect information on demographic characteristics, eHealth literacy (consisting of application, evaluation, and decision dimensions), and medication adherence. eHealth literacy was assessed using the Chinese version of the eHealth Literacy Scale developed by Norman and Skinner, and medication adherence was measured using the 4-item Morisky scale. We used a general descriptive analysis and stratified logistic regression models to examine how eHealth literacy is linked to medication adherence and urban-rural differences. Results: There were 4218 respondents, of which 2316 (54.9%) lived in urban areas and 1902 (45.1%) in rural areas, respectively. After adjusting for potential confounders, among participants with prefrailty, eHealth literacy was associated with medication adherence in urban areas in terms of less application (adjusted odds ratio [AOR] 1.16, 95% CI 0.82?1.63), less evaluation (AOR 1.29, 95% CI 0.92?1.81), and less decision ability (AOR 1.20, 95% CI 0.86?1.68); eHealth literacy was linked with medication adherence in the rural areas in terms of less application (AOR 1.10, 95% CI 0.56?2.13), less evaluation (AOR 1.05, 95% CI 0.61?1.79), and less decision ability (AOR 1.10, 95% CI 0.64?1.90). Among frail participants, less eHealth literacy (AOR 0.85, 95% CI 0.48?1.51), along with its dimensions, including less application (AOR 0.85, 95% CI 0.47?1.54), evaluation (AOR 0.89, 95% CI 0.50?1.57), and decision ability (AOR 0.99, 95% CI 0.55?1.76), were associated with medication adherence in urban areas; less eHealth literacy (AOR 0.89, 95% CI 0.48?1.65), along with its dimensions, including less application (AOR 1.23, 95% CI 0.62?2.44), evaluation (AOR 0.98, 95% CI 0.53?1.82), and decision ability (AOR 0.90, 95% CI 0.49?1.67), were associated with medication adherence in rural areas. Conclusions: The results of this study suggest that there is an association between eHealth literacy and medication adherence among older people with frailty and prefrailty. To promote medication adherence, eHealth literacy can be helpful in tailoring interventions. UR - https://publichealth.jmir.org/2024/1/e54467 UR - http://dx.doi.org/10.2196/54467 ID - info:doi/10.2196/54467 ER - TY - JOUR AU - Kalinowski, Jolaade AU - Bhusal, Sandesh AU - Pagoto, L. Sherry AU - Newton Jr, Robert AU - Waring, E. Molly PY - 2024/9/9 TI - Smart Device Ownership and Use of Social Media, Wearable Trackers, and Health Apps Among Black Women With Hypertension in the United States: National Survey Study JO - JMIR Cardio SP - e59243 VL - 8 KW - Black women KW - Black KW - women KW - tracker KW - trackers KW - wearable KW - wearables KW - hypertension KW - hypertensive KW - cardiology KW - cardiovascular KW - blood pressure KW - social media KW - technology KW - usage KW - digital health KW - eHealth KW - tablet KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - survey KW - surveys KW - questionnaire KW - questionnaires KW - Health Information National Trends Survey KW - HINTS UR - https://cardio.jmir.org/2024/1/e59243 UR - http://dx.doi.org/10.2196/59243 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59243 ER - TY - JOUR AU - Wei, Hanxue AU - Hswen, Yulin AU - Merchant, S. Junaid AU - Drew, B. Laura AU - Nguyen, C. Quynh AU - Yue, Xiaohe AU - Mane, Heran AU - Nguyen, T. Thu PY - 2024/9/9 TI - From Tweets to Streets: Observational Study on the Association Between Twitter Sentiment and Anti-Asian Hate Crimes in New York City from 2019 to 2022 JO - J Med Internet Res SP - e53050 VL - 26 KW - anti-Asian KW - hate crime KW - Twitter KW - racism KW - social media, machine learning, sentiment analysis N2 - Background: Anti-Asian hate crimes escalated during the COVID-19 pandemic; however, limited research has explored the association between social media sentiment and hate crimes toward Asian communities. Objective: This study aims to investigate the relationship between Twitter (rebranded as X) sentiment data and the occurrence of anti-Asian hate crimes in New York City from 2019 to 2022, a period encompassing both before and during COVID-19 pandemic conditions. Methods: We used a hate crime dataset from the New York City Police Department. This dataset included detailed information on the occurrence of anti-Asian hate crimes at the police precinct level from 2019 to 2022. We used Twitter?s application programming interface for Academic Research to collect a random 1% sample of publicly available Twitter data in New York State, including New York City, that included 1 or more of the selected Asian-related keywords and applied support vector machine to classify sentiment. We measured sentiment toward the Asian community using the rates of negative and positive sentiment expressed in tweets at the monthly level (N=48). We used negative binomial models to explore the associations between sentiment levels and the number of anti-Asian hate crimes in the same month. We further adjusted our models for confounders such as the unemployment rate and the emergence of the COVID-19 pandemic. As sensitivity analyses, we used distributed lag models to capture 1- to 2-month lag times. Results: A point increase of 1% in negative sentiment rate toward the Asian community in the same month was associated with a 24% increase (incidence rate ratio [IRR] 1.24; 95% CI 1.07-1.44; P=.005) in the number of anti-Asian hate crimes. The association was slightly attenuated after adjusting for unemployment and COVID-19 emergence (ie, after March 2020; P=.008). The positive sentiment toward Asian tweets with a 0-month lag was associated with a 12% decrease (IRR 0.88; 95% CI 0.79-0.97; P=.002) in expected anti-Asian hate crimes in the same month, but the relationship was no longer significant after adjusting for the unemployment rate and the emergence of COVID-19 pandemic (P=.11). Conclusions: A higher negative sentiment level was associated with more hate crimes specifically targeting the Asian community in the same month. The findings highlight the importance of monitoring public sentiment to predict and potentially mitigate hate crimes against Asian individuals. UR - https://www.jmir.org/2024/1/e53050 UR - http://dx.doi.org/10.2196/53050 UR - http://www.ncbi.nlm.nih.gov/pubmed/39250221 ID - info:doi/10.2196/53050 ER - TY - JOUR AU - Luke, J. Michael AU - Craig, Sansanee AU - Pak-Gorstein, Suzinne AU - Arellano, Marlíse AU - Zhang, Jessica AU - Wright, Margaret S. AU - Chuo, John AU - Scribano, V. Philip PY - 2024/9/4 TI - Narrowing the Digital Divide: Framework for Creating Telehealth Equity Dashboards JO - Interact J Med Res SP - e57435 VL - 13 KW - telehealth KW - equity KW - dashboard KW - data KW - framework KW - televisit KW - healthcare KW - disparity KW - disparities KW - clinician KW - clinicians KW - informaticist KW - informaticists KW - researcher KW - researchers KW - pediatric KW - pediatrics KW - health system KW - health systems KW - dashboards KW - access to care KW - data source mapping UR - https://www.i-jmr.org/2024/1/e57435 UR - http://dx.doi.org/10.2196/57435 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57435 ER - TY - JOUR AU - Willem, Theresa AU - Zimmermann, M. Bettina AU - Matthes, Nina AU - Rost, Michael AU - Buyx, Alena PY - 2024/8/26 TI - Acceptance of Social Media Recruitment for Clinical Studies Among Patients With Hepatitis B: Mixed Methods Study JO - J Med Internet Res SP - e54034 VL - 26 KW - Facebook KW - Twitter KW - social media KW - clinical trial KW - enrollment KW - health technology acceptance KW - ethics KW - infectious diseases KW - privacy KW - data protection KW - stigma KW - discrimination N2 - 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. UR - https://www.jmir.org/2024/1/e54034 UR - http://dx.doi.org/10.2196/54034 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54034 ER - TY - JOUR AU - Ding, Yi AU - Wu, Xianglin AU - Cao, Qiuyu AU - Huang, Jiaojiao AU - Xu, Xiaoli AU - Jiang, Youjin AU - Huo, Yanan AU - Wan, Qin AU - Qin, Yingfen AU - Hu, Ruying AU - Shi, Lixin AU - Su, Qing AU - Yu, Xuefeng AU - Yan, Li AU - Qin, Guijun AU - Tang, Xulei AU - Chen, Gang AU - Xu, Min AU - Wang, Tiange AU - Zhao, Zhiyun AU - Gao, Zhengnan AU - Wang, Guixia AU - Shen, Feixia AU - Luo, Zuojie AU - Chen, Li AU - Li, Qiang AU - Ye, Zhen AU - Zhang, Yinfei AU - Liu, Chao AU - Wang, Youmin AU - Yang, Tao AU - Deng, Huacong AU - Chen, Lulu AU - Zeng, Tianshu AU - Zhao, Jiajun AU - Mu, Yiming AU - Wu, Shengli AU - Chen, Yuhong AU - Lu, Jieli AU - Wang, Weiqing AU - Ning, Guang AU - Xu, Yu AU - Bi, Yufang AU - Li, Mian PY - 2024/8/23 TI - Gender Disparities in the Association Between Educational Attainment and Cardiovascular-Kidney-Metabolic Syndrome: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e57920 VL - 10 KW - cardiovascular-kidney-metabolic syndrome KW - education KW - health behavior KW - sex difference KW - cross-sectional study KW - gender N2 - Background: Cardiovascular-kidney-metabolic (CKM) health is affected by social determinants of health, especially education. CKM syndrome has not been evaluated in Chinese population, and the association of education with CKM syndrome in different sexes and its intertwined relation with lifestyles have not been explored. Objective: We aimed to explore the association between educational attainment and the prevalence of CKM syndrome stages in middle-aged and older Chinese men and women as well as the potential role of health behavior based on Life?s Essential 8 construct. Methods: This study used data from the nationwide, community-based REACTION (Risk Evaluation of Cancers in Chinese diabetic individuals: a longitudinal study). A total of 132,085 participants with complete information to determine CKM syndrome stage and education level were included. Educational attainment was assessed by the self-reported highest educational level achieved by the participants and recategorized as low (elementary school or no formal education) or high (middle school, high school, technical school/college, or above). CKM syndrome was ascertained and classified into 5 stages according to the American Heart Association presidential advisory released in 2023. Results: Among 132,085 participants (mean age 56.95, SD 9.19 years; n=86,675, 65.62% women) included, most had moderate-risk CKM syndrome (stages 1 and 2), and a lower proportion were at higher risk of CKM (stages 3 and 4). Along the CKM continuum, low education was associated with 34% increased odds of moderate-risk CKM syndrome for women (odds ratio 1.36, 95% CI 1.23-1.49) with a significant sex disparity, but was positively correlated with high-risk CKM for both sexes. The association between low education and high-risk CKM was more evident in women with poor health behavior but not in men, which was also interactive with and partly mediated by behavior. Conclusions: Low education was associated with adverse CKM health for both sexes but was especially detrimental to women. Such sex-specific educational disparity was closely correlated with health behavior but could not be completely attenuated by behavior modification. These findings highlight the disadvantage faced by women in CKM health ascribed to low education, underscoring the need for public health support to address this inequality. UR - https://publichealth.jmir.org/2024/1/e57920 UR - http://dx.doi.org/10.2196/57920 ID - info:doi/10.2196/57920 ER - TY - JOUR AU - Riggins, P. Daniel AU - Zhang, Huiyuan AU - Trick, E. William PY - 2024/8/20 TI - Using Social Vulnerability Indices to Predict Priority Areas for Prevention of Sudden Unexpected Infant Death in Cook County, IL: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e48825 VL - 10 KW - infant KW - socioeconomic disparities in health KW - sudden unexpected infant death KW - SUID KW - sudden infant death KW - SID KW - geographic information systems KW - structural racism KW - predict KW - social vulnerability KW - racial disparity KW - socioeconomic KW - disparity KW - child KW - infancy KW - pediatric KW - sudden infant death syndrome KW - SIDS N2 - Background: The incidence of sudden unexpected infant death (SUID) in the United States has persisted at roughly the same level since the mid-2000s, despite intensive prevention efforts around safe sleep. Disparities in outcomes across racial and socioeconomic lines also persist. These disparities are reflected in the spatial distribution of cases across neighborhoods. Strategies for prevention should be targeted precisely in space and time to further reduce SUID and correct disparities. Objective: We sought to aid neighborhood-level prevention efforts by characterizing communities where SUID occurred in Cook County, IL, from 2015 to 2019 and predicting where it would occur in 2021?2025 using a semiautomated, reproducible workflow based on open-source software and data. Methods: This cross-sectional retrospective study queried geocoded medical examiner data from 2015?2019 to identify SUID cases in Cook County, IL, and aggregated them to ?communities? as the unit of analysis. We compared demographic factors in communities affected by SUID versus those unaffected using Wilcoxon rank sum statistical testing. We used social vulnerability indicators from 2014 to train a negative binomial prediction model for SUID case counts in each given community for 2015?2019. We applied indicators from 2020 to the trained model to make predictions for 2021?2025. Results: Validation of our query of medical examiner data produced 325 finalized cases with a sensitivity of 95% (95% CI 93%?97%) and a specificity of 98% (95% CI 94%?100%). Case counts at the community level ranged from a minimum of 0 to a maximum of 17. A map of SUID case counts showed clusters of communities in the south and west regions of the county. All communities with the highest case counts were located within Chicago city limits. Communities affected by SUID exhibited lower median proportions of non-Hispanic White residents at 17% versus 60% (P<.001) and higher median proportions of non-Hispanic Black residents at 32% versus 3% (P<.001). Our predictive model showed moderate accuracy when assessed on the training data (Nagelkerke R2=70.2% and RMSE=17.49). It predicted Austin (17 cases), Englewood (14 cases), Auburn Gresham (12 cases), Chicago Lawn (12 cases), and South Shore (11 cases) would have the largest case counts between 2021 and 2025. Conclusions: Sharp racial and socioeconomic disparities in SUID incidence persisted within Cook County from 2015 to 2019. Our predictive model and maps identify precise regions within the county for local health departments to target for intervention. Other jurisdictions can adapt our coding workflows and data sources to predict which of their own communities will be most affected by SUID. UR - https://publichealth.jmir.org/2024/1/e48825 UR - http://dx.doi.org/10.2196/48825 ID - info:doi/10.2196/48825 ER - TY - JOUR AU - Vazquez, Elias Christian AU - Mauldin, L. Rebecca AU - Mitchell, N. Denise AU - Ohri, Faheem PY - 2024/8/14 TI - Sociodemographic Factors Associated With Using eHealth for Information Seeking in the United States: Cross-Sectional Population-Based Study With 3 Time Points Using Health Information National Trends Survey Data JO - J Med Internet Res SP - e54745 VL - 26 KW - health information seeking KW - eHealth use KW - disparities KW - sex KW - age KW - education KW - mobile phone N2 - Background: Despite the potential benefits of using eHealth, sociodemographic disparities exist in eHealth use, which threatens to further widen health equity gaps. The literature has consistently shown age and education to be associated with eHealth use, while the findings for racial and ethnic disparities are mixed. However, previous disparities may have narrowed as health care interactions shifted to web-based modalities for everyone because of the COVID-19 pandemic. Objective: This study aims to provide an updated examination of sociodemographic disparities that contribute to the health equity gap related to using eHealth for information seeking using 3 time points. Methods: Data for this study came from the nationally representative 2018 (n=3504), 2020 (n=3865), and 2022 (n=6252) time points of the Health Information National Trends Survey. Logistic regression was used to regress the use of eHealth for information seeking on race and ethnicity, sex, age, education, income, health status, and year of survey. Given the consistent association of age with the dependent variable, analyses were stratified by age cohort (millennials, Generation X, baby boomers, and silent generation) to compare individuals of similar age. Results: For millennials, being female, attaining some college or a college degree, and reporting an annual income of US $50,000-$74,999 or >US $75,000 were associated with the use of eHealth for information seeking. For Generation X, being female, having attained some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, better self-reported health, and completing the survey in 2022 (vs 2018; odds ratio [OR] 1.80, 95% CI 1.11-2.91) were associated with the use of eHealth for information seeking. For baby boomers, being female, being older, attaining a high school degree, attaining some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, and completing the survey in 2020 (OR 1.56, 95% CI 1.15-2.12) and 2022 (OR 4.04, 95% CI 2.77-5.87) were associated with the use of eHealth for information seeking. Among the silent generation, being older, attaining some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, and completing the survey in 2022 (OR 5.76, 95% CI 3.05-10.89) were associated with the use of eHealth for information seeking. Conclusions: Baby boomers may have made the most gains in using eHealth for information seeking over time. The race and ethnicity findings, or lack thereof, may indicate a reduction in racial and ethnic disparities. Disparities based on sex, education, and income remained consistent across all age groups. This aligns with health disparities literature focused on individuals with lower socioeconomic status, and more recently on men who are less likely to seek health care compared to women. UR - https://www.jmir.org/2024/1/e54745 UR - http://dx.doi.org/10.2196/54745 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54745 ER - TY - JOUR AU - Kyaw, Yadana Myat AU - Aung, Nyein Myo AU - Koyanagi, Yuka AU - Moolphate, Saiyud AU - Aung, Nyein Thin Nyein AU - Ma, Carol Hok Ka AU - Lee, Hocheol AU - Nam, Hae-Kweun AU - Nam, Woo Eun AU - Yuasa, Motoyuki PY - 2024/8/13 TI - Sociodigital Determinants of eHealth Literacy and Related Impact on Health Outcomes and eHealth Use in Korean Older Adults: Community-Based Cross-Sectional Survey JO - JMIR Aging SP - e56061 VL - 7 KW - eHealth literacy KW - eHEALS KW - electronic health information KW - eHealth information KW - health literacy KW - health education KW - eHealth education KW - health training KW - eHealth training KW - digital health KW - digital technology KW - digital intervention KW - digital interventions KW - gray digital divide KW - healthy aging KW - gerontology KW - geriatric KW - geriatrics KW - older adult KW - older adults KW - older person KW - older people KW - aging KW - eHealth Literacy Scale N2 - Background: eHealth literacy is an essential skill for pursuing electronic health information, particularly for older people whose health needs increase with age. South Korea is now at the intersection of a rapidly digitalizing society and an increasingly aged population. eHealth literacy enables older people to maximize the effective use of emerging digital technology for their health and quality of life. Understanding the eHealth literacy of Korean older adults is critical to eliminating the gray digital divide and inequity in health information access. Objective: This study aims to investigate factors influencing eHealth literacy in older Korean adults and its impact on health outcomes and eHealth use. Methods: This was a cross-sectional survey. Community-dwelling older adults 65 years and older in 2 urban cities in South Korea were included. eHealth literacy was measured by the eHealth Literacy Scale. Ordinal logistic regression was used to analyze factors associated with eHealth literacy and multivariate ANOVA for the impact of eHealth literacy on health outcomes and eHealth use. Results: In total, 434 participants were analyzed. A total of 22.3% (97/434) of participants had high eHealth literacy skills. Increasing age, higher monthly income, and time spent on the internet were significantly associated with eHealth literacy (P<.001), and social media users were 3.97 times (adjusted odds ratio 3.97, 95% CI 1.02?15.43; P=.04) more likely to have higher skill. Higher eHealth literacy was associated with better self-perceived health and frequent use of digital technologies for accessing health and care services (P<.001). Conclusions: Disparity in socioeconomic status and engagement on the internet and social media can result in different levels of eHealth literacy skills, which can have consequential impacts on health outcomes and eHealth use. Tailored eHealth interventions, grounded on the social and digital determinants of eHealth literacy, could facilitate eHealth information access among older adults and foster a digitally inclusive healthy aging community. UR - https://aging.jmir.org/2024/1/e56061 UR - http://dx.doi.org/10.2196/56061 ID - info:doi/10.2196/56061 ER - TY - JOUR AU - Wang, Yunwen AU - O?Connor, Karen AU - Flores, Ivan AU - Berdahl, T. Carl AU - Urbanowicz, J. Ryan AU - Stevens, Robin AU - Bauermeister, A. José AU - Gonzalez-Hernandez, Graciela PY - 2024/8/13 TI - Mpox Discourse on Twitter by Sexual Minority Men and Gender-Diverse Individuals: Infodemiological Study Using BERTopic JO - JMIR Public Health Surveill SP - e59193 VL - 10 KW - mpox KW - monkeypox KW - social media KW - sexual minority KW - SMMGD KW - sexual minority men and gender diverse KW - emerging infectious disease KW - infectious disease outbreak KW - health activism KW - health promotion KW - health stigma KW - stigma prevention KW - health equity KW - natural language processing KW - BERTopic N2 - Background: The mpox outbreak resulted in 32,063 cases and 58 deaths in the United States and 95,912 cases worldwide from May 2022 to March 2024 according to the US Centers for Disease Control and Prevention (CDC). Like other disease outbreaks (eg, HIV) with perceived community associations, mpox can create the risk of stigma, exacerbate homophobia, and potentially hinder health care access and social equity. However, the existing literature on mpox has limited representation of the perspective of sexual minority men and gender-diverse (SMMGD) individuals. Objective: To fill this gap, this study aimed to synthesize themes of discussions among SMMGD individuals and listen to SMMGD voices for identifying problems in current public health communication surrounding mpox to improve inclusivity, equity, and justice. Methods: We analyzed mpox-related posts (N=8688) posted between October 2020 and September 2022 by 2326 users who self-identified on Twitter/X as SMMGD and were geolocated in the United States. We applied BERTopic (a topic-modeling technique) on the tweets, validated the machine-generated topics through human labeling and annotations, and conducted content analysis of the tweets in each topic. Geographic analysis was performed on the size of the most prominent topic across US states in relation to the University of California, Los Angeles (UCLA) lesbian, gay, and bisexual (LGB) social climate index. Results: BERTopic identified 11 topics, which annotators labeled as mpox health activism (n=2590, 29.81%), mpox vaccination (n=2242, 25.81%), and adverse events (n=85, 0.98%); sarcasm, jokes, and emotional expressions (n=1220, 14.04%); COVID-19 and mpox (n=636, 7.32%); government or public health response (n=532, 6.12%); mpox symptoms (n=238, 2.74%); case reports (n=192, 2.21%); puns on the naming of the virus (ie, mpox; n=75, 0.86%); media publicity (n=59, 0.68%); and mpox in children (n=58, 0.67%). Spearman rank correlation indicated significant negative correlation (?=?0.322, P=.03) between the topic size of health activism and the UCLA LGB social climate index at the US state level. Conclusions: Discussions among SMMGD individuals on mpox encompass both utilitarian (eg, vaccine access, case reports, and mpox symptoms) and emotionally charged (ie, promoting awareness, advocating against homophobia, misinformation/disinformation, and health stigma) themes. Mpox health activism is more prevalent in US states with lower LGB social acceptance, suggesting a resilient communicative pattern among SMMGD individuals in the face of public health oppression. Our method for social listening could facilitate future public health efforts, providing a cost-effective way to capture the perspective of impacted populations. This study illuminates SMMGD engagement with the mpox discourse, underscoring the need for more inclusive public health programming. Findings also highlight the social impact of mpox: health stigma. Our findings could inform interventions to optimize the delivery of informational and tangible health resources leveraging computational mixed-method analyses (eg, BERTopic) and big data. UR - https://publichealth.jmir.org/2024/1/e59193 UR - http://dx.doi.org/10.2196/59193 UR - http://www.ncbi.nlm.nih.gov/pubmed/39137013 ID - info:doi/10.2196/59193 ER - TY - JOUR AU - O'Shea, MJ Amy AU - Mulligan, Kailey AU - Carter, D. Knute AU - Haraldsson, Bjarni AU - Wray, M. Charlie AU - Shahnazi, Ariana AU - Kaboli, J. Peter PY - 2024/8/8 TI - Comparing Federal Communications Commission and Microsoft Estimates of Broadband Access for Mental Health Video Telemedicine Among Veterans: Retrospective Cohort Study JO - J Med Internet Res SP - e47100 VL - 26 KW - broadband KW - telemedicine KW - Federal Communications Commission KW - veterans KW - United States Department of Veterans Affairs KW - internet KW - mental health care KW - veteran health KW - broadband access KW - web-based KW - digital N2 - 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. UR - https://www.jmir.org/2024/1/e47100 UR - http://dx.doi.org/10.2196/47100 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/47100 ER - TY - JOUR AU - Bather, R. Jemar AU - Kaphingst, A. Kimberly AU - Goodman, S. Melody PY - 2024/8/8 TI - Racial Composition of Social Environments Over the Life Course Using the Pictorial Racial Composition Measure: Development and Validation Study JO - JMIR Public Health Surveill SP - e55461 VL - 10 KW - racial residential segregation KW - racial composition KW - health equity KW - social environment KW - place KW - neighborhood composition KW - health inequities KW - social determinants of health N2 - Background: Studies investigating the impact of racial segregation on health have reported mixed findings and tended to focus on the racial composition of neighborhoods. These studies use varying racial composition measures, such as census data or investigator-adapted questions, which are currently limited to assessing one dimension of neighborhood racial composition. Objective: This study aims to develop and validate a novel racial segregation measure, the Pictorial Racial Composition Measure (PRCM). Methods: The PRCM is a 10-item questionnaire of pictures representing social environments across adolescence and adulthood: neighborhoods and blocks (adolescent and current), schools and classrooms (junior high and high school), workplace, and place of worship. Cognitive interviews (n=13) and surveys (N=549) were administered to medically underserved patients at a primary care clinic at the Barnes-Jewish Hospital. Development of the PRCM occurred across pilot and main phases. For each social environment and survey phase (pilot and main), we computed positive versus negative pairwise comparisons: mostly Black versus all other categories, half Black versus all other categories, and mostly White versus all other categories. We calculated the following validity metrics for each pairwise comparison: sensitivity, specificity, correct classification rate, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, false positive rate, and false negative rate. Results: For each social environment, the mostly Black and mostly White dichotomizations generated better validity metrics relative to the half Black dichotomization. Across all 10 social environments in the pilot and main phases, mostly Black and mostly White dichotomizations exhibited a moderate-to-high sensitivity, specificity, correct classification rate, positive predictive value, and negative predictive value. The positive likelihood ratio values were >1, and the negative likelihood ratio values were close to 0. The false positive and negative rates were low to moderate. Conclusions: These findings support that using either the mostly Black versus other categories or the mostly White versus other categories dichotomizations may provide accurate and reliable measures of racial composition across the 10 social environments. The PRCM can serve as a uniform measure across disciplines, capture multiple social environments over the life course, and be administered during one study visit. The PRCM also provides an added window into understanding how structural racism has impacted minoritized communities and may inform equitable intervention and prevention efforts to improve lives. UR - https://publichealth.jmir.org/2024/1/e55461 UR - http://dx.doi.org/10.2196/55461 UR - http://www.ncbi.nlm.nih.gov/pubmed/39115929 ID - info:doi/10.2196/55461 ER - TY - JOUR AU - Idalski Carcone, April AU - Holtz, E. Bree AU - Reardon, Madeleine AU - Vesey, Dariane AU - Ellis, A. Deborah AU - Parks, Michael PY - 2024/8/7 TI - Meeting the Needs of Emerging Adults With Type 1 Diabetes Living in a Rural Area With Mobile Health Interventions: Focus Group Study JO - JMIR Form Res SP - e55650 VL - 8 KW - emerging adults KW - type 1 diabetes KW - intervention KW - qualitative KW - mHealth KW - mobile phone KW - smartphone N2 - Background: Emerging adults (EAs; age 18-30 years) with type 1 diabetes (T1D) have more challenges with diabetes management and glycemic control than other age groups. Living in a rural community introduces additional unique diabetes care challenges due to limited access to specialty care and ancillary support services. Yet, few interventions have been developed to improve diabetes management in rural-dwelling EAs with T1D. Objective: This study aimed to understand the diabetes management experiences of older adolescents and EAs (age 16-25 years) with T1D living in a rural area and to assess their perceptions of the acceptability of 4 fully automated mobile health (mHealth) interventions to support diabetes management. Methods: EAs were identified by clinical staff through convenience sampling. In total, 8 EAs participated in 1 focus group and 1 EA completed an individual interview; all data were collected over Zoom. Facilitators explored EAs? experiences living in a rural community with T1D and discussed EAs? impressions of, feedback on, and recommendations for improving 4 mHealth interventions to meet the specific needs of EAs with T1D living in rural communities. Discussions were transcribed and analyzed using conventional content analysis. Results: In total, 9 EAs (aged 18.8, SD 2.7 years; 5, 56% men; 8, 89% White) with a duration of diabetes of 8.6 (SD 4.3) years participated. They described experiences with diabetes stigma (attributing diabetes to poor lifestyle choices) and feelings of self-consciousness (hyperawareness) in their rural communities. They attributed these experiences to the small size of their communities (?everyone knows?) and community members? lack of knowledge about diabetes (unable to differentiate between type 1 and type 2 diabetes). In contrast, EAs reported high levels of social support for diabetes and diabetes care from family, friends, and other community members, but low support for medical needs. The location of their diabetes care providers and the limited accessibility of diabetes-specific and general medical care services in their local community created a challenging medical care context. Overall, EAs found mHealth interventions appealing due to their digital delivery and highlighted features that increased accessibility (voiceovers and simple, jargon-free language), individualization (ability to tailor intervention content and delivery), and applicability to their own lives and other EAs with T1D (relatability of vignettes and other content). EAs suggestions for improving the interventions included more opportunities to tailor the interventions to their preferences (greater frequency and duration, ability to adapt content to emerging needs), increasing opportunities for peer support within the interventions (friend and significant other as identified support person, connecting with peers beyond their local community), and making the tone of intervention components more casual and engaging. Conclusions: mHealth interventions aligned with EAs? needs and preferences are a promising strategy to support EAs in communities where social support and resources might be limited. Trial Registration: N/A, not a clinical trial UR - https://formative.jmir.org/2024/1/e55650 UR - http://dx.doi.org/10.2196/55650 UR - http://www.ncbi.nlm.nih.gov/pubmed/39110496 ID - info:doi/10.2196/55650 ER - TY - JOUR AU - Kepper, M. Maura AU - Fowler, A. Lauren AU - Kusters, S. Isabelle AU - Davis, W. Jean AU - Baqer, Manal AU - Sagui-Henson, Sara AU - Xiao, Yunyu AU - Tarfa, Adati AU - Yi, C. Jean AU - Gibson, Bryan AU - Heron, E. Kristin AU - Alberts, M. Nicole AU - Burgermaster, Marissa AU - Njie-Carr, PS Veronica AU - Klesges, M. Lisa PY - 2024/8/1 TI - Expanding a Behavioral View on Digital Health Access: Drivers and Strategies to Promote Equity JO - J Med Internet Res SP - e51355 VL - 26 KW - digital health KW - health equity KW - mobile health KW - mHealth KW - health care access KW - digital divide KW - behavioral medicine KW - implementation KW - mobile phone UR - https://www.jmir.org/2024/1/e51355 UR - http://dx.doi.org/10.2196/51355 UR - http://www.ncbi.nlm.nih.gov/pubmed/39088246 ID - info:doi/10.2196/51355 ER - TY - JOUR AU - Haq, Ul Zaeem AU - Naeem, Ayesha AU - Zaeem, Durayya AU - Sohail, Mohina AU - Pervaiz, Ain Noor ul PY - 2024/7/31 TI - Development of a Digital Platform to Promote Mother and Child Health in Underserved Areas of a Lower-Middle-Income Country: Mixed Methods Formative Study JO - JMIRx Med SP - e48213 VL - 5 KW - primary health care KW - mother and child health KW - community health worker KW - slums KW - digital applications KW - health communication. N2 - Background: Primary health care (PHC) is the backbone of universal health coverage, with community health workers (CHWs) being one of its critical pillars in lower-middle-income countries. Most CHW functions require them to be an efficient communicator, but their program development has been deficient in this area. Can IT provide some solutions? Moreover, can some IT-based CHW-delivered innovations help mothers and children in areas not covered by PHC services? We explored these questions during the development and feasibility testing of a digital application designed to improve the communication capacity of CHWs in two underserved areas of Islamabad. Objective: This study aims to explore the perceptions, practices, and related gaps about mother and child health, and child development in an underserved area; develop and deploy a behavior change communication program to address the gaps; and assess the feasibility of the program. Methods: We carried out a mixed methods study with three steps. First, we conducted 13 in-depth interviews and two focus group discussions with stakeholders to explore the issues faced by mothers living in these underserved areas. To address these barriers, we developed Sehat Ghar, a video-based health education application to demonstrate practices mothers and families needed to adopt. Second, we trained 10 volunteer CHWs from the same community to deliver health education using the application and assessed their pre-post knowledge and skills. Third, these CHWs visited pregnant and lactating mothers in the community with random observation of their work by a supporting supervisor. Results: Initial exploration revealed a need for health-related knowledge among mothers and suboptimal utilization of public health care. Sehat Ghar used behavior change techniques, including knowledge transfer, enhancing mothers? self-efficacy, and improving family involvement in mother and child care. Volunteer CHWs were identified from the community, who after the training, showed a significant improvement in mean knowledge score (before: mean 8.00, SD 1.49; after: mean 11.40, SD 1.43; P<.001) about health. During supportive supervision, these CHWs were rated as excellent in their interaction with mothers and excellent or very good in using the application. The CHW and her community reported their satisfaction with the application and wanted its delivery regularly. Conclusions: Sehat Ghar is a simple, easy-to-use digital application for CHWs and is acceptable to the community. Mothers appreciate the content and presentation and are ready to incorporate its messages into their daily practices. The real-world effectiveness of the innovation tested on 250 mother-infant pairs will be important for its proof of effectiveness. With its usefulness and adaptability, and the rapidly spreading use of mobile phones and internet technology, this cost-effective innovation can help in delivering health communications at a large scale in a minimum amount of time. UR - https://xmed.jmir.org/2024/1/e48213 UR - http://dx.doi.org/10.2196/48213 ID - info:doi/10.2196/48213 ER - TY - JOUR AU - Sasayama, Kiriko AU - Nishimura, Etsuko AU - Yamaji, Noyuri AU - Ota, Erika AU - Tachimori, Hisateru AU - Igarashi, Ataru AU - Arata, Naoko AU - Yoneoka, Daisuke AU - Saito, Eiko PY - 2024/7/31 TI - Current Use and Discrepancies in the Adoption of Health-Related Internet of Things and Apps Among Working Women in Japan: Large-Scale, Internet-Based, Cross-Sectional Survey JO - JMIR Public Health Surveill SP - e51537 VL - 10 KW - women's health KW - IoT KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - decision tree KW - internet survey KW - women KW - health KW - adoption KW - Internet of Things KW - survey KW - surveys KW - management KW - working women KW - worker KW - workers KW - employee KW - employees KW - occupational health KW - job KW - jobs KW - working KW - employed KW - usage N2 - Background: Demographic changes and a low birth rate have led to a workforce shortage in Japan. To address this issue, the government has promoted engagement of female employment. However, increased female employment can impact women's health. Using Internet of Things (IoT) and apps to manage women's health has gained attention, but few studies have focused on working women. Objective: This study aimed to clarify the current situation of working women and their use of IoT or apps to manage their health. Methods: A large-scale, nationwide internet survey was conducted among 10,000 female participants aged from 20 years to 64 years in Japan. Participants were recruited from a marketing research company?s active survey panel of 5.24 million members. The survey included questions about health status, sociodemographic factors, psychological characteristics, and the use of IoT or apps for health management. We compared perceived health status and reasons for current IoT use using t tests and assessed participant characteristics that predicted IoT use using the C5.0 decision tree algorithm. Ethical approval was granted by St. Luke's International University. Results: Among participants, 14.6% (1455/10,000) currently used IoT or apps, 7% (695/10,000) used them previously, and 78.5% (7850/10,000) had never used them. Current users (42.7 years old) were older than past users (39.7 years old). Discrepancies were observed between participants? perceived health problems and the purpose for using IoT or apps, with 21.3% (2130/10,000) of all women reporting they experienced menstrual symptoms or disorders but only 3.5% (347/10,000) used IoT or apps to manage the same symptom. On the other hand, current users were more likely to use IoT or apps to manage nutrition-related problems such as underweight or obesity (405/1455, 27.8%). Device use was highest among current users, with 87.3% (1270/1455) using smartphones, 19.7% (287/1455) using smartwatches, and 13.3% (194/1455) using PCs. Decision tree analysis identified 6 clusters, the largest consisting of 81.6% (5323/6523) of non-IoT users who did not exercise regularly, while pregnant women were more likely to use IoT or apps. Conclusions: Our findings highlight the idea that woman with particular health problems (ie, menstrual symptoms or disorders and premenstrual syndrome) have lower use of IoT or apps, suggesting an unmet need for IoT and apps in specific areas. UR - https://publichealth.jmir.org/2024/1/e51537 UR - http://dx.doi.org/10.2196/51537 UR - http://www.ncbi.nlm.nih.gov/pubmed/39083338 ID - info:doi/10.2196/51537 ER - TY - JOUR AU - Ferguson, IreLee AU - George, Grace AU - Narine, O. Kevin AU - Turner, Amari AU - McGhee, Zelda AU - Bajwa, Harris AU - Hart, G. Frances AU - Carter, Sierra AU - Beard, Courtney PY - 2024/7/31 TI - Acceptability and Engagement of a Smartphone-Delivered Interpretation Bias Intervention in a Sample of Black and Latinx Adults: Open Trial JO - JMIR Ment Health SP - e56758 VL - 11 KW - interpretation bias KW - anxiety KW - depression KW - Black KW - Latinx KW - smartphone KW - mobile phone N2 - Background: Access to evidence-based interventions is urgently required, especially for individuals of minoritized identities who experience unique barriers to mental health care. Digital mental health interventions have the potential to increase accessibility. Previous pilot studies testing HabitWorks, a smartphone app providing an interpretation bias intervention, have found strong engagement and adherence for HabitWorks; however, previous trials? samples consisted of predominantly non-Hispanic, White individuals. Objective: This study conducted an open trial of HabitWorks in a community sample of adults who identified as Black, Hispanic or Latinx, or both. This study aims to test safety, acceptability, and engagement with the HabitWorks app for Black and Latinx adults. Methods: Black, Hispanic or Latinx adults (mean age 32.83, SD 11.06 y; 22/31, 71% women) who endorsed symptoms of anxiety or depression were asked to complete interpretation modification exercises via HabitWorks 3 times per week for 1 month. Interpretation bias and anxiety and depression symptoms were assessed at baseline and posttreatment assessments. Participants completed qualitative interviews to assess overall perceptions of HabitWorks. Results: Of the 31 participants that downloaded the app, 27 (87%) used HabitWorks all 4 weeks. On average, participants completed 15.74 (SD 7.43) exercises out of the 12 prescribed, demonstrating high engagement. Acceptability ratings met all a priori benchmarks except for relevancy. Qualitative interviews also demonstrated high acceptability and few negative experiences. Significant improvements were found in interpretation style (t30=2.29; P<.001), with a large effect size (Cohen d=1.53); anxiety symptoms (t30=2.29; P=.03), with a small effect size (Cohen d=0.41); and depression symptoms (t30=3.065; P=.005), with a medium effect size (Cohen d=0.55). Conclusions: This study adds to the literature evaluating digital mental health interventions in Black and Latinx adults. Preliminary results further support a future controlled trial testing the effectiveness of HabitWorks as an intervention. UR - https://mental.jmir.org/2024/1/e56758 UR - http://dx.doi.org/10.2196/56758 UR - http://www.ncbi.nlm.nih.gov/pubmed/39083330 ID - info:doi/10.2196/56758 ER - TY - JOUR AU - Bear, Alice Holly AU - Ayala Nunes, Lara AU - Ramos, Giovanni AU - Manchanda, Tanya AU - Fernandes, Blossom AU - Chabursky, Sophia AU - Walper, Sabine AU - Watkins, Edward AU - Fazel, Mina PY - 2024/7/30 TI - The Acceptability, Engagement, and Feasibility of Mental Health Apps for Marginalized and Underserved Young People: Systematic Review and Qualitative Study JO - J Med Internet Res SP - e48964 VL - 26 KW - adolescent mental health KW - marginalized groups KW - smartphone apps KW - engagement KW - implementation science KW - mobile app KW - smartphone KW - mobile health KW - mHealth KW - mental health KW - challenges KW - acceptability KW - young KW - effectiveness KW - mobile phone N2 - Background: Smartphone apps may provide an opportunity to deliver mental health resources and interventions in a scalable and cost-effective manner. However, young people from marginalized and underserved groups face numerous and unique challenges to accessing, engaging with, and benefiting from these apps. Objective: This study aims to better understand the acceptability (ie, perceived usefulness and satisfaction with an app) and feasibility (ie, the extent to which an app was successfully used) of mental health apps for underserved young people. A secondary aim was to establish whether adaptations can be made to increase the accessibility and inclusivity of apps for these groups. Methods: We conducted 2 sequential studies, consisting of a systematic literature review of mental health apps for underserved populations followed by a qualitative study with underserved young male participants (n=20; age: mean 19). Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 5 databases was conducted in 2021. The search yielded 18,687 results, of which 14 articles met the eligibility criteria. Results: The included studies comprised a range of groups, including those affected by homelessness, having physical health conditions, living in low- and middle-income countries, and those with sexual and gender minority identities. Establishing and maintaining user engagement was a pervasive challenge across mental health apps and populations, and dropout was a reported problem among nearly all the included studies. Positive subjective reports of usability, satisfaction, and acceptability were insufficient to determine users? objective engagement. Conclusions: Despite the significant amount of funding directed to the development of mental health apps, juxtaposed with only limited empirical evidence to support their effectiveness, few apps have been deliberately developed or adapted to meet the heterogeneous needs of marginalized and underserved young people. Before mental health apps are scaled up, a greater understanding is needed of the types of services that more at-risk young people and those in limited-resource settings prefer (eg, standard vs digital) followed by more rigorous and consistent demonstrations of acceptability, effectiveness, and cost-effectiveness. Adopting an iterative participatory approach by involving young people in the development and evaluation process is an essential step in enhancing the adoption of any intervention, including apps, in ?real-world? settings and will support future implementation and sustainability efforts to ensure that marginalized and underserved groups are reached. Trial Registration: PROSPERO CRD42021254241; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=254241 UR - https://www.jmir.org/2024/1/e48964 UR - http://dx.doi.org/10.2196/48964 UR - http://www.ncbi.nlm.nih.gov/pubmed/39078699 ID - info:doi/10.2196/48964 ER - TY - JOUR AU - Ge, Xiaochen AU - Chappell, Paul AU - Ledger, Jean AU - Bakhai, Minal AU - Clarke, M. Geraldine PY - 2024/7/26 TI - The Use of Online Consultation Systems and Patient Experience of Primary Care: Cross-Sectional Analysis Using the General Practice Patient Survey JO - J Med Internet Res SP - e51272 VL - 26 KW - general practice KW - online consultation KW - patient experience KW - modern general practice KW - sociodemographic health inequalities KW - General Practice Patient Survey KW - cross-sectional study N2 - Background: NHS England encourages the use of online consultation (OC) systems alongside traditional access methods for patients to contact their general practice online and for practices to manage workflow. Access is a key driver of patients? primary care experience. The use of online technology and patient experience vary by sociodemographic characteristics. Objective: This study aims to assess the association between OC system use and patient experience of primary care in English general practice and how that varies by OC system model and practice sociodemographic characteristics (rurality, deprivation, age, and ethnicity). Methods: We categorized practices as ?low-use? or ?high-use? according to the volume of patient-initiated contacts made via the OC system. We considered practices using one of 2 OC systems with distinct designs and implementation models?shorter ?free text? input with an embedded single workflow OC system (FT practices) and longer ?mixed text? input with variation in implemented workflow OC system (MT practices). We used 2022 General Practice Patient Survey data to capture 4 dimensions of patient experience?overall experience, experience of making an appointment, continuity of care, and use of self-care before making an appointment. We used logistic regression at the practice level to explore the association between OC system use and patient experience, including interaction terms to assess sociodemographic variation. Results: We included 287,194 responses from 2423 MT and 170 FT practices. The proportions of patients reporting positive experiences at MT and FT practices were similar or better than practices nationally, except at high-use MT practices. At high-use MT practices, patients were 19.8% (odds ratio [OR] 0.802, 95% CI 0.782-0.823) less likely to report a good overall experience; 24.5% (OR 0.755, 95% CI 0.738-0.773) less likely to report a good experience of making an appointment; and 18.9% (OR 0.811, 95% CI 0.792-0.83) less likely to see their preferred general practitioner; but 27.8% (OR 1.278, 95% CI 1.249-1.308) more likely to use self-care, compared with low-use MT practices. Opposite trends were seen at FT practices. Sociodemographic inequalities in patient experience were generally lower at high-use than low-use practices; for example, gaps in overall experience between practices with the most and fewest White patients decreased by 2.7 percentage points at MT practices and 6.4 percentage points at FT practices. Trends suggested greater improvements in experience for traditionally underserved groups?patients from urban and deprived areas, younger patients, and non-White patients. Conclusions: An OC system with shorter free text input and an integrated single workflow can enhance patient experience and reduce sociodemographic inequalities. Variation in patient experience between practices with different sociodemographic characteristics and OC systems underscores the importance of tailored design and implementation. Generalizing results across different OC systems is difficult due to variations in how they are integrated into practice workflows and communicated to patients. UR - https://www.jmir.org/2024/1/e51272 UR - http://dx.doi.org/10.2196/51272 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51272 ER - TY - JOUR AU - Lee, JinWook AU - Park, JuWon AU - Kim, Nayeon AU - Nari, Fatima AU - Bae, Seowoo AU - Lee, Ji Hyeon AU - Lee, Mingyu AU - Jun, Kwan Jae AU - Choi, Son Kui AU - Suh, Mina PY - 2024/7/22 TI - Socioeconomic Disparities in Six Common Cancer Survival Rates in South Korea: Population-Wide Retrospective Cohort Study JO - JMIR Public Health Surveill SP - e55011 VL - 10 KW - cancer survival KW - income level KW - socioeconomic status KW - deprivation index KW - inequality KW - nationwide analysis KW - cancer KW - South Korea KW - public health N2 - Background: In South Korea, the cancer incidence rate has increased by 56.5% from 2001 to 2021. Nevertheless, the 5-year cancer survival rate from 2017 to 2021 increased by 17.9% compared with that from 2001 to 2005. Cancer survival rates tend to decline with lower socioeconomic status, and variations exist in the survival rates among different cancer types. Analyzing socioeconomic patterns in the survival of patients with cancer can help identify high-risk groups and ensure that they benefit from interventions. Objective: The aim of this study was to analyze differences in survival rates among patients diagnosed with six types of cancer?stomach, colorectal, liver, breast, cervical, and lung cancers?based on socioeconomic status using Korean nationwide data. Methods: This study used the Korea Central Cancer Registry database linked to the National Health Information Database to follow up with patients diagnosed with cancer between 2014 and 2018 until December 31, 2021. Kaplan-Meier curves stratified by income status were generated, and log-rank tests were conducted for each cancer type to assess statistical significance. Hazard ratios with 95% CIs for any cause of overall survival were calculated using Cox proportional hazards regression models with the time since diagnosis. Results: The survival rates for the six different types of cancer were as follows: stomach cancer, 69.6% (96,404/138,462); colorectal cancer, 66.6% (83,406/125,156); liver cancer, 33.7% (23,860/70,712); lung cancer, 30.4% (33,203/109,116); breast cancer, 91.5% (90,730/99,159); and cervical cancer, 78% (12,930/16,580). When comparing the medical aid group to the highest income group, the hazard ratios were 1.72 (95% CI 1.66?1.79) for stomach cancer, 1.60 (95% CI 1.54?1.56) for colorectal cancer, 1.51 (95% CI 1.45?1.56) for liver cancer, 1.56 (95% CI 1.51?1.59) for lung cancer, 2.19 (95% CI 2.01?2.38) for breast cancer, and 1.65 (95% CI 1.46?1.87) for cervical cancer. A higher deprivation index and advanced diagnostic stage were associated with an increased risk of mortality. Conclusions: Socioeconomic status significantly mediates disparities in cancer survival in several cancer types. This effect is particularly pronounced in less fatal cancers such as breast cancer. Therefore, considering the type of cancer and socioeconomic factors, social and medical interventions such as early cancer detection and appropriate treatment are necessary for vulnerable populations. UR - https://publichealth.jmir.org/2024/1/e55011 UR - http://dx.doi.org/10.2196/55011 ID - info:doi/10.2196/55011 ER - TY - JOUR AU - Naderbagi, Aila AU - Loblay, Victoria AU - Zahed, Md Iqthyer Uddin AU - Ekambareshwar, Mahalakshmi AU - Poulsen, Adam AU - Song, C. Yun J. AU - Ospina-Pinillos, Laura AU - Krausz, Michael AU - Mamdouh Kamel, Mostafa AU - Hickie, B. Ian AU - LaMonica, M. Haley PY - 2024/7/9 TI - Cultural and Contextual Adaptation of Digital Health Interventions: Narrative Review JO - J Med Internet Res SP - e55130 VL - 26 KW - cultural adaptation KW - digital health KW - context KW - translation KW - participatory research KW - mobile phone N2 - Background: Emerging evidence suggests that positive impacts can be generated when digital health interventions are designed to be responsive to the cultural and socioeconomic context of their intended audiences. Objective: This narrative review aims to synthesize the literature about the cultural adaptation of digital health interventions. It examines how concepts of culture and context feature in design and development processes, including the methods, models, and content of these interventions, with the aim of helping researchers to make informed decisions about how to approach cultural adaptation in digital health. Methods: Literature searches for this narrative review were conducted across 4 databases. Following full-text article screening by 2 authors, 16 studies of interventions predominantly focused on the self-management of health were selected based on their detailed focus on the process of cultural adaptation. Key considerations for cultural adaptation were identified and synthesized through a qualitative narrative approach, enabling an integrative and in-depth understanding of cultural adaptation. Results: The literature demonstrates varying approaches and levels of cultural adaptation across stages of intervention development, involving considerations such as the research ethos orienting researchers, the methodologies and models used, and the resultant content adaptations. In relation to the latter, culturally appropriate and accessible user interface design and translation can be seen as particularly important in shaping the level of adaptation. Conclusions: Optimizing cultural adaptation involves linking culture with other contextual factors such as economic conditions and social systems to ensure accessibility and the sustained use of digital health interventions. Culturally humble approaches that use the involvement of a broad range of participants, experts, and other stakeholders are demonstrated to spark vital insights for content development, implementation, and evaluation. UR - https://www.jmir.org/2024/1/e55130 UR - http://dx.doi.org/10.2196/55130 UR - http://www.ncbi.nlm.nih.gov/pubmed/38980719 ID - info:doi/10.2196/55130 ER - TY - JOUR AU - Belanger, Christopher AU - Peixoto, Cayden AU - Francoeur, Sara AU - Bjerre, M. Lise PY - 2024/7/9 TI - Patient and Provider Satisfaction With a Geomapping Tool for Finding Community Family Physicians in Ontario, Canada: Cross-Sectional Online Survey Study JO - JMIR Form Res SP - e56716 VL - 8 KW - primary care KW - language-concordant care KW - web-based maps KW - maps KW - physicians KW - experience KW - language KW - access KW - accessibility N2 - Background: Language-concordant health care, or health care in a patient?s language of choice, is an important element of health accessibility that improves patient safety and comfort and facilitates an increased quality of care. However, prior research has found that linguistic minorities often face higher travel burdens to access language-concordant care compared to the general population. Objective: This study intended to assess patient experiences and satisfaction with an online interactive physician map that allows patients to find family physicians who speak their preferred language in and around Ottawa, Ontario, Canada, as a means of identifying areas of improvement. Methods: This study used an online survey with questions related to user satisfaction. Responses to Likert-scale questions were compiled as summary statistics and short-answer responses underwent thematic analysis. The study setting was Ottawa and Renfrew County, Ontario, and the surrounding region, including the province of Quebec. Results: A total of 93 respondents completed the survey and self-identified as living in Ontario or Quebec. Overall, 57 (61%) respondents were ?very satisfied? or ?somewhat satisfied? with the map, 16 (17%) were ?neither satisfied nor dissatisfied,? and 20 (22%) were ?very dissatisfied? or ?somewhat dissatisfied.? We found no significant differences in satisfaction by preferred language, age group, physician attachment, or intended beneficiary. A total of 56 respondents provided short-answer responses to an open-ended question about map improvements. The most common specific suggestion was to show which physicians are accepting new patients (n=20). Other suggestions included data refreshes (n=6), user interface adjustments (n=23), and additional languages (n=2). Some participants also provided positive feedback (n=5) or expressed concern with their inability to find a family physician (n=5). Several comments included multiple suggestions. Conclusions: While most patients were satisfied with the online map, a significant minority expressed dissatisfaction that the map did not show which family physicians were accepting new patients. This suggests that there may be public interest in an accessible database of which family physicians in Ontario are currently accepting new patients. UR - https://formative.jmir.org/2024/1/e56716 UR - http://dx.doi.org/10.2196/56716 UR - http://www.ncbi.nlm.nih.gov/pubmed/38980717 ID - info:doi/10.2196/56716 ER - TY - JOUR AU - Syed, Ahmed Toufeeq AU - Thompson, L. Erika AU - Johnson, Jason AU - Latif, Zainab AU - Kennedy, Nan AU - Javier, Damaris AU - Stinson, Katie AU - Vishwanatha, K. Jamboor PY - 2024/7/2 TI - A/B Testing of User Enrollment Forms to Enhance Diversity in the Biomedical Workforce via the National Research Mentoring Network: User-Centered Design Case Study JO - JMIR Hum Factors SP - e54532 VL - 11 KW - diversity KW - mentoring KW - health workforce KW - underrepresented groups KW - online platform KW - user-computer interface KW - A/B testing KW - split testing KW - recommendation algorithm KW - network of mentors KW - groups KW - enrollment N2 - Background: The National Research Mentoring Network (NRMN) is a National Institutes of Health?funded program for diversifying the science, technology, engineering, math, and medicine research workforce through the provision of mentoring, networking, and professional development resources. The NRMN provides mentoring resources to members through its online platform?MyNRMN. Objective: MyNRMN helps members build a network of mentors. Our goal was to expand enrollment and mentoring connections, especially among those who have been historically underrepresented in biomedical training and the biomedical workforce. Methods: To improve the ease of enrollment, we implemented the split testing of iterations of our user interface for platform registration. To increase mentoring connections, we developed multiple features that facilitate connecting via different pathways. Results: Our improved user interface yielded significantly higher rates of completed registrations (P<.001). Our analysis showed improvement in completed enrollments that used the version 1 form when compared to those that used the legacy form (odds ratio 1.52, 95% CI 1.30-1.78). The version 2 form, with its simplified, 1-step process and fewer required fields, outperformed the legacy form (odds ratio 2.18, 95% CI 1.90-2.50). By improving the enrollment form, the rate of MyNRMN enrollment completion increased from 57.3% (784/1368) with the legacy form to 74.5% (2016/2706) with the version 2 form. Our newly developed features delivered an increase in connections between members. Conclusions: Our technical efforts expanded MyNRMN?s membership base and increased connections between members. Other platform development teams can learn from these efforts to increase enrollment among underrepresented groups and foster continuing, successful engagement. UR - https://humanfactors.jmir.org/2024/1/e54532 UR - http://dx.doi.org/10.2196/54532 ID - info:doi/10.2196/54532 ER - TY - JOUR AU - Steinman, Lesley AU - Chadwick, Kelly AU - Chavez Santos, Erica AU - Sravanam, Sruthi AU - Johnson, Snowy Selisha AU - Rensema, Elspeth AU - Mayotte, Caitlin AU - Denison, Paige AU - Lorig, Kate PY - 2024/6/13 TI - Remote Evidence-Based Programs for Health Promotion to Support Older Adults During the COVID-19 Pandemic and Beyond: Mixed Methods Outcome Evaluation JO - JMIR Aging SP - e52069 VL - 7 KW - older adults KW - health equity KW - rural KW - chronic disease KW - outcome evaluation KW - behavior change KW - technology KW - community based KW - evidence based KW - health promotion KW - mobile phone N2 - Background: Evidence-based programs (EBPs) for health promotion were developed to reach older adults where they live, work, pray, and play. When the COVID-19 pandemic placed a disproportionate burden on older adults living with chronic conditions and the community-based organizations that support them, these in-person programs shifted to remote delivery. While EBPs have demonstrated effectiveness when delivered in person, less is known about outcomes when delivered remotely. Objective: This study evaluated changes in remote EBP participants? health and well-being in a national mixed methods outcome evaluation in January 1, 2021, to March 31, 2022. Methods: We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) for equity framework to guide the evaluation. We purposively sampled for diverse remote EBP delivery modes and delivery organizations, staff, and traditionally underserved older adults, including people of color and rural dwellers. We included 5 EBPs for self-management, falls prevention, and physical activity: videoconferencing (Chronic Disease Self-Management Program, Diabetes Self-Management Program, and EnhanceFitness), telephone plus mailed materials (Chronic Pain Self-Management Program), and enhanced self-directed mailed materials (Walk With Ease). Participant and provider data included validated surveys, in-depth interviews, and open-ended survey questions. We used descriptive statistics to characterize the sample and the magnitude of change and paired t tests (2-tailed) and the Fisher exact test to test for change in outcomes between enrollment and 6-month follow-up. Thematic analysis was used to identify similarities and differences in outcomes within and across programs. Joint display tables facilitated the integration of quantitative and qualitative findings. Results: A total of 586 older adults, 198 providers, and 37 organizations providing EBPs participated in the evaluation. Of the 586 older adults, 289 (49.3%) provided follow-up outcome data. The mean age of the EBP participants was 65.4 (SD 12.0) years. Of the 289 EBP participants, 241 (83.4%) were female, 108 (37.3%) were people of color, 113 (39.1%) lived alone, and 99 (34.3%) were experiencing financial hardship. In addition, the participants reported a mean of 2.5 (SD 1.7) chronic conditions. Overall, the remote EBP participants showed statistically significant improvements in health, energy, sleep quality, loneliness, depressive symptoms, and technology anxiety. Qualitatively, participants shared improvements in knowledge, attitudes, and skills for healthier living; reduced their social isolation and loneliness; and gained better access to programs. Three-fourths of the providers (149/198, 75.2%) felt that effectiveness was maintained when switching from in-person to remote delivery. Conclusions: The findings suggest that participating in remote EBPs can improve health, social, and technological outcomes of interest for older adults and providers, with benefits extending to policy makers. Future policy and practice can better support remote EBP delivery as one model for health promotion, improving access for all older adults. UR - https://aging.jmir.org/2024/1/e52069 UR - http://dx.doi.org/10.2196/52069 UR - http://www.ncbi.nlm.nih.gov/pubmed/38869932 ID - info:doi/10.2196/52069 ER - TY - JOUR AU - Nguyen, Antony AU - Yu, Filmer AU - Park, G. Linda AU - Fukuoka, Yoshimi AU - Wong, Ching AU - Gildengorin, Ginny AU - Nguyen, T. Tung AU - Tsoh, Y. Janice AU - Jih, Jane PY - 2024/6/10 TI - An App-Based Physical Activity Intervention in Community-Dwelling Chinese-, Tagalog-, and Vietnamese-Speaking Americans: Single-Arm Intervention Study JO - JMIR Form Res SP - e56373 VL - 8 KW - physical activity KW - mHealth KW - mobile health KW - mobile app KW - Asian Americans KW - physical activity tracker KW - mobile phone KW - app KW - apps KW - application KW - applications KW - app-based KW - intervention KW - interventions KW - community-dwelling KW - tracker KW - trackers KW - pilot study KW - feasibility KW - acceptability KW - cultural KW - culturally KW - linguistic KW - linguistically KW - evidence-based KW - community-based KW - sociodemographic KW - lifestyle KW - Chinese KW - Vietnamese KW - Filipino KW - adult KW - adults KW - multicomponent KW - multilingual N2 - Background: Physical inactivity is associated with adverse health outcomes among Asian Americans, who exhibit the least adherence to physical activity guidelines compared with other racial and ethnic groups. Mobile app?based interventions are a promising approach to promote healthy behaviors. However, there is a lack of app-based interventions focused on improving physical activity among Asian Americans whose primary language is not English. Objective: This pilot study aimed to assess the feasibility and acceptability of a 5-week intervention using a culturally and linguistically adapted, evidence-based mobile phone app with an accelerometer program, to promote physical activity among Chinese-, Tagalog-, or Vietnamese-speaking Americans. Methods: Participants were recruited through collaborations with community-based organizations. The intervention was adapted from a 12-month physical activity randomized controlled trial involving the app and accelerometer for English-speaking adults. Sociodemographic characteristics, lifestyle factors, and physical measurements were collected at the baseline visit. A 7-day run-in period was conducted to screen for the participants who could wear a Fitbit One (Fitbit LLC) accelerometer and complete the app?s daily step diary. During the 4-week intervention period, participants wore the accelerometer and reported their daily steps in the app. Participants also received daily messages to reinforce key contents taught during an in-person educational session, remind them to input steps, and provide tailored feedback. Feasibility measures were the percentage of eligible participants completing the run-in period and the percentage of participants who used the app diary for at least 5 out of 7 days during the intervention period. We conducted poststudy participant interviews to explore overall intervention acceptability. Results: A total of 19 participants were enrolled at the beginning of the study with a mean age of 47 (SD 13.3; range 29-70) years, and 58% (n=11) of them were female. Of the participants, 26% (n=5) were Chinese, 32% (n=6) were Vietnamese, and 42% (n=8) were Filipino. All participants met the run-in criteria to proceed with the intervention. Adherence to the app diary ranged from 74% (n=14) in week 2 to 95% (n=18) in week 4. The daily average steps per week from accelerometers increased each week from 8451 (SD 3378) steps during the run-in period to 10,930 (SD 4213) steps in week 4. Participants reported positive experiences including an increased motivation to walk and the enjoyment of being able to monitor their physical activity. Conclusions: This is the first pilot study of a multicomponent intervention and evidence-based mobile phone app to promote physical activity among Asian Americans who use apps in traditional Chinese, Tagalog, or Vietnamese, which demonstrated high feasibility and acceptability. Future work focused on multilingual mobile apps to address disparities in physical inactivity among Asian Americans should be considered. UR - https://formative.jmir.org/2024/1/e56373 UR - http://dx.doi.org/10.2196/56373 UR - http://www.ncbi.nlm.nih.gov/pubmed/38857065 ID - info:doi/10.2196/56373 ER - TY - JOUR AU - Ormiston, K. Cameron AU - Villalobos, Kevin AU - Montiel Ishino, Alejandro Francisco AU - Williams, Faustine PY - 2024/6/6 TI - Association Between Discrimination and Depressive Symptoms Among Hispanic or Latino Adults During the COVID-19 Pandemic: Cross-Sectional Study JO - JMIR Form Res SP - e48076 VL - 8 KW - depressive symptoms KW - everyday discrimination KW - COVID-19 pandemic KW - Hispanic and Latino KW - immigrant health N2 - Background: Discrimination and xenophobia toward Hispanic and Latino communities increased during the COVID-19 pandemic, likely inflicting significant harm on the mental health of Hispanic and Latino individuals. Pandemic-related financial and social instability has disproportionately affected Hispanic and Latino communities, potentially compounding existing disparities and worsening mental health. Objective: This study aims to examine the association between discrimination and depressive symptoms during the COVID-19 pandemic among a national sample of Hispanic and Latino adults. Methods: Data from a 116-item web-based nationally distributed survey from May 2021 to January 2022 were analyzed. The sample (N=1181) was restricted to Hispanic or Latino (Mexican or Mexican American, Puerto Rican; Cuban or Cuban American, Central or South American, and Dominican or another Hispanic or Latino ethnicity) adults. Depression symptoms were assessed using the 2-item Patient Health Questionnaire. Discrimination was assessed using the 5-item Everyday Discrimination Scale. A multinomial logistic regression with a block entry model was used to assess the relationship between discrimination and the likelihood of depressive symptoms, as well as examine how controls and covariates affected the relationship of interest. Results: Mexican or Mexican American adults comprised the largest proportion of the sample (533/1181, 45.13%), followed by Central or South American (204/1181, 17.3%), Puerto Rican (189/1181, 16%), Dominican or another Hispanic or Latino ethnicity (172/1181, 14.6%), and Cuban or Cuban American (83/1181, 7.03%). Approximately 31.26% (367/1181) of the sample had depressive symptoms. Regarding discrimination, 54.56% (634/1181) reported experiencing some form of discrimination. Compared with those who did not experience discrimination, those who experienced discrimination had almost 230% higher odds of depressive symptoms (adjusted odds ratio [AOR] 3.31, 95% CI 2.42-4.54). Also, we observed that sociodemographic factors such as age and gender were significant. Compared with participants aged 56 years and older, participants aged 18-35 years and those aged 36-55 years had increased odds of having depressive symptoms (AOR 3.83, 95% CI 2.13-6.90 and AOR 3.10, 95% CI 1.74-5.51, respectively). Women had higher odds of having depressive symptoms (AOR 1.67, 95% CI 1.23-2.30) than men. Respondents with an annual income of less than US $25,000 (AOR 2.14, 95% CI 1.34-3.41) and US $25,000 to less than US $35,000 (AOR 1.89, 95% CI 1.17-3.06) had higher odds of depressive symptoms than those with an annual income of US $50,000 to less than US $75,000. Conclusions: Our findings provide significant importance especially when considering the compounding, numerous socioeconomic challenges stemming from the pandemic that disproportionately impact the Hispanic and Latino communities. These challenges include rising xenophobia and tensions against immigrants, inadequate access to mental health resources for Hispanic and Latino individuals, and existing hesitations toward seeking mental health services among this population. Ultimately, these findings can serve as a foundation for promoting health equity. UR - https://formative.jmir.org/2024/1/e48076 UR - http://dx.doi.org/10.2196/48076 UR - http://www.ncbi.nlm.nih.gov/pubmed/38843512 ID - info:doi/10.2196/48076 ER - TY - JOUR AU - Burns, Kara AU - Bloom, Shoshana AU - Gilbert, Cecily AU - Merner, Bronwen AU - Kalla, Mahima AU - Sheri, Sreshta AU - Villanueva, Cleva AU - Matenga Ikihele, Amio AU - Nazer, Lama AU - Sarmiento, Francis Raymond AU - Stevens, Lindsay AU - Blow, Ngaree AU - Chapman, Wendy PY - 2024/6/5 TI - Centering Digital Health Equity During Technology Innovation: Protocol for a Comprehensive Scoping Review of Evidence-Based Tools and Approaches JO - JMIR Res Protoc SP - e53855 VL - 13 KW - digital health technology KW - eHealth KW - mHealth KW - health informatics KW - equity KW - inclusion KW - participatory design KW - universal design KW - Validitron KW - digital health KW - cost KW - technology KW - technology innovation KW - innovation KW - evidence-based tools KW - evidence-based KW - tools KW - digital innovation KW - cost-effective KW - accessibility KW - digital inequity KW - digital health equity N2 - Background: In the rush to develop health technologies for the COVID-19 pandemic, the unintended consequence of digital health inequity or the inability of priority communities to access, use, and receive equal benefits from digital health technologies was not well examined. Objective: This scoping review will examine tools and approaches that can be used during digital technology innovation to improve equitable inclusion of priority communities in the development of digital health technologies. The results from this study will provide actionable insights for professionals in health care, health informatics, digital health, and technology development to proactively center equity during innovation. Methods: Based on the Arksey and O?Malley framework, this scoping review will consider priority communities? equitable involvement in digital technology innovation. Bibliographic databases in health, medicine, computing, and information sciences will be searched. Retrieved citations will be double screened against the inclusion and exclusion criteria using Covidence (Veritas Health Innovation). Data will be charted using a tailored extraction tool and mapped to a digital health innovation pathway defined by the Centre for eHealth Research roadmap for eHealth technologies. An accompanying narrative synthesis will describe the outcomes in relation to the review?s objectives. Results: This scoping review is currently in progress. The search of databases and other sources returned a total of 4868 records. After the initial screening of titles and abstracts, 426 studies are undergoing dual full-text review. We are aiming to complete the full-text review stage by May 30, 2024, data extraction in October 2024, and subsequent synthesis in December 2024. Funding was received on October 1, 2023, from the Centre for Health Equity Incubator Grant Scheme, University of Melbourne, Australia. Conclusions: This paper will identify and recommend a series of validated tools and approaches that can be used by health care stakeholders and IT developers to produce equitable digital health technology across the Centre for eHealth Research roadmap. Identified evidence gaps, possible implications, and further research will be discussed. International Registered Report Identifier (IRRID): DERR1-10.2196/53855 UR - https://www.researchprotocols.org/2024/1/e53855 UR - http://dx.doi.org/10.2196/53855 UR - http://www.ncbi.nlm.nih.gov/pubmed/38838333 ID - info:doi/10.2196/53855 ER - TY - JOUR AU - Harris, Daniel AU - Delcher, Chris PY - 2024/5/21 TI - Geospatial Imprecision With Constraints for Precision Public Health: Algorithm Development and Validation JO - Online J Public Health Inform SP - e54958 VL - 16 KW - social determinants of health KW - geocoding KW - privacy KW - poverty KW - obfuscation KW - security KW - confidentiality KW - low income KW - geography KW - geographic KW - location KW - locations KW - spatial KW - geospatial KW - precision N2 - Background: Location and environmental social determinants of health are increasingly important factors in both an individual?s health and the monitoring of community-level public health issues. Objective: We aimed to measure the extent to which location obfuscation techniques, designed to protect an individual?s privacy, can unintentionally shift geographical coordinates into neighborhoods with significantly different socioeconomic demographics, which limits the precision of findings for public health stakeholders. Methods: Point obfuscation techniques intentionally blur geographic coordinates to conceal the original location. The pinwheel obfuscation method is an existing technique in which a point is moved along a pinwheel-like path given a randomly chosen angle and a maximum radius; we evaluate the impact of this technique using 2 data sets by comparing the demographics of the original point and the resulting shifted point by cross-referencing data from the United States Census Bureau. Results: Using poverty measures showed that points from regions of low poverty may be shifted to regions of high poverty; similarly, points in regions with high poverty may be shifted into regions of low poverty. We varied the maximum allowable obfuscation radius; the mean difference in poverty rate before and after obfuscation ranged from 6.5% to 11.7%. Additionally, obfuscation inadvertently caused false hot spots for deaths by suicide in Cook County, Illinois. Conclusions: Privacy concerns require patient locations to be imprecise to protect against risk of identification; precision public health requires accuracy. We propose a modified obfuscation technique that is constrained to generate a new point within a specified census-designated region to preserve both privacy and analytical accuracy by avoiding demographic shifts. UR - https://ojphi.jmir.org/2024/1/e54958 UR - http://dx.doi.org/10.2196/54958 UR - http://www.ncbi.nlm.nih.gov/pubmed/38772021 ID - info:doi/10.2196/54958 ER - TY - JOUR AU - Miller, Soederberg Lisa M. AU - Callegari, A. Rachel AU - Abah, Theresa AU - Fann, Helen PY - 2024/5/14 TI - Digital Literacy Training for Low-Income Older Adults Through Undergraduate Community-Engaged Learning: Single-Group Pretest-Posttest Study JO - JMIR Aging SP - e51675 VL - 7 KW - community-engaged learning KW - digital divide KW - underserved older adults KW - digital literacy training KW - intergenerational programs N2 - Background: Digital technology is a social determinant of health that affects older people?s ability to engage in health maintenance and disease prevention activities; connect with family and friends; and, more generally, age in place. Unfortunately, disparities in technology adoption and use exist among older adults compared with other age groups and are even greater among low-income older adults. Objective: In this study, we described the development and implementation of a digital literacy training program designed with the dual goals of training low-income older adults in the community and teaching students about aging using a community-engaged learning (CEL) approach. Methods: The training program was embedded within a 10-week CEL course that paired undergraduates (N=27) with low-income older adults (n=18) for 8 weeks of digital literacy training. Older adults and students met weekly at the local senior center for the training. Students also met in the classroom weekly to learn about aging and how to use design thinking to train their older adult trainees. Both older adults and students completed pre- and posttraining surveys. Results: Older adults demonstrated increased digital literacy skills and confidence in the use of digital technology. Loneliness did not change from pre to postassessment measurements; however, older adults showed improvements in their attitudes toward their own aging and expressed enthusiasm for the training program. Although students? fear of older adults did not change, their comfort in working with older adults increased. Importantly, older adults and students expressed positive feelings about the trainee-trainer relationship that they formed during the training program. Conclusions: A CEL approach that brings together students and low-income older adults in the community has a strong potential to reduce the digital divide experienced by underserved older adults. Additional work is needed to explore the efficacy and scalability of this approach in terms of older adults? digital literacy as well as other potential benefits to both older and younger adults. UR - https://aging.jmir.org/2024/1/e51675 UR - http://dx.doi.org/10.2196/51675 UR - http://www.ncbi.nlm.nih.gov/pubmed/38599620 ID - info:doi/10.2196/51675 ER - TY - JOUR AU - Radó, Nóra AU - Békási, Sándor AU - Gy?rffy, Zsuzsa PY - 2024/5/14 TI - Health Technology Access and Peer Support Among Digitally Engaged People Experiencing Homelessness: Qualitative Study JO - JMIR Hum Factors SP - e55415 VL - 11 KW - digital health KW - homelessness KW - digital technology KW - internet KW - access KW - health equity N2 - Background: Although the effects of digital health are receiving wide scientific attention, very little is known about the characteristics of digitally engaged people experiencing homelessness, especially in Central and Eastern Europe. Our previous research revealed a considerable level of internet use in the homeless population of Budapest, Hungary, for general purposes (350/662, 52.9%) and medical purposes (229/664, 34.6%). Moreover, a digitally engaged subgroup was identified (129/662, 19.5%). Objective: The aim of this exploratory study was to map out the resources, attitudes, and behaviors of digitally engaged homeless individuals in relation to digital technology to set the basis for potential health policy interventions, which will enable better access to health services through strengthening of the digital components of the existing health care system. Methods: Between August 18, 2022, and October 27, 2022, a total of 12 in-depth semistructured interviews were conducted in 4 homeless shelters in Budapest, Hungary. Upon analysis by 3 independent evaluators, 2 interviews were excluded. The interviewees were chosen based on purposive sampling with predefined inclusion criteria. Thematic analysis of the transcripts was conducted. Results: In the thematic analysis, 4 main themes (attitude, access, usage patterns, and solutions for usage problems) emerged. Health-related technology use mostly appeared in health information?seeking behavior. Online search for prescribed medications (5 interviews), active ingredients of medications (4 interviews), medicinal herbs believed to replace certain pills (2 interviews) or foods, and natural materials (1 interview) were mentioned. Moreover, mobile health app use (3 interviews) was reported. The intention to circumvent or check on mainstream health care solutions was mainly associated with previous negative experiences in the health care system. Several gaps in the daily use of technology were identified by the interviewees; however, more than half of the interviewees (6/10) turned out to be contact points for their peers for digital problem-solving or basic digital literacy skill enhancement in the homeless shelters. Furthermore, a lack of institutional support or special programs targeting senior clients was noted. Conclusions: Digitally engaged homeless individuals might become mediators between their peers and comprehensive digital health programs. They have the trust of their peers, can recognize and harness the benefits of digital technology, and are able to provide meaningful help in technology- and usage-related issues through experience. Digital health services have great promise in community shelters for managing and preventing health issues, and digitally engaged individuals might be important for the success of such services. UR - https://humanfactors.jmir.org/2024/1/e55415 UR - http://dx.doi.org/10.2196/55415 UR - http://www.ncbi.nlm.nih.gov/pubmed/38743937 ID - info:doi/10.2196/55415 ER - TY - JOUR AU - Stimpson, P. Jim AU - Park, Sungchul AU - Pruitt, L. Sandi AU - Ortega, N. Alexander PY - 2024/5/8 TI - Variation in Trust in Cancer Information Sources by Perceptions of Social Media Health Mis- and Disinformation and by Race and Ethnicity Among Adults in the United States: Cross-Sectional Study JO - JMIR Cancer SP - e54162 VL - 10 KW - cancer KW - United States KW - cross-sectional study KW - trust KW - consumer health information KW - misinformation KW - disinformation KW - race KW - ethnicity KW - cancer information KW - source KW - sources KW - perception KW - perceptions KW - social media KW - health information KW - cross-sectional data KW - misleading N2 - Background: Mis- and disinformation on social media have become widespread, which can lead to a lack of trust in health information sources and, in turn, lead to negative health outcomes. Moreover, the effect of mis- and disinformation on trust in information sources may vary by racial and ethnic minoritized populations. Objective: We evaluated how trust in multiple sources of cancer information varied by perceptions of health mis- and disinformation on social media and by race and ethnicity. Methods: Cross-sectional, nationally representative survey data from noninstitutionalized adults in the United States from the 2022 Health Information National Trends Survey 6 (HINTS 6) were analyzed (N=4137). The dependent variable measured the level of trust in cancer information sources. The independent variables were perceptions about health mis- and disinformation on social media and race and ethnicity. Multivariable logistic regression models were adjusted for survey weight and design, age, birth gender, race and ethnicity, marital status, urban/rural designation, education, employment status, feelings about household income, frequency of social media visits, and personal and family history of cancer. We also tested the interaction effect between perceptions of social media health mis- and disinformation and participants? self-reported race and ethnicity. Results: Perception of ?a lot of? health mis- and disinformation on social media, relative to perception of ?less than a lot,? was associated with a lower likelihood of high levels of trusting cancer information from government health agencies (odds ratio [OR] 0.60, 95% CI 0.47-0.77), family or friends (OR 0.56, 95% CI 0.44-0.71), charitable organizations (OR 0.78, 95% CI 0.63-0.96), and religious organizations and leaders (OR 0.64, 95% CI 0.52-0.79). Among White participants, those who perceived a lot of health mis- and disinformation on social media were less likely to have high trust in cancer information from government health agencies (margin=61%, 95% CI 57%-66%) and family or friends (margin=49%, 95% CI 43%-55%) compared to those who perceived less than a lot of health mis- and disinformation on social media. Among Black participants, those who perceived a lot of health mis- and disinformation on social media were less likely to have high trust in cancer information from religious organizations and leaders (margin=20%, 95% CI 10%-30%) compared to participants who perceived no or a little health mis- and disinformation on social media. Conclusions: Certain sources of cancer information may need enhanced support against the threat of mis- and disinformation, such as government health agencies, charitable organizations, religious organizations and leaders, and family or friends. Moreover, interventions should partner with racial and ethnically minoritized populations that are more likely to have low trust in certain cancer information sources associated with mis- and disinformation on social media. UR - https://cancer.jmir.org/2024/1/e54162 UR - http://dx.doi.org/10.2196/54162 UR - http://www.ncbi.nlm.nih.gov/pubmed/38717800 ID - info:doi/10.2196/54162 ER - TY - JOUR AU - Mohebbi, Fahimeh AU - Forati, Masoud Amir AU - Torres, Lucas AU - deRoon-Cassini, A. Terri AU - Harris, Jennifer AU - Tomas, W. Carissa AU - Mantsch, R. John AU - Ghose, Rina PY - 2024/5/3 TI - Exploring the Association Between Structural Racism and Mental Health: Geospatial and Machine Learning Analysis JO - JMIR Public Health Surveill SP - e52691 VL - 10 KW - machine learning KW - geospatial KW - racial disparities KW - social determinant of health KW - structural racism KW - mental health KW - health disparities KW - deep learning N2 - Background: Structural racism produces mental health disparities. While studies have examined the impact of individual factors such as poverty and education, the collective contribution of these elements, as manifestations of structural racism, has been less explored. Milwaukee County, Wisconsin, with its racial and socioeconomic diversity, provides a unique context for this multifactorial investigation. Objective: This research aimed to delineate the association between structural racism and mental health disparities in Milwaukee County, using a combination of geospatial and deep learning techniques. We used secondary data sets where all data were aggregated and anonymized before being released by federal agencies. Methods: We compiled 217 georeferenced explanatory variables across domains, initially deliberately excluding race-based factors to focus on nonracial determinants. This approach was designed to reveal the underlying patterns of risk factors contributing to poor mental health, subsequently reintegrating race to assess the effects of racism quantitatively. The variable selection combined tree-based methods (random forest) and conventional techniques, supported by variance inflation factor and Pearson correlation analysis for multicollinearity mitigation. The geographically weighted random forest model was used to investigate spatial heterogeneity and dependence. Self-organizing maps, combined with K-means clustering, were used to analyze data from Milwaukee communities, focusing on quantifying the impact of structural racism on the prevalence of poor mental health. Results: While 12 influential factors collectively accounted for 95.11% of the variability in mental health across communities, the top 6 factors?smoking, poverty, insufficient sleep, lack of health insurance, employment, and age?were particularly impactful. Predominantly, African American neighborhoods were disproportionately affected, which is 2.23 times more likely to encounter high-risk clusters for poor mental health. Conclusions: The findings demonstrate that structural racism shapes mental health disparities, with Black community members disproportionately impacted. The multifaceted methodological approach underscores the value of integrating geospatial analysis and deep learning to understand complex social determinants of mental health. These insights highlight the need for targeted interventions, addressing both individual and systemic factors to mitigate mental health disparities rooted in structural racism. UR - https://publichealth.jmir.org/2024/1/e52691 UR - http://dx.doi.org/10.2196/52691 UR - http://www.ncbi.nlm.nih.gov/pubmed/38701436 ID - info:doi/10.2196/52691 ER - TY - JOUR AU - Donkin, Liesje AU - Bidois-Putt, Marie-Claire AU - Wilson, Holly AU - Hayward, Penelope AU - Chan, Yan Amy Hai PY - 2024/5/2 TI - An Exploration of the Goodness of Fit of Web-Based Tools for M?ori: Qualitative Study Using Interviews and Focus Groups JO - JMIR Form Res SP - e50385 VL - 8 KW - Indigenous people KW - M?ori KW - eHealth KW - mental health KW - web-based intervention KW - digital intervention N2 - Background: Indigenous communities often have poorer health outcomes and services under traditional models of care. In New Zealand, this holds true for M?ori people who are t?ngata whenua (the indigenous people). Several barriers exist that decrease the likelihood of indigenous communities often have poorer health outcomes and poor service fit under traditional models of care, including access issues, systemic and provider racism, and a lack of culturally safe and responsive services. Web-based interventions (WBIs) have been shown to be effective in supporting mental health and well-being and can overcome some of these barriers. Despite the large number of WBIs developed, more investigation is needed to know how well WBIs fit with an indigenous worldview and how they meet the needs of indigenous communities so that a digitally based future does not drive social and health inequities. Objective: This study aims to explore the goodness-of-fit of WBIs of M?ori individuals, the indigenous people of Aotearoa/New Zealand. Methods: We used interviews (n=3) and focus groups (n=5) with 30 M?ori participants to explore their views about WBIs. Interviews were analyzed using reflexive thematic analysis by members of the research team. Results: Overall, there was a perception that the design of WBIs did not align with the M?ori worldview, which centers around people, relationships, spirituality, and holistic views of well-being. A total of 4 key themes and several subthemes emerged, indicating that WBIs were generally considered a poor fit for M?ori. Specifically, the themes were as follows: (1) WBIs are disconnected from the core values of te ao M?ori (the M?ori worldview), (2) WBIs could be helpful in the right context, (3) there are significant barriers that may make it harder for M?ori to use WBIs than other groups, and (4) ways to improve WBIs to help engagement with M?ori. Conclusions: While WBIs are often considered a way to reduce barriers to care, they may not meet the needs of M?ori when used as a stand-alone intervention. If WBIs are continued to be offered, developers and researchers need to consider how to develop WBIs that are responsive and engaging to the needs of indigenous communities rather than driving inequities. Ideally, WBIs should be developed by the people they are intended for to fit with those populations? world views. UR - https://formative.jmir.org/2024/1/e50385 UR - http://dx.doi.org/10.2196/50385 UR - http://www.ncbi.nlm.nih.gov/pubmed/38696236 ID - info:doi/10.2196/50385 ER - TY - JOUR AU - Ausserhofer, Dietmar AU - Piccoliori, Giuliano AU - Engl, Adolf AU - Mahlknecht, Angelika AU - Plagg, Barbara AU - Barbieri, Verena AU - Colletti, Nicoletta AU - Lombardo, Stefano AU - Gärtner, Timon AU - Tappeiner, Waltraud AU - Wieser, Heike AU - Wiedermann, Josef Christian PY - 2024/4/30 TI - Community-Dwelling Older Adults? Readiness for Adopting Digital Health Technologies: Cross-Sectional Survey Study JO - JMIR Form Res SP - e54120 VL - 8 KW - frail older adults KW - Italy KW - Italian KW - Europe KW - European KW - digital health KW - health technologies KW - health technology KW - telemedicine KW - telehealth KW - eHealth KW - e-health KW - adoption KW - readiness KW - usage KW - survey KW - surveys KW - questionnaire KW - questionnaires KW - robotics KW - cross-sectional study KW - population-based survey KW - stratified probabilistic sampling KW - gerontology KW - geriatric KW - geriatrics KW - older adult KW - older adults KW - elder KW - elderly KW - older person KW - older people KW - ageing KW - aging N2 - Background: Digital health technologies offer the potential to improve the daily lives of older adults, maintain their health efficiently, and allow aging in place. Despite increasing evidence of benefits and advantages, readiness for adopting digital interventions among older people remains underexplored. Objective: This study aims to explore the relationships between sociodemographic-, health-, and lifestyle-related factors and technology use in everyday life and community-dwelling older adults? readiness to adopt telemedicine, smartphones with texting apps, wearables, and robotics. Methods: This was a cross-sectional, population-based survey study with a stratified probabilistic sample of adults aged 75 years or older living in South Tyrol (autonomous province of Bolzano/Bozen, Italy). A random sample of 3600 community-dwelling older adults living at home was invited to complete a questionnaire including single items (older adults? readiness to use health technology) and scales (PRISMA-7; Program of Research on Integration of Services for the Maintenance of Autonomy). Descriptive and logistic regression analyses were performed to analyze the data. Results: In total, 1695 community-dwelling older adults completed the survey (for a response rate of 47%). In terms of potential digital health technology adoption, wearable devices were favored by 33.7% (n=571), telemedicine by 30.1% (n=510), smartphones and texting apps by 24.5% (n=416), and assistant robots by 13.7% (n=232). Sociodemographic-, health- and lifestyle-related factors, as well as the use of technology in everyday life, played a significant role in explaining readiness to adopt digital health technologies. For telemedicine, age ?85 years (odds ratio [OR] 0.74, 95% CI 0.56-0.96), financial constraints (OR 0.68, 95% CI 0.49-0.95), and less than 2 hours of physical activity per week (OR 0.75, 95% CI 0.58-0.98) were associated with nonreadiness, while Italian-speaking participants (OR 1.54, 95% CI 1.16-2.05) and those regularly using computers (OR 1.74, 95% CI 1.16-2.60), smartphones (OR 1.69, 95% CI 1.22-2.35), and the internet (OR 2.26, 95% CI 1.47-3.49) reported readiness for adoption. Conclusions: Community-dwelling older adults display varied readiness toward the adoption of digital health technologies, influenced by age, mother tongue, living situation, financial resources, physical activity, and current use of technology. The findings underscore the need for tailored interventions and educational programs to boost digital health technology adoption among community-dwelling older adults. UR - https://formative.jmir.org/2024/1/e54120 UR - http://dx.doi.org/10.2196/54120 UR - http://www.ncbi.nlm.nih.gov/pubmed/38687989 ID - info:doi/10.2196/54120 ER - TY - JOUR AU - Kim, Jiyeong AU - Cai, Ran Zhuo AU - Chen, L. Michael AU - Onyeka, Sonia AU - Ko, M. Justin AU - Linos, Eleni PY - 2024/4/26 TI - Telehealth Utilization and Associations in the United States During the Third Year of the COVID-19 Pandemic: Population-Based Survey Study in 2022 JO - JMIR Public Health Surveill SP - e51279 VL - 10 KW - telehealth KW - telemedicine KW - digital health KW - e-health KW - e-medicine KW - utilization KW - population-based study KW - clinical practice KW - healthcare delivery KW - sociodemographic factor KW - COVID-19 KW - pandemic N2 - Background: The COVID-19 pandemic rapidly changed the landscape of clinical practice in the United States; telehealth became an essential mode of health care delivery, yet many components of telehealth use remain unknown years after the disease?s emergence. Objective: We aim to comprehensively assess telehealth use and its associated factors in the United States. Methods: This cross-sectional study used a nationally representative survey (Health Information National Trends Survey) administered to US adults (?18 years) from March 2022 through November 2022. To assess telehealth adoption, perceptions of telehealth, satisfaction with telehealth, and the telehealth care purpose, we conducted weighted descriptive analyses. To identify the subpopulations with low adoption of telehealth, we developed a weighted multivariable logistic regression model. Results: Among a total of 6252 survey participants, 39.3% (2517/6252) reported telehealth use in the past 12 months (video: 1110/6252, 17.8%; audio: 876/6252, 11.6%). The most prominent reason for not using telehealth was due to telehealth providers failing to offer this option (2200/3529, 63%). The most common reason for respondents not using offered telehealth services was a preference for in-person care (527/578, 84.4%). Primary motivations to use telehealth were providers? recommendations (1716/2517, 72.7%) and convenience (1516/2517, 65.6%), mainly for acute minor illness (600/2397, 29.7%) and chronic condition management (583/2397, 21.4%), yet care purposes differed by age, race/ethnicity, and income. The satisfaction rate was predominately high, with no technical problems (1829/2517, 80.5%), comparable care quality to that of in-person care (1779/2517, 75%), and no privacy concerns (1958/2517, 83.7%). Younger individuals (odd ratios [ORs] 1.48-2.23; 18-64 years vs ?75 years), women (OR 1.33, 95% CI 1.09-1.61), Hispanic individuals (OR 1.37, 95% CI 1.05-1.80; vs non-Hispanic White), those with more education (OR 1.72, 95% CI 1.03-2.87; at least a college graduate vs less than high school), unemployed individuals (OR 1.25, 95% CI 1.02-1.54), insured individuals (OR 1.83, 95% CI 1.25-2.69), or those with poor general health status (OR 1.66, 95% CI 1.30-2.13) had higher odds of using telehealth. Conclusions: To our best knowledge, this is among the first studies to examine patient factors around telehealth use, including motivations to use, perceptions of, satisfaction with, and care purpose of telehealth, as well as sociodemographic factors associated with telehealth adoption using a nationally representative survey. The wide array of descriptive findings and identified associations will help providers and health systems understand the factors that drive patients toward or away from telehealth visits as the technology becomes more routinely available across the United States, providing future directions for telehealth use and telehealth research. UR - https://publichealth.jmir.org/2024/1/e51279 UR - http://dx.doi.org/10.2196/51279 UR - http://www.ncbi.nlm.nih.gov/pubmed/38669075 ID - info:doi/10.2196/51279 ER - TY - JOUR AU - Hu, Lu AU - Wyatt, C. Laura AU - Mohsin, Farhan AU - Lim, Sahnah AU - Zanowiak, Jennifer AU - Mammen, Shinu AU - Hussain, Sarah AU - Ali, H. Shahmir AU - Onakomaiya, Deborah AU - Belli, M. Hayley AU - Aifah, Angela AU - Islam, S. Nadia PY - 2024/4/26 TI - Characterizing Technology Use and Preferences for Health Communication in South Asian Immigrants With Prediabetes or Diabetes: Cross-Sectional Descriptive Study JO - JMIR Form Res SP - e52687 VL - 8 KW - South Asian immigrants KW - type 2 diabetes KW - technology access KW - technology use KW - prediabetes KW - health disparities KW - mHealth KW - health equity KW - immigrant health KW - mobile health KW - smartphone KW - diabetes KW - diabetic KW - DM KW - diabetes mellitus KW - immigrants KW - prevention KW - regression KW - regression model KW - logistic regression KW - mobile health interventions N2 - Background: Type 2 diabetes disproportionately affects South Asian subgroups. Lifestyle prevention programs help prevent and manage diabetes; however, there is a need to tailor these programs for mobile health (mHealth). Objective: This study examined technology access, current use, and preferences for health communication among South Asian immigrants diagnosed with or at risk for diabetes, overall and by sex. We examined factors associated with interest in receiving diabetes information by (1) text message, (2) online (videos, voice notes, online forums), and (3) none or skipped, adjusting for sociodemographic characteristics and technology access. Methods: We used baseline data collected in 2019-2021 from two clinical trials among South Asian immigrants in New York City (NYC), with one trial focused on diabetes prevention and the other focused on diabetes management. Descriptive statistics were used to examine overall and sex-stratified impacts of sociodemographics on technology use. Overall logistic regression was used to examine the preference for diabetes information by text message, online (videos, voice notes, or forums), and no interest/skipped response. Results: The overall sample (N=816) had a mean age of 51.8 years (SD 11.0), and was mostly female (462/816, 56.6%), married (756/816, 92.6%), with below high school education (476/816, 58.3%) and limited English proficiency (731/816, 89.6%). Most participants had a smartphone (611/816, 74.9%) and reported interest in receiving diabetes information via text message (609/816, 74.6%). Compared to male participants, female participants were significantly less likely to own smartphones (317/462, 68.6% vs 294/354, 83.1%) or use social media apps (Viber: 102/462, 22.1% vs 111/354, 31.4%; WhatsApp: 279/462, 60.4% vs 255/354, 72.0%; Facebook: Messenger 72/462, 15.6% vs 150/354, 42.4%). A preference for receiving diabetes information via text messaging was associated with male sex (adjusted odds ratio [AOR] 1.63, 95% CI 1.01-2.55; P=.04), current unemployment (AOR 1.62, 95% CI 1.03-2.53; P=.04), above high school education (AOR 2.17, 95% CI 1.41-3.32; P<.001), and owning a smart device (AOR 3.35, 95% CI 2.17-5.18; P<.001). A preference for videos, voice notes, or online forums was associated with male sex (AOR 2.38, 95% CI 1.59-3.57; P<.001) and ownership of a smart device (AOR 5.19, 95% CI 2.83-9.51; P<.001). No interest/skipping the question was associated with female sex (AOR 2.66, 95% CI 1.55-4.56; P<.001), high school education or below (AOR 2.02, 95% CI 1.22-3.36; P=.01), not being married (AOR 2.26, 95% CI 1.13-4.52; P=.02), current employment (AOR 1.96, 95% CI 1.18-3.29; P=.01), and not owning a smart device (AOR 2.06, 95% CI 2.06-5.44; P<.001). Conclusions: Technology access and social media usage were moderately high in primarily low-income South Asian immigrants in NYC with prediabetes or diabetes. Sex, education, marital status, and employment were associated with interest in mHealth interventions. Additional support to South Asian women may be required when designing and developing mHealth interventions. Trial Registration: ClinicalTrials.gov NCT03333044; https://classic.clinicaltrials.gov/ct2/show/NCT03333044, ClinicalTrials.gov NCT03188094; https://classic.clinicaltrials.gov/ct2/show/NCT03188094 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3711-y UR - https://formative.jmir.org/2024/1/e52687 UR - http://dx.doi.org/10.2196/52687 UR - http://www.ncbi.nlm.nih.gov/pubmed/38669062 ID - info:doi/10.2196/52687 ER - TY - JOUR AU - Haimi, Motti AU - Sergienko, Ruslan PY - 2024/4/24 TI - Adoption and Use of Telemedicine and Digital Health Services Among Older Adults in Light of the COVID-19 Pandemic: Repeated Cross-Sectional Analysis JO - JMIR Aging SP - e52317 VL - 7 KW - telemedicine KW - digital health KW - older adults KW - COVID-19 KW - use KW - digital divide KW - usability KW - pandemic KW - telehealth KW - Israel KW - working-hours telehealth visits KW - after-hours consultation KW - teleconsultation KW - eHealth KW - mobile health KW - mHealth KW - wearables KW - mobile phone N2 - Background: As the population ages and the prevalence of long-term diseases rises, the use of telecare is becoming increasingly frequent to aid older people. Objective: This study aims to explore the use and adoption of 3 types of telehealth services among the older population in Israel before, during, and after the COVID-19 pandemic. Methods: We explored the use characteristics of older adults (aged ?65 years) belonging to Clalit Health Services in several aspects in the use of 3 types of telehealth services: the use of digital services for administrative tasks; the use of synchronous working-hours telehealth visits with the patient?s personal physician during clinic business hours; and the use of after-hours consultations during evenings, nights, and weekends when the clinics are closed. The data were collected and analyzed throughout 3 distinct periods in Israel: before the COVID-19 pandemic, during the onset of the COVID-19 pandemic, and following the COVID-19 peak. Results: Data of 618,850 patients who met the inclusion criteria were extracted. Telehealth services used for administrative purposes were the most popular. The most intriguing finding was that the older population significantly increased their use of all types of telehealth services during the COVID-19 pandemic, and in most types, this use decreased after the COVID-19 peak, but to a level that was higher than the baseline level before the COVID-19 pandemic. Before the COVID-19 pandemic, 23.1% (142,936/618,850) of the study population used working-hours telehealth visits, and 2.2% (13,837/618,850) used after-hours consultations at least once. The percentage of use for these services increased during the COVID-19 pandemic to 59.2% (366,566/618,850) and 5% (30,777/618,850) and then decreased during the third period to 39.5% (244,572/618,850) and 2.4% (14,584/618,850), respectively (P<.001). Multiple patient variables have been found to be associated with the use of the different telehealth services in each period. Conclusions: Despite the limitations and obstacles, the older population uses telehealth services and can increase their use when they are needed. These people can learn how to use digital health services effectively, and they should be given the opportunity to do so by creating suitable and straightforward telehealth solutions tailored to this population and enhancing their usability. UR - https://aging.jmir.org/2024/1/e52317 UR - http://dx.doi.org/10.2196/52317 UR - http://www.ncbi.nlm.nih.gov/pubmed/38656768 ID - info:doi/10.2196/52317 ER - TY - JOUR AU - Smith, M. Sharissa AU - Bais, Babette AU - Ismaili M'hamdi, Hafez AU - Schermer, HN Maartje AU - Steegers-Theunissen, PM Régine PY - 2024/4/22 TI - Stimulating Preconception Care Uptake by Women With a Vulnerable Health Status Through a Mobile Health App (Pregnant Faster): Pilot Feasibility Study JO - JMIR Hum Factors SP - e53614 VL - 11 KW - preconception care KW - mHealth KW - mobile health KW - pregnancy preparation KW - nudge KW - health inequality KW - socioeconomic status KW - lifestyle KW - women KW - pregnancy KW - pregnant women KW - pregnant KW - socioeconomic KW - pilot feasibility study KW - mHealth app KW - mHealth application KW - app KW - application KW - risk factor KW - nutrition KW - stress KW - chronic stress KW - health literacy KW - usability KW - user satisfaction KW - user KW - users N2 - Background: A low socioeconomic status is associated with a vulnerable health status (VHS) through the accumulation of health-related risk factors, such as poor lifestyle behaviors (eg, inadequate nutrition, chronic stress, and impaired health literacy). For pregnant women, a VHS translates into a high incidence of adverse pregnancy outcomes and therefore pregnancy-related inequity. We hypothesize that stimulating adequate pregnancy preparation, targeting lifestyle behaviors and preconception care (PCC) uptake, can reduce these inequities and improve the pregnancy outcomes of women with a VHS. A nudge is a behavioral intervention aimed at making healthy choices easier and more attractive and may therefore be a feasible way to stimulate engagement in pregnancy preparation and PCC uptake, especially in women with a VHS. To support adequate pregnancy preparation, we designed a mobile health (mHealth) app, Pregnant Faster, that fits the preferences of women with a VHS and uses nudging to encourage PCC consultation visits and engagement in education on healthy lifestyle behaviors. Objective: This study aimed to test the feasibility of Pregnant Faster by determining usability and user satisfaction, the number of visited PCC consultations, and the course of practical study conduction. Methods: Women aged 18-45 years, with low-to-intermediate educational attainment, who were trying to become pregnant within 12 months were included in this open cohort. Recruitment took place through social media, health care professionals, and distribution of flyers and posters from September 2021 until June 2022. Participants used Pregnant Faster daily for 4 weeks, earning coins by reading blogs on pregnancy preparation, filling out a daily questionnaire on healthy lifestyle choices, and registering for a PCC consultation with a midwife. Earned coins could be spent on rewards, such as fruit, mascara, and baby products. Evaluation took place through the mHealth App Usability Questionnaire (MAUQ), an additional interview or questionnaire, and assessment of overall study conduction. Results: Due to limited inclusions, the inclusion criterion ?living in a deprived neighborhood? was dropped. This resulted in the inclusion of 47 women, of whom 39 (83%) completed the intervention. In total, 16 (41%) of 39 participants visited a PCC consultation, with their main motivation being obtaining personalized information. The majority of participants agreed with 16 (88.9%) of 18 statements of the MAUQ, indicating high user satisfaction. The mean rating was 7.7 (SD 1.0) out of 10. Points of improvement included recruitment of the target group, simplification of the log-in system, and automation of manual tasks. Conclusions: Nudging women through Pregnant Faster to stimulate pregnancy preparation and PCC uptake has proven feasible, but the inclusion criteria must be revised. A substantial number of PCC consultations were conducted, and this study will therefore be continued with an open cohort of 400 women, aiming to establish the (cost-)effectiveness of an updated version, named Pregnant Faster 2. International Registered Report Identifier (IRRID): RR2-10.2196/45293 UR - https://humanfactors.jmir.org/2024/1/e53614 UR - http://dx.doi.org/10.2196/53614 UR - http://www.ncbi.nlm.nih.gov/pubmed/38648092 ID - info:doi/10.2196/53614 ER - TY - JOUR AU - Opper, A. Claudia AU - Browne, A. Felicia AU - Howard, N. Brittni AU - Zule, A. William AU - Wechsberg, M. Wendee PY - 2024/4/16 TI - Assessing Differences in mHealth Usability and App Experiences Among Young African American Women: Secondary Analysis of a Randomized Controlled Trial JO - JMIR Hum Factors SP - e51518 VL - 11 KW - HIV KW - Black women KW - mobile apps KW - social determinants of health KW - prevention KW - substance use KW - usability N2 - Background: In North Carolina, HIV continues to disproportionately affect young African American women. Although mobile health (mHealth) technology appears to be a tool capable of making public health information more accessible for key populations, previous technology use and social determinants may impact users? mHealth experiences. Objective: The objective of this study was to evaluate mHealth usability, assessing differences based on previous technology use and social determinants among a sample of African American women in emerging adulthood. Methods: As part of a National Institute on Drug Abuse?funded randomized controlled trial with African American women (aged 18-25 years), counties were assigned to receive an evidence-based HIV risk reduction intervention through mHealth and participants were asked to complete usability surveys at 6- and 12-month follow-ups. Participants? first survey responses were analyzed through 2-tailed t tests and linear regression models to examine associations with previous technology use and social determinants (P<.05). Results: The mean System Usability Scale (SUS) score was 69.2 (SD 17.9; n=159), which was higher than the threshold of acceptability (68.0). Participants who had previously used a tablet indicated higher usability compared to participants without previous use (mean 72.9, SD 18.1 vs mean 57.6, SD 11.4; P<.001), and participants with previous smartphone use also reported higher usability compared to participants without previous use (mean 71.9, SD 18.3 vs mean 58.0, SD 10.7; P<.001). Differences in SUS scores were observed among those reporting homelessness (mean 58.3, SD 19.0 vs mean 70.8, SD 17.2; P=.01), unemployment (mean 65.9, SD 17.2 vs mean 71.6, SD 18.1; P=.04), or current school enrollment (mean 73.2, SD 18.5 vs mean 65.4, SD 16.5; P=.006). Statistically significant associations were not observed for food insecurity (mean 67.3, SD 18.6 vs mean 69.9, SD 17.7; P=.45). Conclusions: Although above-average usability was observed overall, these findings demonstrate differences in mHealth usability based on past and current life experiences. As mHealth interventions become more prevalent, these findings may have important implications for ensuring that mHealth apps improve the reach of evidence-based interventions. Trial Registration: ClinicalTrials.gov NCT02965014; https://clinicaltrials.gov/study/NCT02965014 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5796-8 UR - https://humanfactors.jmir.org/2024/1/e51518 UR - http://dx.doi.org/10.2196/51518 UR - http://www.ncbi.nlm.nih.gov/pubmed/38625721 ID - info:doi/10.2196/51518 ER - TY - JOUR AU - Tuot, S. Delphine AU - Mukherjee, Aarya AU - Churape, Amanda AU - DeFries, Triveni AU - Su, George AU - Khoong, C. Elaine AU - Lyles, Courtney PY - 2024/4/15 TI - Lessons From the Field From a Volunteer Telehealth Ambassador Program to Enhance Video Visits Among Low-Income Patients: Qualitative Improvement Study JO - JMIR Form Res SP - e49993 VL - 8 KW - digital barriers KW - digital support KW - digital technologies KW - equity KW - health care delivery KW - safety-net KW - telehealth N2 - Background: The prevalence of telehealth video use across the United States is uneven, with low uptake in safety-net health care delivery systems, which care for patient populations who face barriers to using digital technologies. Objective: This study aimed to increase video visit use in an urban safety-net delivery system. We piloted a telehealth ambassador program, in which volunteers offered technical support to patients with access to digital technologies to convert primary care visits already scheduled as telehealth audio-only visits to telehealth video visits. Methods: We used a descriptive approach to assess the feasibility, efficacy, and acceptability of the pilot telehealth ambassador program. Feasibility was quantified by the percentage of eligible patients who answered calls from telehealth ambassadors. Program efficacy was measured in two ways: (1) the percentage of patients with access to digital technology who interacted with the navigators and were successfully prepared for a telehealth video visit, and (2) the percentage of prepared patients who completed their scheduled video visits. Program acceptability was ascertained by a structured telephone survey. Results: Telehealth ambassadors attempted to contact 776 eligible patients; 43.6% (338/776) were reached by phone, among whom 44.4% (150/338) were provided digital support between March and May 2021. The mean call duration was 8.8 (range 0-35) minutes. Overall, 67.3% (101/150) of patients who received support successfully completed a telehealth video visit with their provider. Among the 188 patients who were contacted but declined video visit digital support, 61% (114/188) provided a reason for their decline; 42% (48/114) did not see added value beyond a telehealth audio-only visit, 20% (23/114) had insufficient internet access, and 27% (31/114) declined learning about a new technology. The acceptability of the telehealth ambassador program was generally favorable, although some patients preferred having in-real-time technology support on the day of their telehealth video visit. Conclusions: This high-touch program reached approximately one-half of eligible patients and helped two-thirds of interested patients with basic video visit capability successfully complete a video visit. Increasing the program?s reach will require outreach solutions that do not rely solely on phone calls. Routinely highlighting the benefits of video visits, partnering with community-based organizations to overcome structural barriers to telehealth use, and offering in-real-time technology support will help increase the program?s efficacy. UR - https://formative.jmir.org/2024/1/e49993 UR - http://dx.doi.org/10.2196/49993 UR - http://www.ncbi.nlm.nih.gov/pubmed/38619874 ID - info:doi/10.2196/49993 ER - TY - JOUR AU - Choy, Ada Melinda AU - O'Brien, Kathleen AU - Barnes, Katelyn AU - Sturgiss, Ann Elizabeth AU - Rieger, Elizabeth AU - Douglas, Kirsty PY - 2024/4/11 TI - Evaluating the Digital Health Experience for Patients in Primary Care: Mixed Methods Study JO - J Med Internet Res SP - e50410 VL - 26 KW - digital health KW - eHealth KW - primary care KW - general practice KW - digital divide KW - health inequities KW - health inequality KW - disparities KW - digital cost KW - financial cost KW - health technology KW - mixed methods KW - barriers KW - barrier N2 - Background: The digital health divide for socioeconomic disadvantage describes a pattern in which patients considered socioeconomically disadvantaged, who are already marginalized through reduced access to face-to-face health care, are additionally hindered through less access to patient-initiated digital health. A comprehensive understanding of how patients with socioeconomic disadvantage access and experience digital health is essential for improving the digital health divide. Primary care patients, especially those with chronic disease, have experience of the stages of initial help seeking and self-management of their health, which renders them a key demographic for research on patient-initiated digital health access. Objective: This study aims to provide comprehensive primary mixed methods data on the patient experience of barriers to digital health access, with a focus on the digital health divide. Methods: We applied an exploratory mixed methods design to ensure that our survey was primarily shaped by the experiences of our interviewees. First, we qualitatively explored the experience of digital health for 19 patients with socioeconomic disadvantage and chronic disease and second, we quantitatively measured some of these findings by designing and administering a survey to 487 Australian general practice patients from 24 general practices. Results: In our qualitative first phase, the key barriers found to accessing digital health included (1) strong patient preference for human-based health services; (2) low trust in digital health services; (3) high financial costs of necessary tools, maintenance, and repairs; (4) poor publicly available internet access options; (5) reduced capacity to engage due to increased life pressures; and (6) low self-efficacy and confidence in using digital health. In our quantitative second phase, 31% (151/487) of the survey participants were found to have never used a form of digital health, while 10.7% (52/487) were low- to medium-frequency users and 48.5% (236/487) were high-frequency users. High-frequency users were more likely to be interested in digital health and had higher self-efficacy. Low-frequency users were more likely to report difficulty affording the financial costs needed for digital access. Conclusions: While general digital interest, financial cost, and digital health literacy and empowerment are clear factors in digital health access in a broad primary care population, the digital health divide is also facilitated in part by a stepped series of complex and cumulative barriers. Genuinely improving digital health access for 1 cohort or even 1 person requires a series of multiple different interventions tailored to specific sequential barriers. Within primary care, patient-centered care that continues to recognize the complex individual needs of, and barriers facing, each patient should be part of addressing the digital health divide. UR - https://www.jmir.org/2024/1/e50410 UR - http://dx.doi.org/10.2196/50410 UR - http://www.ncbi.nlm.nih.gov/pubmed/38602768 ID - info:doi/10.2196/50410 ER - TY - JOUR AU - Lorenzo-Luaces, Lorenzo AU - Wasil, Akash AU - Kacmarek, N. Corinne AU - DeRubeis, Robert PY - 2024/4/11 TI - Race and Socioeconomic Status as Predictors of Willingness to Use Digital Mental Health Interventions or One-On-One Psychotherapy: National Survey Study JO - JMIR Form Res SP - e49780 VL - 8 KW - digital mental health KW - ethnicity KW - health disparities KW - internet-based CBT KW - cognitive behavioral therapy KW - intervention KW - mental health KW - mental health care KW - race KW - therapy N2 - Background: There is an ongoing debate about whether digital mental health interventions (DMHIs) can reduce racial and socioeconomic inequities in access to mental health care. A key factor in this debate involves the extent to which racial and ethnic minoritized individuals and socioeconomically disadvantaged individuals are willing to use, and pay for, DMHIs. Objective: This study examined racial and ethnic as well as socioeconomic differences in participants? willingness to pay for DMHIs versus one-on-one therapy (1:1 therapy). Methods: We conducted a national survey of people in the United States (N=423; women: n=204; mean age 45.15, SD 16.19 years; non-Hispanic White: n=293) through Prolific. After reading descriptions of DMHIs and 1:1 therapy, participants rated their willingness to use each treatment (1) for free, (2) for a small fee, (3) as a maximum dollar amount, and (4) as a percentage of their total monthly income. At the end of the study, there was a decision task to potentially receive more information about DMHIs and 1:1 therapy. Results: Race and ethnicity was associated with willingness to pay more of one?s income, as a percent or in dollar amounts, and was also associated with information-seeking for DMHIs in the behavioral task. For most outcomes, race and ethnicity was not associated with willingness to try 1:1 therapy. Greater educational attainment was associated to willingness to try DMHIs for free, the decision to learn more about DMHIs, and willingness to pay for 1:1 therapy. Income was inconsistently associated to willingness to try DMHIs or 1:1 therapy. Conclusions: If they are available for free or at very low costs, DMHIs may reduce inequities by expanding access to mental health care for racial and ethnic minoritized individuals and economically disadvantaged groups. UR - https://formative.jmir.org/2024/1/e49780 UR - http://dx.doi.org/10.2196/49780 UR - http://www.ncbi.nlm.nih.gov/pubmed/38602769 ID - info:doi/10.2196/49780 ER - TY - JOUR AU - Shaw, James AU - Glover, Wiljeana PY - 2024/3/26 TI - The Political Economy of Digital Health Equity: Structural Analysis JO - J Med Internet Res SP - e46971 VL - 26 KW - digital health equity KW - health equity KW - health policy KW - telemedicine KW - digital care KW - political economy KW - race KW - ethnicity KW - socioeconomic KW - policy UR - https://www.jmir.org/2024/1/e46971 UR - http://dx.doi.org/10.2196/46971 UR - http://www.ncbi.nlm.nih.gov/pubmed/38530341 ID - info:doi/10.2196/46971 ER - TY - JOUR AU - Hatef, Elham AU - Chang, Hsien-Yen AU - Richards, M. Thomas AU - Kitchen, Christopher AU - Budaraju, Janya AU - Foroughmand, Iman AU - Lasser, C. Elyse AU - Weiner, P. Jonathan PY - 2024/3/12 TI - Development of a Social Risk Score in the Electronic Health Record to Identify Social Needs Among Underserved Populations: Retrospective Study JO - JMIR Form Res SP - e54732 VL - 8 KW - AI KW - algorithms KW - artificial intelligence KW - community health KW - deep learning KW - EHR KW - electronic health record KW - machine learning KW - ML KW - population demographics KW - population health KW - practical models KW - predictive analytics KW - predictive modeling KW - predictive modelling KW - predictive models KW - predictive system KW - public health KW - public surveillance KW - SDOH KW - social determinants of health KW - social needs KW - social risks N2 - Background: Patients with unmet social needs and social determinants of health (SDOH) challenges continue to face a disproportionate risk of increased prevalence of disease, health care use, higher health care costs, and worse outcomes. Some existing predictive models have used the available data on social needs and SDOH challenges to predict health-related social needs or the need for various social service referrals. Despite these one-off efforts, the work to date suggests that many technical and organizational challenges must be surmounted before SDOH-integrated solutions can be implemented on an ongoing, wide-scale basis within most US-based health care organizations. Objective: We aimed to retrieve available information in the electronic health record (EHR) relevant to the identification of persons with social needs and to develop a social risk score for use within clinical practice to better identify patients at risk of having future social needs. Methods: We conducted a retrospective study using EHR data (2016-2021) and data from the US Census American Community Survey. We developed a prospective model using current year-1 risk factors to predict future year-2 outcomes within four 2-year cohorts. Predictors of interest included demographics, previous health care use, comorbidity, previously identified social needs, and neighborhood characteristics as reflected by the area deprivation index. The outcome variable was a binary indicator reflecting the likelihood of the presence of a patient with social needs. We applied a generalized estimating equation approach, adjusting for patient-level risk factors, the possible effect of geographically clustered data, and the effect of multiple visits for each patient. Results: The study population of 1,852,228 patients included middle-aged (mean age range 53.76-55.95 years), White (range 324,279/510,770, 63.49% to 290,688/488,666, 64.79%), and female (range 314,741/510,770, 61.62% to 278,488/448,666, 62.07%) patients from neighborhoods with high socioeconomic status (mean area deprivation index percentile range 28.76-30.31). Between 8.28% (37,137/448,666) and 11.55% (52,037/450,426) of patients across the study cohorts had at least 1 social need documented in their EHR, with safety issues and economic challenges (ie, financial resource strain, employment, and food insecurity) being the most common documented social needs (87,152/1,852,228, 4.71% and 58,242/1,852,228, 3.14% of overall patients, respectively). The model had an area under the curve of 0.702 (95% CI 0.699-0.705) in predicting prospective social needs in the overall study population. Previous social needs (odds ratio 3.285, 95% CI 3.237-3.335) and emergency department visits (odds ratio 1.659, 95% CI 1.634-1.684) were the strongest predictors of future social needs. Conclusions: Our model provides an opportunity to make use of available EHR data to help identify patients with high social needs. Our proposed social risk score could help identify the subset of patients who would most benefit from further social needs screening and data collection to avoid potentially more burdensome primary data collection on all patients in a target population of interest. UR - https://formative.jmir.org/2024/1/e54732 UR - http://dx.doi.org/10.2196/54732 UR - http://www.ncbi.nlm.nih.gov/pubmed/38470477 ID - info:doi/10.2196/54732 ER - TY - JOUR AU - Sharma, Yashoda AU - Saha, Anindita AU - Goldsack, C. Jennifer PY - 2024/2/9 TI - Defining the Dimensions of Diversity to Promote Inclusion in the Digital Era of Health Care: A Lexicon JO - JMIR Public Health Surveill SP - e51980 VL - 10 KW - digital medicine KW - inclusion KW - digital health technology/product KW - digital health KW - digital technology KW - health care system KW - innovation KW - equity KW - quality KW - disparity KW - digital era KW - digital access KW - digital literacy UR - https://publichealth.jmir.org/2024/1/e51980 UR - http://dx.doi.org/10.2196/51980 UR - http://www.ncbi.nlm.nih.gov/pubmed/38335013 ID - info:doi/10.2196/51980 ER - TY - JOUR AU - De Jesús-Romero, Robinson AU - Holder-Dixon, R. Amani AU - Buss, F. John AU - Lorenzo-Luaces, Lorenzo PY - 2024/2/1 TI - Race, Ethnicity, and Other Cultural Background Factors in Trials of Internet-Based Cognitive Behavioral Therapy for Depression: Systematic Review JO - J Med Internet Res SP - e50780 VL - 26 KW - diversity KW - cognitive behavioral therapy KW - internet-based KW - depression KW - race KW - racial KW - ethnicity KW - culture KW - depressive KW - diverse KW - inclusive KW - inclusivity KW - DEI KW - diversity, equity, and inclusion KW - internet-based cognitive behavioral therapy KW - mental health KW - ethnic KW - cultures KW - culturally KW - review methods KW - review methodology KW - systematic KW - clinical trial KW - clinical trials KW - randomized controlled trial KW - randomized controlled trials KW - controlled trial KW - controlled trials KW - reporting KW - immigrant KW - migrant KW - migrants KW - immigrants KW - psychotherapy KW - underrepresented KW - underrepresentation KW - representation KW - mobile phone N2 - Background: There is a growing interest in developing scalable interventions, including internet-based cognitive behavioral therapy (iCBT), to meet the increasing demand for mental health services. Given the growth in diversity worldwide, it is essential that the clinical trials of iCBT for depression include diverse samples or, at least, report information on the race, ethnicity, or other background indicators of their samples. Unfortunately, the field lacks data on how well diversity is currently reported and represented in the iCBT literature. Objective: Thus, the main objective of this systematic review was to examine the overall reporting of racial and ethnic identities in published clinical trials of iCBT for depression. We also aimed to review the representation of specific racial and ethnic minoritized groups and the inclusion of alternative background indicators such as migration status or country of residence. Methods: Studies were included if they were randomized controlled trials in which iCBT was compared to a waiting list, care-as-usual, active control, or another iCBT. The included papers also had to have a focus on acute treatment (eg, 4 weeks to 6 months) of depression, be delivered via the internet on a website or a smartphone app and use guided or unguided self-help. Studies were initially identified from the METAPSY database (n=59) and then extended to include papers up to 2022, with papers retrieved from Embase, PubMed, PsycINFO, and Cochrane (n=3). Risk of bias assessment suggested that reported studies had at least some risk of bias due to use of self-report outcome measures. Results: A total of 62 iCBT randomized controlled trials representing 17,210 participants are summarized in this study. Out of those 62 papers, only 17 (27%) of the trials reported race, and only 12 (19%) reported ethnicity. Reporting outside of the United States was very poor, with the United States accounting for 15 (88%) out of 17 of studies that reported race and 9 (75%) out of 12 for ethnicity. Out of 3,623 participants whose race was reported in the systematic review, the racial category reported the most was White (n=2716, 74.9%), followed by Asian (n=209, 5.8%) and Black (n=274, 7.6%). Furthermore, only 25 (54%) out of the 46 papers conducted outside of the United States reported other background demographics. Conclusions: It is important to note that the underreporting observed in this study does not necessarily indicate an underrepresentation in the actual study population. However, these findings highlight the poor reporting of race and ethnicity in iCBT trials for depression found in the literature. This lack of diversity reporting may have significant implications for the scalability of these interventions. UR - https://www.jmir.org/2024/1/e50780 UR - http://dx.doi.org/10.2196/50780 UR - http://www.ncbi.nlm.nih.gov/pubmed/38300699 ID - info:doi/10.2196/50780 ER - TY - JOUR AU - Nguyen-Truong, Yen Connie Kim AU - Wuestney, Katherine AU - Leung, Holden AU - Chiu, Chenya AU - Park, Maria AU - Chac, Christina AU - Fritz, Lynette Roschelle PY - 2024/1/26 TI - Toward Sustaining Web-Based Senior Center Programming Accessibility With and for Older Adult Immigrants: Community-Based Participatory Research Cross-Sectional Study JO - Asian Pac Isl Nurs J SP - e49493 VL - 8 KW - Asian American KW - Chinese KW - Korean KW - Vietnamese KW - community-based participatory research KW - CBPR KW - COVID-19 KW - health equity KW - immigrants KW - older adults KW - psychosocial KW - technology access KW - telehealth use KW - web-based senior center KW - mobile phone N2 - Background: During the COVID-19 pandemic, many community-based organizations serving Asian Americans pivoted to provide web-based care and social services. Asian American community leaders in the United States Pacific Northwest, including Asian Health & Service Center expressed that there are older immigrant adults who experienced backlash from discrimination, fear, and anxiety owing in part to anti-Asian hate and isolation, including from infection precautions. Pivoting supported staying safe from COVID-19 transmission and anti-Asian hate crimes. Objective: This study aims to examine the readiness of diverse groups of older Asian American immigrant adults (Chinese, Koreans, and Vietnamese) to use a web-based senior center, including technology access and telehealth use, and to identify the psychosocial health impacts that a web-based senior center could be positioned to meet. Methods: A community-based participatory research approach was used to conduct a cross-sectional survey study in an Asian-based health and service center in 2022. We selected surveys from the National Institutes of Health?supported PhenX Toolkit. Analyses were performed using R software. Results: There was an 88.2% (216/245) response rate. Overall, 39.8% (86/216) of participants were Chinese, 25% (54/216) were Korean, and 24.5% (53/216) were Vietnamese. There were significant group differences in mobile data plans (P=.0005). Most had an unlimited mobile data plan (38/86, 44% Chinese; 39/54, 72% Koreans; 25/53, 47% Vietnamese). Significant group differences existed regarding whether they started using a new electronic device to communicate with friends or family after the COVID-19 outbreak (P=.0005); most were Korean participants (31/54, 57%). For written text and audio or video apps, most Chinese participants used WeChat (65/85, 76%; 57/84, 68%, respectively), most Koreans used KakaoTalk (49/54, 91%; 49/54, 91%, respectively), and most Vietnamese used Facebook Messenger for written text (32/50, 64%) and Apple Face Time (33/50, 66%) or Facebook Messenger (31/50, 62%) for audio or video. Significant group differences existed regarding whether to try telehealth (P=.0005); most Vietnamese expressed that they would never consider it (41/53, 77%). Significant group differences existed regarding how well they were able to concentrate (?22=44.7; P<.0001); Chinese participants reported a greater inability (median 5, IQR 4-6). With regard to difficulties in life experiences (?22=51; P<.0001), the median was 6 (IQR 5-7) for the Vietnamese group. Significant group differences existed in having had a family/household member?s salary, hours, and contracts reduced (P=.0005) and having had a family/household member or friend fallen physically ill (P=.0005)?most Vietnamese (15/53, 28%) and Korean participants (10/53, 19%). Conclusions: To build an efficacious, web-based senior center with web-based care and social service options, more older adults need access to the internet and education about using technology-enabled communication devices. Addressing the unique psychosocial impacts of the COVID-19 pandemic on each group could improve health equity. The strength of the participating older adults was observed and honored. UR - https://apinj.jmir.org/2024/1/e49493 UR - http://dx.doi.org/10.2196/49493 UR - http://www.ncbi.nlm.nih.gov/pubmed/38277216 ID - info:doi/10.2196/49493 ER - TY - JOUR AU - Garg, Ashvita AU - Nyitray, G. Alan AU - Roberts, R. James AU - Shungu, Nicholas AU - Ruggiero, J. Kenneth AU - Chandler, Jessica AU - Damgacioglu, Haluk AU - Zhu, Yenan AU - Brownstein, C. Naomi AU - Sterba, R. Katherine AU - Deshmukh, A. Ashish AU - Sonawane, Kalyani PY - 2024/1/15 TI - Consumption of Health-Related Videos and Human Papillomavirus Awareness: Cross-Sectional Analyses of a US National Survey and YouTube From the Urban-Rural Context JO - J Med Internet Res SP - e49749 VL - 26 KW - awareness KW - health awareness KW - health information KW - health videos KW - HINTS KW - HPV vaccine KW - HPV KW - information behavior KW - information behaviors KW - information seeking KW - online information KW - reproductive health KW - rural KW - sexual health KW - sexually transmitted KW - social media KW - STD KW - STI KW - urban KW - video KW - videos KW - YouTube N2 - Background: Nearly 70% of Americans use the internet as their first source of information for health-related questions. Contemporary data on the consumption of web-based videos containing health information among American adults by urbanity or rurality is currently unavailable, and its link with health topic awareness, particularly for human papillomavirus (HPV), is not known. Objective: We aim to describe trends and patterns in the consumption of health-related videos on social media from an urban-rural context, examine the association between exposure to health-related videos on social media and awareness of health topics (ie, HPV and HPV vaccine), and understand public interest in HPV-related video content through search terms and engagement analytics. Methods: We conducted a cross-sectional analysis of the US Health Information National Trends Survey 6, a nationally representative survey that collects data from civilian, noninstitutionalized adults aged 18 years or older residing in the United States. Bivariable analyses were used to estimate the prevalence of consumption of health-related videos on social media among US adults overall and by urbanity or rurality. Multivariable logistic regression models were used to examine the association between the consumption of health-related videos and HPV awareness among urban and rural adults. To provide additional context on the public?s interest in HPV-specific video content, we examined search volumes (quantitative) and related query searches (qualitative) for the terms ?HPV? and ?HPV vaccine? on YouTube. Results: In 2022, 59.6% of US adults (152.3 million) consumed health-related videos on social media, an increase of nearly 100% from 2017 to 2022. Prevalence increased among adults living in both urban (from 31.4% in 2017 to 59.8% in 2022; P<.001) and rural (from 22.4% in 2017 to 58% in 2022; P<.001) regions. Within the urban and rural groups, consumption of health-related videos on social media was most prevalent among adults aged between 18 and 40 years and college graduates or higher-educated adults. Among both urban and rural groups, adults who consumed health-related videos had a significantly higher probability of being aware of HPV and the HPV vaccine compared with those who did not watch health videos on the internet. The term ?HPV? was more frequently searched on YouTube compared with ?HPV vaccine.? Individuals were most commonly searching for videos that covered content about the HPV vaccine, HPV in males, and side effects of the HPV vaccine. Conclusions: The consumption of health-related videos on social media in the United States increased dramatically between 2017 and 2022. The rise was prominent among both urban and rural adults. Watching a health-related video on social media was associated with a greater probability of being aware of HPV and the HPV vaccine. Additional research on designing and developing social media strategies is needed to increase public awareness of health topics. UR - https://www.jmir.org/2024/1/e49749 UR - http://dx.doi.org/10.2196/49749 UR - http://www.ncbi.nlm.nih.gov/pubmed/38224476 ID - info:doi/10.2196/49749 ER - TY - JOUR AU - Howell, Khadesia AU - Alvarado, Gabriela AU - Waymouth, Molly AU - Demirci, Jill AU - Rogers, Rhianna AU - Ray, Kristin AU - Uscher-Pines, Lori PY - 2023/12/29 TI - Acceptability of Telelactation Services for Breastfeeding Support Among Black Parents: Semistructured Interview Study JO - J Med Internet Res SP - e50191 VL - 25 KW - acceptance KW - barrier KW - black parent KW - black KW - breastfeeding KW - concordance KW - consultant KW - consultation KW - digital divide KW - digital equity KW - disparity KW - ethnic KW - health equity KW - lactation KW - mother KW - parent KW - racial KW - telehealth KW - telelactation KW - user N2 - Background: While breastfeeding rates have increased in the United States in recent years, racial and ethnic disparities persist. Telelactation may help reduce disparities by increasing access to lactation consultants, but there is limited research on acceptability among minoritized individuals. Objective: We aimed to explore experiences with telelactation among Black parents and identify strategies to make services more culturally appropriate. Methods: We selected 20 Black parents who were given access to telelactation services from an ongoing National Institutes of Health?funded randomized controlled trial (the Tele-MILC trial) to participate in semistructured interviews. Interviews addressed birth experiences, use and opinions about telelactation, comparison of telelactation to in-person lactation support, and recommendations to improve telelactation services. The thematic analysis was informed by a previously reported theoretical framework of acceptability and RAND Corporation?s equity-centered model. Results: Users appreciated the convenience of telelactation and reported that lactation consultants were knowledgeable and helpful. Participants wanted more options to engage with lactation consultants outside of video visits (eg, SMS text messaging and asynchronous resources). Users who had a lactation consultant of color mentioned that racial concordance improved the experience; however, few felt that racial concordance was needed for high-quality telelactation support. Conclusions: While Black parents in our sample found telelactation services to be acceptable, telelactation could not, in isolation, address the myriad barriers to long-duration breastfeeding. Several changes could be made to telelactation services to increase their use by minoritized populations. UR - https://www.jmir.org/2023/1/e50191 UR - http://dx.doi.org/10.2196/50191 UR - http://www.ncbi.nlm.nih.gov/pubmed/38157241 ID - info:doi/10.2196/50191 ER - TY - JOUR AU - Novak Lauscher, Helen AU - Blacklaws, Brydon AU - Pritchard, Erika AU - Wang, Jiaxi Elsie AU - Stewart, Kurtis AU - Beselt, Jeff AU - Ho, Kendall AU - Pawlovich, John PY - 2023/12/22 TI - Real-Time Virtual Support as an Emergency Department Strategy for Rural, Remote, and Indigenous Communities in British Columbia: Descriptive Case Study JO - J Med Internet Res SP - e45451 VL - 25 KW - telemedicine KW - access KW - rural KW - emergency medicine KW - interprofessional collaboration N2 - Background: British Columbia has over 200 rural, remote, and Indigenous communities that have limited health care resources due to physician isolation, sparsity in clinical resources, the lack of collegial support, and provider burnout. Real-time virtual support (RTVS) peer-to-peer pathways provide support to patients and providers. Amid the COVID-19 pandemic exacerbating existing health care disparities and equitable access to timely care, RTVS presents a portable and additional opportunity to be deployed in a hospital or patient home setting in rural communities. We highlight the story of the Rural Urgent Doctor in-aid (RUDi) pathway within RTVS that successfully supported the Dawson Creek District Hospital (DCDH) emergency department (ED) in 2021. Objective: This study aims to describe the rapid implementation process and identify facilitators and barriers to successful implementation. Methods: This case study is grounded in the Quadruple Aim and Social Accountability frameworks for health systems learning. The entire study period was approximately 6 months. After 1 week of implementation, we interviewed RUDi physicians, DCDH staff, health authority leadership, and RTVS staff to gather their experiences. Content analysis was used to identify themes that emerged from the interviews. Results: RUDi physicians covered 39 overnight shifts and were the most responsible providers (MRPs) for 245 patients who presented to the DCDH ED. A total of 17 interviews with key informants revealed important themes related to leadership and relationships as facilitators of the coverage?s success, the experience of remote physician support, providing a ?safety net,? finding new ways of interprofessional collaboration, and the need for extensive IT support throughout. Quality improvement findings identified barriers and demonstrated tangible recommendations for how this model of support can be improved in future cases. Conclusions: By acting as the MRP during overnight ED shifts, RUDi prevented the closure of the DCDH ED and the diversion of patients to another rural hospital. Rapid codevelopment and implementation of digital health solutions can be leveraged with existing partnerships and mutual trust between RTVS and rural EDs to ease the pressures of a physician shortage, particularly during COVID-19. By establishing new and modified clinical workflows, RTVS provides a safety net for rural patients and providers challenged by burnout. This case study provides learnings to be implemented to serve future rural, remote, and Indigenous communities in crisis. UR - https://www.jmir.org/2023/1/e45451 UR - http://dx.doi.org/10.2196/45451 UR - http://www.ncbi.nlm.nih.gov/pubmed/38133906 ID - info:doi/10.2196/45451 ER - TY - JOUR AU - Dulin, J. Akilah AU - Dunsiger, Shira AU - Benitez, Tanya AU - Larsen, Britta AU - Marcus, H. Bess AU - Champion, Gregory AU - Gans, M. Kim PY - 2023/12/7 TI - The Hombres Saludables Physical Activity Web-Based and Mobile Phone Intervention: Pilot Randomized Controlled Trial With Latino Men JO - J Med Internet Res SP - e39310 VL - 25 KW - physical activity KW - Latino KW - Hispanic KW - men KW - eHealth KW - expert system KW - internet KW - SMS text messaging KW - mobile phone KW - social media KW - mobile health KW - mHealth N2 - Background: Owing to structural-level, interpersonal-level, and individual-level barriers, Latino men have disproportionately high rates of physical inactivity and experience related chronic diseases. Despite these disparities, few physical activity (PA) interventions are culturally targeted for Latino men. Objective: This study reported the feasibility and acceptability of Hombres Saludables PA intervention for Latino men. We also reported the preliminary efficacy of the intervention on PA change and provided the results of the exploratory moderator and mediator analysis. Methods: We completed a 6-month, single-blind, pilot randomized controlled trial of Hombres Saludables with Latino men aged between 18 and 65 years. Men were randomized to either (1) a theory-driven, individually tailored, internet-based and SMS text message?based, Spanish-language PA intervention arm or (2) a nutrition and wellness attention contact control arm that was also delivered via the web and SMS text message. We assessed the primary study outcomes of feasibility using participant retention and acceptability using postintervention survey and open-ended interview questions. We measured the preliminary efficacy via change in minutes of moderate to vigorous PA per week using ActiGraph wGT3X-BT accelerometry (primary measure) and self-reported minutes per week using 7-day Physical Activity Recall. Participants completed the assessments at study enrollment and after 6 months. Results: The 38 participants were predominantly Dominican (n=8, 21%) or Guatemalan (n=5, 13%), and the mean age was 38.6 (SD 12.43) years. Retention rates were 91% (21/23) for the PA intervention arm and 100% (15/15) for the control arm. Overall, 95% (19/20) of the intervention arm participants reported that the Hombres study was somewhat to very helpful in getting them to be more physically active. Accelerometry results indicated that participants in the intervention group increased their PA from a median of 13 minutes per week at study enrollment to 34 minutes per week at 6 months, whereas the control group participants showed no increases. On the basis of self-reports, the intervention group was more likely to meet the US PA guidelines of 150 minutes per week of moderate to vigorous PA at 6-month follow-up, with 42% (8/19) of the intervention participants meeting the PA guidelines versus 27% (4/15) of the control participants (odds ratio 3.22, 95% CI 0.95-13.69). Exploratory analyses suggested conditional effects on PA outcomes based on baseline stage of motivational readiness, employment, and neighborhood safety. Conclusions: The PA intervention demonstrated feasibility and acceptability. Results of this pilot study indicate that the Hombres Saludables intervention is promising for increasing PA in Latino men and suggest that a fully powered trial is warranted. Our technology-based PA intervention provides a potentially scalable approach that can improve health in a population that is disproportionately affected by low PA and related chronic disease. Trial Registration: ClinicalTrials.gov NCT03196570; https://classic.clinicaltrials.gov/ct2/show/NCT03196570 International Registered Report Identifier (IRRID): RR2-10.2196/23690 UR - https://www.jmir.org/2023/1/e39310 UR - http://dx.doi.org/10.2196/39310 UR - http://www.ncbi.nlm.nih.gov/pubmed/38060285 ID - info:doi/10.2196/39310 ER - TY - JOUR AU - Faber, S. Jasper AU - Al-Dhahir, Isra AU - Kraal, J. Jos AU - Breeman, D. Linda AU - van den Berg-Emons, G. Rita J. AU - Reijnders, Thomas AU - van Dijk, Sandra AU - Janssen, R. Veronica AU - Kraaijenhagen, A. Roderik AU - Visch, T. Valentijn AU - Chavannes, H. Niels AU - Evers, M. Andrea W. PY - 2023/12/4 TI - Guide Development for eHealth Interventions Targeting People With a Low Socioeconomic Position: Participatory Design Approach JO - J Med Internet Res SP - e48461 VL - 25 KW - eHealth KW - guide KW - guidelines professionals KW - intervention development KW - intervention evaluation KW - low socioeconomic position KW - low socioeconomic status KW - risk groups KW - tailored care N2 - Background: People with a low socioeconomic position (SEP) are less likely to benefit from eHealth interventions, exacerbating social health inequalities. Professionals developing eHealth interventions for this group face numerous challenges. A comprehensive guide to support these professionals in their work could mitigate these inequalities. Objective: We aimed to develop a web-based guide to support professionals in the development, adaptation, evaluation, and implementation of eHealth interventions for people with a low SEP. Methods: This study consisted of 2 phases. The first phase involved a secondary analysis of 2 previous qualitative and quantitative studies. In this phase, we synthesized insights from the previous studies to develop the guide?s content and information structure. In the second phase, we used a participatory design process. This process included iterative development and evaluation of the guide?s design with 11 professionals who had experience with both eHealth and the target group. We used test versions (prototypes) and think-aloud testing combined with semistructured interviews and a questionnaire to identify design requirements and develop and adapt the guide accordingly. Results: The secondary analysis resulted in a framework of recommendations for developing the guide, which was categorized under 5 themes: development, reach, adherence, evaluation, and implementation. The participatory design process resulted in 16 requirements on system, content, and service aspects for the design of the guide. For the system category, the guide was required to have an open navigation strategy leading to more specific information and short pages with visual elements. Content requirements included providing comprehensible information, scientific evidence, a user perspective, information on practical applications, and a personal and informal tone of voice. Service requirements involved improving suitability for different professionals, ensuring long-term viability, and a focus on implementation. Based on these requirements, we developed the final version of ?the inclusive eHealth guide.? Conclusions: The inclusive eHealth guide provides a practical, user-centric tool for professionals aiming to develop, adapt, evaluate, and implement eHealth interventions for people with a low SEP, with the aim of reducing health disparities in this population. Future research should investigate its suitability for different end-user goals, its external validity, its applicability in specific contexts, and its real-world impact on social health inequality. UR - https://www.jmir.org/2023/1/e48461 UR - http://dx.doi.org/10.2196/48461 UR - http://www.ncbi.nlm.nih.gov/pubmed/38048148 ID - info:doi/10.2196/48461 ER - TY - JOUR AU - Yameogo, Roghemrazangba Achille AU - Délétroz, Carole AU - Sasseville, Maxime AU - Amil, Samira AU - Da, Romaric Sié Mathieu Aymar AU - Bodenmann, Patrick AU - Gagnon, Marie-Pierre PY - 2023/11/2 TI - Effectiveness of Interventions to Improve Digital Health Literacy in Forced Migrant Populations: Protocol for a Mixed Methods Systematic Review JO - JMIR Res Protoc SP - e50798 VL - 12 KW - intervention KW - digital health literacy KW - forced migrant populations KW - health literacy KW - digital literacy KW - migrant KW - migrants KW - immigrant KW - immigrants KW - knowledge synthesis KW - review methods KW - review methodology KW - systematic KW - eHealth literacy N2 - Background: Digital health literacy is considered a health determinant that can influence improved health and well-being, health equity, and the reduction of social health inequalities. Therefore, it serves as an asset for individuals to promote their health. However, low digital health literacy is a major problem among forced migrant populations. They do not always have the capacity and skills to access digital health resources and use them appropriately. To our knowledge, no studies are currently available to examine effective interventions for improving digital health literacy among forced migrant populations. Objective: This paper presents the protocol for a systematic review that aims to assess the effectiveness of digital health literacy interventions among forced migrant populations. With this review, our objectives are as follows: (1) identify interventions designed to improve digital health literacy among forced migrant populations, including interventions aimed at creating enabling conditions or environments that cater to the needs and expectations of forced migrants limited by low levels of digital health literacy, with the goal of facilitating their access to and use of eHealth resources; (2) define the categories and describe the characteristics of these interventions, which are designed to enhance the abilities of forced migrants or adapt digital health services to meet the needs and expectations of forced migrant populations. Methods: A mixed methods systematic review will be conducted according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) checklist. The research will be conducted in an iterative process among the different authors. With the help of a medical information specialist, a specific search strategy will be formulated for the 6 most relevant databases (ie, MEDLINE, Embase, CINAHL, Web of Science, Academic Search Premier, PsycINFO, and the Google Scholar search engine). A literature search covering studies published between 2000 and 2022 has already been conducted. Two reviewers then proceeded, individually and independently, to conduct a double selection of titles, abstracts, and then full texts. Data extraction will be conducted by a reviewer and validated by a senior researcher. We will use the narrative synthesis method (ie, structured narrative summaries of key themes) to present a comprehensive picture of effective digital health literacy interventions among forced migrant populations and the success factors of these interventions. Results: The search strategy and literature search were completed in December 2022. A total of 1232 articles were identified. The first selection was completed in July 2023. The second selection is still in progress. The publication of the systematic review is scheduled for December 2023. Conclusions: This mixed methods systematic review will provide comprehensive knowledge on effective interventions for digital literacy among forced migrant populations. The evidence generated will further inform stakeholders and aid decision makers in promoting equitable access to and use of digital health resources for forced migrant populations and the general population in host countries. International Registered Report Identifier (IRRID): DERR1-10.2196/50798 UR - https://www.researchprotocols.org/2023/1/e50798 UR - http://dx.doi.org/10.2196/50798 UR - http://www.ncbi.nlm.nih.gov/pubmed/37917139 ID - info:doi/10.2196/50798 ER - TY - JOUR AU - Graham, Tatyana AU - Nyambi, Agatha AU - Barkhad, Aisha AU - Stevens-Uninsky, Maya AU - Rehman, Nadia AU - Bhatnagar, Neera AU - Mbuagbaw, Lawrence PY - 2023/10/20 TI - HIV and Black People in Canada: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e49066 VL - 12 KW - African KW - barrier KW - Black community KW - Black research KW - Canada KW - Caribbean KW - community KW - conflict KW - HIV KW - mixed methods KW - public health KW - qualitative KW - quantitative KW - race KW - racial community KW - racial KW - scoping review N2 - Background: Race-based health information is necessary to address disproportionate barriers racial communities face and to achieve optimal health outcomes. In Canada, Black people are disproportionately affected by HIV. There is an emerging body of literature on this topic, but a concise summary is lacking. There is a need to collectively and critically analyze research on HIV in the Black population in Canada to identify knowledge gaps and address this disproportionate burden. Objective: The aim of this scoping review is to summarize the evidence on HIV and Black people in Canada. The main outcomes of interest are HIV prevalence, access to care, HIV prevention and treatment, the HIV care cascade, and related HIV outcomes. Through this scoping review, we aim to provide a comprehensive overview of the existing literature and highlight topics that need more investigation in future research. Methods: We will conduct a scoping review of electronic databases using a systematic search strategy for qualitative, quantitative, or mixed methods studies reporting on HIV and Black people in Canada. We will conduct our searches in MEDLINE, Embase, CINAHL, Web of Science, EBSCO, and Google Scholar for literature published between 1985 and 2023. Gray literature, including government reports, dissertations, and other reports, will be included. Search results will be screened, and the full text of relevant literature will be retrieved. The extraction of data will be conducted independently by 2 reviewers. Consensus meetings will be held to resolve conflicts. Our results will be reported according to the PRISMA-ScR (Preferred Reporting Items for the Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). Results: The initial title and abstract review identified 447 articles. These articles will be critically appraised, and relevant information will be extracted. Information from these articles will be compared using charts and tables. Screening will start in November 2023, and we anticipate publishing the scoping review in June 2024. Conclusions: The findings from this scoping review will help inform policy, practice, and research on HIV and Black people in Canada. International Registered Report Identifier (IRRID): PRR1-10.2196/49066 UR - https://www.researchprotocols.org/2023/1/e49066 UR - http://dx.doi.org/10.2196/49066 UR - http://www.ncbi.nlm.nih.gov/pubmed/37862080 ID - info:doi/10.2196/49066 ER - TY - JOUR AU - Henson, Connie AU - Chapman, Felicity AU - Shepherd, Gina AU - Carlson, Bronwyn AU - Rambaldini, Boe AU - Gwynne, Kylie PY - 2023/10/17 TI - Amplifying Older Aboriginal and Torres Strait Islander Women?s Perspectives to Promote Digital Health Equity: Co-Designed Qualitative Study JO - J Med Internet Res SP - e50584 VL - 25 KW - digital health KW - Aboriginal and Torres Strait Islander KW - Indigenous KW - health technology KW - co-design KW - cultural safety KW - older Indigenous women KW - social media KW - wearables KW - mobile phone N2 - Background: Digital health is becoming ubiquitous, and we must ensure equity in access. Indigenous people across most high-income countries typically have not benefited as much as other citizens from usual health care systems and technologies. Despite Aboriginal and Torres Strait Islander people?s clear interest in, and enthusiastic use of, new technologies, little research has examined the needs or interests of older Aboriginal and Torres Strait Islander women. Objective: This study prioritizes the perspectives of older Aboriginal and Torres Strait Islander women, tapping into their expertise associated with Indigenous ways of knowing, being, and doing, as well as their unique position within their families and communities, to design a model for using digital technologies to improve health for themselves and their families as well as their communities. Methods: Older Aboriginal and Torres Strait Islander women from 4 partner organizations were recruited for this study. This co-designed qualitative research included citizen scientists in shaping the protocol as well as collecting, analyzing, and interpreting data. We used yarning, an Indigenous research method validated for use in health research with Indigenous people and seen as respectful and culturally safe, as a primary research tool. The use of Indigenous methodologies and our iterative process enabled us to deeply explore and incorporate perspectives from all participants and ensure that the perspectives of Indigenous citizen scientists with lived experience were privileged. The data-checking methods also used a yarning methodology, which ensured that the findings and translational model derived from the findings were validated by the participants. Results: Participants comprised 24 Aboriginal and Torres Strait Islander women aged ?41 years and including 3 generations that did not grow up with the internet: seniors, baby boomers, and Generation X. The key findings in this research were that older women use various digital technologies to improve health and well-being for themselves and their families as well as their communities. Older Aboriginal women want a culturally sensitive cyberspace that caters specifically to their needs and includes relevant content and functionality that are accessible and efficient. Our translational model highlights the conditions necessary for anyone to use digital health technologies, summarizes the essential elements needed to promote equity in digital health, and illuminates the unmet needs and requirements for older Aboriginal and Torres Strait Islander women to fully benefit from digital health technologies. Conclusions: Health is a fundamental right. As we move toward greater reliance on digital health solutions, we must recognize and address the concerns of the smaller populations of people who differ in their needs. We must urgently address the financial, connectivity, and other limiting factors highlighted by older Aboriginal and Torres Strait Islander women in this study that limit equitable access to digital health tools. International Registered Report Identifier (IRRID): RR2-10.1177/20552076221084469 UR - https://www.jmir.org/2023/1/e50584 UR - http://dx.doi.org/10.2196/50584 UR - http://www.ncbi.nlm.nih.gov/pubmed/37847550 ID - info:doi/10.2196/50584 ER - TY - JOUR AU - Metting, Esther AU - van Luenen, Sanne AU - Baron, Anna-Jetske AU - Tran, Anthony AU - van Duinhoven, Stijn AU - Chavannes, H. Niels AU - Hevink, Maud AU - Lüers, Jos AU - Kocks, Janwillem PY - 2023/10/3 TI - Overcoming the Digital Divide for Older Patients With Respiratory Disease: Focus Group Study JO - JMIR Form Res SP - e44028 VL - 7 KW - elderly people KW - usability KW - asthma KW - chronic obstructive pulmonary disease KW - website KW - navigation N2 - Background: The need for and adoption of eHealth programs are growing worldwide. However, access can be limited among patients with low socioeconomic backgrounds, often resulting in a so-called ?digital divide? due to a mismatch between eHealth and target populations that can gain benefit. This digital divide can result in unsuccessful eHealth implementations, which is of critical importance to health care. Objective: This study evaluated the opinions of elderly patients with asthma and chronic obstructive pulmonary disease (COPD) about an existing pharmacy-based personalized patient web portal that provides medication overview and information on associated diagnoses. The aim was to obtain insights on the common barriers of elderly people when using health-related websites, which can help to improve accessibility. Methods: This was a cross-sectional qualitative study of a patient panel of the Groningen Research Institute for Asthma and COPD in primary care. Participants were required to be older than 55 years, be Dutch speaking, have no prior experience with the study website, and be diagnosed with a chronic respiratory illness. Two focus groups were created, and they completed a 45-minute session for testing the website and a 120-minute session for semistructured interviews. The focus group sessions were recorded, transcribed verbatim, and analyzed by content analysis. Results: We enrolled 11 patients (9 women) with a mean age of 66 (SD 9) years. Of these, 5 had asthma, 3 had COPD, 2 had asthma-COPD overlap syndrome, and 1 had bronchiectasis. Participants were generally positive about the website, especially the areas providing disease-related information and the medication overview. They appreciated that the website would enable them to share this information with other health care providers. However, some difficulties were reported with navigation, such as opening a new tab, and others reported that the layout of the website was difficult either because of visual impairments or problems with navigation. It was also felt that monitoring would only be relevant if it is also checked by health care professionals as part of a treatment plan. Participants mentioned few privacy or safety concerns. Conclusions: It is feasible to develop websites for elderly patients; however, developers must take the specific needs and limitations of elderly people into account (eg, navigation problems, poor vision, or poor hand-eye coordination). The provision of information appears to be the most important aspect of the website, and as such, we should endeavor to ensure that the layout and navigation remain basic and accessible. Patients are only motivated to use self-management applications if they are an integrated part of their treatment. The usability of the website can be improved by including older people during development and by implementing design features that can improve accessibility in this group. UR - https://formative.jmir.org/2023/1/e44028 UR - http://dx.doi.org/10.2196/44028 UR - http://www.ncbi.nlm.nih.gov/pubmed/37788072 ID - info:doi/10.2196/44028 ER - TY - JOUR AU - Poulsen, Adam AU - Song, C. Yun J. AU - Fosch-Villaronga, Eduard AU - LaMonica, M. Haley AU - Iannelli, Olivia AU - Alam, Mafruha AU - Hickie, B. Ian PY - 2023/10/3 TI - Digital Rights and Mobile Health in Low- and Middle-Income Countries: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e49150 VL - 12 KW - human right KW - digital right KW - mobile health KW - mHealth KW - smartphone KW - mobile phone KW - digital health KW - scoping review KW - health equity KW - patient empowerment N2 - Background: Digital technology is a means to uphold or violate human rights in various domains, including business, military, and health. Given the pervasiveness of mobile technology in low- and middle-income countries (LMICs), mobile health (mHealth) interventions present an opportunity to reach remote populations and enable them to exercise civil and political rights and economic, social, and cultural rights, such as the right to health and education. Simultaneously, the ubiquity of mobile phones involves processing sensitive data which can threaten rights, including the right to privacy and nondiscrimination. Digital health is often promoted as advancing human rights and health equity; however, digital rights are underexplored in the literature on mHealth in LMICs. As such, creating an understanding of the digital rights topics covered in the 2022 literature is important to avoid exacerbating existing inequities relating to digital health design, use, implementation, and access. Objective: This scoping review aims to identify digital rights topics in the 2022 peer-reviewed literature on mHealth in LMICs. Methods: The Arksey and O?Malley framework for scoping reviews guides this review. Searches were performed across 7 electronic databases (Web of Science, Scopus, Ovid, ACM Digital Library, IEEE Xplore, ProQuest, and PubMed). The screening processes were guided by the research question ?What digital rights topics have been explored in the 2022 literature on mHealth in LMICs?? Only papers addressing mHealth in LMICs and digital rights topics were included. Data extraction will include publication title, year, and type; first author?s affiliation country; LMICs implicated; infrastructure challenges; study aims, design, limitations, and future work; health area; mHealth technology, functions, purpose or application, and target end users; human or digital right terms used; explicit rights topics cited; and implied rights topics. The results will be reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Results: This scoping review was registered in Open Science Framework (December 22, 2022). Title and abstract screening and full-text paper screening were completed in 2023. This resulted in 56 papers being included in the study. The target date for completing data extraction and publishing a case study of the initial findings is the end of 2023. The full scoping review findings are expected to be disseminated through various pathways benefiting academia, practice, and policy making by the end of 2024. These include journal papers, conference presentations, publicly available toolkits for research and practice, public webinars, and policy briefs with evidence-based policy recommendations emerging from this review. Conclusions: The planned scoping review will identify digital rights topics in the 2022 literature at the intersection of mHealth and LMICs. Furthermore, it will highlight the importance of patient empowerment, data protection, and inclusion in mHealth research and related policies in LMICs. Trial Registration: Open Science Framework osf.io/7mz24; https://osf.io/7mz24 International Registered Report Identifier (IRRID): DERR1-10.2196/49150 UR - https://www.researchprotocols.org/2023/1/e49150 UR - http://dx.doi.org/10.2196/49150 UR - http://www.ncbi.nlm.nih.gov/pubmed/37788054 ID - info:doi/10.2196/49150 ER - TY - JOUR AU - Buis, R. Lorraine AU - Brown, K. Lindsay AU - Plegue, A. Melissa AU - Kadri, Reema AU - Laurie, R. Anna AU - Guetterman, C. Timothy AU - Vydiswaran, Vinod V. G. AU - Li, Jiazhao AU - Veinot, C. Tiffany PY - 2023/9/29 TI - Identifying Inequities in Video and Audio Telehealth Services for Primary Care Encounters During COVID-19: Repeated Cross-Sectional, Observational Study JO - J Med Internet Res SP - e49804 VL - 25 KW - COVID-19 KW - telemedicine KW - health equity KW - clinical encounters KW - electronic health records N2 - Background: The COVID-19 pandemic resulted in rapid changes in how patient care was provided, particularly through the expansion of telehealth and audio-only phone-based care. Objective: The goal of this study was to evaluate inequities in video and audio-only care during various time points including the initial wave of the COVID-19 pandemic, later stages of the pandemic, and a historical control. We sought to understand the characteristics of care during this time for a variety of different groups of patients that may experience health care inequities. Methods: We conducted a retrospective analysis of electronic health record (EHR) data from encounters from 34 family medicine and internal medicine primary care clinics in a large, Midwestern health system, using a repeated cross-sectional, observational study design. These data included patient demographic data, as well as encounter, diagnosis, and procedure records. Data were obtained for all in-person and telehealth encounters (including audio-only phone-based care) that occurred during 3 separate time periods: an initial COVID-19 period (T2: March 16, 2020, to May 3, 2020), a later COVID-19 period (T3: May 4, 2020, to September 30, 2020), and a historical control period from the previous year (T1: March 16, 2019, to September 30, 2019). Primary analysis focused on the status of each encounter in terms of whether it was completed as scheduled, it was canceled, or the patient missed the appointment. A secondary analysis was performed to evaluate the likelihood of an encounter being completed based on visit modality (phone, video, in-person). Results: In total, there were 938,040 scheduled encounters during the 3 time periods, with 178,747 unique patients, that were included for analysis. Patients with completed encounters were more likely to be younger than 65 years old (71.8%-74.1%), be female (58.8%-61.8%), be White (75.6%-76.7%), and have no significant comorbidities (63.2%-66.8%) or disabilities (53.2%-61.1%) in all time periods than those who had only canceled or missed encounters. Effects on different subpopulations are discussed herein. Conclusions: Findings from this study demonstrate that primary care utilization across delivery modalities (in person, video, and phone) was not equivalent across all groups before and during the COVID-19 pandemic and different groups were differentially impacted at different points. Understanding how different groups of patients responded to these rapid changes and how health care inequities may have been affected is an important step in better understanding implementation strategies for digital solutions in the future. UR - https://www.jmir.org/2023/1/e49804 UR - http://dx.doi.org/10.2196/49804 UR - http://www.ncbi.nlm.nih.gov/pubmed/37773609 ID - info:doi/10.2196/49804 ER - TY - JOUR AU - Lammons, William AU - Silkens, Milou AU - Hunter, Jamie AU - Shah, Sudhir AU - Stavropoulou, Charitini PY - 2023/9/26 TI - Centering Public Perceptions on Translating AI Into Clinical Practice: Patient and Public Involvement and Engagement Consultation Focus Group Study JO - J Med Internet Res SP - e49303 VL - 25 KW - acceptance KW - AI in health care KW - AI KW - artificial intelligence KW - health care research KW - health care KW - patient and public engagement and involvement KW - patient engagement KW - public engagement KW - transition N2 - Background: Artificial intelligence (AI) is widely considered to be the new technical advancement capable of a large-scale modernization of health care. Considering AI?s potential impact on the clinician-patient relationship, health care provision, and health care systems more widely, patients and the wider public should be a part of the development, implementation, and embedding of AI applications in health care. Failing to establish patient and public engagement and involvement (PPIE) can limit AI?s impact. Objective: This study aims to (1) understand patients? and the public?s perceived benefits and challenges for AI and (2) clarify how to best conduct PPIE in projects on translating AI into clinical practice, given public perceptions of AI. Methods: We conducted this qualitative PPIE focus-group consultation in the United Kingdom. A total of 17 public collaborators representing 7 National Institute of Health and Care Research Applied Research Collaborations across England participated in 1 of 3 web-based semistructured focus group discussions. We explored public collaborators? understandings, experiences, and perceptions of AI applications in health care. Transcripts were coanalyzed iteratively with 2 public coauthors using thematic analysis. Results: We identified 3 primary deductive themes with 7 corresponding inductive subthemes. Primary theme 1, advantages of implementing AI in health care, had 2 subthemes: system improvements and improve quality of patient care and shared decision-making. Primary theme 2, challenges of implementing AI in health care, had 3 subthemes: challenges with security, bias, and access; public misunderstanding of AI; and lack of human touch in care and decision-making. Primary theme 3, recommendations on PPIE for AI in health care, had 2 subthemes: experience, empowerment, and raising awareness; and acknowledging and supporting diversity in PPIE. Conclusions: Patients and the public can bring unique perspectives on the development, implementation, and embedding of AI in health care. Early PPIE is therefore crucial not only to safeguard patients but also to increase the chances of acceptance of AI by the public and the impact AI can make in terms of outcomes. UR - https://www.jmir.org/2023/1/e49303 UR - http://dx.doi.org/10.2196/49303 UR - http://www.ncbi.nlm.nih.gov/pubmed/37751234 ID - info:doi/10.2196/49303 ER - TY - JOUR AU - Condron, Claire AU - Power, Mide AU - Mathew, Midhun AU - Lucey, M. Siobhan PY - 2023/9/20 TI - Gender Equality Training for Students in Higher Education: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e44584 VL - 12 KW - gender equality KW - student leaders KW - simulation-based education KW - communications skills KW - training KW - higher education KW - sustainable goal KW - scoping KW - review method KW - PRISMA KW - Preferred Reporting Items for Systematic Reviews and Meta-Analyses KW - search strategy KW - gender KW - equality KW - equalities KW - inclusion KW - diversity KW - postsecondary KW - student KW - teaching KW - coaching KW - teacher KW - educator N2 - Background: The principles of gender equality are integral to the goals, targets, and indicators of all sustainable development goals. Higher education institutes can be powerful agents for promoting gender equality, diversity, and inclusion not only in the higher education context but also in society as a whole. To address and overcome gender inequality in the higher education environment, experts posit that change needs to occur from day 1 of the student?s academic experience. To this end, training is required. A preliminary review of the literature indicates that multiple gender equality?based training programs or initiatives for students have been designed and evaluated in second and third-level education settings. Examples of educational activities undertaken include delivery of didactic teaching, participation in a face-to-face collaboration project, site visits, case studies, and coaching. Yet, our initial search indicated that, to date, a comprehensive review collating the available evidence on gender equality training for third-level students has not yet been carried out. Objective: Our review seeks to identify and explore the existing literature on gender equality training interventions for third-level students, with a particular emphasis on training content, methodology, and outcome evaluation. Methods: This scoping review will be structured using the Arskey and O?Malley?s 5-stage framework and will consider empirical research and other relevant published works that address gender equality training. Systematic searches will be carried out in 6 research databases and the gray literature using key search terms. Inclusion and exclusion criteria have been defined, and a data charting tool created to methodically extract information from selected literature. The free web software Rayyan will be used for primary screening where each reference will be screened in duplicate first by title, then abstract, and finally by full text. Results: This review forms part of the LIBRA (Balance) study and has received peer-reviewed grant funding from the Irish Higher Education Authority. LIBRA aims to use simulation-based education to develop a gender equality leadership training program for student leaders in higher education. The findings will be summarized in tabular form, and a narrative synthesis produced to inform curriculum development. Conclusions: This review seeks to inform curriculum design by reporting on the gender equality?enabling skills and leadership skills necessary to foster gender equality. This paper should inform recommendations for training and catalyze future research in this rapidly evolving area. International Registered Report Identifier (IRRID): DERR1-10.2196/44584 UR - https://www.researchprotocols.org/2023/1/e44584 UR - http://dx.doi.org/10.2196/44584 UR - http://www.ncbi.nlm.nih.gov/pubmed/37728987 ID - info:doi/10.2196/44584 ER - TY - JOUR AU - Herington, Jonathan AU - Connelly, Kay AU - Illes, Judy PY - 2023/9/18 TI - Ethical Imperatives for Working With Diverse Populations in Digital Research JO - J Med Internet Res SP - e47884 VL - 25 KW - digital health research KW - justice KW - research ethics KW - diversity KW - engagement KW - research participants KW - participatory UR - https://www.jmir.org/2023/1/e47884 UR - http://dx.doi.org/10.2196/47884 UR - http://www.ncbi.nlm.nih.gov/pubmed/37721792 ID - info:doi/10.2196/47884 ER - TY - JOUR AU - Chen, Yuling AU - Kruahong, Suratsawadee AU - Elias, Sabrina AU - Turkson-Ocran, Ruth-Alma AU - Commodore-Mensah, Yvonne AU - Koirala, Binu AU - Himmelfarb, Dennison Cheryl R. PY - 2023/9/13 TI - Racial Disparities in Shared Decision-Making and the Use of mHealth Technology Among Adults With Hypertension in the 2017-2020 Health Information National Trends Survey: Cross-Sectional Study in the United States JO - J Med Internet Res SP - e47566 VL - 25 KW - mobile health KW - disparities KW - shared decision-making KW - hypertension KW - association KW - decision-making KW - mHealth KW - technology KW - health disparity KW - adult KW - smartphone KW - racial KW - ethnic KW - health literacy KW - digital literacy N2 - Background: Mobile health (mHealth) technology has the potential to support shared decision-making (SDM) and improve hypertension control. However, our understanding of the variations in individuals? involvement in SDM and mHealth usage across different racial and ethnic groups in the United States is still limited. Objective: This study aimed to investigate the extent of involvement in SDM and the usage of mHealth technology in health-related activities among US adults with hypertension from diverse racial and ethnic backgrounds and to examine whether the mHealth usage differed by individuals? level of engagement in SDM. Methods: This study used cross-sectional data from the 2017 to 2020 Health Information National Trends Survey, which was conducted on US adults with self-reported hypertension, and race and ethnicity data were included. The exposure of interest was race and ethnicity. The outcomes were SDM and mHealth usage. SDM was assessed using an item: ?In the past 12 months, how often did your health professional: involve you in decisions about your healthcare as much as you wanted?? mHealth usage was defined as using a smartphone or tablet to engage in (1) making health decisions, (2) discussing health decisions with health providers, (3) tracking health progress, and (4) sharing health information. Weighted multivariable logistic regression models were used to examine the association between race and ethnicity and SDM or mHealth usage adjusted for covariates and stratified by the level of engagement in SDM. Results: This study included 4893 adults with hypertension, and the mean age was 61 (SD 13) years. The sample was 53% female, 61% (n=3006) non-Hispanic White, 19% (n=907) non-Hispanic Black or African American, 12% (n=605) Hispanic, 4% (n=193) non-Hispanic Asian, and 4% (n=182) non-Hispanic other. Compared to the non-Hispanic White adults, non-Hispanic Black adults were more likely to use mHealth to make health decisions (adjusted odds ratio [aOR] 1.70, 95% CI 1.23-2.34), share health information (aOR 1.46, 95% CI 1.02-2.08), and discuss health decisions with health providers (aOR 1.38, 95% CI 1.02-1.87). Significant associations were observed specifically among those who were always involved in SDM. Asian adults were less likely to be involved in SDM (aOR 0.51, 95% CI 0.26-0.99) and were more likely to use mHealth to track progress on a health-related goal (aOR 2.07, 95% CI 1.28-3.34) than non-Hispanic White adults. Hispanic adults were less likely to use mHealth to share health information (aOR 0.47, 95% CI 0.33-0.67) and discuss health decisions with health providers (aOR 0.65, 95% CI 0.46-0.94) compared to non-Hispanic White adults. Conclusions: This study observed racial and ethnic disparities in SDM and mHealth usage among US adults with hypertension. These findings emphasize the significance of comprehending the involvement of SDM and the usage of mHealth technology within racially and ethnically diverse populations. UR - https://www.jmir.org/2023/1/e47566 UR - http://dx.doi.org/10.2196/47566 UR - http://www.ncbi.nlm.nih.gov/pubmed/37703088 ID - info:doi/10.2196/47566 ER - TY - JOUR AU - Mai, Feng AU - Ko, Dong-Gil AU - Shan, Zhe AU - Zhang, Dawei PY - 2023/8/9 TI - The Impact of Accelerated Digitization on Patient Portal Use by Underprivileged Racial Minority Groups During COVID-19: Longitudinal Study JO - J Med Internet Res SP - e44981 VL - 25 KW - digital divide KW - race KW - health care KW - patient portal KW - mobile health KW - accelerated digitization KW - COVID-19 KW - mobile phone N2 - Background: Prior research on the digital divide has documented substantial racial inequality in using web-based health resources. The recent COVID-19 pandemic led to accelerated mass digitization, raising alarms that underprivileged racial minority groups are left further behind. However, it is unclear to what extent the use of health information and communications technology by underprivileged racial minority groups is affected. Objective: We have considered the COVID-19 disruption as a rare exogenous shock and estimated the impact of the accelerated digitization on the quantity and variety of patient portal use. In this study, we aimed to answer the following 2 key research questions. Did patients alter their use of health information and communications technology owing to COVID-19?induced digital acceleration? Does the effect differ across racial lines? Methods: We used a longitudinal patient portal use data set gathered from a large urban academic medical center to explore the effect of accelerated digitization on the racial digital gap in health care. We limited the sample period of our study to 2 same periods (March 11 to August 30) in 2019 and 2020. Our final sample consisted of 25,612 patients belonging to 1 of the 3 racial groups: Black or African American (n=5157, 20.13%), Hispanic (n=253, 0.99%), and White (n=20,202, 78.88%) patients. We estimated the panel data regression using 3 different models: pooled ordinary least squares (OLS), random effect (RE), and fixed effect (FE). Results: Our study yielded 4 findings. First, we confirmed that the racial digital divide remains a significant issue for telehealth; underprivileged racial minority group patients had lower patient portal use than White patients before the pandemic (Minority: OLS, ?=?.158; P<.001; RE, ?=?.168; P<.001). Second, we found that the digital gap regarding patient portal use frequency between underprivileged racial minority groups and White patients is shrinking rather than widening after the COVID-19 pandemic started (COVID_Period×Minority: OLS, ?=.028; P=.002; RE, ?=.037; P<.001; FE, ?=.043; P<.001). Third, the shrinking gap is foremost driven by access through mobile (vs desktop) devices (COVID_Period×Minority: web, ?=?.020; P=.02; mobile, ?=.037; P<.001). Finally, underprivileged racial minority groups expanded their use of a variety of portal functionalities faster than White patients during the pandemic (COVID_Period×Minority [for functionality]: OLS, ?=?.004; P<.001; RE, ?=?.004; P<.001; FE, ?=?.003; P=.001). Conclusions: Using the COVID-19 pandemic as a natural experiment, we offer empirical evidence that accelerated digitization has shrunk the racial digital divide in telehealth, and the trend is mostly driven by mobile devices. These findings provide new insights into the digital behaviors among underprivileged racial minority groups during accelerated digitization. They also offer policy makers an opportunity to identify new strategies to help close the racial digital gap in the postpandemic world. UR - https://www.jmir.org/2023/1/e44981 UR - http://dx.doi.org/10.2196/44981 UR - http://www.ncbi.nlm.nih.gov/pubmed/37384810 ID - info:doi/10.2196/44981 ER - TY - JOUR AU - Chivela, L. Fernando AU - Burch, E. Ashley AU - Asagbra, Oghale PY - 2023/8/1 TI - An Assessment of Patient Portal Messaging Use by Patients With Multiple Chronic Conditions Living in Rural Communities: Retrospective Analysis JO - J Med Internet Res SP - e44399 VL - 25 KW - patient portal KW - multimorbidity KW - chronic disease KW - patient messaging KW - rural KW - mobile phone N2 - Background: Patient portals can facilitate the delivery of health care services and support self-management for patients with multiple chronic conditions. Despite their benefits, the evidence of patient portal use among patients with multimorbidity in rural communities is limited. Objective: This study aimed to explore the factors associated with portal messaging use by rural patients. Methods: We assessed patient portal use among patients with ?1 chronic diagnoses who sent or received messages via the Epic MyChart (Epic Systems Corporation) portal between January 1, 2015, and November 9, 2021. Patient portal use was defined as sending or receiving a message through the portal during the study period. We fit a zero-inflated negative binomial model to predict portal use based on the patient?s number of chronic conditions, sex, race, age, marital status, and insurance type. County-level characteristics, based on the patient?s home address, were also included in the model to assess the influence of community factors on portal use. County-level factors included educational attainment, smartphone ownership, median income, and primary care provider density. Results: A total of 65,178 patients (n=38,587, 59.2% female and n=21,454, 32.92% Black) were included in the final data set, of which 38,380 (58.88%) sent at least 1 message via the portal during the 7-year study period. As the number of chronic diagnoses increased, so did portal messaging use; however, this relationship was driven primarily by younger patients. Patients with 2 chronic conditions were 1.57 times more likely to send messages via the portal than those with 1 chronic condition (P<.001). In comparison, patients with ?7 chronic conditions were approximately 11 times more likely to send messages than patients with 1 chronic condition (P<.001). A robustness check confirmed the interaction effect of age and the number of diagnoses on portal messaging. In the model including only patients aged <65 years, there was a significant effect of increased portal messaging corresponding to the number of chronic conditions (P<.001). Conversely, this relationship was not significant for the model consisting of older patients. Other significant factors associated with increased portal use include being female; White; married; having private insurance; and living in an area with a higher average level of educational attainment, greater medical provider density, and a lower median income. Conclusions: Patients? use of the portal to send messages to providers was incrementally related to their number of diagnoses. As the number of chronic diagnoses increased, so did portal messaging use. Patients of all ages, particularly those living in rural areas, could benefit from the convenience and cost-effectiveness of portal communication. Health care systems and providers are encouraged to increase the use of patient portals by implementing educational interventions to promote the advantages of portal communication, particularly among patients with multimorbidity. UR - https://www.jmir.org/2023/1/e44399 UR - http://dx.doi.org/10.2196/44399 UR - http://www.ncbi.nlm.nih.gov/pubmed/37526967 ID - info:doi/10.2196/44399 ER - TY - JOUR AU - Nakayama, Filipe Luis AU - Binotti, Warr William AU - Link Woite, Naira AU - Fernandes, Oliveira Chrystinne AU - Alfonso, Gabrielle Pia AU - Celi, Anthony Leo AU - Regatieri, Vinicius Caio PY - 2023/7/21 TI - The Digital Divide in Brazil and Barriers to Telehealth and Equal Digital Health Care: Analysis of Internet Access Using Publicly Available Data JO - J Med Internet Res SP - e42483 VL - 25 KW - digital divide KW - digital health KW - health equity KW - internet access KW - medical care N2 - 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. UR - https://www.jmir.org/2023/1/e42483 UR - http://dx.doi.org/10.2196/42483 UR - http://www.ncbi.nlm.nih.gov/pubmed/37477958 ID - info:doi/10.2196/42483 ER - TY - JOUR AU - Katapally, Reddy Tarun AU - Ibrahim, Tolulope Sheriff PY - 2023/6/30 TI - Digital Health Dashboards for Decision-Making to Enable Rapid Responses During Public Health Crises: Replicable and Scalable Methodology JO - JMIR Res Protoc SP - e46810 VL - 12 KW - big data KW - COVID-19 KW - digital citizen science KW - digital dashboards KW - digital epidemiology KW - digital health KW - digital health platforms KW - eHealth KW - health equity KW - mHealth KW - pandemics KW - public health surveillance KW - virtual health care KW - mobile phone N2 - Background: The COVID-19 pandemic has reiterated the need for cohesive, collective, and deliberate societal efforts to address inherent inefficiencies in our health systems and overcome decision-making gaps using real-time data analytics. To achieve this, decision makers need independent and secure digital health platforms that engage citizens ethically to obtain big data, analyze and convert big data into real-time evidence, and finally, visualize this evidence to inform rapid decision-making. Objective: The objective of this study is to develop replicable and scalable jurisdiction-specific digital health dashboards for rapid decision-making to ethically monitor, mitigate, and manage public health crises via systems integration beyond health care. Methods: The primary approach in the development of the digital health dashboard was the use of global digital citizen science to tackle pandemics like COVID-19. The first step in the development process was to establish an 8-member Citizen Scientist Advisory Council via Digital Epidemiology and Population Health Laboratory?s community partnerships. Based on the consultation with the council, three critical needs of citizens were prioritized: (1) management of household risk of COVID-19, (2) facilitation of food security, and (3) understanding citizen accessibility of public services. Thereafter, a progressive web application (PWA) was developed to provide daily services that address these needs. The big data generated from citizen access to these PWA services are set up to be anonymized, aggregated, and linked to the digital health dashboard for decision-making, that is, the dashboard displays anonymized and aggregated data obtained from citizen devices via the PWA. The digital health dashboard and the PWA are hosted on the Amazon Elastic Compute Cloud server. The digital health dashboard?s interactive statistical navigation was designed using the Microsoft Power Business Intelligence tool, which creates a secure connection with the Amazon Relational Database server to regularly update the visualization of jurisdiction-specific, anonymized, and aggregated data. Results: The development process resulted in a replicable and scalable digital health dashboard for decision-making. The big data relayed to the dashboard in real time reflect usage of the PWA that provides households the ability to manage their risk of COVID-19, request food when in need, and report difficulties and issues in accessing public services. The dashboard also provides (1) delegated community alert system to manage risks in real time, (2) bidirectional engagement system that allows decision makers to respond to citizen queries, and (3) delegated access that provides enhanced dashboard security. Conclusions: Digital health dashboards for decision-making can transform public health policy by prioritizing the needs of citizens as well as decision makers to enable rapid decision-making. Digital health dashboards provide decision makers the ability to directly communicate with citizens to mitigate and manage existing and emerging public health crises, a paradigm-changing approach, that is, inverting innovation by prioritizing community needs, and advancing digital health for equity. International Registered Report Identifier (IRRID): RR1-10.2196/46810 UR - https://www.researchprotocols.org/2023/1/e46810 UR - http://dx.doi.org/10.2196/46810 UR - http://www.ncbi.nlm.nih.gov/pubmed/37389905 ID - info:doi/10.2196/46810 ER - TY - JOUR AU - Goodman, Andrew AU - Mahoney, Ray AU - Spurling, Geoffrey AU - Lawler, Sheleigh PY - 2023/6/23 TI - Influencing Factors to mHealth Uptake With Indigenous Populations: Qualitative Systematic Review JO - JMIR Mhealth Uhealth SP - e45162 VL - 11 KW - mHealth KW - Indigenous KW - Canada KW - Australia KW - New Zealand KW - United States KW - Papua New Guinea KW - Samoa KW - qualitative KW - systematic review KW - feasibility KW - acceptability KW - users KW - design KW - workflow N2 - 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. UR - https://mhealth.jmir.org/2023/1/e45162 UR - http://dx.doi.org/10.2196/45162 UR - http://www.ncbi.nlm.nih.gov/pubmed/37351947 ID - info:doi/10.2196/45162 ER - TY - JOUR AU - Olanlesi-Aliu, Adedoyin AU - Alaazi, Dominic AU - Salami, Bukola PY - 2023/5/25 TI - Black Health in Canada: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e42212 VL - 12 KW - Black people KW - inequities KW - mental health KW - reproductive and sexual health KW - HIV KW - social determinants of health KW - Canada N2 - Background: Black Canadians experience poor health care, poor health outcomes, and a greater burden of health inequalities, much of which is rooted in the unequal distribution of social determinants of health. Despite Canada?s emphasis on social inclusion, Canada?s Black population faces substantial social inequities that affect their health and well-being. These disparities may specifically be attributed to racial discrimination, immigration status, precarious housing, underemployment, and increased poverty among Black Canadians. Objective: This paper describes a protocol for a scoping review that aims to understand the range and nature of research conducted on the health of Black Canadians as well as the gaps in this literature. Methods: Arksey and O'Malley?s methodological framework guided the conduct of the scoping review. We searched electronic databases (CINAHL, Embase, Global Health, MEDLINE, PsycINFO, Scopus, Sociological Abstracts, and Web of Science) and grey literature sources for peer-reviewed articles and grey reports on the health of Black Canadians. Six reviewers independently screened the abstracts and full text of studies to determine eligibility for inclusion. According to the PRISMA-ScR (Preferred Reporting Items for Systematics Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, the findings will be synthesized quantitatively and qualitatively through thematic analysis. Results: Title, abstract, and full-text screening concluded in October 2022. Data collection is in progress and is expected to be completed by April 2023. Data analysis and drafting of the manuscript will be done thereafter. Findings from the scoping review are expected to be provided for peer review in 2023. Conclusions: This review will collect important data and evidence related to the health (mental, reproductive, and sexual; social determinants of health) of the Black population in Canada. The findings could help identify existing gaps in the health of Black individuals in Canada and inform future research paradigms. The findings will further inform the development of a knowledge hub on Black Canadians? health. International Registered Report Identifier (IRRID): PRR1-10.2196/42212 UR - https://www.researchprotocols.org/2023/1/e42212 UR - http://dx.doi.org/10.2196/42212 UR - http://www.ncbi.nlm.nih.gov/pubmed/37227759 ID - info:doi/10.2196/42212 ER - TY - JOUR AU - Hadley, Emily AU - Marcial, Haak Laura AU - Quattrone, Wes AU - Bobashev, Georgiy PY - 2023/5/24 TI - Text Analysis of Trends in Health Equity and Disparities From the Internal Revenue Service Tax Documentation Submitted by US Nonprofit Hospitals Between 2010 and 2019: Exploratory Study JO - J Med Internet Res SP - e44330 VL - 25 KW - text mining KW - natural language processing KW - health care disparities KW - hospital administration N2 - Background: Many US hospitals are classified as nonprofits and receive tax-exempt status partially in exchange for providing benefits to the community. Proof of compliance is collected with the Schedule H form submitted as part of the annual Internal Revenue Service Form 990 (F990H), including a free-response text section that is known for being ambiguous and difficult to audit. This research is among the first to use natural language processing approaches to evaluate this text section with a focus on health equity and disparities. Objective: This study aims to determine the extent to which the free-response text in F990H reveals how nonprofit hospitals address health equity and disparities, including alignment with public priorities. Methods: We used free-response text submitted by hospital reporting entities in Part V and VI of the Internal Revenue Service Form 990 Schedule H between 2010 and 2019. We identified 29 main themes connected to health equity and disparities, and 152 related key phrases. We tallied occurrences of these phrases through term frequency analysis, calculated the Moran I statistic to assess geographic variation in 2018, analyzed Google Trends use for the same terms during the same period, and used semantic search with Sentence-BERT in Python to understand contextual use. Results: We found increased use from 2010 to 2019 across all the 29 phrase themes related to health equity and disparities. More than 90% of hospital reporting entities used terms in 2018 and 2019 related to affordability (2018: 2117/2131, 99.34%; 2019: 1620/1627, 99.57%), government organizations (2018: 2053/2131, 96.33%; 2019: 1577/1627, 96.93%), mental health (2018: 1937/2131, 90.9%; 2019: 1517/1627, 93.24%), and data collection (2018: 1947/2131, 91.37%; 2019: 1502/1627, 92.32%). The themes with the largest relative increase were LGBTQ (lesbian, gay, bisexual, transgender, and queer; 1676%; 2010: 12/2328, 0.51%; 2019: 149/1627, 9.16%) and social determinants of health (958%; 2010: 68/2328, 2.92%; 2019: 503/1627, 30.92%). Terms related to homelessness varied geographically from 2010 to 2018, and terms related to equity, health IT, immigration, LGBTQ, oral health, rural, social determinants of health, and substance use showed statistically significant (P<.05) geographic variation in 2018. The largest percentage point increase was for terms related to substance use (2010: 403/2328, 17.31%; 2019: 1149/1627, 70.62%). However, use in themes such as LGBTQ, disability, oral health, and race and ethnicity ranked lower than public interest in these topics, and some increased mentions of themes were to explicitly say that no action was taken. Conclusions: Hospital reporting entities demonstrate an increasing awareness of health equity and disparities in community benefit tax documentation, but these do not necessarily correspond with general population interests or additional action. We propose further investigation of alignment with community health needs assessments and make suggestions for improvements to F990H reporting requirements. UR - https://www.jmir.org/2023/1/e44330 UR - http://dx.doi.org/10.2196/44330 UR - http://www.ncbi.nlm.nih.gov/pubmed/37223985 ID - info:doi/10.2196/44330 ER - TY - JOUR AU - Woolley, E. Katherine AU - Bright, Diana AU - Ayres, Toby AU - Morgan, Fiona AU - Little, Kirsty AU - Davies, R. Alisha PY - 2023/4/28 TI - Mapping Inequities in Digital Health Technology Within the World Health Organization?s European Region Using PROGRESS PLUS: Scoping Review JO - J Med Internet Res SP - e44181 VL - 25 KW - digital health KW - health inequities KW - PROGRESS PLUS KW - health services accessibility KW - health care disparities KW - mobile phone N2 - Background: The use of digital technologies within health care rapidly increased as services transferred to web-based platforms during the COVID-19 pandemic. Inequalities in digital health across the domains of equity are not routinely examined; yet, the long-term integration of digitally delivered services needs to consider such inequalities to ensure equitable benefits. Objective: This scoping review aimed to map inequities in access, use, and engagement with digital health technologies across equity domains. Methods: We searched 4 electronic databases (MEDLINE, ASSIA, PsycINFO, and Scopus) for quantitative and mixed methods reviews and meta-analyses published between January 2016 and May 2022. Reviews were limited to those that included studies from the World Health Organization?s European region. Extracted data were mapped against Cochrane?s PROGRESS PLUS (place of residence, race, ethnicity, culture, and language, occupation, gender and sex, religion, education, socioeconomic status, social capital, and other characteristics) dimensions of equity. Results: In total, 404 unique citations were identified from the searches, and 2 citations were identified from other sources. After eligibility assessment, 22 reviews were included. Consistent evidence was found showing higher access to digital health technologies among patients who were of White ethnicity, were English speaking, and had no disability. There were no reviews that explored differences in access to digital health care by age, gender and sex, occupation, education, or homeless or substance misuse. Higher use of digital health technologies was observed among populations that were White, English speaking, younger, with a higher level of education, of higher economic status, and residents in urban areas. No clear evidence of differences in the use of digital technologies by occupation, gender and sex, disability, or homeless or substance misuse was found, nor was clear evidence found in the included reviews on inequalities in the engagement with digital technologies. Finally, no reviews were identified that explored differences by place of residence. Conclusions: Despite awareness of the potential impact of inequalities in digital health, there are important evidence gaps across multiple equity domains. The development of a common framework for evaluating digital health equity in new health initiatives and consistency in reporting findings is needed. UR - https://www.jmir.org/2023/1/e44181 UR - http://dx.doi.org/10.2196/44181 UR - http://www.ncbi.nlm.nih.gov/pubmed/37115613 ID - info:doi/10.2196/44181 ER - TY - JOUR AU - Ruiz, Sienna AU - Okere, Charles Uzoma AU - Eggers, Michelle AU - O'Leary, Catina AU - Politi, Mary AU - Wan, Fei AU - Housten, J. Ashley PY - 2023/4/27 TI - Eliciting Opinions on Health Messaging During the COVID-19 Pandemic: Qualitative Survey Study JO - JMIR Hum Factors SP - e39697 VL - 10 KW - COVID-19 KW - health messaging KW - rural populations KW - urban populations KW - communication KW - health information KW - messaging KW - dissemination KW - health equity KW - prevention KW - implementation N2 - Background: Effective public health messaging has been necessary throughout the COVID-19 pandemic, but stakeholders have struggled to communicate critical information to the public, especially in different types of locations such as urban and rural areas. Objective: This study aimed to identify opportunities to improve COVID-19 messages for community distribution in rural and urban settings and to summarize the findings to inform future messaging. Methods: We purposively sampled by region (urban or rural) and participant type (general public or health care professional) to survey participants about their opinions on 4 COVID-19 health messages. We designed open-ended survey questions and analyzed the data using pragmatic health equity implementation science approaches. Following the qualitative analysis of the survey responses, we designed refined COVID-19 messages incorporating participant feedback and redistributed them via a short survey. Results: In total, 67 participants consented and enrolled: 31 (46%) community participants from the rural Southeast Missouri Bootheel, 27 (40%) community participants from urban St Louis, and 9 (13%) health care professionals from St Louis. Overall, we found no qualitative differences between the responses of our urban and rural samples to the open-ended questions. Participants across groups wanted familiar COVID-19 protocols, personal choice in COVID-19 preventive behaviors, and clear source information. Health care professionals contextualized their suggestions within the specific needs of their patients. All groups suggested practices consistent with health-literate communications. We reached 83% (54/65) of the participants for message redistribution, and most had overwhelmingly positive responses to the refined messages. Conclusions: We suggest convenient methods for community involvement in the creation of health messages by using a brief web-based survey. We identified areas of improvement for future health messaging, such as reaffirming the preventive practices advertised early in a crisis, framing messages such that they allow for personal choice of preventive behavior, highlighting well-known source information, using plain language, and crafting messages that are applicable to the readers? circumstances. UR - https://humanfactors.jmir.org/2023/1/e39697 UR - http://dx.doi.org/10.2196/39697 UR - http://www.ncbi.nlm.nih.gov/pubmed/36848256 ID - info:doi/10.2196/39697 ER - TY - JOUR AU - Torous, John AU - Benson, M. Nicole AU - Myrick, Keris AU - Eysenbach, Gunther PY - 2023/4/24 TI - Focusing on Digital Research Priorities for Advancing the Access and Quality of Mental Health JO - JMIR Ment Health SP - e47898 VL - 10 KW - digital phenotyping KW - mental health KW - depression KW - anxiety KW - smartphone UR - https://mental.jmir.org/2023/1/e47898 UR - http://dx.doi.org/10.2196/47898 UR - http://www.ncbi.nlm.nih.gov/pubmed/37093624 ID - info:doi/10.2196/47898 ER - TY - JOUR AU - Monteith, Hiliary AU - Hiscock, Claire Elizabeth AU - Sadeghi, Yasamin AU - Smith, V. Emily AU - Mashford-Pringle, Angela PY - 2023/4/21 TI - Indigenous Food Systems Changes and Resiliency: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e41627 VL - 12 KW - Indigenous KW - food systems KW - Indigenous health KW - scoping review KW - traditional foods KW - colonization KW - climate change KW - pollution KW - environment N2 - Background: Indigenous food systems (IFS) consider the complex relationships and connections between land, animals, plants, water, and people. These food systems may differ between regions, Indigenous cultures, and history; however, given the similar colonial histories and policies influencing Indigenous groups in Canada, the United States, Australia, and Aotearoa (New Zealand), the IFS changes and responses in these regions may follow similar trends. Climate change and pollution continue to impact the environment in catastrophic ways, and this, in turn, impacts IFS. However, to date, there has been no review of the literature on IFS, how they are changing, and how communities are responding to these changes. Objective: In this scoping review, we will summarize primary research in Canada, the United States, Australia, and Aotearoa related to IFS addressing the following questions: (1) What changes are IFS experiencing in the context of climate change and pollution? (2) What actions have been taken in response to IFS changes? (3) What are the characteristics of IFS research in peer-reviewed academic literature? Methods: We will use the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews and the Joanna Briggs Institute reviewer?s manual to inform the review process. MEDLINE, SCOPUS, International Bibliography of the Social Sciences, Sociological Abstracts, and the Bibliography of Native North Americans are the databases included in this review search. All screening and extraction have been supported by Covidence software (Veritas Health Innovation) with 2 independent reviewers conducting the abstract and full-text screening. We will map concepts and themes related to the research questions to contribute to the understanding of IFS within the academic literature and provide a narrative review of the outcomes. Results: The electronic database searches for this review were conducted in May 2021. Screening and full-text review were initially completed in the winter of 2022. We are currently in the process of compiling results and aim to share findings in 2023. Conclusions: This review will provide valuable insight into current IFS needs by summarizing the peer-reviewed literature on how IFS are changing because of climate change and pollution and how communities are responding to these changes. The results of this review will be shared with Indigenous communities, through academic publications, community conversations, and conference presentations. Trial Registration: OSF Registries osf.io/xrj87; https://osf.io/xrj87 International Registered Report Identifier (IRRID): RR1-10.2196/41627 UR - https://www.researchprotocols.org/2023/1/e41627 UR - http://dx.doi.org/10.2196/41627 UR - http://www.ncbi.nlm.nih.gov/pubmed/37083598 ID - info:doi/10.2196/41627 ER - TY - JOUR AU - Koschollek, Carmen AU - Zeisler, Marie-Luise AU - Houben, A. Robin AU - Geerlings, Julia AU - Kajikhina, Katja AU - Bug, Marleen AU - Blume, Miriam AU - Hoffmann, Robert AU - Hintze, Marcel AU - Kuhnert, Ronny AU - Gößwald, Antje AU - Schmich, Patrick AU - Hövener, Claudia PY - 2023/4/12 TI - German Health Update Fokus (GEDA Fokus) among Residents with Croatian, Italian, Polish, Syrian, or Turkish Citizenship in Germany: Protocol for a Multilingual Mixed-Mode Interview Survey JO - JMIR Res Protoc SP - e43503 VL - 12 KW - migration KW - interview survey KW - hard-to-survey KW - health inequalities KW - mixed-mode KW - multilingual N2 - Background: Germany has a long history of migration. In 2020, more than 1 person in every 4 people had a statistically defined, so-called migration background in Germany, meaning that the person or at least one of their parents was born with a citizenship other than German citizenship. People with a history of migration are not represented proportionately to the population within public health monitoring at the Robert Koch Institute, thus impeding differentiated analyses of migration and health. To develop strategies for improving the inclusion of people with a history of migration in health surveys, we conducted a feasibility study in 2018. The lessons learned were implemented in the health interview survey German Health Update (Gesundheit in Deutschland aktuell [GEDA]) Fokus, which was conducted among people with selected citizenships representing the major migrant groups in Germany. Objective: GEDA Fokus aimed to collect comprehensive data on the health status and social, migration-related, and structural factors among people with selected citizenships to enable differentiated explanations of the associations between migration-related aspects and their impact on migrant health. Methods: GEDA Fokus is an interview survey among people with Croatian, Italian, Polish, Syrian, or Turkish citizenship living in Germany aged 18-79 years, with a targeted sample size of 1200 participants per group. The gross sample of 33,436 people was drawn from the residents? registration offices of 99 German municipalities based on citizenship. Sequentially, multiple modes of administration were offered. The questionnaire was available for self-administration (web-based and paper-based); in larger municipalities, personal or phone interviews were possible later on. Study documents and the questionnaire were bilingual?in German and the respective translation language depending on the citizenship. Data were collected from November 2021 to May 2022. Results: Overall, 6038 respondents participated in the survey, of whom 2983 (49.4%) were female. The median age was 39 years; the median duration of residence in Germany was 10 years, with 19.69% (1189/6038) of the sample being born in Germany. The overall response rate was 18.4% (American Association for Public Opinion Research [AAPOR] response rate 1) and was 6.8% higher in the municipalities where personal interviews were offered (19.3% vs 12.5%). Overall, 78.12% (4717/6038) of the participants self-administered the questionnaire, whereas 21.88% (1321/6038) took part in personal interviews. In total, 41.85% (2527/6038) of the participants answered the questionnaire in the German language only, 16.69% (1008/6038) exclusively used the translation. Conclusions: Offering different modes of administration, as well as multiple study languages, enabled us to recruit a heterogeneous sample of people with a history of migration. The data collected will allow differentiated analyses of the role and interplay of migration-related and social determinants of health and their impact on the health status of people with selected citizenships. International Registered Report Identifier (IRRID): DERR1-10.2196/43503 UR - https://www.researchprotocols.org/2023/1/e43503 UR - http://dx.doi.org/10.2196/43503 UR - http://www.ncbi.nlm.nih.gov/pubmed/36790192 ID - info:doi/10.2196/43503 ER - TY - JOUR AU - Jackson, Malia Alexandra AU - Woo, Juhee AU - Olson, Marley AU - Dalisay, Francis AU - Pokhrel, Pallav AU - Muller, J. Clemma AU - Okamoto, K. Scott PY - 2023/3/30 TI - Methodological Challenges in Web-Based Qualitative Research With Medically Underserved Populations JO - J Med Internet Res SP - e44086 VL - 25 KW - data collection KW - internet KW - mischievous responders KW - recruitment KW - qualitative KW - technology UR - https://www.jmir.org/2023/1/e44086 UR - http://dx.doi.org/10.2196/44086 UR - http://www.ncbi.nlm.nih.gov/pubmed/36995748 ID - info:doi/10.2196/44086 ER - TY - JOUR AU - Park, Minah AU - Yun, Choa AU - Joo, Hong Jae AU - Kang, Hyun Soo AU - Jeong, Hoon Sung AU - Nam, Chung-Mo AU - Park, Eun-Cheol AU - Han, Yoondae AU - Jang, In Sung PY - 2023/3/30 TI - Regional Differences in Medical Costs of Chronic Kidney Disease in the South Korean Population: Marginalized Two-Part Model JO - JMIR Public Health Surveill SP - e39904 VL - 9 KW - chronic kidney disease KW - cost analysis KW - medical expenses KW - medically vulnerable regions KW - kidney KW - public health KW - cost KW - economic KW - chronic disease KW - insurance KW - regional KW - longitudinal model N2 - 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. UR - https://publichealth.jmir.org/2023/1/e39904 UR - http://dx.doi.org/10.2196/39904 UR - http://www.ncbi.nlm.nih.gov/pubmed/36995749 ID - info:doi/10.2196/39904 ER - TY - JOUR AU - Drazich, F. Brittany AU - Lee, Won Ji AU - Bowles, H. Kathryn AU - Taylor, L. Janiece AU - Shah, Shivani AU - Resnick, Barbara AU - Kim, Nayeon AU - Szanton, L. Sarah PY - 2023/3/29 TI - Pandemic-Related Changes in Technology Use Among a Sample of Previously Hospitalized Older Adult New Yorkers: Observational Study JO - JMIR Aging SP - e41692 VL - 6 KW - older adults KW - technology KW - COVID-19 KW - well-being KW - elderly population KW - technology use KW - physical disability KW - virtual health KW - social interaction KW - digital gaming KW - digital learning N2 - Background: The COVID-19 pandemic increased the importance of technology for all Americans, including older adults. Although a few studies have indicated that older adults might have increased their technology use during the COVID-19 pandemic, further research is needed to confirm these findings, especially among different populations, and using validated surveys. In particular, research on changes in technology use among previously hospitalized community-dwelling older adults, especially those with physical disability, is needed because older adults with multimorbidity and hospital associated deconditioning were a population greatly impacted by COVID-19 and related distancing measures. Obtaining knowledge regarding previously hospitalized older adults? technology use, before and during the pandemic, could inform the appropriateness of technology-based interventions for vulnerable older adults. Objective: In this paper, we 1) described changes in older adult technology-based communication, technology-based phone use, and technology-based gaming during the COVID-19 pandemic, compared to before the COVID-19 pandemic and 2) tested whether technology use moderated the association between changes in in-person visits and well-being, controlling for covariates. Methods: Between December 2020 and January 2021 we conducted a telephone-based objective survey with 60 previously hospitalized older New Yorkers with physical disability. We measured technology-based communication through three questions pulled from the National Health and Aging Trends Study COVID-19 Questionnaire. We measured technology-based smart phone use and technology-based video gaming through the Media Technology Usage and Attitudes Scale. We used paired t tests and interaction models to analyze survey data. Results: This sample of previously hospitalized older adults with physical disability consisted of 60 participants, 63.3% of whom identified as female, 50.0% of whom identified as White, and 63.8% of whom reported an annual income of $25,000 or less. This sample had not had physical contact (such as friendly hug or kiss) for a median of 60 days and had not left their home for a median of 2 days. The majority of older adults from this study reported using the internet, owning smart phones, and nearly half learned a new technology during the pandemic. During the pandemic, this sample of older adults significantly increased their technology-based communication (mean difference=.74, P=.003), smart phone use (mean difference=2.9, P=.016), and technology-based gaming (mean difference=.52, P=.030). However, this technology use during the pandemic did not moderate the association between changes in in-person visits and well-being, controlling for covariates. Conclusions: These study findings suggest that previously hospitalized older adults with physical disability are open to using or learning technology, but that technology use might not be able to replace in-person social interactions. Future research might explore the specific components of in-person visits that are missing in virtual interactions, and if they could be replicated in the virtual environment, or through other means. UR - https://aging.jmir.org/2023/1/e41692 UR - http://dx.doi.org/10.2196/41692 UR - http://www.ncbi.nlm.nih.gov/pubmed/36881528 ID - info:doi/10.2196/41692 ER - TY - JOUR AU - Perkes, Jane Sarah AU - Bonevski, Billie AU - Hall, Kerry AU - Mattes, Joerg AU - Chamberlain, Catherine AU - Bennett, Jessica AU - Whittaker, Robyn AU - Palazzi, Kerrin AU - Lambkin, David AU - Kennedy, Michelle PY - 2023/3/6 TI - Aboriginal and Torres Strait Islander Women?s Access to and Interest in mHealth: National Web-based Cross-sectional Survey JO - J Med Internet Res SP - e42660 VL - 25 KW - mHealth KW - Aboriginal KW - Torres Strait Islander KW - public health KW - health literacy KW - digital literacy KW - Australia KW - native KW - cross-sectional KW - national survey KW - technology use KW - technology ownership KW - digital device KW - mobile device KW - usage KW - adoption KW - acceptance KW - digital divide N2 - Background: Health programs delivered through digital devices such as mobile phones (mobile health [mHealth]) have become an increasingly important component of the health care tool kit. Aboriginal and Torres Strait Islander women of reproductive age are likely to be caring for children and family members and needing health care, but little is known about their access to and interest in mHealth. Objective: The objectives of this study were to investigate Aboriginal and Torres Strait Islander women?s ownership of digital devices, access to the internet, current mHealth use, and interest and preferences for future mHealth. We examined the factors (age, remoteness, caring for a child younger than 5 years, and level of education) associated with the ownership of digital devices, use of internet, and interest in using a mobile phone to improve health. This study also examines if women are more likely to use mHealth for topics that they are less confident to talk about face-to-face with a health professional. Methods: A national web-based cross-sectional survey targeting Aboriginal and Torres Strait Islander women of reproductive age (16-49 years) was performed. Descriptive statistics were reported, and logistic regressions were used to examine the associations. Results: In total, 379 women completed the survey; 89.2% (338/379) owned a smartphone, 53.5% (203/379) a laptop or home computer, 35.6% (135/379) a tablet, and 93.1% (353/379) had access to the internet at home. Most women used social media (337/379, 88.9%) or the internet (285/379, 75.2%) everyday. The most common modality used on the mobile phone for health was Google (232/379, 61.2%), followed by social media (195/379, 51.5%). The most preferred modality for future programs was SMS text messaging (211/379, 55.7%) and social media (195/379, 51.4%). The most preferred topics for future mHealth programs were healthy eating (210/379, 55.4%) and cultural engagement (205/379, 54.1%). Women who were younger had greater odds of owning a smartphone, and women with tertiary education were more likely to own a tablet or laptop. Older age was associated with interest to use telehealth, and higher educational attainment was associated with interest for videoconferencing. Most women (269/379, 70.9%) used an Aboriginal medical service and overall reported high rates of confidence to discuss health topics with a health professional. Overall, women showed a similar likelihood of selecting a topic in mHealth whether they were or were not confident to talk to a health professional about that. Conclusions: Our study found that Aboriginal and Torres Strait Islander women were avid users of the internet and had strong interest in mHealth. Future mHealth programs for these women should consider utilizing SMS text messaging and social media modalities and including content on nutrition and culture. A noteworthy limitation of this study was that participant recruitment was web-based (due to COVID-19 restrictions). UR - https://www.jmir.org/2023/1/e42660 UR - http://dx.doi.org/10.2196/42660 UR - http://www.ncbi.nlm.nih.gov/pubmed/36877565 ID - info:doi/10.2196/42660 ER - TY - JOUR AU - Miller, John AU - Ioffreda, Patrick AU - Nugent, Shannon AU - Jones, Elizabeth PY - 2023/2/28 TI - Demographic Data Associated With Digital Inequity Reported in Patient-to-Provider Teledermatology Studies in the United States From 2011 to 2021: Scoping Review JO - JMIR Dermatol SP - e43983 VL - 6 KW - teledermatology KW - equity KW - inequity KW - scoping review KW - digital divide KW - dermatology KW - racial minority KW - ethnic minority KW - digital inequity KW - patient care KW - COVID-19 N2 - Background: Patient-to-provider teledermatology relies on a patient?s access to technology to ensure a successful visit. However, access to broadband internet and technology varies across populations in the United States?leading to the digital divide. While teledermatology has been recognized as a model to improve access, little is known about how often demographic data associated with digital inequity are captured in studies. Objective: Given the expansion of teledermatology over the past decade, we sought to determine how often demographic data associated with digital inequity are reported in patient-to-provider teledermatology studies. Methods: A scoping literature review search was conducted using the search term teledermatology in the following databases: PubMed, Embase, and the Cochrane Database of Systematic Reviews. All studies published between December 31, 2011, and December 31, 2021, that evaluated patient-to-provider teledermatology were eligible. Results: In total, 1412 publications describing teledermatology were identified, of which 46 met the inclusion criteria. Race or ethnicity was the most frequently reported demographic characteristic (28/46, 61%). However, only 41% (19/46) of studies were representative of race or ethnicity, defined as including >20% nonwhite participants. Studies rarely reported the number of participants greater than 65 years of age (14/46, 30%), preferred language (9/46, 20%), income (6/46, 13%), highest level of education (5/46, 11%), or access to a device (4/46, 9%). Studies conducted after the onset of the COVID-19 pandemic were significantly more likely to report preferred language (9/25, 36% vs 0%; P=.002) and appeared more likely to report other demographic data associated with digital inequity, without reaching statistical significance (P>.05). Conclusions: Demographic data associated with digital inequity are rarely reported in patient-to-provider teledermatology studies to date. These studies frequently lack adequate representation of racial and ethnic minorities. With increased calls for equitable representation in dermatology studies, future teledermatology studies can improve the reporting of race and ethnicity and consider demographic data associated with digital inequity as an important criterion in research design. UR - https://derma.jmir.org/2023/1/e43983 UR - http://dx.doi.org/10.2196/43983 UR - http://www.ncbi.nlm.nih.gov/pubmed/36938315 ID - info:doi/10.2196/43983 ER - TY - JOUR AU - Bazzano, N. Alessandra AU - Noel, Lesley-Ann AU - Patel, Tejal AU - Dominique, Chantel C. AU - Haywood, Catherine AU - Moore, Shenitta AU - Mantsios, Andrea AU - Davis, A. Patricia PY - 2023/2/28 TI - Improving the Engagement of Underrepresented People in Health Research Through Equity-Centered Design Thinking: Qualitative Study and Process Evaluation for the Development of the Grounding Health Research in Design Toolkit JO - JMIR Form Res SP - e43101 VL - 7 KW - health equity KW - patient participation KW - health behavior KW - universal design KW - human-centered design KW - COVID-19 N2 - Background: Health inequalities are rooted in historically unjust differences in economic opportunities, environment, access to health care services, and other social determinants. Owing to these health inequalities, the COVID-19 pandemic has disproportionately affected underserved populations, notably people of color, incarcerated and formerly incarcerated individuals, and those unable to physically distance themselves from others. However, people most strongly impacted by health disparities, and the pandemic, are not frequently engaged in research, either as researchers or as participants, resulting in slow progress toward improving health equity. Establishing ways to foster the engagement of historically excluded people is crucial to improving health equity through patient-centered health research. Objective: This study aimed to assess the use of equity-centered design thinking (EDT) for engaging community members in research prioritization related to COVID-19. The co-design methods and subsequent production of a toolkit that can be used for engagement were assessed through process evaluation and qualitative methods. Methods: Process evaluation and qualitative inquiry, using reflexive thematic analysis, were undertaken to examine the use of EDT. Patient community members and stakeholders remotely partnered with design and health researchers in a year-long digital process to cocreate capacity-building tools for setting agenda for research regarding the impact of COVID-19 on health outcomes. Through a series of 3 workshops, 5 community partners engaged in EDT activities to identify critical challenges for the health and well-being of their communities. The subsequent tools were tested with 10 health researchers who provided critical input over the course of 2 workshops. Interviews with co-designers, project materials, and feedback sessions were used in the process evaluation and finalization of an equity-centered toolkit for community engagement in research. Data from the co-design process, meetings, workshops, and interviews were analyzed using reflexive thematic analysis to identify salient themes. Results: Process evaluation illustrated how the EDT co-design process offered an approach to engage patient partners and community stakeholders in health-related research around COVID-19. The participants expressed satisfaction with design thinking approaches, including creative activities and iterative co-design, as a means of working together. Thematic analysis identified 3 key themes: the value of authentic partnerships, building trust and empathy through design, and fostering candid dialogue around health and social issues impacting historically underrepresented and underinvested communities. Conclusions: The project addressed the need to test EDT strategies for fostering inclusive community engagement in health research agenda setting and provided an alternative to traditional top-down models. Despite the increasing use of human-centered design in health, few projects explicitly include equity in design thinking approaches. The use of methods and tools to intentionally engage underrepresented stakeholders in the process of research agenda setting and equitably sharing power between researchers and community members may improve health research, ultimately improving health equity. UR - https://formative.jmir.org/2023/1/e43101 UR - http://dx.doi.org/10.2196/43101 UR - http://www.ncbi.nlm.nih.gov/pubmed/36649162 ID - info:doi/10.2196/43101 ER - TY - JOUR AU - Turin, C. Tanvir AU - Subroto, Sujoy AU - Raihan, H. Mohammad M. AU - Koch, Katharina AU - Wiles, Robert AU - Ruttan, Erin AU - Nesset, Monique AU - Chowdhury, Nashit PY - 2022/12/8 TI - Identifying Challenges, Enabling Practices, and Reviewing Existing Policies Regarding Digital Equity and Digital Divide Toward Smart and Healthy Cities: Protocol for an Integrative Review JO - JMIR Res Protoc SP - e40068 VL - 11 IS - 12 KW - healthy city KW - smart city KW - digital equity KW - digital divide KW - digital literacy KW - equity KW - urban community KW - inequality KW - urban area KW - challenges KW - barriers KW - participation KW - social interaction KW - structural inequality N2 - Background: Digital equity denotes that all individuals and communities have equitable access to the information technology required to participate in digital life and can fully capitalize on this technology for their individual and community gain and benefits. Recent research highlighted that COVID-19 heightened the existing structural inequities and further exacerbated the technology-related social divide, especially for racialized communities, including new immigrants, refugees, and ethnic minorities. The intersection of challenges associated with racial identity (eg, racial discrimination and cultural differences), socioeconomic marginalization, and age- and gender-related barriers affects their access to health and social services, education, economic activity, and social life owing to digital inequity. Objective: Our aim is to understand the current state of knowledge on digital equity and the digital divide (which is often considered a complex social-political challenge) among racialized communities in urban cities of high-income countries and how they impact the social interactions, economic activities, and mental well-being of racialized city dwellers. Methods: We will conduct an integrative review adapting the Whittemore and Knafl methodology to summarize past empirical or theoretical literature describing digital equity issues pertaining to urban racialized communities. The context will be limited to studies on multicultural cities in high-income countries (eg, Calgary, Alberta) in the last 10 years. We will use a comprehensive search of 8 major databases across multiple disciplines and gray literature (eg, Google Scholar), using appropriate search terms related to digital ?in/equity? and ?divide.? A 2-stage screening will be conducted, including single citation tracking and a hand search of reference lists. Results will be synthesized using thematic analysis guidelines. Results: As of August 25, 2022, we have completed a systematic search of 8 major academic databases from multiple disciplines, gray literature, and citation or hand searching. After duplicate removal, we identified 8647 articles from all sources. Two independent reviewers are expected to complete the 2-step screening (title, abstract, and full-text screening) using Covidence followed by data extraction and analysis in 4 months (by December 2022). Data will be extracted regarding digital equity?related initiatives, programs, activities, research findings, issues, barriers, policies, recommendations, etc. Thematic analysis will reveal how barriers and facilitators of digital equity affect or benefit racialized population groups and what social, material, and systemic issues need to be addressed to establish digital equity for racialized communities in the context of a multicultural city. Conclusions: This project will inform public policy about digital inequity alongside conventional systemic inequities (eg, education and income levels); promote digital equity by exploring and examining the pattern, extent, and determinants and barriers of digital inequity across sociodemographic variables and groups; and analyze its interconnectedness with spatial dimensions and variations of the urban sphere (geographic differences). International Registered Report Identifier (IRRID): DERR1-10.2196/40068 UR - https://www.researchprotocols.org/2022/12/e40068 UR - http://dx.doi.org/10.2196/40068 UR - http://www.ncbi.nlm.nih.gov/pubmed/36480264 ID - info:doi/10.2196/40068 ER - TY - JOUR AU - Husain, Laiba AU - Greenhalgh, Trisha AU - Hughes, Gemma AU - Finlay, Teresa AU - Wherton, Joseph PY - 2022/12/7 TI - Desperately Seeking Intersectionality in Digital Health Disparity Research: Narrative Review to Inform a Richer Theorization of Multiple Disadvantage JO - J Med Internet Res SP - e42358 VL - 24 IS - 12 KW - digital health disparities KW - video consultations KW - intersectionality KW - health inequity KW - narrative review KW - digital capital KW - fundamental cause theory KW - mobile phone N2 - Background: Digital consultations between patients and clinicians increased markedly during the COVID-19 pandemic, raising questions about equity. Objective: This study aimed to review the literature on how multiple disadvantage?specifically, older age, lower socioeconomic status, and limited English proficiency?has been conceptualized, theorized, and studied empirically in relation to digital consultations. We focused mainly on video consultations as they have wider disparities than telephone consultations and relevant data on e-consultations are sparse. Methods: Using keyword and snowball searching, we identified relevant papers published between 2012 and 2022 using Ovid MEDLINE, Web of Science, Google Scholar, and PubMed. The first search was completed in July 2022. Papers meeting the inclusion criteria were analyzed thematically and summarized, and their key findings were tabulated using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative Research criteria. Explanations for digital disparities were critically examined, and a search was undertaken in October 2022 to identify theoretical lenses on multiple disadvantage. Results: Of 663 articles from the initial search, 27 (4.1%) met our inclusion criteria. In total, 37% (10/27) were commentaries, and 63% (17/27) were peer-reviewed empirical studies (11/27, 41% quantitative; 5/27, 19% qualitative; 1/27, 4% mixed methods; 1/27, 4% systematic reviews; and 1/27, 4% narrative reviews). Empirical studies were mostly small, rapidly conducted, and briefly reported. Most studies (25/27, 93%) identified marked digital disparities but lacked a strong theoretical lens. Proposed solutions focused on identifying and removing barriers, but the authors generally overlooked the pervasive impact of multiple layers of disadvantage. The data set included no theoretically informed studies that examined how different dimensions of disadvantage combined to affect digital health disparities. In our subsequent search, we identified 3 theoretical approaches that might help account for these digital disparities. Fundamental cause theory by Link and Phelan addresses why the association between socioeconomic status and health is pervasive and persists over time. Digital capital theory by Ragnedda and Ruiu explains how people mobilize resources to participate in digitally mediated activities and services. Intersectionality theory by Crenshaw states that systems of oppression are inherently bound together, creating singular social experiences for people who bear the force of multiple adverse social structures. Conclusions: A limitation of our initial sample was the sparse and undertheorized nature of the primary literature. The lack of attention to how digital health disparities emerge and play out both within and across categories of disadvantage means that solutions proposed to date may be oversimplistic and insufficient. Theories of multiple disadvantage have bearing on digital health, and there may be others of relevance besides those discussed in this paper. We call for greater interdisciplinary dialogue between theoretical research on multiple disadvantage and empirical studies on digital health disparities. UR - https://www.jmir.org/2022/12/e42358 UR - http://dx.doi.org/10.2196/42358 UR - http://www.ncbi.nlm.nih.gov/pubmed/36383632 ID - info:doi/10.2196/42358 ER - TY - JOUR AU - Weeks, Rose AU - White, Sydney AU - Hartner, Anna-Maria AU - Littlepage, Shea AU - Wolf, Jennifer AU - Masten, Kristin AU - Tingey, Lauren PY - 2022/11/25 TI - COVID-19 Messaging on Social Media for American Indian and Alaska Native Communities: Thematic Analysis of Audience Reach and Web Behavior JO - JMIR Infodemiology SP - e38441 VL - 2 IS - 2 KW - COVID-19 KW - American Indian or Alaska Native KW - social media KW - communication KW - tribal organization KW - community health KW - infodemiology KW - Twitter KW - online behavior KW - content analysis KW - thematic analysis N2 - Background: During the COVID-19 pandemic, tribal and health organizations used social media to rapidly disseminate public health guidance highlighting protective behaviors such as masking and vaccination to mitigate the pandemic?s disproportionate burden on American Indian and Alaska Native (AI/AN) communities. Objective: Seeking to provide guidance for future communication campaigns prioritizing AI/AN audiences, this study aimed to identify Twitter post characteristics associated with higher performance, measured by audience reach (impressions) and web behavior (engagement rate). Methods: We analyzed Twitter posts published by a campaign by the Johns Hopkins Center for Indigenous Health from July 2020 to June 2021. Qualitative analysis was informed by in-depth interviews with members of a Tribal Advisory Board and thematically organized according to the Health Belief Model. A general linearized model was used to analyze associations between Twitter post themes, impressions, and engagement rates. Results: The campaign published 162 Twitter messages, which organically generated 425,834 impressions and 6016 engagements. Iterative analysis of these Twitter posts identified 10 unique themes under theory- and culture-related categories of framing knowledge, cultural messaging, normalizing mitigation strategies, and interactive opportunities, which were corroborated by interviews with Tribal Advisory Board members. Statistical analysis of Twitter impressions and engagement rate by theme demonstrated that posts featuring culturally resonant community role models (P=.02), promoting web-based events (P=.002), and with messaging as part of Twitter Chats (P<.001) were likely to generate higher impressions. In the adjusted analysis controlling for the date of posting, only the promotion of web-based events (P=.003) and Twitter Chat messaging (P=.01) remained significant. Visual, explanatory posts promoting self-efficacy (P=.01; P=.01) and humorous posts (P=.02; P=.01) were the most likely to generate high?engagement rates in both the adjusted and unadjusted analysis. Conclusions: Results from the 1-year Twitter campaign provide lessons to inform organizations designing social media messages to reach and engage AI/AN social media audiences. The use of interactive events, instructional graphics, and Indigenous humor are promising practices to engage community members, potentially opening audiences to receiving important and time-sensitive guidance. UR - https://infodemiology.jmir.org/2022/2/e38441 UR - http://dx.doi.org/10.2196/38441 UR - http://www.ncbi.nlm.nih.gov/pubmed/36471705 ID - info:doi/10.2196/38441 ER - TY - JOUR AU - Hendricks-Sturrup, Rachele AU - Nafie, Maryam AU - Lu, Christine PY - 2022/10/26 TI - Practical Considerations and Recommendations for ?a Revised Hippocratic Oath for the Era of Digital Health? JO - J Med Internet Res SP - e43383 VL - 24 IS - 10 KW - digital health KW - Hippocratic Oath KW - eHealth KW - ethics KW - digital divide UR - https://www.jmir.org/2022/10/e43383 UR - http://dx.doi.org/10.2196/43383 UR - http://www.ncbi.nlm.nih.gov/pubmed/36287597 ID - info:doi/10.2196/43383 ER - TY - JOUR AU - Meskó, Bertalan AU - Spiegel, Brennan PY - 2022/9/7 TI - A Revised Hippocratic Oath for the Era of Digital Health JO - J Med Internet Res SP - e39177 VL - 24 IS - 9 KW - hippocratic oath KW - digital health KW - eHealth KW - future KW - automation KW - ethics KW - viewpoint KW - medical perspective KW - physician perspective KW - ethical KW - digital divide KW - artificial intelligence KW - moral UR - https://www.jmir.org/2022/9/e39177 UR - http://dx.doi.org/10.2196/39177 UR - http://www.ncbi.nlm.nih.gov/pubmed/36069845 ID - info:doi/10.2196/39177 ER - TY - JOUR AU - Brakefield, S. Whitney AU - Olusanya, A. Olufunto AU - Shaban-Nejad, Arash PY - 2022/8/9 TI - Association Between Neighborhood Factors and Adult Obesity in Shelby County, Tennessee: Geospatial Machine Learning Approach JO - JMIR Public Health Surveill SP - e37039 VL - 8 IS - 8 KW - obesity KW - obesity surveillance KW - disease surveillance KW - machine learning KW - geographic information systems KW - social determinants of health KW - SDOH KW - disparities N2 - Background: Obesity is a global epidemic causing at least 2.8 million deaths per year. This complex disease is associated with significant socioeconomic burden, reduced work productivity, unemployment, and other social determinants of health (SDOH) disparities. Objective: The objective of this study was to investigate the effects of SDOH on obesity prevalence among adults in Shelby County, Tennessee, the United States, using a geospatial machine learning approach. Methods: Obesity prevalence was obtained from the publicly available 500 Cities database of Centers for Disease Control and Prevention, and SDOH indicators were extracted from the US census and the US Department of Agriculture. We examined the geographic distributions of obesity prevalence patterns, using Getis-Ord Gi* statistics and calibrated multiple models to study the association between SDOH and adult obesity. Unsupervised machine learning was used to conduct grouping analysis to investigate the distribution of obesity prevalence and associated SDOH indicators. Results: Results depicted a high percentage of neighborhoods experiencing high adult obesity prevalence within Shelby County. In the census tract, the median household income, as well as the percentage of individuals who were Black, home renters, living below the poverty level, 55 years or older, unmarried, and uninsured, had a significant association with adult obesity prevalence. The grouping analysis revealed disparities in obesity prevalence among disadvantaged neighborhoods. Conclusions: More research is needed to examine links between geographical location, SDOH, and chronic diseases. The findings of this study, which depict a significantly higher prevalence of obesity within disadvantaged neighborhoods, and other geospatial information can be leveraged to offer valuable insights, informing health decision-making and interventions that mitigate risk factors of increasing obesity prevalence. UR - https://publichealth.jmir.org/2022/8/e37039 UR - http://dx.doi.org/10.2196/37039 UR - http://www.ncbi.nlm.nih.gov/pubmed/35943795 ID - info:doi/10.2196/37039 ER - TY - JOUR AU - Bonnell, Jarvis Tyler AU - Revere, Debra AU - Baseman, Janet AU - Hills, Rebecca AU - Karras, Thomas Bryant PY - 2022/8/3 TI - Equity and Accessibility of Washington State?s COVID-19 Digital Exposure Notification Tool (WA Notify): Survey and Listening Sessions Among Community Leaders JO - JMIR Form Res SP - e38193 VL - 6 IS - 8 KW - COVID-19 exposure notifications KW - digital public health KW - health equity KW - mHealth KW - mobile health KW - mHealth equity KW - digital health tool KW - public health KW - surveillance KW - COVID-19 KW - smartphone KW - health inequity KW - sociodemographic factor KW - epidemiology N2 - Background: In November 2020, WA Notify, Washington State?s COVID-19 digital exposure notification tool, was launched statewide to mitigate ongoing COVID-19 transmission. WA Notify uses the Bluetooth proximity?triggered, Google/Apple Exposure Notification Express framework to distribute notifications to users who have added or activated this tool on their smartphones. This smartphone-based tool relies on sufficient population-level activation to be effective; however, little is known about its adoption among communities disproportionately impacted by the COVID-19 pandemic or what barriers might limit its adoption and use among diverse populations. Objective: We sought to (1) conduct a formative exploration of equity-related issues that may influence the access, adoption, and use of WA Notify, as perceived by community leaders of populations disproportionately impacted by the COVID-19 pandemic; and (2) generate recommendations for promoting the equitable access to and impact of this novel intervention for these communities. Methods: We used a 2-step data collection process to gather the perspectives of community leaders across Washington regarding the launch and implementation of WA Notify in their communities. A web-based, brief, and informational survey measured the perceptions of the community-level familiarity and effectiveness of WA Notify at slowing the spread of COVID-19 and identified potential barriers and concerns to accessing and adopting WA Notify (n=17). Semistructured listening sessions were conducted to expand upon survey findings and explore the community-level awareness, barriers, facilitators, and concerns related to activating WA Notify in greater depth (n=13). Results: Our findings overlap considerably with those from previous mobile health equity studies. Digital literacy, trust, information accessibility, and misinformation were highlighted as key determinants of the adoption and use of WA Notify. Although WA Notify does not track users or share data, community leaders expressed concerns about security, data sharing, and personal privacy, which were cited as outweighing the potential benefits to adoption. Both the survey and informational sessions indicated low community-level awareness of WA Notify. Community leaders recommended the following approaches to improve engagement: tailoring informational materials for low-literacy levels, providing technology navigation, describing more clearly that WA Notify can help the community, and using trusted messengers who are already engaged with the communities to communicate about WA Notify. Conclusions: As digital public health tools, such as WA Notify, emerge to address public health problems, understanding the key determinants of adoption and incorporating equity-focused recommendations into the development, implementation, and communication efforts around these tools will be instrumental to their adoption, use, and retention. UR - https://formative.jmir.org/2022/8/e38193 UR - http://dx.doi.org/10.2196/38193 UR - http://www.ncbi.nlm.nih.gov/pubmed/35787520 ID - info:doi/10.2196/38193 ER - TY - JOUR AU - Yang, Keng AU - Hu, Yekang AU - Qi, Hanying PY - 2022/7/6 TI - Digital Health Literacy: Bibliometric Analysis JO - J Med Internet Res SP - e35816 VL - 24 IS - 7 KW - digital health literacy KW - eHealth KW - digital divide KW - bibliometrics KW - VOSviewer KW - CiteSpace N2 - Background: Digital health is growing at a rapid pace, and digital health literacy has attracted increasing attention from the academic community. Objective: The purposes of this study are to conduct a systematic bibliometric analysis on the field of digital health literacy and to understand the research context and trends in this field. Methods: Methods: A total of 1955 scientific publications were collected from the Web of Science core collection. Institutional co-operation, journal co-citation, theme bursting, keyword co-occurrence, author co-operation, author co-citation, literature co-citation, and references in the field of digital health literacy were analyzed using the VOSviewer and CiteSpace knowledge mapping tools. Results: The results demonstrate that the United States has the highest number of publications and citations in this field. The University of California System was first in terms of institutional contributions. The Journal of Medical Internet Research led in the number of publications, citations, and co-citations. Research areas of highly cited articles in the field of digital health literacy mainly include the definition and scale of health literacy, health literacy and health outcomes, health literacy and the digital divide, and the influencing factors of health literacy. Conclusions: We summarized research progress in the field of digital health literacy and reveal the context, trends, and trending topics of digital health literacy research through statistical analysis and network visualization. We found that digital health literacy has a significant potential to improve health outcomes, bridge the digital divide, and reduce health inequalities. Our work can serve as a fundamental reference and directional guide for future research in this field. UR - https://www.jmir.org/2022/7/e35816 UR - http://dx.doi.org/10.2196/35816 UR - http://www.ncbi.nlm.nih.gov/pubmed/35793141 ID - info:doi/10.2196/35816 ER - TY - JOUR AU - Li, Shiyu AU - Yin, Zenong AU - Lesser, Janna AU - Li, Chengdong AU - Choi, Yeob Byeong AU - Parra-Medina, Deborah AU - Flores, Belinda AU - Dennis, Brittany AU - Wang, Jing PY - 2022/5/30 TI - Community Health Worker-Led mHealth-Enabled Diabetes Self-management Education and Support Intervention in Rural Latino Adults: Single-Arm Feasibility Trial JO - JMIR Diabetes SP - e37534 VL - 7 IS - 2 KW - health disparity KW - rural health KW - rural KW - community health worker KW - health education KW - digital health KW - diabetes KW - diabetes management KW - mHealth KW - community health KW - self management KW - mobile health KW - technology feasibility KW - underserved KW - Latino N2 - Background: Latinos living in rural South Texas have a higher prevalence of diabetes, but their access to diabetes self-management education and support (DSMES) is limited. Objective: We aimed to test the feasibility of a community health worker-led, mobile health (mHealth)-based DSMES intervention to reduce disparities in accessing DSMES in underserved rural Latino residents in South Texas. Methods: This 12-week, single-arm, pre-post trial was delivered by trained community health workers to 15 adults with type 2 diabetes. The intervention consisted of digital diabetes education, self-monitoring, a cloud-based connected platform, and community health worker support. Feasibility was evaluated as retention, actual intervention use, program satisfaction, and barriers to implementation. We also explored the intervention?s effect on weight loss and hemoglobin A1c (HbA1c). Results: All 15 participants were Latino (mean age 61.87 years, SD 10.67; 9/15 female, 60%). The retention rate at posttest was 14 of 15 (93%). On average, the participants completed 37 of 42 (88%) digital diabetes education lessons with 8 participants completing all lessons. Participants spent 81/91 days (89%) step tracking, 71/91 days (78%) food logging, 43/91 days (47%) blood glucose self-monitoring, and 74/91 days (81%) weight self-monitoring. The level of program satisfaction was high. On average, participants lost 3.5 (SD 3.2) kg of body weight (P=.001), while HbA1c level remained unchanged from baseline (6.91%, SD 1.28%) to posttest (7.04%, SD 1.66%; P=.668). Conclusions: A community health worker-led mHealth-based intervention was feasible and acceptable to improve access to DSMES services for Latino adults living in rural communities. Future randomized controlled trials are needed to test intervention efficacy on weight loss and glycemic control. UR - https://diabetes.jmir.org/2022/2/e37534 UR - http://dx.doi.org/10.2196/37534 UR - http://www.ncbi.nlm.nih.gov/pubmed/35635752 ID - info:doi/10.2196/37534 ER - TY - JOUR AU - Evans, Laura AU - Evans, Jay AU - Pagliari, Claudia AU - Källander, Karin PY - 2022/5/17 TI - Exploring the Equity Impact of Current Digital Health Design Practices: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e34013 VL - 11 IS - 5 KW - digital health KW - health equity KW - design KW - human-centered design N2 - 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. UR - https://www.researchprotocols.org/2022/5/e34013 UR - http://dx.doi.org/10.2196/34013 UR - http://www.ncbi.nlm.nih.gov/pubmed/35579918 ID - info:doi/10.2196/34013 ER - TY - JOUR AU - Baptist, Alan AU - Gibson-Scipio, Wanda AU - Carcone, Idalski April AU - Ghosh, Samiran AU - Jacques-Tiura, J. Angela AU - Hall, Amy AU - MacDonell, Kolmodin Karen PY - 2022/5/10 TI - Asthma and Technology in Emerging African American Adults (The ATHENA Project): Protocol for a Trial Using the Multiphase Optimization Strategy Framework JO - JMIR Res Protoc SP - e37946 VL - 11 IS - 5 KW - African American emerging adults KW - asthma management KW - mHealth KW - mobile health KW - motivational interviewing KW - asthma control KW - physical activity N2 - Background: Asthma causes substantial morbidity and mortality in the United States, particularly among African American emerging adults (AAEAs; aged 18-30 years), but very few asthma programs have targeted this population. Interventions that provide education and address underlying motivation for managing asthma may be the most effective. However, intensive face-to-face interventions are often difficult to implement in this population. Objective: The purpose of this study is to develop an effective mobile asthma management intervention to improve control among AAEAs. Methods: We will assess the ability of multiple technologic components to assist and improve traditional asthma education. The first component is the Motivational Enhancement System for asthma management. It is a mobile 4-session intervention using supported self-regulation and motivational interviewing. Personalized content is based on each participant?s activity level, daily experiences, and goals. The second component is supportive accountability. It is administered by asthma nurses using targeted mobile support (Skype/voice calls) to provide education, promote self-efficacy, and overcome barriers through a motivational interviewing?based framework. The third component is SMS text messaging. It provides reminders for asthma education, medication adherence, and physical activity. The fourth component is physical activity tracking. It uses wearable technology to help meet user-defined physical activity goals. Using a multiphase optimization strategy (MOST) framework, we will test intervention components and combinations of components to identify the most effective mobile intervention. The MOST framework is an innovative, and cost- and time-effective framework that uses engineering principles to produce effective behavioral interventions. We will conduct a component selection experiment using a factorial research design to build an intervention that has been optimized for maximum efficacy, using a clinically significant improvement in asthma. Participants (N=180) will be randomized to 1 of 6 intervention arms. Participants will be recruited from multiple sites of the American Lung Association-Airway Clinical Research Centers network and ambulatory care clinics at the Detroit Medical Center. Data collections will occur at baseline, and 3, 6, and 12 months. Results: At study completion, we will have an empirically supported optimized mobile asthma management intervention to improve asthma control for AAEAs. We hypothesize that postintervention (3, 6, and 12 months), participants with uncontrolled asthma will show a clinically significant improvement in asthma control. We also hypothesize that improvements in asthma management behaviors (including physical activity), quality of life, symptoms, adherence, and exacerbation (secondary outcomes) will be observed. Conclusions: AAEAs are disproportionately impacted by asthma, but have been underrepresented in research. Mobile asthma management interventions may help improve asthma control and allow people to live healthier lives. During this project, we will use an innovative strategy to develop an optimized mobile asthma management intervention using the most effective combination of nurse-delivered asthma education, a smartphone app, and text messaging. International Registered Report Identifier (IRRID): PRR1-10.2196/37946 UR - https://www.researchprotocols.org/2022/5/e37946 UR - http://dx.doi.org/10.2196/37946 UR - http://www.ncbi.nlm.nih.gov/pubmed/35536642 ID - info:doi/10.2196/37946 ER - TY - JOUR AU - Wolff, L. Jennifer AU - Dukhanin, Vadim AU - Burgdorf, G. Julia AU - DesRoches, M. Catherine PY - 2022/5/4 TI - Shared Access to Patient Portals for Older Adults: Implications for Privacy and Digital Health Equity JO - JMIR Aging SP - e34628 VL - 5 IS - 2 KW - patient portal KW - electronic health record KW - care partners KW - proxy KW - health equity KW - health informatics KW - health services KW - elderly KW - older adults KW - aging KW - cognition KW - health system KW - care delivery KW - elderly care UR - https://aging.jmir.org/2022/2/e34628 UR - http://dx.doi.org/10.2196/34628 UR - http://www.ncbi.nlm.nih.gov/pubmed/35507405 ID - info:doi/10.2196/34628 ER - TY - JOUR AU - Krishnamurti, Tamar AU - Birru Talabi, Mehret AU - Callegari, S. Lisa AU - Kazmerski, M. Traci AU - Borrero, Sonya PY - 2022/4/28 TI - A Framework for Femtech: Guiding Principles for Developing Digital Reproductive Health Tools in the United States JO - J Med Internet Res SP - e36338 VL - 24 IS - 4 KW - United States KW - North America KW - femtech KW - mHealth KW - health equity KW - pregnancy KW - women's health KW - preterm birth KW - contraception KW - family planning KW - reproductive care KW - sterilization KW - cystic fibrosis KW - rheumatic disease KW - eHealth KW - mobile health KW - reproductive health KW - digital health KW - health technology KW - health outcomes UR - https://www.jmir.org/2022/4/e36338 UR - http://dx.doi.org/10.2196/36338 UR - http://www.ncbi.nlm.nih.gov/pubmed/35482371 ID - info:doi/10.2196/36338 ER - TY - JOUR AU - Perales-Puchalt, Jaime AU - Acosta-Rullán, Mariola AU - Ramírez-Mantilla, Mariana AU - Espinoza-Kissell, Paul AU - Vidoni, Eric AU - Niedens, Michelle AU - Ellerbeck, Edward AU - Hinton, Ladson AU - Loera, Linda AU - Ramírez, Susana A. AU - Lara, Esther AU - Watts, Amber AU - Williams, Kristine AU - Resendez, Jason AU - Burns, Jeffrey PY - 2022/4/28 TI - A Text Messaging Intervention to Support Latinx Family Caregivers of Individuals With Dementia (CuidaTEXT): Development and Usability Study JO - JMIR Aging SP - e35625 VL - 5 IS - 2 KW - Latinx individuals KW - mHealth KW - dementia KW - caregiving N2 - Background: Latinx family caregivers of individuals with dementia face many barriers to caregiver support access. Interventions to alleviate these barriers are urgently needed. Objective: This study aimed to describe the development of CuidaTEXT, a tailored SMS text messaging intervention to support Latinx family caregivers of individuals with dementia. Methods: CuidaTEXT is informed by the stress process framework and social cognitive theory. We developed and refined CuidaTEXT using a mixed methods approach that included thematic analysis and descriptive statistics. We followed 6 user-centered design stages, namely, the selection of design principles, software vendor collaboration, evidence-based foundation, caregiver and research and clinical advisory board guidance, sketching and prototyping, and usability testing of the prototype of CuidaTEXT among 5 Latinx caregivers. Results: CuidaTEXT is a bilingual 6-month-long SMS text messaging?based intervention tailored to caregiver needs that includes 1-3 daily automatic messages (n=244) about logistics, dementia education, self-care, social support, end of life, care of the person with dementia, behavioral symptoms, and problem-solving strategies; 783 keyword-driven text messages for further help with the aforementioned topics; live chat interaction with a coach for further help; and a 19-page reference booklet summarizing the purpose and functions of the intervention. The 5 Latinx caregivers who used the prototype of CuidaTEXT scored an average of 97 out of 100 on the System Usability Scale. Conclusions: CuidaTEXT?s prototype demonstrated high usability among Latinx caregivers. CuidaTEXT?s feasibility is ready to be tested. UR - https://aging.jmir.org/2022/2/e35625 UR - http://dx.doi.org/10.2196/35625 UR - http://www.ncbi.nlm.nih.gov/pubmed/35482366 ID - info:doi/10.2196/35625 ER - TY - JOUR AU - Kokorelias, Marie Kristina AU - Nelson, LA Michelle AU - Tang, Terence AU - Steele Gray, Carolyn AU - Ellen, Moriah AU - Plett, Donna AU - Jarach, Micaela Carlotta AU - Xin Nie, Jason AU - Thavorn, Kednapa AU - Singh, Hardeep PY - 2022/4/27 TI - Inclusion of Older Adults in Digital Health Technologies to Support Hospital-to-Home Transitions: Secondary Analysis of a Rapid Review and Equity-Informed Recommendations JO - JMIR Aging SP - e35925 VL - 5 IS - 2 KW - older adults KW - digital technology KW - transitions KW - older adult population KW - digital health KW - Digital Hospital KW - health intervention KW - aging KW - gender diversity KW - home transition KW - epidemiology N2 - Background: Digital health technologies have been proposed to support hospital-to-home transition for older adults. The COVID-19 pandemic and the associated physical distancing guidelines have propelled a shift toward digital health technologies. However, the characteristics of older adults who participated in digital health research interventions to support hospital-to-home transitions remain unclear. This information is needed to assess whether current digital health interventions are generalizable to the needs of the broader older adult population. Objective: This rapid review of the existing literature aimed to identify the characteristics of the populations targeted by studies testing the implementation of digital health interventions designed to support hospital-to-home transitions, identify the characteristics of the samples included in studies testing digital health interventions used to support hospital-to-home transitions, and create recommendations for enhancing the diversity of samples within future hospital-to-home digital health interventions. Methods: A rapid review methodology based on scoping review guidelines by Arksey and O?Malley was developed. A search for peer-reviewed literature published between 2010 and 2021 on digital health solutions that support hospital-to-home transitions for older adults was conducted using MEDLINE, Embase, and CINAHL databases. The data were analyzed using descriptive statistics and qualitative content analysis. The Sex- and Gender-Based Analysis Plus lens theoretically guided the study design, analysis, and interpretation. Results: A total of 34 studies met the inclusion criteria. Our findings indicate that many groups of older adults were excluded from these interventions and remain understudied. Specifically, the oldest old and those living with cognitive impairments were excluded from the studies included in this review. In addition, very few studies have described the characteristics related to gender diversity, education, race, ethnicity, and culture. None of the studies commented on the sexual orientation of the participants. Conclusions: This is the first review, to our knowledge, that has mapped the literature focusing on the inclusion of older adults in digital hospital-to-home interventions. The findings suggest that the literature on digital health interventions tends to operationalize older adults as a homogenous group, ignoring the heterogeneity in older age definitions. Inconsistency in the literature surrounding the characteristics of the included participants suggests a need for further study to better understand how digital technologies to support hospital-to-home transitions can be inclusive. UR - https://aging.jmir.org/2022/2/e35925 UR - http://dx.doi.org/10.2196/35925 UR - http://www.ncbi.nlm.nih.gov/pubmed/35475971 ID - info:doi/10.2196/35925 ER - TY - JOUR AU - Crotty, H. Bradley AU - Somai, Melek PY - 2022/4/22 TI - Bugs in the Virtual Clinic: Confronting Telemedicine?s Challenges Through Empathy and Support JO - J Particip Med SP - e25688 VL - 14 IS - 1 KW - telemedicine KW - virtual care KW - patient experience KW - consumer informatics KW - telehealth KW - access KW - challenge KW - electronic health record KW - digital health UR - https://jopm.jmir.org/2022/1/e25688 UR - http://dx.doi.org/10.2196/25688 UR - http://www.ncbi.nlm.nih.gov/pubmed/35452399 ID - info:doi/10.2196/25688 ER - TY - JOUR AU - Garbin, Alexander AU - Díaz, Jesús AU - Bui, Vy AU - Morrison, Janina AU - Fisher, E. Beth AU - Palacios, Carina AU - Estrada-Darley, Ingrid AU - Haase, Danielle AU - Wing, David AU - Amezcua, Lilyana AU - Jakowec, W. Michael AU - Kaplan, Charles AU - Petzinger, Giselle PY - 2022/4/20 TI - Promoting Physical Activity in a Spanish-Speaking Latina Population of Low Socioeconomic Status With Chronic Neurological Disorders: Proof-of-Concept Study JO - JMIR Form Res SP - e34312 VL - 6 IS - 4 KW - exercise KW - quality of life KW - motivation KW - promotion KW - community study KW - clinical trial N2 - Background: Physical activity (PA) is known to improve quality of life (QoL) as well as reduce mortality and disease progression in individuals with chronic neurological disorders. However, Latina women are less likely to participate in recommended levels of PA due to common socioeconomic barriers, including limited resources and access to exercise programs. Therefore, we developed a community-based intervention with activity monitoring and behavioral coaching to target these barriers and facilitate sustained participation in an exercise program promoting PA. Objective: The aim of this study was to determine the feasibility and efficacy of a community-based intervention to promote PA through self-monitoring via a Fitbit and behavioral coaching among Latina participants with chronic neurological disorders.  Methods: We conducted a proof-of-concept study among 21 Spanish-speaking Latina participants recruited from the Los Angeles County and University of Southern California (LAC+USC) neurology clinic; participants enrolled in the 16-week intervention at The Wellness Center at The Historic General Hospital in Los Angeles. Demographic data were assessed at baseline. Feasibility was defined by participant attrition and Fitbit adherence. PA promotion was determined by examining change in time spent performing moderate-to-vigorous PA (MVPA) over the 16-week period. The effect of behavioral coaching was assessed by quantifying the difference in MVPA on days when coaching occurred versus on days without coaching. Change in psychometric measures (baseline vs postintervention) and medical center visits (16 weeks preintervention vs during the intervention) were also examined. Results: Participants were of low socioeconomic status and acculturation. A total of 19 out of 21 (90%) participants completed the study (attrition 10%), with high Fitbit wear adherence (mean 90.31%, SD 10.12%). Time performing MVPA gradually increased by a mean of 0.16 (SD 0.23) minutes per day (P<.001), which was equivalent to an increase of approximately 18 minutes in MVPA over the course of the 16-week study period. Behavioral coaching enhanced intervention effectiveness as evidenced by a higher time spent on MVPA on days when coaching occurred via phone (37 min/day, P=.02) and in person (45.5 min/day, P=.01) relative to days without coaching (24 min/day). Participants improved their illness perception (effect size g=0.30) and self-rated QoL (effect size g=0.32). Additionally, a reduction in the number of medical center visits was observed (effect size r=0.44), and this reduction was associated with a positive change in step count during the study period (P.=04). Conclusions: Self-monitoring with behavioral coaching is a feasible community-based intervention for PA promotion among Latina women of low socioeconomic status with chronic neurological conditions. PA is known to be important for brain health in neurological conditions but remains relatively unexplored in minority populations. Trial Registration: ClinicalTrials.gov NCT04820153; https://clinicaltrials.gov/ct2/show/NCT04820153 UR - https://formative.jmir.org/2022/4/e34312 UR - http://dx.doi.org/10.2196/34312 UR - http://www.ncbi.nlm.nih.gov/pubmed/35442197 ID - info:doi/10.2196/34312 ER - TY - JOUR AU - Dang, Stuti AU - Muralidhar, Kiranmayee AU - Li, Shirley AU - Tang, Fei AU - Mintzer, Michael AU - Ruiz, Jorge AU - Valencia, Marcos Willy PY - 2022/4/8 TI - Gap in Willingness and Access to Video Visit Use Among Older High-risk Veterans: Cross-sectional Study JO - J Med Internet Res SP - e32570 VL - 24 IS - 4 KW - high-risk veterans KW - older adults KW - telemedicine KW - video visits KW - health disparities KW - Area Deprivation Index KW - mobile phone N2 - Background: The recent shift to video care has exacerbated disparities in health care access, especially among high-need, high-risk (HNHR) adults. Developing data-driven approaches to improve access to care necessitates a deeper understanding of HNHR adults? attitudes toward telemedicine and technology access. Objective: This study aims to identify the willingness, access, and ability of HNHR veterans to use telemedicine for health care. Methods: WWe designed a questionnaire conducted via mail or telephone or in person. Among HNHR veterans who were identified using predictive modeling with national Veterans Affairs data, we assessed willingness to use video visits for health care, access to necessary equipment, and comfort with using technology. We evaluated physical health, including frailty, physical function, performance of activities of daily living (ADL) and instrumental ADL (IADL); mental health; and social needs, including Area Deprivation Index, transportation, social support, and social isolation. Results: The average age of the 602 HNHR veteran respondents was 70.6 (SD 9.2; range 39-100) years; 99.7% (600/602) of the respondents were male, 61% (367/602) were White, 36% (217/602) were African American, 17.3% (104/602) were Hispanic, 31.2% (188/602) held at least an associate degree, and 48.2% (290/602) were confident filling medical forms. Of the 602 respondents, 327 (54.3%) reported willingness for video visits, whereas 275 (45.7%) were unwilling. Willing veterans were younger (P<.001) and more likely to have an associate degree (P=.002), be health literate (P<.001), live in socioeconomically advantaged neighborhoods (P=.048), be independent in IADLs (P=.02), and be in better physical health (P=.04). A higher number of those willing were able to use the internet and email (P<.001). Of the willing veterans, 75.8% (248/327) had a video-capable device. Those with video-capable technology were younger (P=.004), had higher health literacy (P=.01), were less likely to be African American (P=.007), were more independent in ADLs (P=.005) and IADLs (P=.04), and were more adept at using the internet and email than those without the needed technology (P<.001). Age, confidence in filling forms, general health, and internet use were significantly associated with willingness to use video visits. Conclusions: Approximately half of the HNHR respondents were unwilling for video visits and a quarter of those willing lacked requisite technology. The gap between those willing and without requisite technology is greater among older, less health literate, African American veterans; those with worse physical health; and those living in more socioeconomically disadvantaged neighborhoods. Our study highlights that HNHR veterans have complex needs, which risk being exacerbated by the video care shift. Although technology holds vast potential to improve health care access, certain vulnerable populations are less likely to engage, or have access to, technology. Therefore, targeted interventions are needed to address this inequity, especially among HNHR older adults. UR - https://www.jmir.org/2022/4/e32570 UR - http://dx.doi.org/10.2196/32570 UR - http://www.ncbi.nlm.nih.gov/pubmed/35394440 ID - info:doi/10.2196/32570 ER - TY - JOUR AU - Senteio, Charles AU - Murdock, Joseph Paul PY - 2022/4/4 TI - The Efficacy of Health Information Technology in Supporting Health Equity for Black and Hispanic Patients With Chronic Diseases: Systematic Review JO - J Med Internet Res SP - e22124 VL - 24 IS - 4 KW - chronic disease KW - minority health KW - technology assessment KW - biomedical KW - self-management KW - systematic review KW - mobile phone N2 - Background: Racial inequity persists for chronic disease outcomes amid the proliferation of health information technology (HIT) designed to support patients in following recommended chronic disease self-management behaviors (ie, medication behavior, physical activity, and dietary behavior and attending follow-up appointments). Numerous interventions that use consumer-oriented HIT to support self-management have been evaluated, and some of the related literature has focused on racial minorities who experience disparate chronic disease outcomes. However, little is known about the efficacy of these interventions. Objective: This study aims to conduct a systematic review of the literature that describes the efficacy of consumer-oriented HIT interventions designed to support self-management involving African American and Hispanic patients with chronic diseases. Methods: We followed an a priori protocol using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-Equity 2012 Extension guidelines for systematic reviews that focus on health equity. Themes of interest included the inclusion and exclusion criteria. We identified 7 electronic databases, created search strings, and conducted the searches. We initially screened results based on titles and abstracts and then performed full-text screening. We then resolved conflicts and extracted relevant data from the included articles. Results: In total, there were 27 included articles. The mean sample size was 640 (SD 209.5), and 52% (14/27) of the articles focused on African American participants, 15% (4/27) of the articles focused on Hispanic participants, and 33% (9/27) included both. Most articles addressed 3 of the 4 self-management behaviors: medication (17/27, 63%), physical activity (17/27, 63%), and diet (16/27, 59%). Only 15% (4/27) of the studies focused on follow-up appointment attendance. All the articles investigated HIT for use at home, whereas 7% (2/27) included use in the hospital. Conclusions: This study addresses a key gap in research that has not sufficiently examined what technology designs and capabilities may be effective for underserved populations in promoting health behavior in concordance with recommendations. UR - https://www.jmir.org/2022/4/e22124 UR - http://dx.doi.org/10.2196/22124 UR - http://www.ncbi.nlm.nih.gov/pubmed/35377331 ID - info:doi/10.2196/22124 ER - TY - JOUR AU - Lawrence, Katharine AU - Chong, Stella AU - Krelle, Holly AU - Roberts, Timothy AU - Thorpe, Lorna AU - Trinh-Shevrin, Chau AU - Yi, Stella AU - Kwon, Simona PY - 2022/4/1 TI - Chinese Americans? Use of Patient Portal Systems: Scoping Review JO - JMIR Hum Factors SP - e27924 VL - 9 IS - 2 KW - patient portal KW - electronic health records KW - personal health records KW - ehealth KW - health equity KW - digital divide KW - Chinese Americans KW - Asian Americans N2 - Background: Electronic patient portals are increasingly used in health care systems as communication and information-sharing tools and show promise in addressing health care access, quality, and outcomes. However, limited research exists on portal use patterns and practices among diverse patient populations, resulting in the lack of culturally and contextually tailored portal systems for these patients. Objective: This study aimed to summarize existing evidence on the access and use patterns, barriers, and facilitators of patient portals among Chinese Americans, who represent a growing patient population in the United States with unique health care and health technology needs. Methods: The authors conducted a literature search using the PRISMA Protocol for Scoping Reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR) for extracting articles published in major databases (MEDLINE, Embase, and PsycINFO) on patient portals and Chinese Americans. Authors independently reviewed the papers during initial screening and full-text review. The studies were analyzed and coded for the study method type, sample population, and main outcomes of interest. Results: In total, 17 articles were selected for inclusion in the review. The included articles were heterogenous and varied in their study aims, methodologies, sample populations, and outcomes. Major findings identified from the articles include variable patterns of portal access and use among Chinese Americans compared to other racial or ethnic groups, with limited evidence on the specific barriers and facilitators for this group; a preference for cross-sectional quantitative tools such as patient surveys and electronic health record?based data over qualitative or other methodologies; and a pattern of aggregating Chinese American?related data into a larger Asian or Asian American designation. Conclusions: There is limited research evaluating the use patterns, experiences, and needs of Chinese Americans who access and use patient portal systems. Existing research is heterogeneous, largely cross-sectional, and does not disaggregate Chinese Americans from larger Asian demographics. Future research should be devoted to the specific portal use patterns, preferences, and needs of Chinese Americans to help ensure contextually appropriate and acceptable design and implementation of these digital health tools. UR - https://humanfactors.jmir.org/2022/2/e27924 UR - http://dx.doi.org/10.2196/27924 UR - http://www.ncbi.nlm.nih.gov/pubmed/35363153 ID - info:doi/10.2196/27924 ER - TY - JOUR AU - Yao, Rui AU - Zhang, Wenli AU - Evans, Richard AU - Cao, Guang AU - Rui, Tianqi AU - Shen, Lining PY - 2022/3/21 TI - Inequities in Health Care Services Caused by the Adoption of Digital Health Technologies: Scoping Review JO - J Med Internet Res SP - e34144 VL - 24 IS - 3 KW - health inequities KW - digital health technologies KW - health care services KW - socially disadvantaged groups KW - scoping review KW - mobile phone N2 - Background: Digital health technologies (ie, the integration of digital technology and health information) aim to increase the efficiency of health care delivery; they are rapidly adapting to health care contexts to provide improved medical services for citizens. However, contrary to expectations, their rapid adoption appears to have led to health inequities, with differences in health conditions or inequality in the distribution of health care resources among different populations. Objective: This scoping review aims to identify and describe the inequities of health care services brought about by the adoption of digital health technologies. The factors influencing such inequities, as well as the corresponding countermeasures to ensure health equity among different groups of citizens, were also studied. Methods: Primary studies and literature, including articles and reviews, published in English between 1990 and 2020 were retrieved using appropriate search strategies across the following three electronic databases: Clarivate Analytics? Web of Science, PubMed, and Scopus. Data management was performed by two authors (RY and WZ) using Thomson Endnote (Clarivate Analytics, Inc), by systematically screening and identifying eligible articles for this study. Any conflicts of opinion were resolved through discussions with the corresponding author. A qualitative descriptive synthesis was performed to determine the outcomes of this scoping review. Results: A total of 2325 studies were collected during the search process, of which 41 (1.76%) papers were identified for further analysis. The quantity of literature increased until 2016, with a peak in 2020. The United States, the United Kingdom, and Norway ranked among the top 3 countries for publication output. Health inequities caused by the adoption of digital health technologies in health care services can be reflected in the following two dimensions: the inability of citizens to obtain and adopt technology and the different disease outcomes found among citizens under technical intervention measures. The factors that influenced inequities included age, race, region, economy, and education level, together with health conditions and eHealth literacy. Finally, action can be taken to alleviate inequities in the future by government agencies and medical institutions (eg, establishing national health insurance), digital health technology providers (eg, designing high-quality tools), and health care service recipients (eg, developing skills to access digital technologies). Conclusions: The application of digital health technologies in health care services has caused inequities to some extent. However, existing research has certain limitations. The findings provide a comprehensive starting point for future research, allowing for further investigation into how digital health technologies may influence the unequal distribution of health care services. The interaction between individual subjective factors as well as social support and influencing factors should be included in future studies. Specifically, access to and availability of digital health technologies for socially disadvantaged groups should be of paramount importance. UR - https://www.jmir.org/2022/3/e34144 UR - http://dx.doi.org/10.2196/34144 UR - http://www.ncbi.nlm.nih.gov/pubmed/35311682 ID - info:doi/10.2196/34144 ER - TY - JOUR AU - Medero, Kristina AU - Merrill Jr, Kelly AU - Ross, Quinn Morgan PY - 2022/3/15 TI - Modeling Access Across the Digital Divide for Intersectional Groups Seeking Web-Based Health Information: National Survey JO - J Med Internet Res SP - e32678 VL - 24 IS - 3 KW - Black KW - African American KW - first-level digital divide KW - health disparities KW - home computer KW - internet access KW - intersectionality KW - Latino KW - Latine KW - Hispanic KW - mobile KW - online health information seeking KW - public computer KW - structural equation modeling KW - work computer KW - mobile phone N2 - Background: The digital divide refers to technological disparities based on demographic characteristics (eg, race and ethnicity). Lack of physical access to the internet inhibits online health information seeking (OHIS) and exacerbates health disparities. Research on the digital divide examines where and how people access the internet, whereas research on OHIS investigates how intersectional identities influence OHIS. We combine these perspectives to explicate how unique context?device access pairings operate differently across intersectional identities?particularly racial and ethnic groups?in the domain of OHIS. Objective: This study aims to examine how different types of internet access relate to OHIS for different racial and ethnic groups. We investigate relationships among predisposing characteristics (ie, age, sex, education, and income), internet access (home computer, public computer, work computer, and mobile), health needs, and OHIS. Methods: Analysis was conducted using data from the 2019 Health Information National Trends Survey. Our theoretical model of OHIS explicates the roles of internet access and health needs for racial and ethnic minority groups? OHIS. Participant responses were analyzed using structural equation modeling. Three separate group structural equation modeling models were specified based on Black, Latine, and White self-categorizations. Results: Overall, predisposing characteristics (ie, age, sex, education, and income) were associated with internet access, health needs, and OHIS; internet access was associated with OHIS; and health needs were associated with OHIS. Home computer and mobile access were most consistently associated with OHIS. Several notable linkages between predisposing characteristics and internet access differed for Black and Latine individuals. Older racial and ethnic minorities tended to access the internet on home and public computers less frequently; home computer access was a stronger predictor of OHIS for White individuals, and mobile access was a stronger predictor of OHIS for non-White individuals. Conclusions: Our findings necessitate a deeper unpacking of how physical internet access, the foundational and multifaceted level of the digital divide, affects specific racial and ethnic groups and their OHIS. We not only find support for prior work on the digital divide but also surface new insights, including distinct impacts of context?device access pairings for OHIS and several relationships that differ between racial and ethnic groups. As such, we propose interventions with an intersectional approach to access to ameliorate the impact of the digital divide. UR - https://www.jmir.org/2022/3/e32678 UR - http://dx.doi.org/10.2196/32678 UR - http://www.ncbi.nlm.nih.gov/pubmed/35289761 ID - info:doi/10.2196/32678 ER - TY - JOUR AU - Jackson, N. Devlon AU - Sehgal, Neil AU - Baur, Cynthia PY - 2022/3/9 TI - Benefits of mHealth Co-design for African American and Hispanic Adults: Multi-Method Participatory Research for a Health Information App JO - JMIR Form Res SP - e26764 VL - 6 IS - 3 KW - mHealth app design KW - health literacy KW - health disparities KW - health equity KW - African Americans KW - Hispanics KW - mobile phone N2 - Background: Participatory research methodologies can provide insight into the use of mobile health (mHealth) apps, cultural preferences and needs, and health literacy issues for racial and ethnic groups, such as African Americans and Hispanics who experience health disparities. Objective: This methodological paper aims to describe a 1-year multi-method participatory research process that directly engaged English-speaking African American and bilingual or Spanish-speaking Hispanic adults in designing a prevention-focused, personalized mHealth, information-seeking smartphone app. We report design team participants? experiences with the methods to show why our approach is valuable in producing apps that are more aligned with their needs. Methods: Three design sessions were conducted to inform the iteration of a prevention-focused, personalized mHealth, information-seeking app. The research team led sessions with 2 community member design teams. Design team participants described their goals, motives, and interests regarding prevention information using different approaches, such as collage and card sorting (design session 1), interaction with the app prototype (design session 2), and rating of cultural appropriateness strategies (design session 3). Results: Each design team had 5 to 6 participants: 2 to 3 male participants and 3 female participants aged between 30 and 76 years. Design team participants shared their likes and dislikes about the sessions and the overall experience of the design sessions. Both African American and Hispanic teams reported positive participation experience. The primary reasons included the opportunity for their views to be heard, collectively working together in the design process, having their apprehension about mHealth reduced, and an opportunity to increase their knowledge of how they could manage their health through mHealth. The feedback from each session informed the following design sessions and a community-engaged process. In addition, the specific findings for each design session informed the design of the app for both communities. Conclusions: This multi-method participatory research process revealed 4 key lessons learned and recommendations for future research in mHealth app design for African Americans and Hispanics. Lesson 1?community partnerships are key because they provide the chain of trust that helps African American and Hispanic participants feel comfortable participating in app research. Lesson 2?community-based participatory research principles continue to yield promising results to engage these populations in mHealth research. Lesson 3?interactive design sessions uncover participants? needs and development opportunities for mHealth tools. Lesson 4?multiple design sessions with different methods provide an in-depth understanding of participants? mHealth preferences and needs. Future developers should consider these methods and lessons to ensure health apps in the marketplace contribute to eliminating health disparities and achieving health equity. UR - https://formative.jmir.org/2022/3/e26764 UR - http://dx.doi.org/10.2196/26764 UR - http://www.ncbi.nlm.nih.gov/pubmed/35262496 ID - info:doi/10.2196/26764 ER - TY - JOUR AU - Hartford, Anna AU - Stein, J. Dan PY - 2022/2/11 TI - Attentional Harms and Digital Inequalities JO - JMIR Ment Health SP - e30838 VL - 9 IS - 2 KW - digital inequalities KW - attentional harms KW - excessive internet use KW - persuasive technologies KW - internet ethics KW - attention economies UR - https://mental.jmir.org/2022/2/e30838 UR - http://dx.doi.org/10.2196/30838 UR - http://www.ncbi.nlm.nih.gov/pubmed/35147504 ID - info:doi/10.2196/30838 ER - TY - JOUR AU - Dangerfield II, T. Derek AU - Wylie, Charleen PY - 2022/2/7 TI - 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 JO - JMIR Hum Factors SP - e28798 VL - 9 IS - 1 KW - HIV KW - sexual health KW - stigma KW - medical mistrust KW - PrEP KW - telehealth KW - medication adherence KW - minorities KW - focus groups KW - sexual minorities KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2022/1/e28798 UR - http://dx.doi.org/10.2196/28798 UR - http://www.ncbi.nlm.nih.gov/pubmed/35129448 ID - info:doi/10.2196/28798 ER - TY - JOUR AU - Weatherburn, Christopher PY - 2022/2/3 TI - Digital Inclusion as a Foundation for Health Equity. Comment on ?Expanding Video Consultation Services at Pace and Scale in Scotland During the COVID-19 Pandemic: National Mixed Methods Case Study? JO - J Med Internet Res SP - e34702 VL - 24 IS - 2 KW - technology-enabled care KW - video consultations KW - quality improvement KW - COVID-19 KW - PERCS framework KW - remote consultation KW - Scotland KW - general practice KW - digital inclusion KW - digital divide KW - digital health equity UR - https://www.jmir.org/2022/2/e34702 UR - http://dx.doi.org/10.2196/34702 UR - http://www.ncbi.nlm.nih.gov/pubmed/35038303 ID - info:doi/10.2196/34702 ER - TY - JOUR AU - Marsall, Matthias AU - Engelmann, Gerrit AU - Skoda, Eva-Maria AU - Teufel, Martin AU - Bäuerle, Alexander PY - 2022/2/2 TI - Measuring Electronic Health Literacy: Development, Validation, and Test of Measurement Invariance of a Revised German Version of the eHealth Literacy Scale JO - J Med Internet Res SP - e28252 VL - 24 IS - 2 KW - eHealth KW - eHeals KW - health literacy KW - factor analysis KW - validation KW - measurement invariance KW - internet KW - health information N2 - Background: The World Wide Web has become an essential source of health information. Nevertheless, the amount and quality of information provided may lead to information overload. Therefore, people need certain skills to search for, identify, and evaluate information from the internet. In the context of health information, these competencies are summarized as the construct of eHealth literacy. Previous research has highlighted the relevance of eHealth literacy in terms of health-related outcomes. However, the existing instrument assessing eHealth literacy in the German language reveals methodological limitations regarding test development and validation. The development and validation of a revised scale for this important construct is highly relevant. Objective: The objective of this study was the development and validation of a revised German eHealth literacy scale. In particular, this study aimed to focus on high methodological and psychometric standards to provide a valid and reliable instrument for measuring eHealth literacy in the German language. Methods: Two internationally validated instruments were merged to cover a wide scope of the construct of eHealth literacy and create a revised eHealth literacy scale. Translation into the German language followed scientific guidelines and recommendations to ensure content validity. Data from German-speaking people (n=470) were collected in a convenience sample from October to November 2020. Validation was performed by factor analyses. Further, correlations were performed to examine convergent, discriminant, and criterion validity. Additionally, analyses of measurement invariance of gender, age, and educational level were conducted. Results: Analyses revealed a 2-factorial model of eHealth literacy. By item-reduction, the 2 factors information seeking and information appraisal were measured with 8 items reaching acceptable-to-good model fits (comparative fit index [CFI]: 0.942, Tucker Lewis index [TLI]: 0.915, root mean square error of approximation [RMSEA]: 0.127, and standardized root mean square residual [SRMR]: 0.055). Convergent validity was comprehensively confirmed by significant correlations of information seeking and information appraisal with health literacy, internet confidence, and internet anxiety. Discriminant and criterion validity were examined by correlation analyses with various scales and could partly be confirmed. Scalar level of measurement invariance for gender (CFI: 0.932, TLI: 0.923, RMSEA: 0.122, and SRMR: 0.068) and educational level (CFI: 0.937, TLI: 0.934, RMSEA: 0.112, and SRMR: 0.063) were confirmed. Measurement invariance of age was rejected. Conclusions: Following scientific guidelines for translation and test validation, we developed a revised German eHealth Literacy Scale (GR-eHEALS). Our factor analyses confirmed an acceptable-to-good model fit. Construct validation in terms of convergent, discriminant, and criterion validity could mainly be confirmed. Our findings provide evidence for measurement invariance of the instrument regarding gender and educational level. The newly revised GR-eHEALS questionnaire represents a valid instrument to measure the important health-related construct eHealth literacy. UR - https://www.jmir.org/2022/2/e28252 UR - http://dx.doi.org/10.2196/28252 UR - http://www.ncbi.nlm.nih.gov/pubmed/35107437 ID - info:doi/10.2196/28252 ER - TY - JOUR AU - Agachi, Elena AU - Bijmolt, A. Tammo H. AU - Mierau, O. Jochen AU - van Ittersum, Koert PY - 2022/2/2 TI - Adoption of the Website and Mobile App of a Preventive Health Program Across Neighborhoods With Different Socioeconomic Conditions in the Netherlands: Longitudinal Study JO - JMIR Hum Factors SP - e32112 VL - 9 IS - 1 KW - eHealth KW - mHealth KW - mobile health KW - mobile app KW - internet KW - preventive health program KW - health disparities KW - NSES KW - program adoption KW - survival analysis N2 - 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. UR - https://humanfactors.jmir.org/2022/1/e32112 UR - http://dx.doi.org/10.2196/32112 UR - http://www.ncbi.nlm.nih.gov/pubmed/35107433 ID - info:doi/10.2196/32112 ER - TY - JOUR AU - Myers-Ingram, Richard AU - Sampford, Jade AU - Milton-Cole, Rhian AU - Jones, David Gareth PY - 2022/1/20 TI - Outcomes Following eHealth Weight Management Interventions in Adults With Overweight and Obesity From Low Socioeconomic Groups: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e34546 VL - 11 IS - 1 KW - obesity KW - eHealth KW - technology KW - weight management KW - weight loss KW - low socioeconomic status KW - socioeconomic KW - systematic review KW - weight KW - obese N2 - Background: Obesity is a complex health condition with multiple associated comorbidities and increased economic costs. People from low socioeconomic status (SES) backgrounds are more likely to be overweight and obese and are less successful in traditional weight management programs. It is possible that eHealth interventions may be more successful in reaching people from low SES groups than traditional face-to-face models, by overcoming certain barriers associated with traditional interventions. It is not yet known, however, if eHealth weight management interventions are effective in people living with overweight and obesity from a low SES background. Objective: The primary aim of this study is to evaluate the efficacy of eHealth weight management interventions for people with overweight and obesity from low SES groups. Methods: A systematic review on relevant electronic databases (MEDLINE, Embase, Emcare, and CINAHL) will be undertaken to identify eligible studies published in English up until May 2021. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement to guide the systematic review, two reviewers will independently screen, select, and extract data and complete a risk of bias assessment of search results according to predefined criteria. Studies that have investigated an eHealth weight management intervention within a low SES population will be included. Primary outcomes include weight, BMI, and percentage weight change compared at baseline and at least one other time point. Secondary outcomes may include a range of anthropometric and physical fitness and activity measures. If sufficient studies are homogeneous, then we will pool results of individual outcomes using meta-analysis. Results: Searches have been completed, resulting in 2256 studies identified. Once duplicates were removed, 1545 studies remained for title and abstract review. Conclusions: The use of eHealth in weight management programs has increased significantly in recent years and will continue to do so; however, it is uncertain if eHealth weight management programs are effective in a low SES population. The results of this systematic review will therefore provide a summary of the evidence for interventions using eHealth for people living with overweight and obesity and from a low SES background. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021243973; https://tinyurl.com/2p8fxtnw International Registered Report Identifier (IRRID): DERR1-10.2196/34546 UR - https://www.researchprotocols.org/2022/1/e34546 UR - http://dx.doi.org/10.2196/34546 UR - http://www.ncbi.nlm.nih.gov/pubmed/35049506 ID - info:doi/10.2196/34546 ER - TY - JOUR AU - Wang, Xiaohui AU - Shi, Jingyuan AU - Lee, Min Kwan PY - 2022/1/13 TI - The Digital Divide and Seeking Health Information on Smartphones in Asia: Survey Study of Ten Countries JO - J Med Internet Res SP - e24086 VL - 24 IS - 1 KW - smartphone KW - health information seeking KW - Asia KW - user profile KW - digital divide N2 - Background: Although recent developments in mobile health have elevated the importance of how smartphones empower individuals to seek health information, research investigating this phenomenon in Asian countries has been rare. Objective: The goal of our study was to provide a comprehensive profile of mobile health information seekers and to examine the individual- and country-level digital divide in Asia. Methods: With survey data from 10 Asian countries (N=9086), we ran multilevel regression models to assess the effect of sociodemographic factors, technological factors, and country-level disparities on using smartphones to seek health information. Results: Respondents who were women (?=.13, P<.001), parents (?=.16, P<.001), employed (?=.08, P=.002), of higher social status (?=.08, P<.001), and/or from countries with low health expenditures (?=.19, P=.02) were more likely to use smartphones to seek health information. In terms of technological factors, technology innovativeness (?=.10, P<.001) and frequency of smartphone use (?=.42, P<.001) were important factors of health information seeking, whereas the effect of online information quality was marginal (?=?.04, P<.001). Conclusions: Among smartphone users in Asia, health information seeking varies according to individuals? socioeconomic status, their innovativeness toward technology, and their frequency of smartphone use. Although smartphones widen the digital divide among individuals with different socioeconomic status, they also bridge the divide between countries with varying health expenditures. Smartphones appear to be a particularly useful complement to manage health in developing countries. UR - https://www.jmir.org/2022/1/e24086 UR - http://dx.doi.org/10.2196/24086 UR - http://www.ncbi.nlm.nih.gov/pubmed/35023845 ID - info:doi/10.2196/24086 ER - TY - JOUR AU - Hyman, Antonia AU - Stacy, Elizabeth AU - Mohsin, Humaira AU - Atkinson, Kaitlin AU - Stewart, Kurtis AU - Novak Lauscher, Helen AU - Ho, Kendall PY - 2022/1/13 TI - Barriers and Facilitators to Accessing Digital Health Tools Faced by South Asian Canadians in Surrey, British Columbia: Community-Based Participatory Action Exploration Using Photovoice JO - J Med Internet Res SP - e25863 VL - 24 IS - 1 KW - immigrants KW - community-based participatory action research KW - eHealth KW - delivery of health care KW - photovoice KW - South Asian KW - digital health KW - mobile phone N2 - Background: South Asian community members in Canada experience a higher burden of chronic disease than the general population. Digital health innovations provide a significant opportunity to address various health care challenges such as supporting patients in their disease self-management. However, South Asian community members are less likely to use digital tools for their health and face significant barriers in accessing them because of language or cultural factors. Objective: The aim of this study is to understand the barriers to and facilitators of digital health tool uptake experienced by South Asian community members residing in Canada. Methods: This study used a qualitative community-based participatory action research approach. Residents from Surrey, British Columbia, Canada, who spoke 1 of 4 South Asian languages (Hindi, Punjabi, Urdu, or Tamil) were invited to participate in focus group discussions. A subsample of the participants were invited to use photovoice methods in greater depth to explore the research topics. Results: A total of 197 participants consented to the focus group discussions, with 12 (6.1%) participating in the photovoice phase. The findings revealed several key obstacles (older age, lack of education, and poor digital health literacy) and facilitators (social support from family or community members and positive attitudes toward technology) to using digital health tools. Conclusions: The results support the value of using a community-based participatory action research approach and photovoice methods to engage the South Asian community in Canada to better understand digital health competencies and needs. There were several important implications for policy makers and future research, such as continued engagement of community leaders by health care providers and administrators to learn about attitudes and preferences. UR - https://www.jmir.org/2022/1/e25863 UR - http://dx.doi.org/10.2196/25863 UR - http://www.ncbi.nlm.nih.gov/pubmed/35023842 ID - info:doi/10.2196/25863 ER - TY - JOUR AU - Wang, Y. Seamus AU - Yeh, Hsin-Chieh AU - Stein, Apfel Arielle AU - Miller, R. Edgar PY - 2022/1/12 TI - Use of Health Information Technology by Adults With Diabetes in the United States: Cross-sectional Analysis of National Health Interview Survey Data (2016-2018) JO - JMIR Diabetes SP - e27220 VL - 7 IS - 1 KW - health information technology KW - National Health Interview Survey KW - diabetes KW - Healthy People 2020 KW - Healthy People 2030 KW - mobile phone N2 - Background: The use of health information technology (HIT) has been proposed to improve disease management in patients with type 2 diabetes mellitus. Objective: This study aims to report the prevalence of HIT use in adults with diabetes in the United States and examine the factors associated with HIT use. Methods: We analyzed data from 7999 adults who self-reported a diabetes diagnosis as collected by the National Health Interview Survey (2016-2018). All analyses were weighted to account for the complex survey design. Results: Overall, 41.2% of adults with diabetes reported looking up health information on the web, and 22.8% used eHealth services (defined as filled a prescription on the web, scheduled an appointment with a health care provider on the web, or communicated with a health care provider via email). In multivariable models, patients who were female (vs male: prevalence ratio [PR] 1.16, 95% CI 1.10-1.24), had higher education (above college vs less than high school: PR 3.61, 95% CI 3.01-4.33), had higher income (high income vs poor: PR 1.40, 95% CI 1.23-1.59), or had obesity (vs normal weight: PR 1.11, 95% CI 1.01-1.22) were more likely to search for health information on the web. Similar associations were observed among age, race and ethnicity, education, income, and the use of eHealth services. Patients on insulin were more likely to use eHealth services (on insulin vs no medication: PR 1.21, 95% CI 1.04-1.41). Conclusions: Among adults with diabetes, HIT use was lower in those who were older, were members of racial minority groups, had less formal education, or had lower household income. Health education interventions promoted through HIT should account for sociodemographic factors. UR - https://diabetes.jmir.org/2022/1/e27220 UR - http://dx.doi.org/10.2196/27220 UR - http://www.ncbi.nlm.nih.gov/pubmed/35019844 ID - info:doi/10.2196/27220 ER - TY - JOUR AU - Pham, Quynh AU - El-Dassouki, Noor AU - Lohani, Raima AU - Jebanesan, Aravinth AU - Young, Karen PY - 2022/1/7 TI - The Future of Virtual Care for Older Ethnic Adults Beyond the COVID-19 Pandemic JO - J Med Internet Res SP - e29876 VL - 24 IS - 1 KW - virtual care KW - digital health KW - health equity KW - cultural equity KW - chronic disease KW - caregivers KW - ethnocultural minority KW - older adults KW - ethnicity KW - ethnic patients KW - technology-mediated care KW - equity KW - diversity KW - family UR - https://www.jmir.org/2022/1/e29876 UR - http://dx.doi.org/10.2196/29876 UR - http://www.ncbi.nlm.nih.gov/pubmed/34994707 ID - info:doi/10.2196/29876 ER - TY - JOUR AU - Lee, WJ Edmund AU - McCloud, F. Rachel AU - Viswanath, Kasisomayajula PY - 2022/1/7 TI - Designing Effective eHealth Interventions for Underserved Groups: Five Lessons From a Decade of eHealth Intervention Design and Deployment JO - J Med Internet Res SP - e25419 VL - 24 IS - 1 KW - eHealth KW - mobile health KW - communication inequalities KW - health disparities KW - health informatics KW - mobile phone UR - https://www.jmir.org/2022/1/e25419 UR - http://dx.doi.org/10.2196/25419 UR - http://www.ncbi.nlm.nih.gov/pubmed/34994700 ID - info:doi/10.2196/25419 ER - TY - JOUR AU - Koziol-McLain, Jane AU - Wilson, Denise AU - Vandal, C. Alain AU - Eruera, Moana AU - Nada-Raja, Shyamala AU - Dobbs, Terry AU - Roguski, Michael AU - Barbarich-Unasa, Wai Te PY - 2021/12/30 TI - Evaluation of a Healthy Relationship Smartphone App With Indigenous Young People: Protocol for a Co-designed Stepped Wedge Randomized Trial JO - JMIR Res Protoc SP - e24792 VL - 10 IS - 12 KW - indigenous KW - M?ori KW - young people KW - relationships KW - school KW - mHealth KW - smartphone app KW - mobile phone N2 - Background: We co-designed a smartphone app, Harmonised, with taitamariki (young people aged 13-17 years) to promote healthy intimate partner relationships. The app also provides a pathway for friends and family, or wh?nau (indigenous M?ori extended family networks), to learn how to offer better support to taitamariki. Objective: The aim of our taitamariki- and M?ori-centered study is to evaluate the implementation of the app in secondary schools. The study tests the effectiveness of the app in promoting taitamariki partner relationship self-efficacy (primary outcome). Methods: We co-designed a pragmatic, randomized, stepped wedge trial (retrospectively registered on September 12, 2019) for 8 Aotearoa, New Zealand, secondary schools (years 9 through 13). The schools were randomly assigned to implement the app in 1 of the 2 school terms. A well-established evaluation framework (RE-AIM [Reach, Effectiveness, Adoption, Implementation, Maintenance]) guided the selection of mixed data collection methods. Our target sample size is 600 taitamariki enrolled across the 8 schools. Taitamariki will participate by completing 5 web-based surveys over a 15-month trial period. Taitamariki partner relationship self-efficacy (primary outcome) and well-being, general health, cybersafety management, and connectedness (secondary outcomes) will be assessed with each survey. The general effectiveness hypotheses will be tested by using a linear mixed model with nested participant, year-group, and school random effects. The primary analysis will also include testing effectiveness in the M?ori subgroup. Results: The study was funded by the New Zealand Ministry of Business, Innovation, and Employment in October 2015 and approved by the Auckland University of Technology Ethics Committee on May 3, 2017 (application number: 17/71). Conclusions: This study will generate robust evidence evaluating the impact of introducing a healthy relationship app in secondary schools on taitamariki partner relationship self-efficacy, well-being, general health, cybersafety management, and connectedness. This taitamariki- and indigenous M?ori?centered research fills an important gap in developing and testing strengths-based mobile health interventions in secondary schools. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001262190; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377584 International Registered Report Identifier (IRRID): RR1-10.2196/24792 UR - https://www.researchprotocols.org/2021/12/e24792 UR - http://dx.doi.org/10.2196/24792 UR - http://www.ncbi.nlm.nih.gov/pubmed/34967750 ID - info:doi/10.2196/24792 ER - TY - JOUR AU - Appleton, Rebecca AU - Williams, Julie AU - Vera San Juan, Norha AU - Needle, J. Justin AU - Schlief, Merle AU - Jordan, Harriet AU - Sheridan Rains, Luke AU - Goulding, Lucy AU - Badhan, Monika AU - Roxburgh, Emily AU - Barnett, Phoebe AU - Spyridonidis, Spyros AU - Tomaskova, Magdalena AU - Mo, Jiping AU - Harju-Seppänen, Jasmine AU - Haime, Zoë AU - Casetta, Cecilia AU - Papamichail, Alexandra AU - Lloyd-Evans, Brynmor AU - Simpson, Alan AU - Sevdalis, Nick AU - Gaughran, Fiona AU - Johnson, Sonia PY - 2021/12/9 TI - Implementation, Adoption, and Perceptions of Telemental Health During the COVID-19 Pandemic: Systematic Review JO - J Med Internet Res SP - e31746 VL - 23 IS - 12 KW - telemental health KW - COVID-19 KW - remote care KW - telemedicine KW - mental health KW - systematic review, implementation science N2 - Background: Early in 2020, mental health services had to rapidly shift from face-to-face models of care to delivering the majority of treatments remotely (by video or phone call or occasionally messaging) due to the COVID-19 pandemic. This resulted in several challenges for staff and patients, but also in benefits such as convenience or increased access for people with impaired mobility or in rural areas. There is a need to understand the extent and impacts of telemental health implementation, and barriers and facilitators to its effective and acceptable use. This is relevant both to future emergency adoption of telemental health and to debates on its future use in routine mental health care. Objective: To investigate the adoption and impacts of telemental health approaches during the COVID-19 pandemic, and facilitators and barriers to optimal implementation. Methods: Four databases (PubMed, PsycINFO, CINAHL, and Web of Science) were searched for primary research relating to remote working, mental health care, and the COVID-19 pandemic. Preprint servers were also searched. Results of studies were synthesized using framework synthesis. Results: A total of 77 papers met our inclusion criteria. In most studies, the majority of contacts could be transferred to a remote form during the pandemic, and good acceptability to service users and clinicians tended to be reported, at least where the alternative to remote contacts was interrupting care. However, a range of impediments to dealing optimal care by this means were also identified. Conclusions: Implementation of telemental health allowed some continuing support to the majority of service users during the COVID-19 pandemic and has value in an emergency situation. However, not all service users can be reached by this means, and better evidence is now needed on long-term impacts on therapeutic relationships and quality of care, and on impacts on groups at risk of digital exclusion and how to mitigate these. Trial Registration: PROSPERO International prospective register of systematic reviews CRD42021211025; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021211025 UR - https://www.jmir.org/2021/12/e31746 UR - http://dx.doi.org/10.2196/31746 UR - http://www.ncbi.nlm.nih.gov/pubmed/34709179 ID - info:doi/10.2196/31746 ER - TY - JOUR AU - MacKinnon, Ross Kinnon AU - Kia, Hannah AU - Lacombe-Duncan, Ashley PY - 2021/12/9 TI - Examining TikTok?s Potential for Community-Engaged Digital Knowledge Mobilization With Equity-Seeking Groups JO - J Med Internet Res SP - e30315 VL - 23 IS - 12 KW - trans KW - nonbinary KW - marginalized communities KW - gender-affirming care KW - digital health KW - community-engaged research KW - knowledge mobilization KW - mobile phone UR - https://www.jmir.org/2021/12/e30315 UR - http://dx.doi.org/10.2196/30315 UR - http://www.ncbi.nlm.nih.gov/pubmed/34889739 ID - info:doi/10.2196/30315 ER - TY - JOUR AU - Liu, Dianbo AU - Zheng, Ming AU - Sepulveda, Andres Nestor PY - 2021/12/8 TI - Using Artificial Neural Network Condensation to Facilitate Adaptation of Machine Learning in Medical Settings by Reducing Computational Burden: Model Design and Evaluation Study JO - JMIR Form Res SP - e20767 VL - 5 IS - 12 KW - artificial neural network KW - electronic medical records KW - parameter pruning KW - machine learning KW - computational burden KW - N2 - Background: Machine learning applications in the health care domain can have a great impact on people?s lives. At the same time, medical data is usually big, requiring a significant number of computational resources. Although this might not be a problem for the wide adoption of machine learning tools in high-income countries, the availability of computational resources can be limited in low-income countries and on mobile devices. This can limit many people from benefiting from the advancement in machine learning applications in the field of health care. Objective: In this study, we explore three methods to increase the computational efficiency and reduce model sizes of either recurrent neural networks (RNNs) or feedforward deep neural networks (DNNs) without compromising their accuracy. Methods: We used inpatient mortality prediction as our case analysis upon review of an intensive care unit dataset. We reduced the size of RNN and DNN by applying pruning of ?unused? neurons. Additionally, we modified the RNN structure by adding a hidden layer to the RNN cell but reducing the total number of recurrent layers to accomplish a reduction of the total parameters used in the network. Finally, we implemented quantization on DNN by forcing the weights to be 8 bits instead of 32 bits. Results: We found that all methods increased implementation efficiency, including training speed, memory size, and inference speed, without reducing the accuracy of mortality prediction. Conclusions: Our findings suggest that neural network condensation allows for the implementation of sophisticated neural network algorithms on devices with lower computational resources. UR - https://formative.jmir.org/2021/12/e20767 UR - http://dx.doi.org/10.2196/20767 UR - http://www.ncbi.nlm.nih.gov/pubmed/34889747 ID - info:doi/10.2196/20767 ER - TY - JOUR AU - Schroeder, Kristin AU - Maiarana, James AU - Gisiri, Mwitasrobert AU - Joo, Emma AU - Muiruri, Charles AU - Zullig, Leah AU - Masalu, Nestory AU - Vasudevan, Lavanya PY - 2021/12/8 TI - Caregiver Acceptability of Mobile Phone Use for Pediatric Cancer Care in Tanzania: Cross-sectional Questionnaire Study JO - JMIR Pediatr Parent SP - e27988 VL - 4 IS - 4 KW - mHealth KW - literacy KW - smartphone use KW - developing countries KW - pediatric cancer KW - cancer KW - pediatrics KW - children KW - parents KW - caregivers KW - mobile health KW - smartphone KW - SMS KW - education KW - knowledge transfer KW - communication N2 - Background: There is a 60% survival gap between children diagnosed with cancer in low- and middle-income countries (LMICs) and those in high-income countries. Low caregiver knowledge about childhood cancer and its treatment results in presentation delays and subsequent treatment abandonment in LMICs. However, in-person education to improve caregiver knowledge can be challenging due to health worker shortages and inadequate training. Due to the rapid expansion of mobile phone use worldwide, mobile health (mHealth) technologies offer an alternative to delivering in-person education. Objective: The aim of this study is to assess patterns of mobile phone ownership and use among Tanzanian caregivers of children diagnosed with cancer as well as their acceptability of an mHealth intervention for cancer education, patient communication, and care coordination. Methods: In July 2017, caregivers of children <18 years diagnosed with cancer and receiving treatment at Bugando Medical Centre (BMC) were surveyed to determine mobile phone ownership, use patterns, technology literacy, and acceptability of mobile phone use for cancer education, patient communication, and care coordination. Descriptive statistics were generated from the survey data by using mean and SD values for continuous variables and percentages for binary or categorical variables. Results: All eligible caregivers consented to participate and completed the survey. Of the 40 caregivers who enrolled in the study, most used a mobile phone (n=34, 85%) and expressed high acceptability in using these devices to communicate with a health care provider regarding treatment support (n=39, 98%), receiving laboratory results (n=37, 93%), receiving reminders for upcoming appointments (n=38, 95%), and receiving educational information on cancer (n=35, 88%). Although only 9% (3/34) of mobile phone owners owned phones with smartphone capabilities, about 74% (25/34) self-reported they could view and read SMS text messages. Conclusions: To our knowledge, this is the first study to assess patterns of mobile phone ownership and use among caregivers of children with cancer in Tanzania. The high rate of mobile phone ownership and caregiver acceptability for a mobile phone?based education and communication strategy suggests that a mobile phone?based intervention, particularly one that utilizes SMS technology, could be feasible in this setting. UR - https://pediatrics.jmir.org/2021/4/e27988 UR - http://dx.doi.org/10.2196/27988 UR - http://www.ncbi.nlm.nih.gov/pubmed/34889763 ID - info:doi/10.2196/27988 ER - TY - JOUR AU - Bailey, E. James AU - Gurgol, Cathy AU - Pan, Eric AU - Njie, Shirilyn AU - Emmett, Susan AU - Gatwood, Justin AU - Gauthier, Lynne AU - Rosas, G. Lisa AU - Kearney, M. Shannon AU - Robler, Kleindienst Samantha AU - Lawrence, H. Raymona AU - Margolis, L. Karen AU - Osunkwo, Ifeyinwa AU - Wilfley, Denise AU - Shah, O. Vallabh PY - 2021/12/7 TI - Early Patient-Centered Outcomes Research Experience With the Use of Telehealth to Address Disparities: Scoping Review JO - J Med Internet Res SP - e28503 VL - 23 IS - 12 KW - telehealth KW - scoping review KW - disparities KW - implementation science N2 - 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. UR - https://www.jmir.org/2021/12/e28503 UR - http://dx.doi.org/10.2196/28503 UR - http://www.ncbi.nlm.nih.gov/pubmed/34878986 ID - info:doi/10.2196/28503 ER - TY - JOUR AU - Herrmann-Werner, Anne AU - Loda, Teresa AU - Zipfel, Stephan AU - Holderried, Martin AU - Holderried, Friederike AU - Erschens, Rebecca PY - 2021/12/2 TI - Evaluation of a Language Translation App in an Undergraduate Medical Communication Course: Proof-of-Concept and Usability Study JO - JMIR Mhealth Uhealth SP - e31559 VL - 9 IS - 12 KW - undergraduate medical students KW - translation app KW - simulation KW - physician-patient communication KW - mHealth KW - mobile applications KW - digital health KW - app development KW - language translation KW - translation apps N2 - Background: Language barriers in medical encounters pose risks for interactions with patients, their care, and their outcomes. Because human translators, the gold standard for mitigating language barriers, can be cost- and time-intensive, mechanical alternatives such as language translation apps (LTA) have gained in popularity. However, adequate training for physicians in using LTAs remains elusive. Objective: A proof-of-concept pilot study was designed to evaluate the use of a speech-to-speech LTA in a specific simulated physician-patient situation, particularly its perceived usability, helpfulness, and meaningfulness, and to assess the teaching unit overall. Methods: Students engaged in a 90-min simulation with a standardized patient (SP) and the LTA iTranslate Converse. Thereafter, they rated the LTA with six items?helpful, intuitive, informative, accurate, recommendable, and applicable?on a 7-point Likert scale ranging from 1 (don?t agree at all) to 7 (completely agree) and could provide free-text responses for four items: general impression of the LTA, the LTA?s benefits, the LTA?s risks, and suggestions for improvement. Students also assessed the teaching unit on a 6-point scale from 1 (excellent) to 6 (insufficient). Data were evaluated quantitatively with mean (SD) values and qualitatively in thematic content analysis. Results: Of 111 students in the course, 76 (68.5%) participated (59.2% women, age 20.7 years, SD 3.3 years). Values for the LTA?s being helpful (mean 3.45, SD 1.79), recommendable (mean 3.33, SD 1.65) and applicable (mean 3.57, SD 1.85) were centered around the average of 3.5. The items intuitive (mean 4.57, SD 1.74) and informative (mean 4.53, SD 1.95) were above average. The only below-average item concerned its accuracy (mean 2.38, SD 1.36). Students rated the teaching unit as being excellent (mean 1.2, SD 0.54) but wanted practical training with an SP plus a simulated human translator first. Free-text responses revealed several concerns about translation errors that could jeopardize diagnostic decisions. Students feared that patient-physician communication mediated by the LTA could decrease empathy and raised concerns regarding data protection and technical reliability. Nevertheless, they appreciated the LTA?s cost-effectiveness and usefulness as the best option when the gold standard is unavailable. They also reported wanting more medical-specific vocabulary and images to convey all information necessary for medical communication. Conclusions: This study revealed the feasibility of using a speech-to-speech LTA in an undergraduate medical course. Although human translators remain the gold standard, LTAs could be valuable alternatives. Students appreciated the simulated teaching and recognized the LTA?s potential benefits and risks for use in real-world clinical settings. To optimize patients? and health care professionals? experiences with LTAs, future investigations should examine specific design options for training interventions and consider the legal aspects of human-machine interaction in health care settings. UR - https://mhealth.jmir.org/2021/12/e31559 UR - http://dx.doi.org/10.2196/31559 UR - http://www.ncbi.nlm.nih.gov/pubmed/34860678 ID - info:doi/10.2196/31559 ER - TY - JOUR AU - Trofholz, Amanda AU - Tate, Allan AU - Janowiec, Mark AU - Fertig, Angela AU - Loth, Katie AU - de Brito, N. Junia AU - Berge, Jerica PY - 2021/12/1 TI - Ecological Momentary Assessment of Weight-Related Behaviors in the Home Environment of Children From Low-Income and Racially and Ethnically Diverse Households: Development and Usability Study JO - JMIR Res Protoc SP - e30525 VL - 10 IS - 12 KW - methods KW - ecological momentary assessment KW - weight-related behaviors KW - racially and ethnically diverse KW - children KW - mobile phone N2 - Background: Ecological momentary assessment (EMA) is an innovative tool for capturing in-the-moment health behaviors as people go about their daily lives. EMA is an ideal tool to measure weight-related behaviors, such as parental feeding practices, stress, and dietary intake, as these occur on a daily basis and vary across time and context. A recent systematic review recommended standardized reporting of EMA design for studies that address weight-related behaviors. Objective: To answer the call for reporting study designs using EMA, this paper describes in detail the EMA design of the Family Matters study and how it was adapted over time to improve functionality and meet the needs of a racially, ethnically, and socioeconomically diverse sample. Methods: Family Matters is an incremental, 2-phased, mixed methods study, conducted with a racially and ethnically diverse, immigrant and refugee sample from largely low-income households, designed to examine risk and protective factors for child weight and weight-related behaviors in the home environment. The Family Matters study intentionally recruited White, Black, Hmong, Latino, Native American, and Somali parents with young children. Parents in phase 1 of the study completed 8 days of EMA on their smartphones, which included signal-contingent surveys (eg, asking about the parent?s stress at the time of the survey), event-contingent surveys (eg, descriptions of the meal the child ate), and end-of-day surveys (eg, overall assessment of the child?s day). Results: A detailed description of EMA strategies, protocols, and methods used in phase 1 of the Family Matters study is provided. Compliance with EMA surveys and participants? time spent completing EMA surveys are presented and stratified by race and ethnicity. In addition, lessons learned while conducting phase 1 EMA are shared to document how EMA methods were improved and expanded upon for phase 2 of the Family Matters study. Conclusions: The results from this study provided an important next step in identifying best practices for EMA use in assessing weight-related behaviors in the home environment. International Registered Report Identifier (IRRID): DERR1-10.2196/30525 UR - https://www.researchprotocols.org/2021/12/e30525 UR - http://dx.doi.org/10.2196/30525 UR - http://www.ncbi.nlm.nih.gov/pubmed/34855612 ID - info:doi/10.2196/30525 ER - TY - JOUR AU - Iyamu, Ihoghosa AU - Xu, T. Alice X. AU - Gómez-Ramírez, Oralia AU - Ablona, Aidan AU - Chang, Hsiu-Ju AU - Mckee, Geoff AU - Gilbert, Mark PY - 2021/11/26 TI - Defining Digital Public Health and the Role of Digitization, Digitalization, and Digital Transformation: Scoping Review JO - JMIR Public Health Surveill SP - e30399 VL - 7 IS - 11 KW - digital public health KW - digital transformation KW - digitalization KW - scoping review KW - digitization KW - definition KW - mobile phone N2 - Background: The recent proliferation and application of digital technologies in public health has spurred interest in digital public health. However, as yet, there appears to be a lack of conceptual clarity and consensus on its definition. Objective: In this scoping review, we seek to assess formal and informal definitions of digital public health in the literature and to understand how these definitions have been conceptualized in relation to digitization, digitalization, and digital transformation. Methods: We conducted a scoping literature search in Ovid MEDLINE, Embase, Google Scholar, and 14 government and intergovernmental agency websites encompassing 6 geographic regions. Among a total of 409 full articles identified, we reviewed 11 publications that either formally defined digital public health or informally described the integration of digital technologies into public health in relation to digitization, digitalization, and digital transformation, and we conducted a thematic analysis of the identified definitions. Results: Two explicit definitions of digital public health were identified, each with divergent meanings. The first definition suggested digital public health was a reimagination of public health using new ways of working, blending established public health wisdom with new digital concepts and tools. The second definition highlighted digital public health as an asset to achieve existing public health goals. In relation to public health, digitization was used to refer to the technical process of converting analog records to digital data, digitalization referred to the integration of digital technologies into public health operations, and digital transformation was used to describe a cultural shift that pervasively integrates digital technologies and reorganizes services on the basis of the health needs of the public. Conclusions: The definition of digital public health remains contested in the literature. Public health researchers and practitioners need to clarify these conceptual definitions to harness opportunities to integrate digital technologies into public health in a way that maximizes their potential to improve public health outcomes. International Registered Report Identifier (IRRID): RR2-10.2196/preprints.27686 UR - https://publichealth.jmir.org/2021/11/e30399 UR - http://dx.doi.org/10.2196/30399 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842555 ID - info:doi/10.2196/30399 ER - TY - JOUR AU - Kunonga, Patience Tafadzwa AU - Spiers, Frances Gemma AU - Beyer, R. Fiona AU - Hanratty, Barbara AU - Boulton, Elisabeth AU - Hall, Alex AU - Bower, Peter AU - Todd, Chris AU - Craig, Dawn PY - 2021/11/24 TI - Effects of Digital Technologies on Older People?s Access to Health and Social Care: Umbrella Review JO - J Med Internet Res SP - e25887 VL - 23 IS - 11 KW - digital health KW - social care KW - access KW - older adults KW - review of reviews KW - umbrella review N2 - Background: The 2020 COVID-19 pandemic prompted the rapid implementation of new and existing digital technologies to facilitate access to health and care services during physical distancing. Older people may be disadvantaged in that regard if they are unable to use or have access to smartphones, tablets, computers, or other technologies. Objective: In this study, we synthesized evidence on the impact of digital technologies on older adults? access to health and social services. Methods: We conducted an umbrella review of systematic reviews published from January 2000 to October 2019 using comprehensive searches of 6 databases. We looked for reviews in a population of adults aged ?65 years in any setting, reporting outcomes related to the impact of technologies on access to health and social care services. Results: A total of 7 systematic reviews met the inclusion criteria, providing data from 77 randomized controlled trials and 50 observational studies. All of them synthesized findings from low-quality primary studies, 2 of which used robust review methods. Most of the reviews focused on digital technologies to facilitate remote delivery of care, including consultations and therapy. No studies examined technologies used for first contact access to care, such as online appointment scheduling. Overall, we found no reviews of technology to facilitate first contact access to health and social care such as online appointment booking systems for older populations. Conclusions: The impact of digital technologies on equitable access to services for older people is unclear. Research is urgently needed in order to understand the positive and negative consequences of digital technologies on health care access and to identify the groups most vulnerable to exclusion. UR - https://www.jmir.org/2021/11/e25887 UR - http://dx.doi.org/10.2196/25887 UR - http://www.ncbi.nlm.nih.gov/pubmed/34821564 ID - info:doi/10.2196/25887 ER - TY - JOUR AU - Aylward, Marion Shannon AU - Farrell, Alison AU - Walsh, Anna AU - Godwin, Marshall AU - Chafe, Roger AU - Asghari, Shabnam PY - 2021/11/19 TI - Quality of Primary Care for the Adult Population With Autism Spectrum Disorder: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e28196 VL - 10 IS - 11 KW - autism spectrum disorder KW - primary care KW - family physician KW - quality KW - scoping review KW - protocol N2 - Background: A strong primary care system is vital to overall health. Research on the primary care of people with autism spectrum disorder (ASD) has mostly focused on children. A synthesis of the existing literature related to the quality of primary care for the adult population with ASD would elucidate what is known about the topic as well as inform future research and clinical practice. Objective: The purpose of our scoping review is to describe what is known about the quality of primary care for adults with ASD and identify knowledge gaps. Methods: Prior to beginning the literature search, we reviewed literature related to defining both primary care and primary care quality to establish the context and concept of the research question. The search strategy was designed and executed by a research librarian. The MEDLINE, CINAHL, EMBASE, PsycINFO, and ProQuest Dissertations and Theses databases were searched for relevant literature. Grey literature will include relevant reports from government websites and associations with a focus on ASD. Two members of the research team will independently screen the academic and grey literature. Quantitative, qualitative, or mixed methods study designs involving the quality of primary care services or patient-centered care for adults with ASD are eligible for inclusion in our scoping review. Studies that make it past the full-text review will undergo data extraction and quality appraisal by 2 independent reviewers. The data extraction results will be presented in a tabular format to clearly present what is known about the quality of primary care for adults with ASD; this table will be accompanied by a narrative synthesis. Literature selected for extraction will be coded for themes, which will form the basis of a thematic synthesis. The scoping review will follow the guidance proposed by the Joanna Briggs Institute. Results: The search of electronic databases was conducted in October 2020, and it returned 2820 results. This research is still in progress. The results from our scoping review are expected to be available by fall 2021. Conclusions: The results from our scoping review will be useful for guiding future research on the quality of primary care for adults with ASD. International Registered Report Identifier (IRRID): PRR1-10.2196/28196 UR - https://www.researchprotocols.org/2021/11/e28196 UR - http://dx.doi.org/10.2196/28196 UR - http://www.ncbi.nlm.nih.gov/pubmed/34806989 ID - info:doi/10.2196/28196 ER - TY - JOUR AU - Rajamani, Geetanjali AU - Rodriguez Espinosa, Patricia AU - Rosas, G. Lisa PY - 2021/11/19 TI - Intersection of Health Informatics Tools and Community Engagement in Health-Related Research to Reduce Health Inequities: Scoping Review JO - J Particip Med SP - e30062 VL - 13 IS - 3 KW - community engagement KW - stakeholder involvement KW - underserved communities KW - health informatics KW - health information technology KW - health inequities KW - health-related research N2 - Background: The exponential growth of health information technology has the potential to facilitate community engagement in research. However, little is known about the use of health information technology in community-engaged research, such as which types of health information technology are used, which populations are engaged, and what are the research outcomes. Objective: The objectives of this scoping review were to examine studies that used health information technology for community engagement and to assess (1) the types of populations, (2) community engagement strategies, (3) types of health information technology tools, and (4) outcomes of interest. Methods: We searched PubMed and PCORI Literature Explorer using terms related to health information technology, health informatics, community engagement, and stakeholder involvement. This search process yielded 967 papers for screening. After inclusion and exclusion criteria were applied, a total of 37 papers were analyzed for key themes and for approaches relevant to health information technology and community engagement research. Results: This analysis revealed that the communities engaged were generally underrepresented populations in health-related research, including racial or ethnic minority communities such as Black/African American, American Indian/Alaska Native, Latino ethnicity, and communities from low socioeconomic backgrounds. The studies focused on various age groups, ranging from preschoolers to older adults. The studies were also geographically spread across the United States and the world. Community engagement strategies included collaborative development of health information technology tools and partnerships to promote use (encompassing collaborative development, use of community advisory boards, and focus groups for eliciting information needs) and use of health information technology to engage communities in research (eg, through citizen science). The types of technology varied across studies, with mobile or tablet-based apps being the most common platform. Outcomes measured included eliciting user needs and requirements, assessing health information technology tools and prototypes with participants, measuring knowledge, and advocating for community change. Conclusions: This study illustrates the current landscape at the intersection of health information technology tools and community-engaged research approaches. It highlights studies in which various community-engaged research approaches were used to design culturally centered health information technology tools, to promote health information technology uptake, or for engagement in health research and advocacy. Our findings can serve as a platform for generating future research upon which to expand the scope of health information technology tools and their use for meaningful stakeholder engagement. Studies that incorporate community context and needs have a greater chance of cocreating culturally centered health information technology tools and better knowledge to promote action and improve health outcomes. UR - https://jopm.jmir.org/2021/3/e30062 UR - http://dx.doi.org/10.2196/30062 UR - http://www.ncbi.nlm.nih.gov/pubmed/34797214 ID - info:doi/10.2196/30062 ER - TY - JOUR AU - Vidrine, J. Damon AU - Bui, C. Thanh AU - Businelle, S. Michael AU - Shih, Tina Ya-Chen AU - Sutton, K. Steven AU - Shahani, Lokesh AU - Hoover, Stewart Diana AU - Bowles, Kristina AU - Vidrine, I. Jennifer PY - 2021/11/17 TI - Evaluating the Efficacy of Automated Smoking Treatment for People With HIV: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e33183 VL - 10 IS - 11 KW - smoking cessation KW - health disparities KW - HIV/AIDS KW - mHealth KW - mobile phone N2 - Background: Smoking prevalence rates among people with HIV are nearly 3 times higher than those in the general population. Nevertheless, few smoking cessation trials targeting smokers with HIV have been reported in the literature. Efforts to develop and evaluate sustainable, low-cost, and evidence-based cessation interventions for people with HIV are needed. Given the widespread proliferation of mobile phones, the potential of using mobile health apps to improve the reach and efficacy of cessation interventions is promising, but evidence of efficacy is lacking, particularly among people with HIV. Objective: This study will consist of a 2-group randomized controlled trial to evaluate a fully automated smartphone intervention for people with HIV seeking cessation treatment. Methods: Participants (N=500) will be randomized to receive either standard treatment (ST; 250/500, 50%) or automated treatment (AT; 250/500, 50%). ST participants will be connected to the Florida Quitline and will receive nicotine replacement therapy in the form of transdermal patches and lozenges. This approach, referred to as Ask Advise Connect, was developed by our team and has been implemented in numerous health systems. ST will be compared with AT, a fully automated behavioral treatment approach. AT participants will receive nicotine replacement therapy and an interactive smartphone-based intervention that comprises individually tailored audiovisual and text content. The major goal is to determine whether AT performs better in terms of facilitating long-term smoking abstinence than the more resource-intensive ST approach. Our primary aim is to evaluate the efficacy of AT in facilitating smoking cessation among people with HIV. As a secondary aim, we will explore potential mediators and moderators and conduct economic evaluations to assess the cost and cost-effectiveness of AT compared with ST. Results: The intervention content has been developed and finalized. Recruitment and enrollment will begin in the fall of 2021. Conclusions: There is a critical need for efficacious, cost-effective, and sustainable cessation treatments for people with HIV who smoke. The AT intervention was designed to help fill this need. If efficacy is established, the AT approach will be readily adoptable by HIV clinics and community-based organizations, and it will offer an efficient way to allocate limited public health resources to tobacco control interventions. Trial Registration: ClinicalTrials.gov NCT05014282; https://clinicaltrials.gov/ct2/show/NCT05014282 International Registered Report Identifier (IRRID): PRR1-10.2196/33183 UR - https://www.researchprotocols.org/2021/11/e33183 UR - http://dx.doi.org/10.2196/33183 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787590 ID - info:doi/10.2196/33183 ER - TY - JOUR AU - Biau, Sandrine AU - Bonnet, Emmanuel AU - Dagenais, Christian AU - De Allegri, Manuela AU - Traoré, Zoumana AU - Ouedraogo, Wahabo Abdoul AU - Sow, Abdramane AU - Dubois-Nguyen, Karina AU - Ridde, Valéry PY - 2021/11/16 TI - Using Information and Communication Technologies to Engage Citizens in Health System Governance in Burkina Faso: Protocol for Action Research JO - JMIR Res Protoc SP - e28780 VL - 10 IS - 11 KW - health governance KW - ICTs KW - citizen participation KW - responsiveness KW - social responsibility KW - Burkina Faso KW - technology platforms KW - democracy KW - health systems KW - equity KW - West Africa KW - public health KW - participation KW - health policy N2 - Background: Health systems are complex systems involving a vast range of actors. In West Africa, they are often not accessible or responsive. Burkina Faso has widely expressed, in its public health policy, the need to improve both access to quality care and health system responsiveness. There is also a strong wish to give more voice to citizens. To support Burkinabè institutions in achieving these goals, we have developed an action research (AR) protocol. Objective: This paper presents the protocol that will address citizens? participation in health policies and their empowerment through the expression of opinions, for accountability, as well as the strengthening of the health system using information and communication technologies (ICTs). Methods: Our approach will consist of (1) enabling people to express their opinions on the health system by means of a toll-free (TF) service coupled with an interactive voice server (IVS); (2) building an information base with anonymous and reliable data; and (3) conducting information awareness-raising activities, including knowledge transfer (KT) and advocacy, social integration activities, development of OpenData platforms, and the capitalization and media coverage of governance issues. For this purpose, the AR project will be implemented in Burkina Faso. The design uses a concurrent mixed-methods approach. This AR project will evaluate the acceptability, process, effectiveness, and economic costs of the device?s implementation. We will also analyze the potential for the data collected by the device to be used to improve practices. Results: Data collection is in progress; the TF number was officially launched on July 1, 2020, and data collection is planned to continue throughout 2021. By using mixed methods, our AR will be approached from a variety of perspectives. Mixed methods will support us in combining the partial insights into sophisticated realities from qualitative inquiries with the data analyses produced by quantitative research. Conclusions: This AR is expected to add knowledge on how to increase the empowerment of the population, especially the most vulnerable, to participate in democratic processes and enjoy and exercise their human rights. This protocol recommends implementing a low-cost, contextually adapted technology, associated with an evidence-based approach and carried out on a significant scale. The originality of this approach lies in the fact that it introduces a real AR dimension with local communities and nongovernmental organizations (NGOs), combined with an integrated strategy of KT and application throughout the project for all stakeholders. International Registered Report Identifier (IRRID): DERR1-10.2196/28780 UR - https://www.researchprotocols.org/2021/11/e28780 UR - http://dx.doi.org/10.2196/28780 UR - http://www.ncbi.nlm.nih.gov/pubmed/34783671 ID - info:doi/10.2196/28780 ER - TY - JOUR AU - Lee, Jiyeon AU - Lee, Eun-Hyun AU - Chae, Duckhee PY - 2021/11/15 TI - eHealth Literacy Instruments: Systematic Review of Measurement Properties JO - J Med Internet Res SP - e30644 VL - 23 IS - 11 KW - eHealth literacy KW - systematic review KW - meta-analysis KW - psychometrics KW - reliability KW - validity KW - scale KW - instrument N2 - Background: The internet is now a major source of health information. With the growth of internet users, eHealth literacy has emerged as a new concept for digital health care. Therefore, health professionals need to consider the eHealth literacy of consumers when providing care utilizing digital health technologies. Objective: This study aimed to identify currently available eHealth literacy instruments and evaluate their measurement properties to provide robust evidence to researchers and clinicians who are selecting an eHealth literacy instrument. Methods: We conducted a systematic review and meta-analysis of self-reported eHealth literacy instruments by applying the updated COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) methodology. Results: This study included 7 instruments from 41 articles describing 57 psychometric studies, as identified in 4 databases (PubMed, CINAHL, Embase, and PsycInfo). No eHealth literacy instrument provided evidence for all measurement properties. The eHealth literacy scale (eHEALS) was originally developed with a single-factor structure under the definition of eHealth literacy before the rise of social media and the mobile web. That instrument was evaluated in 18 different languages and 26 countries, involving diverse populations. However, various other factor structures were exhibited: 7 types of two-factor structures, 3 types of three-factor structures, and 1 bifactor structure. The transactional eHealth literacy instrument (TeHLI) was developed to reflect the broader concept of eHealth literacy and was demonstrated to have a sufficient low-quality and very low-quality evidence for content validity (relevance, comprehensiveness, and comprehensibility) and sufficient high-quality evidence for structural validity and internal consistency; however, that instrument has rarely been evaluated. Conclusions: The eHealth literacy scale was the most frequently investigated instrument. However, it is strongly recommended that the instrument's content be updated to reflect recent advancements in digital health technologies. In addition, the transactional eHealth literacy instrument needs improvements in content validity and further psychometric studies to increase the credibility of its synthesized evidence. UR - https://www.jmir.org/2021/11/e30644 UR - http://dx.doi.org/10.2196/30644 UR - http://www.ncbi.nlm.nih.gov/pubmed/34779781 ID - info:doi/10.2196/30644 ER - TY - JOUR AU - Neves, Luisa Ana AU - Smalley, R. Katelyn AU - Freise, Lisa AU - Harrison, Paul AU - Darzi, Ara AU - Mayer, K. Erik PY - 2021/11/11 TI - Determinants of Use of the Care Information Exchange Portal: Cross-sectional Study JO - J Med Internet Res SP - e23481 VL - 23 IS - 11 KW - patient portals KW - electronic health records KW - patient participation N2 - Background: Sharing electronic health records with patients has been shown to improve patient safety and quality of care. Patient portals represent a convenient tool to enhance patient access to their own health care data. However, the success of portals will only be possible through sustained adoption by its end users: the patients. A better understanding of the characteristics of users and nonusers is critical for understanding which groups remain excluded from using such tools. Objective: This study aims to identify the determinants of the use of the Care Information Exchange, a shared patient portal program in the United Kingdom. Methods: A cross-sectional study was conducted using a web-based questionnaire. Information collected included age, gender, ethnicity, educational level, health status, postcode, and digital literacy. Registered individuals were defined as having had an account created in the portal, independent of their actual use of the platform; users were defined as having ever used the portal. Multivariate logistic regression was used to model the probability of being a user. Statistical analysis was performed in R and Tableau was used to create maps of the proportion of Care Information Exchange users by postcode area. Results: A total of 1083 participants replied to the survey (186% of the estimated minimum target sample). The proportion of users was 61.58% (667/1083). Among these, most (385/667, 57.7%) used the portal at least once a month. To characterize the system?s users and nonusers, we performed a subanalysis of the sample, including only participants who had provided at least information regarding gender and age. The subanalysis included 650 individuals (389/650, 59.8% women; 551/650, 84.8% >40 years). Most participants were White (498/650, 76.6%) and resided in London (420/650, 64.6%). Individuals with a higher educational degree (undergraduate and professional, or postgraduate and higher) had higher odds of being a portal user (adjusted odds ratio [OR] 1.58, 95% CI 1.04-2.39 and OR 2.38, 95% CI 1.42-4.02, respectively) compared with those with a secondary degree or below. Higher digital literacy scores (?30) were associated with higher odds of being a user (adjusted OR 2.96, 95% CI 2.02-4.35). Those with a good overall health status had lower odds of being a user (adjusted OR 0.58, 95% CI 0.37-0.91). Conclusions: This work adds to the growing body of evidence highlighting the importance of educational aspects (educational level and digital literacy) in the adoption of patient portals. Further research should not only describe but also systematically address these inequalities through patient-centered interventions aimed at reducing the digital divide. Health care providers and policy makers must partner in investing and delivering strategic programs that improve access to technology and digital literacy in an effort to improve digital inclusion and reduce inequities in the delivery of care. UR - https://www.jmir.org/2021/11/e23481 UR - http://dx.doi.org/10.2196/23481 UR - http://www.ncbi.nlm.nih.gov/pubmed/34762063 ID - info:doi/10.2196/23481 ER - TY - JOUR AU - Lang, Michael AU - Lemieux, Sébastien AU - Hébert, Josée AU - Sauvageau, Guy AU - Zawati, H. Ma'n PY - 2021/11/11 TI - Legal and Ethical Considerations for the Design and Use of Web Portals for Researchers, Clinicians, and Patients: Scoping Literature Review JO - J Med Internet Res SP - e26450 VL - 23 IS - 11 KW - medical ethics KW - web portal KW - scoping review KW - eHealth KW - portal N2 - Background: This study aims to identify a novel potential use for web portals in health care and health research: their adoption for the purposes of rapidly sharing health research findings with clinicians, scientists, and patients. In the era of precision medicine and learning health systems, the translation of research findings into targeted therapies depends on the availability of big data and emerging research results. Web portals may work to promote the availability of novel research, working in tandem with traditional scientific publications and conference proceedings. Objective: This study aims to assess the potential use of web portals, which facilitate the sharing of health research findings among researchers, clinicians, patients, and the public. It also summarizes the potential legal, ethical, and policy implications associated with such tools for public use and in the management of patient care for complex diseases. Methods: This study broadly adopts the methods for scoping literature reviews outlined by Arskey and O?Malley in 2005. Raised by the integration of web portals into patient care for complex diseases, we systematically searched 3 databases, PubMed, Scopus, and WestLaw Next, for sources describing web portals for sharing health research findings among clinicians, researchers, and patients and their associated legal, ethical, and policy challenges. Of the 719 candidate source citations, 22 were retained for the review. Results: We found varied and inconsistent treatment of web portals for sharing health research findings among clinicians, researchers, and patients. Although the literature supports the view that portals of this kind are potentially highly promising, they remain novel and are not yet widely adopted. We also found a wide range of discussions on the legal, ethical, and policy issues related to the use of web portals to share research data. Conclusions: We identified 5 important legal and ethical challenges: privacy and confidentiality, patient health literacy, equity, training, and decision-making. We contend that each of these has meaningful implications for the increased integration of web portals into clinical care. UR - https://www.jmir.org/2021/11/e26450 UR - http://dx.doi.org/10.2196/26450 UR - http://www.ncbi.nlm.nih.gov/pubmed/34762055 ID - info:doi/10.2196/26450 ER - TY - JOUR AU - Drazich, F. Brittany AU - Nyikadzino, Yeukai AU - Gleason, T. Kelly PY - 2021/11/10 TI - A Program to Improve Digital Access and Literacy Among Community Stakeholders: Cohort Study JO - JMIR Form Res SP - e30605 VL - 5 IS - 11 KW - technology KW - disparities KW - digital access KW - digital literacy KW - community KW - stakeholders KW - digital health KW - digital divide KW - patient-centered outcomes N2 - Background: For many research teams, the role of community stakeholders is critical. However, community stakeholders, especially those in low-income settings, are at risk of being excluded from research and community engagement initiatives during and after the COVID-19 pandemic because of the rapid transition to digital operations. Objective: We aimed to describe the implementation and feasibility of a program called Addressing the Digital Divide to Improve Patient-Centered Outcomes Research, which was designed to address barriers to technology use, and to examine changes in participants? perceived comfort with digital technology before and after the program. Methods: To promote full engagement, we worked with 20 existing community leaders to cocreate a training course on using digital technology. We assessed the frequency of technology use and comfort with technology through an adapted 8-item version of the Functional Assessment of Comfort Employing Technology Scale and used the Wilcoxon signed-rank test for survey analysis. We also conducted a focus group session with 10 participants and then performed reflective journaling and content analysis to determine emergent themes. Results: We found that the program was feasible to implement and worthwhile for participants (15/16, 94%). After the program, the participants perceived an increase in the frequency of technology use (z=2.76, P=.006). The participants reported that the program was successful because of the technology training program, but recommended that the program have a slower pace and include a helpline number that they could call with questions. Conclusions: Future programs should consider that populations with low literacy view technology training as a core element to decreasing technology disparity. This study demonstrates that through low-cost input, community members can be provided the resources and training needed to virtually participate in research studies or community engagement initiatives. UR - https://formative.jmir.org/2021/11/e30605 UR - http://dx.doi.org/10.2196/30605 UR - http://www.ncbi.nlm.nih.gov/pubmed/34757316 ID - info:doi/10.2196/30605 ER - TY - JOUR AU - Singh, Akansha AU - Lai, Yan Angel Hor AU - Wang, Jingxuan AU - Asim, Saba AU - Chan, Shing-Fong Paul AU - Wang, Zixin AU - Yeoh, Kiong Eng PY - 2021/11/9 TI - Multilevel Determinants of COVID-19 Vaccine Uptake Among South Asian Ethnic Minorities in Hong Kong: Cross-sectional Web-Based Survey JO - JMIR Public Health Surveill SP - e31707 VL - 7 IS - 11 KW - COVID-19 KW - South Asian ethnic minorities KW - COVID-19 vaccination KW - uptake KW - cultural and religious reasons for vaccine hesitancy KW - perceptions KW - information exposure on social media KW - influence of peers KW - socioecological model KW - Hong Kong N2 - Background: The COVID-19 pandemic continues to have a disproportionate effect on ethnic minorities. Across countries, greater vaccine hesitancy has been observed among ethnic minorities. After excluding foreign domestic helpers, South Asians make up the largest proportion of ethnic minorities in Hong Kong. It is necessary to plan for COVID-19 vaccination promotional strategies that cater to the unique needs of South Asians in Hong Kong. Objective: This study investigated the prevalence of COVID-19 vaccine uptake among a sample of South Asians in Hong Kong. We examined the effects of sociodemographic data and factors at individual level (perceptions), interpersonal level (information exposure on social media), and sociostructural level (cultural) based on the socioecological model. Methods: A cross-sectional web-based survey was conducted on May 1-31, 2021. Participants were South Asian people aged 18 years or older living in Hong Kong; able to comprehend English, Hindi, Nepali, or Urdu; and having access to a smartphone. Three community-based organizations providing services to South Asians in Hong Kong facilitated the data collection. The staff of the community-based organizations posted the study information in WhatsApp groups involving South Asian clients and invited them to participate in a web-based survey. Logistic regression models were fit for data analysis. Results: Among 245 participants, 81 (33.1%) had taken at least one dose of the COVID-19 vaccine (one dose, 62/245, 25.2%; and both doses, 19/245, 7.9%). After adjusting for significant background characteristics, cultural and religious reasons for COVID-19 vaccine hesitancy were associated with lower COVID-19 vaccine uptake (adjusted odds ratio [AOR] 0.83, 95% CI 0.71-0.97; P=.02). At the individual level, having more positive attitudes toward COVID-19 vaccination (AOR 1.31, 95% CI 1.10-1.55; P=.002), perceived support from significant others (AOR 1.29, 95% CI 1.03-1.60; P=.03), and perceived higher behavioral control to receive COVID-19 vaccination (AOR 2.63, 95% CI 1.65-4.19; P<.001) were associated with higher COVID-19 vaccine uptake, while a negative association was found between negative attitudes and the dependent variable (AOR 0.73, 95% CI 0.62-0.85; P<.001). Knowing more peers who had taken the COVID-19 vaccine was also associated with higher uptake (AOR 1.39, 95% CI 1.11-1.74; P=.01). At the interpersonal level, higher exposure to information about deaths and other serious conditions caused by COVID-19 vaccination was associated with lower uptake (AOR 0.54, 95% CI 0.33-0.86; P=.01). Conclusions: In this study, one-third (81/245) of our participants received at least one dose of the COVID-19 vaccine. Cultural or religious reasons, perceptions, information exposure on social media, and influence of peers were found to be the determinants of COVID-19 vaccine uptake among South Asians. Future programs should engage community groups, champions, and faith leaders, and develop culturally competent interventions. UR - https://publichealth.jmir.org/2021/11/e31707 UR - http://dx.doi.org/10.2196/31707 UR - http://www.ncbi.nlm.nih.gov/pubmed/34653014 ID - info:doi/10.2196/31707 ER - TY - JOUR AU - Nwaogu, Mayowa Janet AU - Chan, C. Albert P. AU - Naslund, A. John AU - Hon, H. Carol K. AU - Belonwu, Christopher AU - Yang, Jackie PY - 2021/11/9 TI - Exploring the Barriers to and Motivators for Using Digital Mental Health Interventions Among Construction Personnel in Nigeria: Qualitative Study JO - JMIR Form Res SP - e18969 VL - 5 IS - 11 KW - mental health KW - construction personnel KW - digital technology KW - digital intervention KW - barriers KW - motivators KW - mobile phone N2 - Background: Work-related stress in the construction industry increases the prevalence of depression and anxiety among personnel. In low-resource settings such as Nigeria, construction personnel face high demands and severe working conditions but only have a few services to address their mental health needs. With emerging research showing that digital interventions can be used to self-manage mental health across diverse settings, there may be new opportunities to support construction personnel in the construction industry. Objective: This study aims to determine the use of digital interventions for mental health management among construction personnel in Nigeria and to explore the factors that facilitate or impede the use of these interventions. Methods: This qualitative study explored the perspectives of a convenience sample of 62 construction personnel. The data were subjected to inductive content analysis. Results: A total of 6 barrier and 3 motivator themes were identified and categorized into 2 groups. The barrier themes were subcategorized into barriers to adoption and barriers to persistent use, whereas the motivator themes were subcategorized into intrinsic and extrinsic motivators. Lack of awareness and knowledge about the interventions may constitute a barrier to adoption and use. Participants frequently reported concerns regarding their effectiveness and usability. Conclusions: This study provides an understanding of the design needs required to facilitate sustained self-management of mental health based on the experiences and expectations of construction personnel with digital interventions. UR - https://formative.jmir.org/2021/11/e18969 UR - http://dx.doi.org/10.2196/18969 UR - http://www.ncbi.nlm.nih.gov/pubmed/34751652 ID - info:doi/10.2196/18969 ER - TY - JOUR AU - El Morr, Christo AU - Maret, Pierre AU - Muhlenbach, Fabrice AU - Dharmalingam, Dhayananth AU - Tadesse, Rediet AU - Creighton, Alexandra AU - Kundi, Bushra AU - Buettgen, Alexis AU - Mgwigwi, Thumeka AU - Dinca-Panaitescu, Serban AU - Dua, Enakshi AU - Gorman, Rachel PY - 2021/11/5 TI - A Virtual Community for Disability Advocacy: Development of a Searchable Artificial Intelligence?Supported Platform JO - JMIR Form Res SP - e33335 VL - 5 IS - 11 KW - virtual community KW - machine learning KW - Semantic Web KW - natural language processing KW - web intelligence KW - health informatics KW - Wikibase KW - disability rights KW - human rights KW - CRPD KW - equity KW - community KW - disability KW - ethics KW - rights KW - pilot KW - platform N2 - Background: The lack of availability of disability data has been identified as a major challenge hindering continuous disability equity monitoring. It is important to develop a platform that enables searching for disability data to expose systemic discrimination and social exclusion, which increase vulnerability to inequitable social conditions. Objective: Our project aims to create an accessible and multilingual pilot disability website that structures and integrates data about people with disabilities and provides data for national and international disability advocacy communities. The platform will be endowed with a document upload function with hybrid (automated and manual) paragraph tagging, while the querying function will involve an intelligent natural language search in the supported languages. Methods: We have designed and implemented a virtual community platform using Wikibase, Semantic Web, machine learning, and web programming tools to enable disability communities to upload and search for disability documents. The platform data model is based on an ontology we have designed following the United Nations Convention on the Rights of Persons with Disabilities (CRPD). The virtual community facilitates the uploading and sharing of validated information, and supports disability rights advocacy by enabling dissemination of knowledge. Results: Using health informatics and artificial intelligence techniques (namely Semantic Web, machine learning, and natural language processing techniques), we were able to develop a pilot virtual community that supports disability rights advocacy by facilitating uploading, sharing, and accessing disability data. The system consists of a website on top of a Wikibase (a Semantic Web?based datastore). The virtual community accepts 4 types of users: information producers, information consumers, validators, and administrators. The virtual community enables the uploading of documents, semiautomatic tagging of their paragraphs with meaningful keywords, and validation of the process before uploading the data to the disability Wikibase. Once uploaded, public users (information consumers) can perform a semantic search using an intelligent and multilingual search engine (QAnswer). Further enhancements of the platform are planned. Conclusions: The platform ontology is flexible and can accommodate advocacy reports and disability policy and legislation from specific jurisdictions, which can be accessed in relation to the CRPD articles. The platform ontology can be expanded to fit international contexts. The virtual community supports information upload and search. Semiautomatic tagging and intelligent multilingual semantic search using natural language are enabled using artificial intelligence techniques, namely Semantic Web, machine learning, and natural language processing. UR - https://formative.jmir.org/2021/11/e33335 UR - http://dx.doi.org/10.2196/33335 UR - http://www.ncbi.nlm.nih.gov/pubmed/34738910 ID - info:doi/10.2196/33335 ER - TY - JOUR AU - Sabherwal, Shalinder AU - Chinnakaran, Anand AU - Sood, Ishaana AU - Garg, K. Gaurav AU - Singh, P. Birendra AU - Shukla, Rajan AU - Reddy, A. Priya AU - Gilbert, Suzanne AU - Bassett, Ken AU - Murthy, S. Gudlavalleti V. AU - PY - 2021/11/4 TI - Effect of Door-to-Door Screening and Awareness Generation Activities in the Catchment Areas of Vision Centers on Service Use: Protocol for a Randomized Experimental Study JO - JMIR Res Protoc SP - e31951 VL - 10 IS - 11 KW - study protocol KW - randomized intervention study KW - vision centers KW - door-to-door screening KW - cost-effectiveness KW - sustainability KW - screening KW - awareness KW - vision KW - eye KW - utilization KW - usage KW - India KW - rural KW - intervention KW - engagement KW - scalability N2 - Background: A vision center (VC) is a significant eye care service model to strengthen primary eye care services. VCs have been set up at the block level, covering a population of 150,000-250,000 in rural areas in North India. Inadequate use by rural communities is a major challenge to sustainability of these VCs. This not only reduces the community?s vision improvement potential but also impacts self-sustainability and limits expansion of services in rural areas. The current literature reports a lack of awareness regarding eye diseases and the need for care, social stigmas, low priority being given to eye problems, prevailing gender discrimination, cost, and dependence on caregivers as factors preventing the use of primary eye care. Objective: Our organization is planning an awareness-cum-engagement intervention?door-to-door basic eye checkup and visual acuity screening in VCs coverage areas?to connect with the community and improve the rational use of VCs. Methods: In this randomized, parallel-group experimental study, we will select 2 VCs each for the intervention arm and the control arm from among poor, low-performing VCs (ie, walk-in of ?10 patients/day) in our 2 operational regions (Vrindavan, Mathura District, and Mohammadi, Kheri District) of Uttar Pradesh. Intervention will include door-to-door screening and awareness generation in 8-12 villages surrounding the VCs, and control VCs will follow existing practices of awareness generation through community activities and health talks. Data will be collected from each VC for 4 months of intervention. Primary outcomes will be an increase in the number of walk-in patients, spectacle advise and uptake, referral and uptake for cataract and specialty surgery, and operational expenses. Secondary outcomes will be uptake of refraction correction and referrals for cataract and other eye conditions. Differences in the number of walk-in patients, referrals, uptake of services, and cost involved will be analyzed. Results: Background work involved planning of interventions and selection of VCs has been completed. Participant recruitment has begun and is currently in progress. Conclusions: Through this study, we will analyze whether our door-to-door intervention is effective in increasing the number of visits to a VC and, thus, overall sustainability. We will also study the cost-effectiveness of this intervention to recommend its scalability. Trial Registration: ClinicalTrials.gov NCT04800718; https://clinicaltrials.gov/ct2/show/NCT04800718 International Registered Report Identifier (IRRID): DERR1-10.2196/31951 UR - https://www.researchprotocols.org/2021/11/e31951 UR - http://dx.doi.org/10.2196/31951 UR - http://www.ncbi.nlm.nih.gov/pubmed/34734839 ID - info:doi/10.2196/31951 ER - TY - JOUR AU - Chae, Steve AU - Lee, Yoon-Jae AU - Han, Hae-Ra PY - 2021/10/29 TI - Sources of Health Information, Technology Access, and Use Among Non?English-Speaking Immigrant Women: Descriptive Correlational Study JO - J Med Internet Res SP - e29155 VL - 23 IS - 10 KW - technology use KW - internet KW - text messaging KW - health literacy KW - English proficiency KW - immigrant KW - health disparities KW - Korean American KW - women KW - mobile phone N2 - 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. UR - https://www.jmir.org/2021/10/e29155 UR - http://dx.doi.org/10.2196/29155 UR - http://www.ncbi.nlm.nih.gov/pubmed/34714249 ID - info:doi/10.2196/29155 ER - TY - JOUR AU - Adu, Kofi Medard AU - Shalaby, Reham AU - Eboreime, Ejemai AU - Sapara, Adegboyega AU - Nkire, Nnamdi AU - Chawla, Rajan AU - Chima, Chidi AU - Achor, Michael AU - Osiogo, Felix AU - Chue, Pierre AU - Greenshaw, J. Andrew AU - Agyapong, Israel Vincent PY - 2021/10/13 TI - Text Messaging Versus Email Messaging to Support Patients With Major Depressive Disorder: Protocol for a Randomized Hybrid Type II Effectiveness-Implementation Trial JO - JMIR Res Protoc SP - e29495 VL - 10 IS - 10 KW - email messaging KW - text messaging KW - supportive KW - major depressive disorder KW - randomized trial KW - mental health KW - digital health KW - mobile health KW - mHealth KW - patient care KW - health policy KW - decision-making KW - health care resources N2 - Background: Major depressive disorder (MDD) accounts for 40.5% of disability-adjusted life years caused by mental and substance use disorders. Barriers such as stigma and financial and physical access to care have been reported, highlighting the need for innovative, accessible, and cost-effective psychological interventions. The effectiveness of supportive SMS text messaging in alleviating depression symptoms has been proven in clinical trials, but this approach can only help those with mobile phones. Objective: This paper presents the protocol for a study that will aim to evaluate the feasibility, comparative effectiveness, and user satisfaction of daily supportive email messaging as an effective strategy compared to daily supportive text messaging as part of the treatment of patients with MDD. Methods: This trial will be carried out using a hybrid type II implementation-effectiveness design. This design evaluates the effectiveness of an implementation strategy or intervention, while also evaluating the implementation context associated with the intervention. Patients with MDD receiving usual care will be randomized to receive either daily supportive email messaging or daily supportive text messaging of the same content for 6 months. The Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the 5-item World Health Organization Well-Being Index will be used to evaluate the effectiveness of both strategies. The implementation evaluation will be guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, as well as the Consolidated Framework for Implementation Research. All outcome measures will be analyzed using descriptive and inferential statistics. Qualitative data will be analyzed using thematic analysis. Results: Data collection for this trial began in April 2021. We expect the study results to be available within 18 months of study commencement. The results will shed light on the feasibility, acceptability, and effectiveness of using automated emails as a strategy for delivering supportive messages to patients with MDD in comparison to text messaging. Conclusions: The outcome of this trial will have translational impact on routine patient care and access to mental health, as well as potentially support mental health policy decision-making for health care resource allocation. Trial Registration: ClinicalTrials.gov NCT04638231; https://clinicaltrials.gov/ct2/show/NCT04638231 International Registered Report Identifier (IRRID): DERR1-10.2196/29495 UR - https://www.researchprotocols.org/2021/10/e29495 UR - http://dx.doi.org/10.2196/29495 UR - http://www.ncbi.nlm.nih.gov/pubmed/34643541 ID - info:doi/10.2196/29495 ER - TY - JOUR AU - Marshall, Gard Emily AU - Breton, Mylaine AU - Cossette, Benoit AU - Isenor, Jennifer AU - Mathews, Maria AU - Ayn, Caitlyn AU - Smithman, Ann Mélanie AU - Stock, David AU - Frymire, Eliot AU - Edwards, Lynn AU - Green, Michael PY - 2021/10/13 TI - Problems in Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year (the PUPPY Study): Protocol for a Longitudinal Mixed Methods Study JO - JMIR Res Protoc SP - e29984 VL - 10 IS - 10 KW - primary care KW - health services research KW - health policy KW - mixed methods research KW - COVID-19 KW - protocol KW - policy KW - longitudinal KW - coordination KW - access KW - impact KW - virtual care KW - virtual health KW - Canada N2 - Background: The COVID-19 pandemic has significantly disrupted primary care in Canada, with many walk-in clinics and family practices initially closing or being perceived as inaccessible; pharmacies remaining open with restrictions on patient interactions; rapid uptake of virtual care; and reduced referrals for lab tests, diagnostics, and specialist care. Objective: The PUPPY Study (Problems in Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year) seeks to understand the impact of the COVID-19 pandemic across the quadruple aims of primary care, with particular focus on the effects on patients without attachment to a regular provider and those with chronic health conditions. Methods: The PUPPY study builds on an existing research program exploring patients? access and attachment to a primary care practice, pivoted to adapt to the emerging COVID-19 context. We intend to undertake a longitudinal mixed methods study to understand critical gaps in primary care access and coordination, as well as compare prepandemic and postpandemic data across 3 Canadian provinces (Quebec, Ontario, and Nova Scotia). Multiple data sources will be used such as a policy review; qualitative interviews with primary care policymakers, providers (ie, family physicians, nurse practitioners, and pharmacists), and patients (N=120); and medication prescriptions and health care billing data. Results: This study has received funding by the Canadian Institutes of Health Research COVID-19 Rapid Funding Opportunity Grant. Ethical approval to conduct this study was granted in Ontario (Queens Health Sciences & Affiliated Teaching Hospitals Research Ethics Board, file 6028052; Western University Health Sciences Research Ethics Board, project 116591; University of Toronto Health Sciences Research Ethics Board, protocol 40335) in November 2020, Québec (Centre intégré universitaire de santé et de services sociaux de l'Estrie, project 2020-3446) in December 2020, and Nova Scotia (Nova Scotia Health Research Ethics Board, file 1024979) in August 2020. Conclusions: To our knowledge, this is the first study of its kind to explore the effects of the COVID-19 pandemic on primary care systems, with particular focus on the issues of patient?s attachment and access to primary care. Through a multistakeholder, cross-jurisdictional approach, the findings of the PUPPY study will inform the strengthening of primary care during and beyond the COVID-19 pandemic, as well as have implications for future policy and practice. International Registered Report Identifier (IRRID): DERR1-10.2196/29984 UR - https://www.researchprotocols.org/2021/10/e29984 UR - http://dx.doi.org/10.2196/29984 UR - http://www.ncbi.nlm.nih.gov/pubmed/34559672 ID - info:doi/10.2196/29984 ER - TY - JOUR AU - Albouy-Llaty, Marion AU - Martin, Caroline AU - Benamouzig, Daniel AU - Bothorel, Eric AU - Munier, Gilles AU - Simonin, Catherine AU - Guéant, Jean-Louis AU - Rusch, Emmanuel PY - 2021/10/7 TI - Positioning Digital Tracing Applications in the Management of the COVID-19 Pandemic in France JO - J Med Internet Res SP - e27301 VL - 23 IS - 10 KW - COVID-19 pandemic KW - digital contact tracing applications KW - health inequalities KW - Europe KW - health promotion UR - https://www.jmir.org/2021/10/e27301 UR - http://dx.doi.org/10.2196/27301 UR - http://www.ncbi.nlm.nih.gov/pubmed/34313588 ID - info:doi/10.2196/27301 ER - TY - JOUR AU - Nowaskie, Z. Dustin PY - 2021/9/22 TI - Development, Implementation, and Effectiveness of a Self-sustaining, Web-Based LGBTQ+ National Platform: A Framework for Centralizing Local Health Care Resources and Culturally Competent Providers JO - JMIR Form Res SP - e17913 VL - 5 IS - 9 KW - cultural competency KW - disparities KW - e-health KW - healthcare KW - internet KW - LGBTQ+ KW - online platform KW - providers KW - resources KW - eHealth KW - health care N2 - Background: The lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) population has long faced substantial marginalization, discrimination, and health care disparities compared to the cisgender, heterosexual population. As the etiology of such disparities is multifaceted, finding concrete solutions for LGBTQ+ health care equity is challenging. However, the internet may offer the space to initiate an effective model. Objective: In an effort to make LGBTQ+ public resources and culturally competent providers transparent, modernize medical education, and promote cultural competency, OutCare Health?a nonprofit 501(c)(3) multidisciplinary, multicenter web-based platform?was created. Methods: The organization employs a cyclic, multidimensional framework to conduct needs assessments, identify resources and providers, promote these efforts on the website, and educate the next generation of providers. LGBTQ+ public health services are identified via the internet, email, and word of mouth and added to the Public Resource Database; culturally competent providers are recruited to the OutList directory via listservs, medical institutions, local organizations, and word of mouth; and mentors are invited to the Mentorship Program by emailing OutList providers. These efforts are replicated across nearly 30 states in the United States. Results: The organization has identified over 500 public health organizations across all states, recognized more than 2000 OutList providers across all states and 50 specialties, distributed hundreds of thousands of educational materials, received over 10,000 monthly website visits (with 83% unique viewership), and formed nearly 30 state-specific teams. The total number of OutList providers and monthly website views has doubled every 12-18 months. The majority of OutList providers are trained in primary, first point-of-care specialties such as family medicine, infectious disease, internal medicine, mental health, obstetrics and gynecology, and pediatrics. Conclusions: A web-based LGBTQ+ platform is a feasible, effective model to identify public health resources, culturally competent providers, and mentors as well as provide cultural competency educational materials and education across the country. Such a platform also has the opportunity to reach self-perpetuating sustainability. The cyclic, multidisciplinary, multidimensional, multicenter framework presented here appears to be pivotal in achieving such growth and stability. Other organizations and medical institutions should heavily consider using this framework to reach their own communities with high-quality, culturally competent care for the LGBTQ+ population. UR - https://formative.jmir.org/2021/9/e17913 UR - http://dx.doi.org/10.2196/17913 UR - http://www.ncbi.nlm.nih.gov/pubmed/34550083 ID - info:doi/10.2196/17913 ER - TY - JOUR AU - Rantanen, Teemu AU - Gluschkoff, Kia AU - Silvennoinen, Piia AU - Heponiemi, Tarja PY - 2021/9/21 TI - The Associations Between Mental Health Problems and Attitudes Toward Web-Based Health and Social Care Services: Evidence From a Finnish Population-Based Study JO - J Med Internet Res SP - e28066 VL - 23 IS - 9 KW - digital inclusion KW - digital exclusion KW - digital divide KW - mental health KW - attitudes N2 - Background: The significance of web-based health and social care services has been highlighted in recent years. There is a risk that the digitalization of public services will reinforce the digital and social exclusion of vulnerable groups, such as individuals with mental health problems. Objective: This study aims to examine the associations between mental health problems and attitudes toward web-based health and social care services in the general population. The attitudes measured include lack of interest, perceived need for face-to-face encounters, and concern for safety. The study also evaluates whether sociodemographic characteristics (age, gender, education level, and poverty) modify these associations. Methods: Cross-sectional population-based data were collected from 4495 Finnish adults in 2017. Linear regression was used to examine the main effects and interactions of poor mental health and sociodemographic characteristics on attitudes toward web-based health and social care services. Results: The results show that mental health was associated with attitudes toward web-based health and social care services. Individuals with mental health problems were especially concerned about the safety of web-based services. Poor mental health was independently associated with negative attitudes toward web-based services over the effects of sociodemographic factors. Some of the associations between poor mental health and negative attitudes toward web-based services were stronger among older people and men. With regard to sociodemographic characteristics, particularly higher age, low education, and poverty were associated with negative attitudes toward web-based health and social care services. Conclusions: Poor mental health is associated with negative attitudes toward web-based health and social care services and thus indirectly with exclusion. It seems that being older and being male both reinforce the link between poor mental health and exclusion. In supporting the digital inclusion of people with mental health problems, attention should be paid to guidance and counseling, reliability, and the user-friendliness of web-based services as well as to the prevention of poverty. In addition, it is essential to see web-based services as complementary to, and not a substitute for, face-to-face services. UR - https://www.jmir.org/2021/9/e28066 UR - http://dx.doi.org/10.2196/28066 UR - http://www.ncbi.nlm.nih.gov/pubmed/34546184 ID - info:doi/10.2196/28066 ER - TY - JOUR AU - Wang, Xin Jonathan AU - Somani, Sulaiman AU - Chen, H. Jonathan AU - Murray, Sara AU - Sarkar, Urmimala PY - 2021/9/17 TI - Health Equity in Artificial Intelligence and Primary Care Research: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e27799 VL - 10 IS - 9 KW - artificial intelligence KW - health information technology KW - health informatics KW - electronic health records KW - big data KW - data mining KW - primary care KW - family medicine KW - decision support KW - diagnosis KW - treatment KW - scoping review KW - health equity KW - health disparity N2 - 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 UR - https://www.researchprotocols.org/2021/9/e27799 UR - http://dx.doi.org/10.2196/27799 UR - http://www.ncbi.nlm.nih.gov/pubmed/34533458 ID - info:doi/10.2196/27799 ER - TY - JOUR AU - Bhawra, Jasmin AU - Skinner, Kelly AU - Favel, Duane AU - Green, Brenda AU - Coates, Ken AU - Katapally, Reddy Tarun PY - 2021/9/15 TI - The Food Equity and Environmental Data Sovereignty (FEEDS) Project: Protocol for a Quasi-Experimental Study Evaluating a Digital Platform for Climate Change Preparedness JO - JMIR Res Protoc SP - e31389 VL - 10 IS - 9 KW - food security KW - food sovereignty KW - food equity KW - mental health KW - solastalgia KW - climate change impacts KW - climate change preparedness KW - digital health KW - digital dashboards KW - Indigenous health KW - mobile phone N2 - Background: Despite having the tools at our disposal to enable an adequate food supply for all people, inequities in food acquisition, distribution, and most importantly, food sovereignty, worsen food insecurity. The detrimental impact of climate change on food systems and mental health is further exacerbated by a lack of food sovereignty. We urgently require innovative solutions to enable food sovereignty, minimize food insecurity, and address climate change?related mental distress (ie, solastalgia). Indigenous communities have a wealth of Traditional Knowledge for climate change adaptation and preparedness to strengthen food systems. Traditional Knowledge combined with Western methods can revolutionize ethical data collection, engagement, and knowledge mobilization. Objective: The Food Equity and Environmental Data Sovereignty (FEEDS) Project takes a participatory action, citizen science approach for early detection and warning of climate change impacts on food sovereignty, food security, and solastalgia. The aim of this project is to develop and implement a sustainable digital platform that enables real-time decision-making to mitigate climate change?related impacts on food systems and mental well-being. Methods: Citizen science enables citizens to actively contribute to all aspects of the research process. The FEEDS Project is being implemented in five phases: participatory project planning, digital climate change platform customization, community-led evaluation, digital platform and project refinement, and integrated knowledge translation. The project is governed by a Citizen Scientist Advisory Council comprising Elders, Traditional Knowledge Keepers, key community decision makers, youth, and FEEDS Project researchers. The Council governs all phases of the project, including coconceptualizing a climate change platform, which consists of a smartphone app and a digital decision-making dashboard. Apart from capturing environmental and health-related big data (eg, weather, permafrost degradation, fire hazards, and human movement), the custom-built app uses artificial intelligence to engage and enable citizens to report on environmental hazards, changes in biodiversity or wildlife, and related food and mental health issues in their communities. The app provides citizens with valuable information to mitigate health-related risks and relays big data in real time to a digital dashboard. Results: This project is currently in phase 1, with the subarctic Métis jurisdiction of Île-à-la-Crosse, Saskatchewan, Canada. Conclusions: The FEEDS Project facilitates Indigenous Peoples? self-determination, governance, and data sovereignty. All citizen data are anonymous and encrypted, and communities have ownership, access, control, and possession of their data. The digital dashboard system provides decision makers with real-time data, thereby increasing the capacity to self-govern. The participatory action research approach, combined with digital citizen science, advances the cocreation of knowledge and multidisciplinary collaboration in the digital age. Given the urgency of climate change, leveraging technology provides communities with tools to respond to existing and emerging crises in a timely manner, as well as scientific evidence regarding the urgency of current health and environmental issues. International Registered Report Identifier (IRRID): PRR1-10.2196/31389 UR - https://www.researchprotocols.org/2021/9/e31389 UR - http://dx.doi.org/10.2196/31389 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524106 ID - info:doi/10.2196/31389 ER - TY - JOUR AU - Frew, M. Paula AU - Randall, A. Laura AU - King, R. Adrian AU - Schamel, T. Jay AU - Spaulding, C. Anne AU - AU - Holloway, W. Ian PY - 2021/9/10 TI - Health Behavior Survey Among People Who Use Opioids: Protocol for Implementing Technology-Based Rapid Response Surveillance in Community Settings JO - JMIR Res Protoc SP - e25575 VL - 10 IS - 9 KW - substance use KW - opioid KW - opioid crisis KW - social determinants KW - hidden populations KW - health equity N2 - Background: In 2018, 2 million Americans met the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition diagnostic criteria for an opioid use disorder, and 9.9 million Americans had misused prescription pain relievers the previous year. Despite a rapid increase in opioid misuse, opioid use disorders, and overdoses, data are limited on the behavioral and contextual risks as well as the protective factors fueling the opioid epidemic in some hard hit US cities?Atlanta, Los Angeles, and Las Vegas. Opioid use also contributes to the risk of other health problems such as HIV and hepatitis C virus infections or mental health disorders and is linked to behavioral and environmental risks (eg, homelessness, experiences of violence, involvement in the justice system). Knowledge of the relationships between these linked vulnerabilities and how they influence service utilization is critical to effective policy and interventions. Objective: This survey explores the relationships between demographic and economic characteristics, behavioral and environmental risk factors, and service utilization of people who use opioids to inform public health practice, policy, and future efforts to mitigate the risks faced by this population experiencing multiple health, social, and economic vulnerabilities. The results of this survey will be used to identify needs and intervention points for people who use drugs currently served by public health organizations. Methods: We implemented a community-engaged strategy that involved development and execution of a two-stage purposive sampling plan involving selection of partner organizations (syringe exchange programs in urban settings) and recruitment and enrollment of participants aged 18-69 years served by these organizations in Atlanta, Los Angeles, and Las Vegas from 2019 to 2020. The recruited participants completed a survey, including a variety of measures to assess health (physical and mental) and health behaviors such as sexual behavior, vaccine receipt, and HIV/ hepatitis C virus infection testing. Additional items assessed drug use and misuse, syringe exchange and health service utilization, sex exchange, histories of interpersonal violence, and vaccine confidence. Results: This protocol was successfully implemented despite challenges such as real-time technology issues and rapidly finding and surveying a difficult-to-reach population. We sampled 1127 unique participants (248 in Atlanta, 465 in Los Angeles, and 414 in Las Vegas). Conclusions: The establishment and utilization of strong community partnerships enabled the rapid collection of data from a typically difficult-to-reach population. Local efforts such as these are needed to develop policies and practices that promote harm reduction among people who use opioids. International Registered Report Identifier (IRRID): RR1-10.2196/25575 UR - https://www.researchprotocols.org/2021/9/e25575 UR - http://dx.doi.org/10.2196/25575 UR - http://www.ncbi.nlm.nih.gov/pubmed/34505834 ID - info:doi/10.2196/25575 ER - TY - JOUR AU - Champlin, Sara AU - Cuculick, Jessica AU - Hauser, C. Peter AU - Wyse, Kelley AU - McKee, M. Michael PY - 2021/9/7 TI - Using Gaze Tracking as a Research Tool in the Deaf Health Literacy and Access to Health Information Project: Protocol for a Multisite Mixed Methods Study and Preliminary Results JO - JMIR Res Protoc SP - e26708 VL - 10 IS - 9 KW - gaze tracking KW - deaf KW - disabilities KW - accessibility KW - online health information KW - health information seeking KW - mobile phone N2 - Background: Previous studies have identified the internet as a major source of health information. Reliable and accessible sources of web-based health information are critical for cultivating patient-centered care. However, the accessibility and use of web-based health information remains largely unknown for deaf individuals. We used gaze-tracking technology to understand the navigation and use of web-based health information by deaf adults who communicate with sign language and by hearing adults. Objective: This paper discusses our protocol for implementing gaze-tracking technology in a study that included both deaf and hearing participants. We report the preliminary results and lessons learned from the implementation of the protocol. Methods: We conducted gaze-tracking sessions with 450 deaf signers and 450 hearing participants as a part of a larger, multisite mixed methods research study. Then, we conducted qualitative elicitation interviews with a subsample of 21 deaf and 13 hearing participants, who engaged in a search task and reviewed their gaze recordings. To our knowledge, no study has implemented a similar research protocol to better understand the experiences of deaf adults. As such, we also examined research staff notes and observations from team meetings regarding the conduct of gaze-tracking data to delineate lessons learned and best practices for research protocols in this area. Results: Findings from the implementation of this study protocol highlight the use of gaze technology with deaf participants. We developed additional protocol steps to minimize gaze disruption from either lipreading or communicating in sign language. For example, research assistants were often unable to maintain eye contact with participants while signing because of the need to simultaneously point at the computer monitor to provide instructions related to gaze study components, such as the calibration process. In addition to developing ways to effectively provide instructions in American Sign Language, a practice exercise was included in the gaze tracker session to familiarize participants with the computer and technology. The use of the playback feature permitted a deeper dialogue between researchers and participants, which we found vital for understanding the experiences of deaf participants. Conclusions: On the basis of our experience using the study protocol through a large research project, incorporating gaze-tracking technology offers beneficial avenues for better understanding how individuals interact with health information. Gaze tracking can determine the type and placement of visual content that attracts attention from the viewers of diverse backgrounds, including deaf individuals. The lessons learned through this study will help future researchers in determining ideal study designs, such as suitable protocols and participant characteristics (eg, deaf signers), while including gaze trackers in their projects. This approach explored how different ways of presenting health information can affect or enable visual learners to engage and use health information effectively. International Registered Report Identifier (IRRID): RR1-10.2196/26708 UR - https://www.researchprotocols.org/2021/9/e26708 UR - http://dx.doi.org/10.2196/26708 UR - http://www.ncbi.nlm.nih.gov/pubmed/34491211 ID - info:doi/10.2196/26708 ER - TY - JOUR AU - Qian, Lei AU - Sy, S. Lina AU - Hong, Vennis AU - Glenn, C. Sungching AU - Ryan, S. Denison AU - Morrissette, Kerresa AU - Jacobsen, J. Steven AU - Xu, Stanley PY - 2021/9/1 TI - Disparities in Outpatient and Telehealth Visits During the COVID-19 Pandemic in a Large Integrated Health Care Organization: Retrospective Cohort Study JO - J Med Internet Res SP - e29959 VL - 23 IS - 9 KW - COVID-19 KW - pandemic KW - health care utilization KW - telehealth KW - disparity N2 - Background: Dramatic decreases in outpatient visits and sudden increases in telehealth visits were observed during the COVID-19 pandemic, but it was unclear whether these changes differed by patient demographics and socioeconomic status. Objective: This study aimed to assess the impact of the pandemic on in-person outpatient and telehealth visits (telephone and video) by demographic characteristics and household income in a diverse population. Methods: We calculated weekly rates of outpatient and telehealth visits by age, sex, race/ethnicity, and neighborhood-level median household income among members of Kaiser Permanente Southern California (KPSC) from January 5, 2020, to October 31, 2020, and the corresponding period in 2019. We estimated the percentage change in visit rates during the early pandemic period (March 22 to April 25, 2020) and the late pandemic period (October 4 to October 31, 2020) from the prepandemic period (January 5 to March 7, 2020) in Poisson regression models for each subgroup while adjusting for seasonality using 2019 data. We examined if the changes in visit rates differed by subgroups statistically by comparing their 95% CIs. Results: Among 4.56 million KPSC members enrolled in January 2020, 15.0% (n=682,947) were ?65 years old, 51.5% (n=2,345,020) were female, 39.4% (n=1,795,994) were Hispanic, and 7.7% (n=350,721) lived in an area of median household income 18 years) detailed sociodemographic characteristics, family history of stroke, and stroke survivorship. Participant health interests were compared by race or ethnicity using Kruskal-Wallis or chi-square test at an ?=.05. A Bonferroni-corrected P value of .0083 was used for multiple comparisons. Results: Stomp Out Stroke registrants (N=1401) were 70% (973/1390) female (median age 45 years) and largely self-identified as members of minority groups: 32.05% (449/1401) Hispanic, 25.62% (359/1401) African American, 13.63% (191/1401) Asian compared with 23.63% (331/1401) non-Hispanic White. Stroke survivors comprised 11.55% (155/1401) of our population. A total of 124 stroke caregivers participated. Approximately 36.81% (493/1339) of participants had a family history of stroke. African American participants were most likely to have Medicare or Medicaid insurance (84/341, 24.6%), whereas Hispanic participants were most likely to be uninsured (127/435, 29.2%). Hispanic participants were more likely than non-Hispanic White participants to obtain health screenings (282/449, 62.8% vs 175/331, 52.9%; P=.03). Asian (105/191, 54.9%) and African American (201/359, 55.9%) participants were more likely to request stroke education than non-Hispanic White (138/331, 41.6%) or Hispanic participants (193/449, 42.9%). African American participants were more likely to seek overall health education than non-Hispanic White participants (166/359, 46.2% vs 108/331, 32.6%; P=.002). Non-Hispanic White participants (48/331, 14.5%) were less likely to speak to health care providers than African American (91/359, 25.3%) or Asian participants (54/191, 28.3%). During the 2018 and 2019 events, 2774 health screenings were completed across 12 hours, averaging four health screenings per minute. These included blood pressure (1031/2774, 37.16%), stroke risk assessment (496/2774, 17.88%), bone density (426/2774, 15.35%), carotid ultrasound (380/2774, 13.69%), BMI (182/2774, 6.56%), serum lipids (157/2774, 5.65%), and hemoglobin A1c (102/2774, 3.67%). Twenty multimedia placements using the Stomp Out Stroke webpage, social media, #stompoutstroke, television, iQ radio, and web-based news reached approximately 849,731 people in the Houston area. Conclusions: Using a combination of internet-based recruitment, registration, and in-person assessments, Stomp Out Stroke identified race- or ethnicity-specific health care needs and provided appropriate screenings to minority populations at increased risk of urban flooding and stroke. This protocol can be replicated in Southern US Stroke Belt cities with similar flood risks. UR - https://www.jmir.org/2021/8/e28748 UR - http://dx.doi.org/10.2196/28748 UR - http://www.ncbi.nlm.nih.gov/pubmed/34397385 ID - info:doi/10.2196/28748 ER - TY - JOUR AU - Bauer, Cici AU - Zhang, Kehe AU - Lee, Miryoung AU - Fisher-Hoch, Susan AU - Guajardo, Esmeralda AU - McCormick, Joseph AU - de la Cerda, Isela AU - Fernandez, E. Maria AU - Reininger, Belinda PY - 2021/8/5 TI - Census Tract Patterns and Contextual Social Determinants of Health Associated With COVID-19 in a Hispanic Population From South Texas: A Spatiotemporal Perspective JO - JMIR Public Health Surveill SP - e29205 VL - 7 IS - 8 KW - COVID-19 KW - spatial pattern KW - social determinants of health KW - Bayesian KW - underserved population KW - health inequity N2 - Background: Previous studies have shown that various social determinants of health (SDOH) may have contributed to the disparities in COVID-19 incidence and mortality among minorities and underserved populations at the county or zip code level. Objective: This analysis was carried out at a granular spatial resolution of census tracts to explore the spatial patterns and contextual SDOH associated with COVID-19 incidence from a Hispanic population mostly consisting of a Mexican American population living in Cameron County, Texas on the border of the United States and Mexico. We performed age-stratified analysis to identify different contributing SDOH and quantify their effects by age groups. Methods: We included all reported COVID-19?positive cases confirmed by reverse transcription?polymerase chain reaction testing between March 18 (first case reported) and December 16, 2020, in Cameron County, Texas. Confirmed COVID-19 cases were aggregated to weekly counts by census tracts. We adopted a Bayesian spatiotemporal negative binomial model to investigate the COVID-19 incidence rate in relation to census tract demographics and SDOH obtained from the American Community Survey. Moreover, we investigated the impact of local mitigation policy on COVID-19 by creating the binary variable ?shelter-in-place.? The analysis was performed on all COVID-19?confirmed cases and age-stratified subgroups. Results: Our analysis revealed that the relative incidence risk (RR) of COVID-19 was higher among census tracts with a higher percentage of single-parent households (RR=1.016, 95% posterior credible intervals [CIs] 1.005, 1.027) and a higher percentage of the population with limited English proficiency (RR=1.015, 95% CI 1.003, 1.028). Lower RR was associated with lower income (RR=0.972, 95% CI 0.953, 0.993) and the percentage of the population younger than 18 years (RR=0.976, 95% CI 0.959, 0.993). The most significant association was related to the ?shelter-in-place? variable, where the incidence risk of COVID-19 was reduced by over 50%, comparing the time periods when the policy was present versus absent (RR=0.506, 95% CI 0.454, 0.563). Moreover, age-stratified analyses identified different significant contributing factors and a varying magnitude of the ?shelter-in-place? effect. Conclusions: In our study, SDOH including social environment and local emergency measures were identified in relation to COVID-19 incidence risk at the census tract level in a highly disadvantaged population with limited health care access and a high prevalence of chronic conditions. Results from our analysis provide key knowledge to design efficient testing strategies and assist local public health departments in COVID-19 control, mitigation, and implementation of vaccine strategies. UR - https://publichealth.jmir.org/2021/8/e29205 UR - http://dx.doi.org/10.2196/29205 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081608 ID - info:doi/10.2196/29205 ER - TY - JOUR AU - Miyawaki, Atsushi AU - Tabuchi, Takahiro AU - Ong, K. Michael AU - Tsugawa, Yusuke PY - 2021/7/23 TI - Age and Social Disparities in the Use of Telemedicine During the COVID-19 Pandemic in Japan: Cross-sectional Study JO - J Med Internet Res SP - e27982 VL - 23 IS - 7 KW - telemedicine KW - telehealth KW - disparity KW - access to care KW - COVID-19 KW - Japan N2 - Background: The use of telemedicine outpatient visits has increased dramatically during the COVID-19 pandemic in many countries. Although disparities in access to telemedicine by age and socioeconomic status (SES) have been well-documented, evidence is limited as to how these disparities changed during the COVID-19 pandemic. Moreover, the equity of patient access to telemedicine has been scarcely reported in Japan, despite the huge potential for telemedicine expansion. Objective: We aimed to investigate changes due to age and SES disparities in telemedicine use during the COVID-19 pandemic in Japan. Methods: Using data from a large internet survey conducted between August 25 and September 30, 2020, in Japan, we examined the associations of participant age and SES (educational attainment, urbanicity of residence, and income level) with their telemedicine use in the following two time periods during the pandemic: April 2020 and August-September 2020. Results: Of the 24,526 participants aged 18 to 79 years (50.8% [n=12,446] women), the proportion of individuals who reported using telemedicine increased from 2.0% (n=497) in April 2020 to 4.7% (n=1159) in August-September 2020. After adjusting for potential confounders, younger individuals were more likely to use telemedicine than older individuals in April 2020. Although this pattern persisted in August-September 2020, we also observed a substantial increase in telemedicine use among individuals aged 70 to 79 years (adjusted rates, 0.2% in April 2020 vs 3.8% in August-September 2020; P<.001 after multiple comparisons). We found disparities in telemedicine use by SES in August-September 2020 that did not exist in April 2020. In August-September 2020, individuals with a university degree were more likely to use telemedicine than those with a high school diploma or less (adjusted rates, 6.6% vs 3.5%; P<.001). Individuals living in urban areas exhibited higher rates of telemedicine use than those living in rural areas only in August-September 2020 (adjusted rates, 5.2% vs 3.8%; P<.001). Disparities in telemedicine use by income level were not observed in either time period. Conclusions: In general, younger individuals increased their use of telemedicine compared to older individuals during the pandemic, although individuals in their 70s also increased their use of telemedicine. Disparities in telemedicine use by educational attainment and urbanicity of residence widened during the COVID-19 pandemic. UR - https://www.jmir.org/2021/7/e27982 UR - http://dx.doi.org/10.2196/27982 UR - http://www.ncbi.nlm.nih.gov/pubmed/34259641 ID - info:doi/10.2196/27982 ER - TY - JOUR AU - Shah, K. Megha AU - Gibbs, Christina Ashley AU - Ali, K. Mohammed AU - Narayan, Venkat K. M. AU - Islam, Nadia PY - 2021/7/8 TI - Overcoming the Digital Divide in the Post?COVID-19 ?Reset?: Enhancing Group Virtual Visits with Community Health Workers JO - J Med Internet Res SP - e27682 VL - 23 IS - 7 KW - community health workers KW - COVID-19 KW - diabetes mellitus KW - eHealth KW - elderly KW - health equity KW - telemedicine KW - virtual KW - vulnerable populations UR - https://www.jmir.org/2021/7/e27682 UR - http://dx.doi.org/10.2196/27682 UR - http://www.ncbi.nlm.nih.gov/pubmed/34152995 ID - info:doi/10.2196/27682 ER - TY - JOUR AU - Kebede, Sahilemichael Abraham AU - Ozolins, Lise-Lotte AU - Holst, Hanna AU - Galvin, Kathleen PY - 2021/7/5 TI - The Digital Engagement of Older People: Systematic Scoping Review Protocol JO - JMIR Res Protoc SP - e25616 VL - 10 IS - 7 KW - digital divide KW - digital engagement KW - digital inclusion KW - initial adoption KW - older people KW - older users KW - sustained engagement KW - technological nonuse KW - older adults N2 - Background: There is an ongoing negative narrative about aging that portrays older people as a socioeconomic burden on society. However, increased longevity and good health will allow older adults to contribute meaningfully to society and maximize their well-being. As such, a paradigm shift toward healthy and successful aging can be potentially facilitated by the growing digital technology use for mainstream (day-to-day activities) and assisted living (health and social care). Despite the rising digital engagement trend, digital inequality between the age groups persists. Objective: The aims of this scoping review are to identify the extent and breadth of existing literature of older people?s perspectives on digital engagement and summarize the barriers and facilitators for technological nonuse, initial adoption, and sustained digital technology engagement. Methods: This review will be based on the Arksey and O?Malley framework for scoping reviews. The 6-stage framework includes: identifying research questions, identifying relevant studies, study selection, charting the data, summarizing and reporting the results, and a consultation exercise. Published literature will be searched on primary electronic databases such as the Association of Computing Machinery, Web of Science, MEDLINE, PsycINFO, CINAHL, and ScienceDirect. Common grey literature sources will complement the database search on the topic. A two-stage (title/abstract and full article) screening will be conducted to obtain eligible studies for final inclusion. A standardized data extraction tool will be used to extract variables such as the profile of the study population, technologies under investigation, stage of digital engagement, and the barriers and facilitators. Identified and eligible studies will be analyzed using a quantitative (ie, frequency analysis) and qualitative (ie, content analysis) approach suitable for comparing and evaluating literature to provide an evaluation of the current state of the older person?s digital engagement. Inclusion will be based on the Joanna Briggs Institute?recommended participant, concept, and context framework. Articles on older people (65 years and older), on digital technology engagement, and from a global context will be included in our review. Results: The results of this review are expected in July 2021. Conclusions: The findings from this review will identify the extent and nature of empirical evidence on how older people digitally engage and the associated barriers and facilitators. International Registered Report Identifier (IRRID): PRR1-10.2196/25616 UR - https://www.researchprotocols.org/2021/7/e25616 UR - http://dx.doi.org/10.2196/25616 UR - http://www.ncbi.nlm.nih.gov/pubmed/36260392 ID - info:doi/10.2196/25616 ER - TY - JOUR AU - Brown, I. Nashira AU - Powell, Anne Mary AU - Baskin, Monica AU - Oster, Robert AU - Demark-Wahnefried, Wendy AU - Hardy, Claudia AU - Pisu, Maria AU - Thirumalai, Mohanraj AU - Townsend, Sh'Nese AU - Neal, N. Whitney AU - Rogers, Q. Laura AU - Pekmezi, Dori PY - 2021/5/25 TI - Design and Rationale for the Deep South Interactive Voice Response System?Supported Active Lifestyle Study: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e29245 VL - 10 IS - 5 KW - exercise KW - health disparities KW - interactive voice response system KW - physical activity KW - rural health KW - telehealth N2 - Background: The rates of physical inactivity and related cancer incidence and mortality are disproportionately high in the Deep South region in the United States, a rural, medically underserved region with a large African American population compared with the rest of the nation. Given this region?s lower rates of literacy and internet access, interactive voice response (IVR) system?automated telephone-based interventions have the potential to help overcome physical activity intervention barriers (literacy, internet access, costs, and transportation) but have yet to be extended to rural, underserved populations, such as in the Deep South. Thus, extensive formative research is being conducted to develop and beta test the Deep South IVR System?Supported Active Lifestyle intervention in preparation for dissemination in rural Alabama counties. Objective: This paper aims to describe the design and rationale of an ongoing efficacy trial of the Deep South IVR System?Supported Active Lifestyle intervention. Methods: A two-arm randomized controlled trial will be conducted to compare a 12-month physical activity intervention versus a wait-list control condition in 240 underactive adults from 6 rural Alabama counties. The Deep South IVR System?Supported Active Lifestyle intervention is based on the Social Cognitive Theory and includes IVR-automated physical activity?related phone counseling (daily in months 0-3, twice weekly in months 4-6, and weekly in months 7-12) and support from local rural county coordinators with the University of Alabama O?Neal Comprehensive Cancer Center Community Outreach and Engagement Office. The primary outcome is weekly minutes of moderate- to vigorous-intensity physical activity (7-day physical activity recall; accelerometry) at baseline, 6 months, 12 months, and 18 months. Rural Active Living Assessments will be conducted in each rural county to assess walkability, assess recreational amenities, and inform future environment and policy efforts. Results: This study was funded in March 2019 and approved by the institutional review board of the University of Alabama at Birmingham in April 2019. As of February 2020, start-up activities (hiring and training staff and purchasing supplies) were completed. Study recruitment and assessments began in September 2020 and are ongoing. As of February 2021, a total of 43 participants have been enrolled in Dallas County, 42 in Sumter County, and 51 in Greene County. Conclusions: IVR-supported phone counseling has great potential for addressing physical activity barriers (eg, culture, literacy, cost, or transportation) and reducing related rural health disparities in this region. Trial Registration: ClinicalTrials.gov NCT03903874; https://clinicaltrials.gov/ct2/show/NCT03903874. International Registered Report Identifier (IRRID): DERR1-10.2196/29245 UR - https://www.researchprotocols.org/2021/5/e29245 UR - http://dx.doi.org/10.2196/29245 UR - http://www.ncbi.nlm.nih.gov/pubmed/34032575 ID - info:doi/10.2196/29245 ER - TY - JOUR AU - Diniz, Grilo Carmen Simone AU - Franzon, Arruda Ana Carolina AU - Fioretti-Foschi, Beatriz AU - Niy, Yoshie Denise AU - Pedrilio, Sanches Livia AU - Amaro Jr, Edson AU - Sato, Ricardo João PY - 2021/5/21 TI - Communication Intervention Using Digital Technology to Facilitate Informed Choices at Childbirth in the Context of the COVID-19 Pandemic: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e25016 VL - 10 IS - 5 KW - app KW - childbirth KW - communication KW - COVID-19 KW - health literacy KW - informatics KW - internet KW - intervention KW - maternal health KW - neonatal health KW - neonate public health KW - society KW - technology KW - women N2 - Background: In Brazil and other low- and middle-income countries, excess interventions in childbirth are associated with an increase in preterm and early-term births, contributing to stagnant morbidity and mortality of mothers and neonates. The fact that women often report a negative experience with vaginal childbirth, with physical pain and feelings of unsafety, neglect, or abuse, may explain the high acceptability of elective cesarean sections. The recognition of information needs and of the right to informed choice during childbirth can help change this reality. The internet has been the main source of health information, but its quality is highly variable. Objective: This study aimed to develop and evaluate an information and communication strategy through a smartphone app with respect to childbirth, to facilitate informed choices for access to safer and evidence-based care in the context of the COVID-19 pandemic. Methods: A randomized controlled trial, with 2 arms (intervention and control) and a closed, blind, parallel design, will be conducted with a smartphone app designed for behavior and opinion research in Brazil, with women of reproductive age previously registered on the app. After completing an entry questionnaire to verify the eligibility criteria and obtaining ethical consent, approximately 20,000 participants will be randomly allocated to the intervention and control groups at a 1:1 ratio. Participants allocated to the intervention group will be invited to engage in a digital information and communication strategy, which is designed to expand evidence-based knowledge on the advantages and disadvantages of options for labor and childbirth and the safety of the care processes. The information is based on the guidelines of the Ministry of Health and the World Health Organization for a positive childbirth experience and has been updated to include the new challenges and disruptions in maternity care within the context of the COVID-19 pandemic. The control group will receive information regarding disposable and reusable diapers as a placebo intervention. The groups will be compared in their responses in generating the birth plan and the entry and exit questionnaires, regarding responses less or more aligned with the guidelines for a positive childbirth experience. A qualitative component to map information needs is included. Results: The digital trial started recruiting participants in late October 2020, and data collection has been projected to be complete by December 2020. Conclusions: This study will evaluate an innovative intervention that has the potential to promote better communication between women and providers, such that they can make better choices using an approach suitable for use during the COVID-19 pandemic. Trial Registration: The Brazilian Clinical Trials Registry U1111-1255-8683; http://www.ensaiosclinicos.gov.br/rg/RBR-3g5f9f/ International Registered Report Identifier (IRRID): PRR1-10.2196/25016 UR - https://www.researchprotocols.org/2021/5/e25016 UR - http://dx.doi.org/10.2196/25016 UR - http://www.ncbi.nlm.nih.gov/pubmed/33945496 ID - info:doi/10.2196/25016 ER - TY - JOUR AU - Stevens, P. Jennifer AU - Mechanic, Oren AU - Markson, Lawrence AU - O'Donoghue, Ashley AU - Kimball, B. Alexa PY - 2021/5/20 TI - Telehealth Use by Age and Race at a Single Academic Medical Center During the COVID-19 Pandemic: Retrospective Cohort Study JO - J Med Internet Res SP - e23905 VL - 23 IS - 5 KW - access KW - barrier KW - cohort KW - COVID-19 KW - demographic KW - equity of care KW - equity KW - outpatient KW - telehealth N2 - Background: During the COVID-19 pandemic, many ambulatory clinics transitioned to telehealth, but it remains unknown how this may have exacerbated inequitable access to care. Objective: Given the potential barriers faced by different populations, we investigated whether telehealth use is consistent and equitable across age, race, and gender. Methods: Our retrospective cohort study of outpatient visits was conducted between March 2 and June 10, 2020, compared with the same time period in 2019, at a single academic health center in Boston, Massachusetts. Visits were divided into in-person visits and telehealth visits and then compared by racial designation, gender, and age. Results: At our academic medical center, using a retrospective cohort analysis of ambulatory care delivered between March 2 and June 10, 2020, we found that over half (57.6%) of all visits were telehealth visits, and both Black and White patients accessed telehealth more than Asian patients. Conclusions: Our findings indicate that the rapid implementation of telehealth does not follow prior patterns of health care disparities. UR - https://www.jmir.org/2021/5/e23905 UR - http://dx.doi.org/10.2196/23905 UR - http://www.ncbi.nlm.nih.gov/pubmed/33974549 ID - info:doi/10.2196/23905 ER - TY - JOUR AU - Remiker, Mark AU - Sabo, Samantha AU - Jiménez, Dulce AU - Samarron Longorio, Alexandra AU - Chief, Carmenlita AU - Williamson, Heather AU - Teufel-Shone, Nicolette PY - 2021/5/12 TI - Using a Multisectoral Approach to Advance Health Equity in Rural Arizona: Community-Engaged Survey Development and Implementation Study JO - JMIR Form Res SP - e25577 VL - 5 IS - 5 KW - health equity KW - community-engaged KW - multisector KW - survey development N2 - Background: Over the past decade, public health research and practice sectors have shifted their focus away from identifying health disparities and toward addressing the social, environmental, and economic determinants of health equity. Given the complex and interrelated nature of these determinants, developing policies that will advance health equity requires collaboration across sectors outside of health. However, engaging various stakeholder groups, tapping into their unique knowledge systems, and identifying common objectives across sectors is difficult and time consuming and can impede collaborative efforts. Objective: The Southwest Health Equity Research Collaborative at Northern Arizona University, in partnership with an 11-member community advisory council, is addressing this need with a joint community-campus effort to develop and implement a Regional Health Equity Survey (RHES) designed to generate an interdisciplinary body of knowledge, which will be used to guide future multisectoral action for improving community health and well-being. Methods: Researchers and community partners used facilitated discussions and free listing techniques to generate survey items. The community partners pilot tested the survey instrument to evaluate its feasibility and duration before survey administration. Respondent-driven sampling was used to ensure that participants included leadership from across all sectors and regions of northern Arizona. Results: Over the course of 6 months, 206 participants representing 13 sectors across the 5 counties of northern Arizona were recruited to participate in an RHES. Survey response rates, completion percentage, and sector representation were used to assess the effectiveness and feasibility of using a community-engaged apporach for survey development and participant recruitment. The findings describe the current capacity to impact health equity by using a multisectoral approach in northern Arizona. Conclusions: The Southwest Health Equity Research Collaborative effectively engaged community members to assist with the development and implementation of an RHES aimed at understanding and promoting multisectoral action on the root causes of health inequity. The results will help to build research and evaluation capacity to address the social, economic, and environmental conditions of health inequity in the region. UR - https://formative.jmir.org/2021/5/e25577 UR - http://dx.doi.org/10.2196/25577 UR - http://www.ncbi.nlm.nih.gov/pubmed/33978596 ID - info:doi/10.2196/25577 ER - TY - JOUR AU - Resnicow, Ken AU - Patel, Minal AU - Green, Molly AU - Smith, Alyssa AU - Bacon, Elizabeth AU - Goodell, Stefanie AU - Kilby, Dylan AU - Tariq, Madiha AU - Alhawli, Asraa AU - Syed, Nadia AU - Griggs, Jennifer AU - Stiffler, Matthew PY - 2021/5/10 TI - The Association of Unfairness with Mental and Physical Health in a Multiethnic Sample of Adults: Cross-sectional Study JO - JMIR Public Health Surveill SP - e26622 VL - 7 IS - 5 KW - unfairness KW - discrimination KW - health disparities KW - social determinants KW - substance use KW - mental health KW - physical health KW - disparity KW - ethnicity KW - health outcome KW - behavior KW - outcome KW - cross-sectional KW - survey N2 - Background: Two psychosocial constructs that have shown consistent associations with negative health outcomes are discrimination and perceived unfairness. Objective: The current analyses report the effects of discrimination and unfairness on medical, psychological, and behavioral outcomes from a recent cross-sectional survey conducted in a multiethnic sample of adults in Michigan. Methods: A cross-section survey was collected using multiple approaches: community settings, telephone-listed sample, and online panel. Unfairness was assessed with a single-item previously used in the Whitehall study, and everyday discrimination was assessed with the Williams 9-item scale. Outcomes included mental health symptoms, past-month cigarette use, past-month alcohol use, past-month marijuana use, lifetime pain medication use, and self-reported medical history. Results: A total of 2238 usable surveys were collected. In bivariate analyses, higher unfairness values were significantly associated with lower educational attainment, lower age, lower household income, and being unmarried. The highest unfairness values were observed for African American and multiracial respondents followed by Middle Eastern or North African participants. Unfairness was significantly related to worse mental health functioning, net adjustment for sociodemographic variables, and everyday discrimination. Unfairness was also related to self-reported history of depression and high blood pressure although, after including everyday discrimination in the model, only the association with depression remained significant. Unfairness was significantly related to 30-day marijuana use, 30-day cigarette use, and lifetime opiate use. Conclusions: Our findings of a generally harmful effect of perceived unfairness on health are consistent with prior studies. Perceived unfairness may be one of the psychological pathways through which discrimination negatively impacts health. Future studies examining the relationships we observed using longitudinal data and including more objective measures of behavior and health status are needed to confirm and extend our findings. UR - https://publichealth.jmir.org/2021/5/e26622 UR - http://dx.doi.org/10.2196/26622 UR - http://www.ncbi.nlm.nih.gov/pubmed/33970121 ID - info:doi/10.2196/26622 ER - TY - JOUR AU - Mitchell, Suzanne AU - Bragg, Alexa AU - Moldovan, Ioana AU - Woods, Shakiyla AU - Melo, Katherine AU - Martin-Howard, Jessica AU - Gardiner, Paula PY - 2021/5/3 TI - Stigma as a Barrier to Participant Recruitment of Minority Populations in Diabetes Research: Development of a Community-Centered Recruitment Approach JO - JMIR Diabetes SP - e26965 VL - 6 IS - 2 KW - diabetes KW - stigma KW - research KW - recruitment KW - minority health KW - disparities KW - virtual health KW - virtual management N2 - Background: The development of evidence-based care geared towards Black and Latina women living with uncontrolled type 2 diabetes is contingent upon their active recruitment into clinical interventions. Well-documented impediments to recruitment include a historical mistrust of the research community and socioeconomic factors that limit awareness and access to research studies. Although sociocultural and socioeconomic factors deter minorities from participating in clinical research, it is equally important to consider the role of stigma in chronic disease intervention studies. Objective: We aim to share our discovery of diabetes-related stigma as an underrecognized impediment to recruitment for the Women in Control 2.0 virtual diabetes self-management education study. Methods: Our initial recruitment plan used traditional strategies to recruit minority women with uncontrolled type 2 diabetes, which included letters and phone calls to targeted patients, referrals from clinicians, and posted flyers. After engaging a patient advisory group and consulting with experts in community advocacy, diabetes-related stigma emerged as a prominent barrier to recruitment. The study team reviewed and revised recruitment scripts and outreach material in order to better align with the lived experience and needs of potential enrollees. Results: Using a more nuanced, community-centered recruitment approach, we achieved our target recruitment goal, enrolling 309 participants into the study, exceeding our target of 212. Conclusions: There is a need for updated recruitment methods that can increase research participation of patients who experience internalized diabetes stigma. To address disparities in minority health, further research is needed to better understand diabetes-related stigma and devise strategies to avert or address it. UR - https://diabetes.jmir.org/2021/2/e26965 UR - http://dx.doi.org/10.2196/26965 UR - http://www.ncbi.nlm.nih.gov/pubmed/33938811 ID - info:doi/10.2196/26965 ER - TY - JOUR AU - Davies, R. Alisha AU - Honeyman, Matthew AU - Gann, Bob PY - 2021/4/7 TI - Addressing the Digital Inverse Care Law in the Time of COVID-19: Potential for Digital Technology to Exacerbate or Mitigate Health Inequalities JO - J Med Internet Res SP - e21726 VL - 23 IS - 4 KW - COVID-19 KW - digital divide KW - digital exclusion KW - digital health KW - health inequality KW - population health UR - https://www.jmir.org/2021/4/e21726 UR - http://dx.doi.org/10.2196/21726 UR - http://www.ncbi.nlm.nih.gov/pubmed/33735096 ID - info:doi/10.2196/21726 ER - TY - JOUR AU - Kazevman, Gill AU - Mercado, Marck AU - Hulme, Jennifer AU - Somers, Andrea PY - 2021/4/6 TI - Prescribing Phones to Address Health Equity Needs in the COVID-19 Era: The PHONE-CONNECT Program JO - J Med Internet Res SP - e23914 VL - 23 IS - 4 KW - digital health equity KW - health inequity KW - digital determinants of health KW - emergency medicine KW - COVID-19 KW - public health KW - health policy KW - primary care KW - cell phone UR - https://www.jmir.org/2021/4/e23914 UR - http://dx.doi.org/10.2196/23914 UR - http://www.ncbi.nlm.nih.gov/pubmed/33760753 ID - info:doi/10.2196/23914 ER - TY - JOUR AU - Acorda, Darlene AU - Businelle, Michael AU - Santa Maria, Diane PY - 2021/4/6 TI - Perceived Impacts, Acceptability, and Recommendations for Ecological Momentary Assessment Among Youth Experiencing Homelessness: Qualitative Study JO - JMIR Form Res SP - e21638 VL - 5 IS - 4 KW - youth experiencing homelessness KW - ecological momentary assessment KW - mobile apps KW - behavior change N2 - Background: The use of ecological momentary assessment (EMA) to study youth experiencing homelessness (YEH) behaviors is an emerging area of research. Despite high rates of participation and potential clinical utility, few studies have investigated the acceptability and recommendations for EMA from the YEH perspective. Objective: This study aimed to describe the perceived benefits, usability, acceptability, and barriers to the use of EMA from the homeless youth perspective. Methods: YEH were recruited from a larger EMA study. Semistructured exit interviews were performed using an interview guide that focused on the YEH experience with the EMA app, and included perceived barriers and recommendations for future studies. Data analyses used an inductive approach with thematic analysis to identify major themes and subthemes. Results: A total of 18 YEH aged 19-24 years participated in individual and group exit interviews. The EMA was highly acceptable to YEH and they found the app and EMA surveys easy to navigate. Perceived benefits included increased behavioral and emotional awareness with some YEH reporting a decrease in their high-risk behaviors as a result of participation. Another significant perceived benefit was the ability to use the phones for social support and make connections to family, friends, and potential employers. Barriers were primarily survey and technology related. Survey-related barriers included the redundancy of questions, the lack of customizable responses, and the timing of survey prompts. Technology-related barriers included the ?freezing? of the app, battery charge, and connectivity issues. Recommendations for future studies included the need to provide real-time mental health support for symptomatic youth, to create individually customized questions, and to test the use of personalized motivational messages that respond to the EMA data in real time. Conclusions: YEH are highly receptive to the use of EMA in studies. Further studies are warranted to understand the impact of EMA on YEH behaviors. Incorporating the YEH perspective into the design and implementation of EMA studies may help minimize barriers, increase acceptability, and improve participation rates in this hard-to-reach, disconnected population. UR - https://formative.jmir.org/2021/4/e21638 UR - http://dx.doi.org/10.2196/21638 UR - http://www.ncbi.nlm.nih.gov/pubmed/33821805 ID - info:doi/10.2196/21638 ER - TY - JOUR AU - Shaw, James AU - Brewer, C. LaPrincess AU - Veinot, Tiffany PY - 2021/4/5 TI - Recommendations for Health Equity and Virtual Care Arising From the COVID-19 Pandemic: Narrative Review JO - JMIR Form Res SP - e23233 VL - 5 IS - 4 KW - virtual care KW - health equity KW - health disparities KW - health informatics KW - COVID-19 KW - telemedicine KW - telehealth KW - digital health N2 - Background: The COVID-19 health crisis has disproportionately impacted populations who have been historically marginalized in health care and public health, including low-income and racial and ethnic minority groups. Members of marginalized communities experience undue barriers to accessing health care through virtual care technologies, which have become the primary mode of ambulatory health care delivery during the COVID-19 pandemic. Insights generated during the COVID-19 pandemic can inform strategies to promote health equity in virtual care now and in the future. Objective: The aim of this study is to generate insights arising from literature that was published in direct response to the widespread use of virtual care during the COVID-19 pandemic, and had a primary focus on providing recommendations for promoting health equity in the delivery of virtual care. Methods: We conducted a narrative review of literature on health equity and virtual care during the COVID-19 pandemic published in 2020, describing strategies that have been proposed in the literature at three levels: (1) policy and government, (2) organizations and health systems, and (3) communities and patients. Results: We highlight three strategies for promoting health equity through virtual care that have been underaddressed in this literature: (1) simplifying complex interfaces and workflows, (2) using supportive intermediaries, and (3) creating mechanisms through which marginalized community members can provide immediate input into the planning and delivery of virtual care. Conclusions: We conclude by outlining three areas of work that are required to ensure that virtual care is employed in ways that are equity enhancing in a post?COVID-19 reality. UR - https://formative.jmir.org/2021/4/e23233 UR - http://dx.doi.org/10.2196/23233 UR - http://www.ncbi.nlm.nih.gov/pubmed/33739931 ID - info:doi/10.2196/23233 ER - TY - JOUR AU - Pham, Quynh AU - Gamble, Anissa AU - Hearn, Jason AU - Cafazzo, A. Joseph PY - 2021/2/10 TI - The Need for Ethnoracial Equity in Artificial Intelligence for Diabetes Management: Review and Recommendations JO - J Med Internet Res SP - e22320 VL - 23 IS - 2 KW - diabetes KW - artificial intelligence KW - digital health KW - ethnoracial equity KW - ethnicity KW - race UR - http://www.jmir.org/2021/2/e22320/ UR - http://dx.doi.org/10.2196/22320 UR - http://www.ncbi.nlm.nih.gov/pubmed/33565982 ID - info:doi/10.2196/22320 ER - TY - JOUR AU - Phiri, Peter AU - Delanerolle, Gayathri AU - Al-Sudani, Ayaat AU - Rathod, Shanaya PY - 2021/2/1 TI - COVID-19 and Black, Asian, and Minority Ethnic Communities: A Complex Relationship Without Just Cause JO - JMIR Public Health Surveill SP - e22581 VL - 7 IS - 2 KW - BAME KW - COVID-19 KW - ethnicity KW - health care professionals KW - health care worker KW - impact KW - inequalities KW - minority KW - risk UR - https://publichealth.jmir.org/2021/2/e22581 UR - http://dx.doi.org/10.2196/22581 UR - http://www.ncbi.nlm.nih.gov/pubmed/33481752 ID - info:doi/10.2196/22581 ER - TY - JOUR AU - Lee, Yun Hee AU - Jin, Won Seok AU - Henning-Smith, Carrie AU - Lee, Jongwook AU - Lee, Jaegoo PY - 2021/1/27 TI - Role of Health Literacy in Health-Related Information-Seeking Behavior Online: Cross-sectional Study JO - J Med Internet Res SP - e14088 VL - 23 IS - 1 KW - digital divide KW - health literacy KW - internet KW - technology KW - access N2 - Background: The internet has emerged as a main venue of health information delivery and health-related activities. However, few studies have examined how health literacy determines online health-related behavior. Objective: The aim of this study was to investigate the current level of health-related information-seeking using the internet and how health literacy, access to technology, and sociodemographic characteristics impact health-related information-seeking behavior. Methods: We conducted a cross-sectional study through a survey with Minnesotan adults (N=614) to examine their health literacy, access to technology, and health-related information-seeking internet use. We used multivariate regression analysis to assess the relationship between health-related information-seeking on the internet and health literacy and access to technology, controlling for sociodemographic characteristics. Results: Better health literacy (?=.35, SE 0.12) and greater access to technological devices (eg, mobile phone and computer or tablet PC; ?=.06, SE 0.19) were both associated with more health-related information-seeking behavior on the internet after adjusting for all other sociodemographic characteristics. Possession of a graduate degree (?=.28, SE 0.07), female gender (?=.15, SE 0.05), poor health (?=.22, SE 0.06), participation in social groups (?=.13, SE 0.05), and having an annual health exam (?=.35, SE 0.12) were all associated with online health-related information-seeking. Conclusions: Our findings indicate that access to online health-related information is not uniformly distributed throughout the population, which may exacerbate disparities in health and health care. Research, policy, and practice attention are needed to address the disparities in access to health information as well as to ensure the quality of the information and improve health literacy. UR - http://www.jmir.org/2021/1/e14088/ UR - http://dx.doi.org/10.2196/14088 UR - http://www.ncbi.nlm.nih.gov/pubmed/33502332 ID - info:doi/10.2196/14088 ER - TY - JOUR AU - Friis-Healy, A. Elsa AU - Nagy, A. Gabriela AU - Kollins, H. Scott PY - 2021/1/26 TI - It Is Time to REACT: Opportunities for Digital Mental Health Apps to Reduce Mental Health Disparities in Racially and Ethnically Minoritized Groups JO - JMIR Ment Health SP - e25456 VL - 8 IS - 1 KW - digital health KW - app KW - public mental health KW - health disparities KW - COVID-19 KW - pandemic KW - mental health KW - disparity KW - behavior UR - http://mental.jmir.org/2021/1/e25456/ UR - http://dx.doi.org/10.2196/25456 UR - http://www.ncbi.nlm.nih.gov/pubmed/33406050 ID - info:doi/10.2196/25456 ER - TY - JOUR AU - Makowsky, J. Mark AU - Jones, A. Charlotte AU - Davachi, Shahnaz PY - 2021/1/8 TI - Prevalence and Predictors of Health-Related Internet and Digital Device Use in a Sample of South Asian Adults in Edmonton, Alberta, Canada: Results From a 2014 Community-Based Survey JO - JMIR Public Health Surveill SP - e20671 VL - 7 IS - 1 KW - consumer health information KW - cardiovascular disease KW - type 2 diabetes KW - eHealth KW - mobile phone KW - ethnicity KW - cross-sectional survey KW - Canada N2 - Background: South Asian Canadians are at high risk of developing cardiovascular disease and diabetes. Consumer-oriented health information technology may help mitigate lifestyle risk factors and improve chronic disease self-management. Objective: This study aims to explore the prevalence, patterns, and predictors of the use of the internet, digital devices, and apps for health purposes as well as preferences for future use of eHealth support in South Asian Canadians. Methods: We conducted a cross-sectional, mixed-mode survey in a convenience sample of 831 South Asian adults recruited at faith-based gathering places, health care settings, and community events in Edmonton, Alberta, in 2014. The 706 responders (mean age 47.1, SD 17.6 years; n=356, 50.4% female; n=509, 72.1% Sikh) who provided complete sociodemographic information were included in the analysis, and the denominators varied based on the completeness of responses to each question. Multivariate logistic regression was used to determine sociodemographic and health status predictors of internet use, being a web-based health information seeker, smartphone or tablet ownership, health app use, and willingness to use various modes of eHealth support. Results: Of all respondents, 74.6% (527/706) were internet users and 47.8% (336/703) were web-based health information seekers. In addition, 74.9% (527/704) of respondents owned a smartphone or tablet and 30.7% (159/518) of these had a health and fitness app. Most internet users (441/527, 83.7%) expressed interest in using ?1 mode of eHealth support. Older age, being female, having less than high school education, preferring written health information in languages other than English, and lacking confidence in completing medical forms predicted lack of internet use. Among internet users, factors that predicted web-based health information seeking were being female, use of the internet several times per day, being confident in completing medical forms, and preferring health information in English. Predictors of not owning a smartphone or tablet were being older, preferring health information in languages other than English, having less than high school education, living in Canada for <5 years, having a chronic health condition, and having diabetes. Increasing age was associated with lower odds of having a health app. Preferring health information in languages other than English consistently predicted lower interest in all modes of eHealth support. Conclusions: eHealth-based chronic disease prevention and management interventions are feasible for South Asian adults, but digital divides exist according to language preference, education, age, sex, confidence in completing medical forms, and number of years lived in Canada. Community-based, culturally tailored strategies targeting these factors are required to address existing divides and increase the uptake of credible web-based and app-based resources for health purposes. UR - https://publichealth.jmir.org/2021/1/e20671 UR - http://dx.doi.org/10.2196/20671 UR - http://www.ncbi.nlm.nih.gov/pubmed/33416506 ID - info:doi/10.2196/20671 ER - TY - JOUR AU - Fujioka, Keiko Jamie AU - Budhwani, Suman AU - Thomas-Jacques, Tyla AU - De Vera, Kristina AU - Challa, Priyanka AU - Fuller, Kaitlin AU - Hogeveen, Sophie AU - Gordon, Dara AU - Shahid, Simone AU - Seto, Emily AU - Shaw, James PY - 2020/12/7 TI - Challenges and Strategies for Promoting Health Equity in Virtual Care: Protocol for a Scoping Review of Reviews JO - JMIR Res Protoc SP - e22847 VL - 9 IS - 12 KW - health equity KW - digital health KW - virtual care KW - telemedicine KW - scoping review KW - COVID-19 KW - challenge KW - strategy N2 - Background: The rapid virtualization of health services during the COVID-19 pandemic has drawn increasing attention to the impact of virtual care technologies on health equity. In some circumstances, virtual care initiatives have been shown to increase health disparities, as individuals from underserved communities are less likely to benefit from such initiatives. Objective: The purpose of this paper is to describe a protocol for a scoping review of reviews that aims to map review-level evidence that describes challenges and strategies for promoting effective engagement with virtual care technologies among underserved communities. Methods: Our methodology was adapted from seminal scoping review guidelines provided by Arksey and O?Malley, Levac at al, Colquhoun et al, and the Joanna Briggs Institute. Our search strategy was developed for the following databases: MEDLINE (on Ovid), EMBASE (on Ovid), CINAHL (on EBSCO), Scopus, and Epistemonikos. Supplementary searches will include the use of Google Scholar and reference tracking. Each citation will be independently screened by 2 researchers at the title and abstract level, and full-text screening will be performed in accordance with our eligibility criteria. The eligibility criteria focused on the inclusion of methods-driven reviews (ie, systematic reviews, scoping reviews, meta-analyses, realist reviews, and critical interpretative syntheses) to enhance rigor and quality. Other inclusion criteria included a focus on virtual care services that facilitate bidirectional patient-provider communication (ie, video, telephone, and asynchronous messaging visits) for underserved populations (ie, those who experience social disadvantage due to race, age, income, and other factors related to the social determinants of health). Results: This scoping review of reviews will provide a broad overview of identified challenges associated with the accessibility of virtual health care services among underserved communities. In addition, strategies for improving the access to, uptake of, and engagement with virtual care technologies among underserved communities will be identified. The knowledge synthesized from this review will aid in developing and implementing virtual services that acknowledge the unique needs of populations who experience barriers to care and disproportionately worse health outcomes. The results will also inform gaps in current research. Conclusions: The rapid shift toward virtual health services has highlighted the urgent need to critically examine the intersection of virtual care and health equity. Although technology-driven innovations in health care generally aim to improve access, quality, and health outcomes, it is also possible for these innovations to produce intervention-generated inequities. Assessing current review-level evidence on the key challenges and strategies for improving the application of virtual care in underserved communities is imperative for ensuring that virtual care benefits all populations. International Registered Report Identifier (IRRID): PRR1-10.2196/22847 UR - http://www.researchprotocols.org/2020/12/e22847/ UR - http://dx.doi.org/10.2196/22847 UR - http://www.ncbi.nlm.nih.gov/pubmed/33211020 ID - info:doi/10.2196/22847 ER - TY - JOUR AU - Camp, Pat AU - Girt, Mirha AU - Wells, Alix AU - Malas, Adeeb AU - Peter, Maryke AU - Crosbie, Stephanie AU - Holyk, Travis PY - 2020/12/1 TI - Virtual Care for Indigenous Populations in Canada, the United States, Australia, and New Zealand: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e21860 VL - 9 IS - 12 KW - virtual care KW - Indigenous KW - Indigenous health KW - accessibility KW - cultural competency KW - feasibility KW - acceptability KW - utility N2 - Background: Indigenous people in Canada, the United States, Australia, and New Zealand experience an increased burden of chronic diseases compared to non-Indigenous people in these countries. Lack of necessary services and culturally relevant care for Indigenous people contributes to this burden. Many Indigenous communities have implemented systems, such as virtual care, to improve chronic disease management. Virtual care has extended beyond videoconferencing to include more advanced technologies, such as remote biometric monitoring devices. However, given the historical and ongoing Western intrusion into Indigenous day to day life, these technologies may seem more invasive and thus require additional research on their acceptability and utility within Indigenous populations. Objective: The objective of this paper is to present the protocol for a scoping review, which aims to map existing evidence. This study is based on the following guiding research question: What are the characteristics of virtual care use by Indigenous adult populations in Canada, the United States, Australia, and New Zealand? The subquestions are related to the technology used, health conditions and nature of the virtual care, cultural safety, and key concepts for effective use. Methods: This scoping review protocol is informed by the methodology described by the Joanna Briggs Institute and is supplemented by the frameworks proposed by Arksey and O?Malley and Levac et al. A search for published and gray literature, written in English, and published between 2000 and present will be completed utilizing electronic databases and search engines, including MEDLINE, CINAHL, Embase, Indigenous Peoples of North America, Australian Indigenous HealthInfoNet, Informit, and Native Health Database. Search results will be uploaded to the review software, Covidence, for title and abstract screening before full-text screening begins. This process will be repeated for gray literature. Upon completion, a data abstraction tool will organize the relevant information into categorical formations. Results: The search strategy has been confirmed, and the screening of titles and abstracts is underway. As of October 2020, we have identified over 300 articles for full-text screening. Conclusions: Previous reviews have addressed virtual care within Indigenous communities. However, new virtual care technologies have since emerged; subsequently, additional literature has been published. Mapping and synthesizing this literature will inform new directions for research and discussion. International Registered Report Identifier (IRRID): PRR1-10.2196/21860 UR - https://www.researchprotocols.org/2020/12/e21860 UR - http://dx.doi.org/10.2196/21860 UR - http://www.ncbi.nlm.nih.gov/pubmed/33258789 ID - info:doi/10.2196/21860 ER - TY - JOUR AU - Strange, Michael AU - Nilsson, Carol AU - Zdravkovic, Slobodan AU - Mangrio, Elisabeth PY - 2020/11/30 TI - The Precision Health and Everyday Democracy (PHED) Project: Protocol for a Transdisciplinary Collaboration on Health Equity and the Role of Health in Society JO - JMIR Res Protoc SP - e17324 VL - 9 IS - 11 KW - precision health KW - health care access KW - health literacy KW - everyday democracy N2 - Background: The project ?Precision Health and Everyday Democracy? (PHED) is a transdisciplinary partnership that combines a diverse range of perspectives necessary for understanding the increasingly complex societal role played by modern health care and medical research. The term ?precision health? is being increasingly used to express the need for greater awareness of environmental and genomic characteristics that may lead to divergent health outcomes between different groups within a population. Enhancing awareness of diversity has parallels with calls for ?health democracy? and greater patient-public participation within health care and medical research. Approaching health care in this way goes beyond a narrow focus on the societal determinants of health, since it requires considering health as a deliberative space, which occurs often at the banal or everyday level. As an initial empirical focus, PHED is directed toward the health needs of marginalized migrants (including refugees and asylum seekers, as well as migrants with temporary residency, often involving a legally or economically precarious situation) as vulnerable groups that are often overlooked by health care. Developing new transdisciplinary knowledge on these groups provides the potential to enhance their wellbeing and benefit the wider society through challenging the exclusions of these groups that create pockets of extreme ill-health, which, as we see with COVID-19, should be better understood as ?acts of self-harm? for the wider negative impact on humanity. Objective: We aim to establish and identify precision health strategies, as well as promote equal access to quality health care, drawing upon knowledge gained from studying the health care of marginalized migrants. Methods: The project is based in Sweden at Malmö and Lund Universities. At the outset, the network activities do not require ethical approval where they will not involve data collection, since the purpose of PHED is to strengthen international research contacts, establish new research within precision strategies, and construct educational research activities for junior colleagues within academia. However, whenever new research is funded and started, ethical approval for that specific data collection will be sought. Results: The PHED project has been funded from January 1, 2019. Results of the transdisciplinary collaboration will be disseminated via a series of international conferences, workshops, and web-based materials. To ensure the network project advances toward applied research, a major goal of dissemination is to produce tools for applied research, including information to enhance health accessibility for vulnerable communities, such as marginalized migrant populations in Sweden. Conclusions: There is a need to identify tools to enable the prevention and treatment of a wide spectrum of health-related outcomes and their link to social as well as environmental issues. There is also a need to identify and investigate barriers to precision health based on democratic principles. International Registered Report Identifier (IRRID): DERR1-10.2196/17324 UR - http://www.researchprotocols.org/2020/11/e17324/ UR - http://dx.doi.org/10.2196/17324 UR - http://www.ncbi.nlm.nih.gov/pubmed/33252352 ID - info:doi/10.2196/17324 ER - TY - JOUR AU - Casillas, Alejandra AU - Abhat, Anshu AU - Mahajan, Anish AU - Moreno, Gerardo AU - Brown, F. Arleen AU - Simmons, Sara AU - Szilagyi, Peter PY - 2020/10/23 TI - Portals of Change: How Patient Portals Will Ultimately Work for Safety Net Populations JO - J Med Internet Res SP - e16835 VL - 22 IS - 10 KW - patient portal KW - safety net KW - health disparities KW - digital divide UR - https://www.jmir.org/2020/10/e16835 UR - http://dx.doi.org/10.2196/16835 UR - http://www.ncbi.nlm.nih.gov/pubmed/33094732 ID - info:doi/10.2196/16835 ER - TY - JOUR AU - Ghaddar, Suad AU - Vatcheva, P. Kristina AU - Alvarado, G. Samantha AU - Mykyta, Laryssa PY - 2020/9/3 TI - Understanding the Intention to Use Telehealth Services in Underserved Hispanic Border Communities: Cross-Sectional Study JO - J Med Internet Res SP - e21012 VL - 22 IS - 9 KW - telehealth KW - eHealth literacy KW - health information technologies N2 - Background: Despite the United States having one of the leading health care systems in the world, underserved minority communities face significant access challenges. These communities can benefit from telehealth innovations that promise to improve health care access and, consequently, health outcomes. However, little is known about the attitudes toward telehealth in these communities, an essential first step toward effective adoption and use. Objective: The purpose of this study is to assess the factors that shape behavioral intention to use telehealth services in underserved Hispanic communities along the Texas-Mexico border and examine the role of electronic health (eHealth) literacy in telehealth use intention. Methods: We used cross-sectional design to collect data at a community health event along the Texas-Mexico border. The area is characterized by high poverty rates, low educational attainment, and health care access challenges. Trained bilingual students conducted 322 in-person interviews over a 1-week period. The survey instrument assessed sociodemographic information and telehealth-related variables. Attitudes toward telehealth were measured by asking participants to indicate their level of agreement with 9 statements reflecting different aspects of telehealth use. For eHealth literacy, we used the eHealth Literacy Scale (eHEALS), an 8-item scale designed to measure consumer confidence in finding, evaluating, and acting upon eHealth information. To assess the intention to use telehealth, we asked participants about the likelihood that they would use telehealth services if offered by a health care provider. We analyzed data using univariate, multivariate, and mediation statistical models. Results: Participants were primarily Hispanic (310/319, 97.2%) and female (261/322, 81.1%), with an average age of 43 years. Almost three-quarters (219/298) reported annual household incomes below $20,000. Health-wise, 42.2% (136/322) self-rated their health as fair or poor, and 79.7% (255/320) were uninsured. The overwhelming majority (289/319, 90.6%) had never heard of telehealth. Once we defined the term, participants exhibited positive attitudes toward telehealth, and 78.9% (254/322) reported being somewhat likely or very likely to use telehealth services if offered by a health care provider. Based on multivariate proportional odds regression analysis, a 1-point increase in telehealth attitudes reduced the odds of lower versus higher response in the intention to use telehealth services by 23% (OR 0.77, 95% CI 0.73-0.81). Mediation analysis revealed that telehealth attitudes fully mediated the association between eHealth literacy and intention to use telehealth services. For a 1-point increase in eHEALS, the odds of lower telehealth use decreased by a factor of 0.95 (5%; OR 0.95, 95% CI 0.93-0.98; P<.001) via the increase in the score of telehealth attitudes. Conclusions: Telehealth promises to address many of the access challenges facing ethnic and racial minorities, rural communities, and low-income populations. Findings underscore the importance of raising awareness of telehealth and promoting eHealth literacy as a key step in fostering positive attitudes toward telehealth and furthering interest in its use. UR - https://www.jmir.org/2020/9/e21012 UR - http://dx.doi.org/10.2196/21012 UR - http://www.ncbi.nlm.nih.gov/pubmed/32880579 ID - info:doi/10.2196/21012 ER - TY - JOUR AU - van Deursen, JAM Alexander PY - 2020/8/20 TI - Digital Inequality During a Pandemic: Quantitative Study of Differences in COVID-19?Related Internet Uses and Outcomes Among the General Population JO - J Med Internet Res SP - e20073 VL - 22 IS - 8 KW - COVID-19 KW - digital inequality KW - internet use KW - survey KW - personality KW - literacy KW - internet skills KW - information KW - communication N2 - Background: The World Health Organization considers coronavirus disease (COVID-19) to be a public emergency threatening global health. During the crisis, the public?s need for web-based information and communication is a subject of focus. Digital inequality research has shown that internet access is not evenly distributed among the general population. Objective: The aim of this study was to provide a timely understanding of how different people use the internet to meet their information and communication needs and the outcomes they gain from their internet use in relation to the COVID-19 pandemic. We also sought to reveal the extent to which gender, age, personality, health, literacy, education, economic and social resources, internet attitude, material access, internet access, and internet skills remain important factors in obtaining internet outcomes after people engage in the corresponding uses. Methods: We used a web-based survey to draw upon a sample collected in the Netherlands. We obtained a dataset with 1733 respondents older than 18 years. Results: Men are more likely to engage in COVID-19?related communication uses. Age is positively related to COVID-19?related information uses and negatively related to information and communication outcomes. Agreeableness is negatively related to both outcomes and to information uses. Neuroticism is positively related to both uses and to communication outcomes. Conscientiousness is not related to any of the uses or outcomes. Introversion is negatively related to communication outcomes. Finally, openness relates positively to all information uses and to both outcomes. Physical health has negative relationships with both outcomes. Health perception contributes positively to information uses and both outcomes. Traditional literacy has a positive relationship with information uses and both outcomes. Education has a positive relationship with information and communication uses. Economic and social resources played no roles. Internet attitude is positively related to information uses and outcomes but negatively related to communication uses and outcomes. Material access and internet access contributed to all uses and outcomes. Finally, several of the indicators and outcomes became insignificant after accounting for engagement in internet uses. Conclusions: Digital inequality is a major concern among national and international scholars and policy makers. This contribution aimed to provide a broader understanding in the case of a major health pandemic by using the ongoing COVID-19 crisis as a context for empirical work. Several groups of people were identified as vulnerable, such as older people, less educated people, and people with physical health problems, low literacy levels, or low levels of internet skills. Generally, people who are already relatively advantaged are more likely to use the information and communication opportunities provided by the internet to their benefit in a health pandemic, while less advantaged individuals are less likely to benefit. Therefore, the COVID-19 crisis is also enforcing existing inequalities. UR - http://www.jmir.org/2020/8/e20073/ UR - http://dx.doi.org/10.2196/20073 UR - http://www.ncbi.nlm.nih.gov/pubmed/32750005 ID - info:doi/10.2196/20073 ER - TY - JOUR AU - Ahmed, Tanvir AU - Rizvi, Raza Syed Jafar AU - Rasheed, Sabrina AU - Iqbal, Mohammad AU - Bhuiya, Abbas AU - Standing, Hilary AU - Bloom, Gerald AU - Waldman, Linda PY - 2020/7/21 TI - Digital Health and Inequalities in Access to Health Services in Bangladesh: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e16473 VL - 8 IS - 7 KW - health equity KW - eHealth KW - mHealth KW - digital health KW - health technology KW - Bangladesh KW - developing countries N2 - Background: Globally, the rapid growth of technology and its use as a development solution has generated much interest in digital health. In line with global trends, Bangladesh is also integrating technology into its health system to address disparities. Strong political endorsement and uptake of digital platforms by the government has influenced the rapid proliferation of such initiatives in the country. This paper aims to examine the implications of digital health on access to health care in Bangladesh, considering who uses electronic devices to access health information and services and why. Objective: This study aims to understand how access to health care and related information through electronic means (digital health) is affected by sociodemographic determinants (ie, age, gender, education, socioeconomic status, and personal and household ownership of mobile phones) in a semiurban community in Bangladesh. Methods: A cross-sectional survey of 854 households (between October 2013 and February 2014) and 20 focus group discussions (between February 2017 and March 2017) were conducted to understand (1) who owns electronic devices; (2) who, among the owners, uses these to access health information and services and why; (3) the awareness of electronic sources of health information; and (4) the role of intermediaries (family members or peers who helped to look for health information using electronic devices). Results: A total of 90.3% (771/854) of households (471/854, 55.2% of respondents) owned electronic devices, mostly mobile phones. Among these, 7.2% (34/471) used them to access health information or services. Middle-aged (35-54 years), female, less (or not) educated, and poorer people used these devices the least (?=.05, ? is the level of significance). The lack of awareness, discomfort, differences with regular care-seeking habits, lack of understanding and skills, and proximity to a health facility were the main reasons for not using devices to access digital health. Conclusions: Although influenced by sociodemographic traits, access to digital health is not merely related to device ownership and technical skill. Rather, it is a combination of general health literacy, phone ownership, material resources, and technical skill as well as social recognition of health needs and inequity. This study?s findings should serve as a basis for better integrating technology within the health system and ensuring equitable access to health care. UR - http://mhealth.jmir.org/2020/7/e16473/ UR - http://dx.doi.org/10.2196/16473 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706736 ID - info:doi/10.2196/16473 ER - TY - JOUR AU - Casillas, Alejandra AU - Cemballi, Gunshekar Anupama AU - Abhat, Anshu AU - Lemberg, Miya AU - Portz, D. Jennifer AU - Sadasivaiah, Shobha AU - Ratanawongsa, Neda AU - Semere, Wagahta AU - Brown, Arleen AU - Lyles, Rees Courtney PY - 2020/7/20 TI - An Untapped Potential in Primary Care: Semi-Structured Interviews with Clinicians on How Patient Portals Will Work for Caregivers in the Safety Net JO - J Med Internet Res SP - e18466 VL - 22 IS - 7 KW - patient portal KW - caregivers KW - vulnerable populations KW - digital divide KW - mobile phone N2 - Background: Patients within safety-net settings are less likely to access health information on patient portals, despite expressed interest. Family and friends are important resources to assist these patients (ie, Medicaid recipients, older patients, patients with limited English proficiency) in navigating health systems, and provider support of the use of patient portals among these groups may also facilitate caregivers? use of their patients? portal. Objective: Because safety net providers work closely with caregivers to care for their patients, we used qualitative methods to explore safety net providers? perspectives on portal use among caregivers for their patients, especially as there is limited literature about caregivers? use of portals in the safety net. Methods: We conducted 45- to 60-min semistructured telephone interviews with providers from three large California safety-net health systems. The interviews focused on providers? experiences with caregivers, caregiver roles, and how the portal could be leveraged as a tool to support caregivers in their responsibilities. A total of three coders analyzed the interview transcripts using both deductive and inductive approaches and established a consensus regarding major themes. Results: Of the 16 participants interviewed, 4 specialized in geriatrics, and all held a leadership or administrative role. We described themes highlighting providers? recognition of potential benefits associated with caregiver portal use and specific challenges to caregiver engagement. Conclusions: Providers recognized the potential for portals to improve information delivery and communication by helping caregivers assist socially and medically complex patients in the safety net. Providers in safety net sites also discussed a clear need for better ways to keep in touch with patients and connect with caregivers, yet security and privacy are perhaps of higher importance in these settings and may pose challenges to portal adoption. They noted that caregivers of patients in the safety net likely face similar communication barriers as patients, especially with respect to digital literacy, health literacy, and English proficiency. Further research is needed to assess and support caregivers? interest and ability to access portals across barriers in health and digital literacy, and English proficiency. Portal platforms and health systems must also address specific strategies to uphold patient preferences while maintaining privacy and security. UR - https://www.jmir.org/2020/7/e18466 UR - http://dx.doi.org/10.2196/18466 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706709 ID - info:doi/10.2196/18466 ER - TY - JOUR AU - Chung, Alicia AU - Seixas, Azizi AU - Williams, Natasha AU - Senathirajah, Yalini AU - Robbins, Rebecca AU - Newsome Garcia, Valerie AU - Ravenell, Joseph AU - Jean-Louis, Girardin PY - 2020/7/14 TI - Development of ?Advancing People of Color in Clinical Trials Now!?: Web-Based Randomized Controlled Trial Protocol JO - JMIR Res Protoc SP - e17589 VL - 9 IS - 7 KW - health communication KW - health care disparities KW - eHealth N2 - Background: Participation in clinical trials among people of color remains low, compared with white subjects. This protocol describes the development of ?Advancing People of Color in Clinical Trials Now!? (ACT Now!), a culturally tailored website designed to influence clinical trial decision making among people of color. Objective: This cluster randomized study aims to test the efficacy of a culturally tailored website to increase literacy, self-efficacy, and willingness to enroll in clinical trials among people of color. Methods: ACT Now! is a randomized trial including 2 groups: (1) intervention group (n=50) with access to the culturally tailored website and (2) control group (n=50) exposed to a standard clinical recruitment website. Clinical trial literacy and willingness to enroll in a clinical trial will be measured before and after exposure to the website corresponding to their assigned group (intervention or control). Surveys will be conducted at baseline and during the 1-month postintervention and 3-month follow-up. Website architecture and wireframing will be informed by the literature and experts in the field. Statistical analysis will be conducted using a two-tailed t test, with 80% power, at .05 alpha level, to increase clinical trial literacy, self-efficacy, and willingness to enroll in clinical trials 3 months post intervention. Results: We will design a culturally tailored website that will provide leverage for community stakeholders to influence clinical trial literacy, self-efficacy, and willingness to enroll in clinical trials among racial and ethnic groups. ACT Now! applies a community-based participatory research approach through the use of a community steering committee (CSC). The CSC provides input during the research study conception, development, implementation, and enrollment. CSC relationships help foster trust among communities of color. ACT Now! has the potential to fill a gap in clinical trial enrollment among people of color through an accessible web-based website. This study was funded in July 2017 and obtained institutional review board approval in spring 2017. As of December 2019, we had enrolled 100 participants. Data analyses are expected to be completed by June 2020, and expected results are to be published in fall 2020. Conclusions: ACT Now! has the potential to fill an important gap in clinical trial enrollment among people of color through an accessible web-based website. Trial Registration: ClinicalTrials.gov NCT03243071; https://clinicaltrials.gov/ct2/show/NCT00102401 International Registered Report Identifier (IRRID): DERR1-10.2196/17589 UR - https://www.researchprotocols.org/2020/7/e17589 UR - http://dx.doi.org/10.2196/17589 UR - http://www.ncbi.nlm.nih.gov/pubmed/32673274 ID - info:doi/10.2196/17589 ER - TY - JOUR AU - Jones, Jeb AU - Sullivan, S. Patrick AU - Sanchez, H. Travis AU - Guest, L. Jodie AU - Hall, W. Eric AU - Luisi, Nicole AU - Zlotorzynska, Maria AU - Wilde, Gretchen AU - Bradley, Heather AU - Siegler, J. Aaron PY - 2020/7/10 TI - Similarities and Differences in COVID-19 Awareness, Concern, and Symptoms by Race and Ethnicity in the United States: Cross-Sectional Survey JO - J Med Internet Res SP - e20001 VL - 22 IS - 7 KW - COVID-19 KW - SARS-CoV-2 KW - race KW - ethnicity KW - awareness KW - concern KW - symptom KW - cross-sectional KW - knowledge KW - health disparity KW - inequality N2 - Background: Existing health disparities based on race and ethnicity in the United States are contributing to disparities in morbidity and mortality during the coronavirus disease (COVID-19) pandemic. We conducted an online survey of American adults to assess similarities and differences by race and ethnicity with respect to COVID-19 symptoms, estimates of the extent of the pandemic, knowledge of control measures, and stigma. Objective: The aim of this study was to describe similarities and differences in COVID-19 symptoms, knowledge, and beliefs by race and ethnicity among adults in the United States. Methods: We conducted a cross-sectional survey from March 27, 2020 through April 1, 2020. Participants were recruited on social media platforms and completed the survey on a secure web-based survey platform. We used chi-square tests to compare characteristics related to COVID-19 by race and ethnicity. Statistical tests were corrected using the Holm Bonferroni correction to account for multiple comparisons. Results: A total of 1435 participants completed the survey; 52 (3.6%) were Asian, 158 (11.0%) were non-Hispanic Black, 548 (38.2%) were Hispanic, 587 (40.9%) were non-Hispanic White, and 90 (6.3%) identified as other or multiple races. Only one symptom (sore throat) was found to be different based on race and ethnicity (P=.003); this symptom was less frequently reported by Asian (3/52, 5.8%), non-Hispanic Black (9/158, 5.7%), and other/multiple race (8/90, 8.9%) participants compared to those who were Hispanic (99/548, 18.1%) or non-Hispanic White (95/587, 16.2%). Non-Hispanic White and Asian participants were more likely to estimate that the number of current cases was at least 100,000 (P=.004) and were more likely to answer all 14 COVID-19 knowledge scale questions correctly (Asian participants, 13/52, 25.0%; non-Hispanic White participants, 180/587, 30.7%) compared to Hispanic (108/548, 19.7%) and non-Hispanic Black (25/158, 15.8%) participants. Conclusions: We observed differences with respect to knowledge of appropriate methods to prevent infection by the novel coronavirus that causes COVID-19. Deficits in knowledge of proper control methods may further exacerbate existing race/ethnicity disparities. Additional research is needed to identify trusted sources of information in Hispanic and non-Hispanic Black communities and create effective messaging to disseminate correct COVID-19 prevention and treatment information. UR - http://www.jmir.org/2020/7/e20001/ UR - http://dx.doi.org/10.2196/20001 UR - http://www.ncbi.nlm.nih.gov/pubmed/32614778 ID - info:doi/10.2196/20001 ER - TY - JOUR AU - Hamidian Jahromi, Alireza AU - Hamidianjahromi, Anahid PY - 2020/6/12 TI - Why African Americans Are a Potential Target for COVID-19 Infection in the United States JO - J Med Internet Res SP - e19934 VL - 22 IS - 6 KW - coronavirus KW - COVID-19 KW - African American KW - mortality KW - race KW - virus KW - minority KW - infectious disease UR - http://www.jmir.org/2020/6/e19934/ UR - http://dx.doi.org/10.2196/19934 UR - http://www.ncbi.nlm.nih.gov/pubmed/32496205 ID - info:doi/10.2196/19934 ER - TY - JOUR AU - Turnbull, Sophie AU - Cabral, Christie AU - Hay, Alastair AU - Lucas, J. Patricia PY - 2020/6/5 TI - Health Equity in the Effectiveness of Web-Based Health Interventions for the Self-Care of People With Chronic Health Conditions: Systematic Review JO - J Med Internet Res SP - e17849 VL - 22 IS - 6 KW - health equity KW - self-care KW - eHealth KW - intervention KW - diabetes KW - asthma KW - pulmonary disease, chronic obstructive KW - osteoarthritis N2 - Background: Web-based self-care interventions have the potential to reduce health inequalities by removing barriers to access to health care. However, there is a lack of evidence about the equalizing effects of these interventions on chronic conditions. Objective: This study investigated the differences in the effectiveness of web-based behavioral change interventions for the self-care of high burden chronic health conditions (eg, asthma, chronic obstructive pulmonary disease [COPD], diabetes, and osteoarthritis) across socioeconomic and cultural groups. Methods: A systematic review was conducted, following Cochrane review guidelines. We conducted searches in Ovid Medical Literature Analysis and Retrieval System Online and Cumulative Index to Nursing and Allied Health Literature databases. Studies with any quantitative design were included (published between January 1, 2006, and February 20, 2019) if they investigated web-based self-care interventions targeting asthma, COPD, diabetes, and osteoarthritis; were conducted in any high-income country; and reported variations in health, behavior, or psychosocial outcomes across social groups. Study outcomes were investigated for heterogeneity, and the possibility of a meta-analysis was explored. A narrative synthesis was provided together with a novel figure that was developed for this review, displaying heterogeneous outcomes. Results: Overall, 7346 records were screened and 18 studies were included, most of which had a high or critical risk of bias. Important study features and essential data were often not reported. The meta-analysis was not possible due to the heterogeneity of outcomes. There was evidence that intervention effectiveness was modified by participants? social characteristics. Minority ethnic groups were found to benefit more from interventions than majority ethnic groups. Single studies with variable quality showed that those with higher education, who were employed, and adolescents with divorced parents benefited more from interventions. The evidence for differences by age, gender, and health literacy was conflicting (eg, in some instances, older people benefited more, and in others, younger people benefited more). There was no evidence of differences in income, numeracy, or household size. Conclusions: There was evidence that web-based self-care interventions for chronic conditions can be advantageous for some social groups (ie, minority ethnic groups, adolescents with divorced parents) and disadvantageous for other (ie, low education, unemployed) social groups who have historically experienced health inequity. However, these findings should be treated with caution as most of the evidence came from a small number of low-quality studies. The findings for gender and health literacy were mixed across studies on diabetes, and the findings for age were mixed across studies on asthma, COPD, and diabetes. There was no evidence that income, numeracy, or the number of people living in the household modified intervention effectiveness. We conclude that there appear to be interaction effects, which warrant exploration in future research, and recommend a priori consideration of the predicted interaction effects. Trial Registration: PROSPERO CRD42017056163; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=56163 UR - http://www.jmir.org/2020/6/e17849/ UR - http://dx.doi.org/10.2196/17849 UR - http://www.ncbi.nlm.nih.gov/pubmed/32459632 ID - info:doi/10.2196/17849 ER - TY - JOUR AU - Pechmann, Cornelia AU - Phillips, Connor AU - Calder, Douglas AU - Prochaska, J. Judith PY - 2020/6/5 TI - Facebook Recruitment Using Zip Codes to Improve Diversity in Health Research: Longitudinal Observational Study JO - J Med Internet Res SP - e17554 VL - 22 IS - 6 KW - smoking KW - advertisement KW - social media N2 - Background: Facebook?s advertising platform reaches most US households and has been used for health-related research recruitment. The platform allows for advertising segmentation by age, gender, and location; however, it does not explicitly allow for targeting by race or ethnicity to facilitate a diverse participant pool. Objective: This study looked at the efficacy of zip code targeting in Facebook advertising to reach blacks/African Americans and Hispanics/Latinos who smoke daily for a quit-smoking web-based social media study. Methods: We ran a general market campaign for 61 weeks using all continental US zip codes as a baseline. Concurrently, we ran 2 campaigns to reach black/African American and Hispanic-/Latino-identified adults, targeting zip codes ranked first by the percentage of households of the racial or ethnic group of interest and then by cigarette expenditure per household. We also ran a Spanish language campaign for 13 weeks, targeting all continental US zip codes but utilizing Facebook?s Spanish language targeting. The advertising images and language were common across campaigns. Costs were compared for advertisement clicks, queries, applications, and participants, and yields were compared for the final three outcomes. We examined outcomes before and after the Cambridge Analytica scandal that broke in March 2018. Finally, we examined 2 promoted Facebook features: lookalike audiences and audience network placement. Results: Zip code targeting campaigns were effective for yielding the racial or ethnic groups of interest. The black-/African American?focused versus general market campaign increased black/African American weekly queries (mean 9.48, SD 5.69 vs general market mean 2.83, SD 2.05; P<.001) and applicants (mean 1.11, SD 1.21 vs general market mean 0.54, SD 0.58; P<.001). The Hispanic-/Latino-focused versus general market campaign increased Hispanic/Latino weekly queries (mean 3.10, SD 2.16 vs general market mean 0.71, SD 0.48; P<.001) and applicants (mean 0.36, SD 0.55 vs general market mean 0.10, SD 0.14; P=.001). Cost metrics did not differ between campaigns at generating participants (overall P=.54). Costs increased post- versus prescandal for the black-/African American?focused campaign for queries (mean US $8.51, SD 3.08 vs US $5.87, SD 1.89; P=.001) and applicants (mean US $59.64, SD 35.63 vs US $38.96, SD 28.31; P=.004) and for the Hispanic-/Latino-focused campaign for queries (mean US $9.24, SD 4.74 vs US $7.04, SD 3.39; P=.005) and applicants (mean US $61.19, SD 40.08 vs US $38.19, SD 21.20; P=.001). Conclusions: Zip code targeting in Facebook advertising is an effective way to recruit diverse populations for health-based interventions. Audience network placement should be avoided. The Facebook lookalike audience may not be necessary for recruitment, with drawbacks including an unknown algorithm and unclear use of Facebook user data, and so public concerns around data privacy should be considered. Trial Registration: ClinicalTrial.gov NCT02823028; https://clinicaltrials.gov/ct2/show/NCT02823028 UR - https://www.jmir.org/2020/6/e17554 UR - http://dx.doi.org/10.2196/17554 UR - http://www.ncbi.nlm.nih.gov/pubmed/32501274 ID - info:doi/10.2196/17554 ER - TY - JOUR AU - Brewer, C. LaPrincess AU - Fortuna, L. Karen AU - Jones, Clarence AU - Walker, Robert AU - Hayes, N. Sharonne AU - Patten, A. Christi AU - Cooper, A. Lisa PY - 2020/1/14 TI - Back to the Future: Achieving Health Equity Through Health Informatics and Digital Health JO - JMIR Mhealth Uhealth SP - e14512 VL - 8 IS - 1 KW - health informatics KW - digital health KW - mobile health KW - eHealth KW - community-based participatory research KW - health equity UR - https://mhealth.jmir.org/2020/1/e14512 UR - http://dx.doi.org/10.2196/14512 UR - http://www.ncbi.nlm.nih.gov/pubmed/31934874 ID - info:doi/10.2196/14512 ER - TY - JOUR AU - Lee, J. Edmund W. AU - Viswanath, Kasisomayajula PY - 2020/1/7 TI - Big Data in Context: Addressing the Twin Perils of Data Absenteeism and Chauvinism in the Context of Health Disparities Research JO - J Med Internet Res SP - e16377 VL - 22 IS - 1 KW - big data KW - artificial intelligence KW - health informatics KW - wearable electronic devices KW - mobile health KW - social media KW - electronic health records KW - digital divide KW - health disparities UR - https://www.jmir.org/2020/1/e16377 UR - http://dx.doi.org/10.2196/16377 UR - http://www.ncbi.nlm.nih.gov/pubmed/31909724 ID - info:doi/10.2196/16377 ER - TY - JOUR AU - Côté, Mélina AU - Lapointe, Annie AU - Laramée, Catherine AU - Lemieux, Simone AU - Desroches, Sophie AU - Belanger-Gravel, Ariane AU - Lamarche, Benoît PY - 2019/12/10 TI - Beliefs Related to Participation in a Large Web-Based Prospective Survey on Diet and Health Among Individuals With a Low Socioeconomic Status: Qualitative Study JO - JMIR Form Res SP - e13854 VL - 3 IS - 4 KW - focus groups KW - qualitative research KW - social class KW - research subject KW - retention N2 - Background: NutriQuébec is a Web-based prospective study on the relationship between diet and health as well as the impact of food-related health policies in the adult population of Québec, Canada. Recruitment and retention of individuals with a low socioeconomic status (SES) in such a study are known to be challenging, yet critical for achieving representativeness of the entire population. Objective: This study aimed to identify the behavioral, normative, and control beliefs of individuals with a low SES regarding participation in the NutriQuébec project and to identify their preferences regarding recruitment methods. Methods: A total of four focus groups were conducted in community centers located in low-income areas of Québec City, Canada. On the basis of the theory of planned behavior, participants? beliefs associated with attitude, subjective norm, and perceived behavioral control regarding hypothetical participation in the NutriQuébec project were identified. Focus groups were recorded, transcribed, and coded by two analysts. Results: Participants (16 men and 12 women) were aged between 28 and 72 years, and a majority of the participants had an annual household income of Can $19,999 or less. The main perceived advantages of participating in the NutriQuébec project were contributing to improved collective health and supporting research. The only disadvantage identified was the risk of having to fill out too many questionnaires. Participants could not, in general, identify persons from their entourage who would approve or disapprove their participation in the study. The main facilitators identified were obtaining a brief health assessment and the ability to complete questionnaires in a way that is not Web-based. The main barrier was the lack of internet access. The preferred means of recruitment were through social media, television, and community centers. Conclusions: These results provide insightful information regarding the best methods and messages to use in order to recruit and retain individuals with a low SES in a population-based prospective study on lifestyle and health on the internet. UR - http://formative.jmir.org/2019/4/e13854/ UR - http://dx.doi.org/10.2196/13854 UR - http://www.ncbi.nlm.nih.gov/pubmed/31821149 ID - info:doi/10.2196/13854 ER - TY - JOUR AU - Russomanno, Jennifer AU - Patterson, G. Joanne AU - Jabson Tree, M. Jennifer PY - 2019/12/2 TI - Social Media Recruitment of Marginalized, Hard-to-Reach Populations: Development of Recruitment and Monitoring Guidelines JO - JMIR Public Health Surveill SP - e14886 VL - 5 IS - 4 KW - transgender KW - LGBTQ KW - TGNC KW - marginalized populations KW - cyberbullying KW - engagement KW - compassion fatigue KW - human subjects KW - research protections KW - adverse events N2 - Background: Social media can be a useful strategy for recruiting hard-to-reach, stigmatized populations into research studies; however, it may also introduce risks for participant and research team exposure to negative comments. Currently, there is no published formal social media recruitment and monitoring guidelines that specifically address harm reduction for social media recruitment of marginalized populations. Objective: The purpose of this research study was to investigate the utility, successes, challenges, and positive and negative consequences of using targeted Facebook advertisements as a strategy to recruit transgender and gender nonconforming (TGNC) people into a research study. Methods: TGNC adults living in the Southeast Unites States were recruited via targeted Facebook advertisements over two cycles in April and June 2017. During cycle 1, researchers only used inclusion terms to recruit the target population. During cycle 2, the social media recruitment and monitoring protocol and inclusion and exclusion terms were used. Results: The cycle 1 advertisement reached 8518 people and had 188 reactions, comments, and shares but produced cyberbullying, including discriminatory comments from Facebook members. Cycle 2 reached fewer people (6976) and received 166 reactions, comments, and shares but produced mostly positive comments. Conclusions: Researchers must consider potential harms of using targeted Facebook advertisements to recruit hard-to-reach and stigmatized populations. To minimize harm to participants and research staff, researchers must preemptively implement detailed social media recruitment and monitoring guidelines for monitoring and responding to negative feedback on targeted Facebook advertisements. UR - http://publichealth.jmir.org/2019/4/e14886/ UR - http://dx.doi.org/10.2196/14886 UR - http://www.ncbi.nlm.nih.gov/pubmed/31789598 ID - info:doi/10.2196/14886 ER - TY - JOUR AU - Golembiewski, Elizabeth AU - Allen, S. Katie AU - Blackmon, M. Amber AU - Hinrichs, J. Rachel AU - Vest, R. Joshua PY - 2019/10/7 TI - Combining Nonclinical Determinants of Health and Clinical Data for Research and Evaluation: Rapid Review JO - JMIR Public Health Surveill SP - e12846 VL - 5 IS - 4 KW - social determinants of health KW - socioeconomic factors KW - inequalities KW - population characteristics KW - social conditions N2 - Background: Nonclinical determinants of health are of increasing importance to health care delivery and health policy. Concurrent with growing interest in better addressing patients? nonmedical issues is the exponential growth in availability of data sources that provide insight into these nonclinical determinants of health. Objective: This review aimed to characterize the state of the existing literature on the use of nonclinical health indicators in conjunction with clinical data sources. Methods: We conducted a rapid review of articles and relevant agency publications published in English. Eligible studies described the effect of, the methods for, or the need for combining nonclinical data with clinical data and were published in the United States between January 2010 and April 2018. Additional reports were obtained by manual searching. Records were screened for inclusion in 2 rounds by 4 trained reviewers with interrater reliability checks. From each article, we abstracted the measures, data sources, and level of measurement (individual or aggregate) for each nonclinical determinant of health reported. Results: A total of 178 articles were included in the review. The articles collectively reported on 744 different nonclinical determinants of health measures. Measures related to socioeconomic status and material conditions were most prevalent (included in 90% of articles), followed by the closely related domain of social circumstances (included in 25% of articles), reflecting the widespread availability and use of standard demographic measures such as household income, marital status, education, race, and ethnicity in public health surveillance. Measures related to health-related behaviors (eg, smoking, diet, tobacco, and substance abuse), the built environment (eg, transportation, sidewalks, and buildings), natural environment (eg, air quality and pollution), and health services and conditions (eg, provider of care supply, utilization, and disease prevalence) were less common, whereas measures related to public policies were rare. When combining nonclinical and clinical data, a majority of studies associated aggregate, area-level nonclinical measures with individual-level clinical data by matching geographical location. Conclusions: A variety of nonclinical determinants of health measures have been widely but unevenly used in conjunction with clinical data to support population health research. UR - https://publichealth.jmir.org/2019/4/e12846 UR - http://dx.doi.org/10.2196/12846 UR - http://www.ncbi.nlm.nih.gov/pubmed/31593550 ID - info:doi/10.2196/12846 ER - TY - JOUR AU - Tatara, Naoe AU - Hammer, Lewi Hugo AU - Mirkovic, Jelena AU - Kjøllesdal, Råberg Marte Karoline AU - Andreassen, Kristin Hege PY - 2019/08/16 TI - Associations Between Immigration-Related User Factors and eHealth Activities for Self-Care: Case of First-Generation Immigrants From Pakistan in the Oslo Area, Norway JO - JMIR Public Health Surveill SP - e11998 VL - 5 IS - 3 KW - immigrants KW - type 2 diabetes KW - self-care KW - information-seeking behavior KW - literacy KW - language N2 - Background: Immigrant populations are often disproportionally affected by chronic diseases, such as type 2 diabetes mellitus (T2DM). Use of information and communication technology (ICT) is one promising approach for better self-care of T2DM to mitigate the social health inequalities, if designed for a wider population. However, knowledge is scarce about immigrant populations? diverse electronic health (eHealth) activities for self-care, especially in European countries. Objective: With a target group of first-generation immigrants from Pakistan in the Oslo area, Norway, we aimed to understand their diverse eHealth activities for T2DM self-care in relation to immigration-related user factors specific to this target group: proficiency in relevant languages (Urdu, Norwegian, English), length of residence in Norway, and diagnosis of T2DM compared with general user factors (age, gender, education and digital skills, and self-rated health status). Methods: Data were from a survey among the target population (N=176) conducted in 2015-2016. Using logistic regression, we analyzed associations between user factors and experiences of each of the following eHealth activities for T2DM self-care in the last 12 months: first, information seeking by (1) search engines and (2) Web portals or email subscriptions; second, communication and consultation (1) by closed conversation with a few acquaintances using ICT and (2) on social network services; and third, active decision making by using apps for (1) tracking health information and (2) self-assessment of health status. Using Poisson regression, we also assessed the relationship between user factors and variety of eHealth activities experienced. The Bonferroni correction was used to address the multiple testing problem. Results: Regression analyses yielded the following significantly positive associations: between Urdu literacy and (1) information seeking by Web portals or email subscriptions (odds ratio [OR] 2.155, 95% CI 1.388-3.344), (2) communication and consultation on social network services (OR 5.697, 95% CI 2.487-13.053), and (3) variety (estimate=0.350, 95% CI 0.148-0.552); between length of residence in Norway and (1) communication and consultation by closed conversation with a few acquaintances using ICT (OR 1.728, 95% CI 1.193-2.503), (2) communication and consultation on social network services (OR 2.098, 95% CI 1.265-3.480), and (3) variety (estimate=0.270, 95% CI 0.117-0.424); between Norwegian language proficiency and active decision making by using apps for self-assessment of health status (OR 2.285, 95% CI 1.294-4.036); between education and digital skills and active decision making by using apps for tracking health information (OR 3.930, 95% CI 1.627-9.492); and between being a female and communication and consultation by closed conversation with a few acquaintances using ICT (OR 2.883, 95% CI 1.335-6.227). Conclusions: This study implies immigration-related factors may confound associations between general user factors and eHealth activities. Further studies are needed to explore the influence of immigration-related user factors for eHealth activities in other immigrant groups and countries. International Registered Report: RR2-DOI 10.2196/resprot.5468 UR - http://publichealth.jmir.org/2019/3/e11998/ UR - http://dx.doi.org/10.2196/11998 UR - http://www.ncbi.nlm.nih.gov/pubmed/31420957 ID - info:doi/10.2196/11998 ER - TY - JOUR AU - Ceasar, Nashae Joniqua AU - Claudel, Elizabeth Sophie AU - Andrews, R. Marcus AU - Tamura, Kosuke AU - Mitchell, Valerie AU - Brooks, T. Alyssa AU - Dodge, Tonya AU - El-Toukhy, Sherine AU - Farmer, Nicole AU - Middleton, Kimberly AU - Sabado-Liwag, Melanie AU - Troncoso, Melissa AU - Wallen, R. Gwenyth AU - Powell-Wiley, M. Tiffany PY - 2019/01/04 TI - Community Engagement in the Development of an mHealth-Enabled Physical Activity and Cardiovascular Health Intervention (Step It Up): Pilot Focus Group Study JO - JMIR Formativ Res SP - e10944 VL - 3 IS - 1 KW - cardiovascular health KW - community-based participatory research KW - health behaviors KW - mHealth KW - mobile phone KW - physical activity KW - qualitative data N2 - Background: Community-based participatory research is an effective tool for improving health outcomes in minority communities. Few community-based participatory research studies have evaluated methods of optimizing smartphone apps for health technology-enabled interventions in African Americans. Objective: This study aimed to utilize focus groups (FGs) for gathering qualitative data to inform the development of an app that promotes physical activity (PA) among African American women in Washington, DC. Methods: We recruited a convenience sample of African American women (N=16, age range 51-74 years) from regions of Washington, DC metropolitan area with the highest burden of cardiovascular disease. Participants used an app created by the research team, which provided motivational messages through app push notifications and educational content to promote PA. Subsequently, participants engaged in semistructured FG interviews led by moderators who asked open-ended questions about participants? experiences of using the app. FGs were audiorecorded and transcribed verbatim, with subsequent behavioral theory-driven thematic analysis. Key themes based on the Health Belief Model and emerging themes were identified from the transcripts. Three independent reviewers iteratively coded the transcripts until consensus was reached. Then, the final codebook was approved by a qualitative research expert. Results: In this study, 10 main themes emerged. Participants emphasized the need to improve the app by optimizing automation, increasing relatability (eg, photos that reflect target demographic), increasing educational material (eg, health information), and connecting with community resources (eg, cooking classes and exercise groups). Conclusions: Involving target users in the development of a culturally sensitive PA app is an essential step for creating an app that has a higher likelihood of acceptance and use in a technology-enabled intervention. This may decrease health disparities in cardiovascular diseases by more effectively increasing PA in a minority population. UR - https://formative.jmir.org/2019/1/e10944/ UR - http://dx.doi.org/10.2196/10944 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684422 ID - info:doi/10.2196/10944 ER - TY - JOUR AU - Saez, Laura AU - Langlois, Johanne AU - Legrand, Karine AU - Quinet, Marie-Hélène AU - Lecomte, Edith AU - Omorou, Y. Abdou AU - Briançon, Serge AU - PY - 2018/05/18 TI - Reach and Acceptability of a Mobile Reminder Strategy and Facebook Group Intervention for Weight Management in Less Advantaged Adolescents: Insights From the PRALIMAP-INÈS Trial JO - JMIR Mhealth Uhealth SP - e110 VL - 6 IS - 5 KW - adolescent KW - social media KW - text messaging KW - overweight KW - socioeconomic factors KW - weight loss N2 - Background: Although information and communication technology interventions appear to be a promising means of reducing the health inequality gap in overweight and obesity prevention, research on information and communication technology interventions is lacking outside the Anglo-Saxon world. Objective: The aim of this study was to assess the reach and acceptability of 2 information and communication technology interventions delivered as part of a French nutritional program: an SMS text messaging (short message service, SMS) attendance-reminder for collective sessions strategy and a Facebook challenge group. Methods: This study sample comprised 262 socially less advantaged overweight adolescents aged between 13 and 18 years. The information and communication technology interventions were carried out during the 2013-2014 academic year in 33 French state-run schools. For the SMS attendance-reminder for collective sessions strategy, at the start of the academic year, adolescents were asked to give their mobile number. SMS attendance-reminders were sent shortly before each of the 5 collective sessions. For the Facebook challenge group, adolescents were invited to join a closed Facebook group in which challenges on physical activity and on diet were posted weekly. Process data and 2 sets of face-to-face interviews were also used to interpret participation rates and access to Facebook. Appreciation for both interventions was evaluated by a questionnaire at the end of the academic year. Results: Of the recruited adolescents, 79.0% (207/262) gave their mobile number, reflecting high access to a mobile phone. Giving a number was significantly more likely for girls (odds ratio [OR] 2.1, 95% CI 1.1-3.9; P=.02) and adolescents in a vocational or general high school as opposed to middle school (OR 1.0, 95% CI 0.4-2.7; OR 0.2, 95% CI 0.1-0.5; P<.001). Indicating a mobile number at the start of the year was not significantly associated with participation in collective sessions. Of the adolescents seen at the start-of-year face-to-face interviews, 78.1% (153/196) declared an interest in the Facebook challenge group, which implies having a Facebook account or being able to have access to one. However, only 21 adolescents went through the process of joining the group. Although there was satisfaction with the Facebook group among the participants, the low participation rate in the Facebook group does not allow conclusions to be drawn with confidence. Conclusions: The results are in line with the claim that using information and communication technologies in health programs is unlikely to widen health inequalities. However, in this population of French adolescents, mobile phone strategies seem more adapted to a high school context, and caution should be exercised with a younger audience. Although there is positive appreciation of the SMS attendance-reminders and a Facebook intervention is initially highly appealing to less advantaged adolescents, no evidence of impact could be demonstrated. These results highlight the difficulty in assessing the impact of specific interventions in complex health programs. Trial Registration: Clinicaltrials.gov NCT01688453; https://clinicaltrials.gov/ct2/show/NCT01688453 (Archived by WebCite at http://www.webcitation.org/6yy6EQ0SM) UR - http://mhealth.jmir.org/2018/5/e110/ UR - http://dx.doi.org/10.2196/mhealth.7657 UR - http://www.ncbi.nlm.nih.gov/pubmed/29776897 ID - info:doi/10.2196/mhealth.7657 ER - TY - JOUR AU - Grande, W. Stuart AU - Sherman, D. Ledric PY - 2018/05/14 TI - Too Important to Ignore: Leveraging Digital Technology to Improve Chronic Illness Management Among Black Men JO - J Med Internet Res SP - e182 VL - 20 IS - 5 KW - black men KW - digital health KW - chronic illness UR - http://www.jmir.org/2018/5/e182/ UR - http://dx.doi.org/10.2196/jmir.9434 UR - http://www.ncbi.nlm.nih.gov/pubmed/29759956 ID - info:doi/10.2196/jmir.9434 ER - TY - JOUR AU - Sheon, R. Amy AU - Bolen, D. Shari AU - Callahan, Bill AU - Shick, Sarah AU - Perzynski, T. Adam PY - 2017/07/13 TI - Addressing Disparities in Diabetes Management Through Novel Approaches to Encourage Technology Adoption and Use JO - JMIR Diabetes SP - e16 VL - 2 IS - 2 KW - diabetes KW - chronic illness KW - vulnerable populations KW - digital divide KW - community health workers KW - healthcare disparities KW - patient portals KW - patient engagement KW - meaningful use KW - health literacy UR - http://diabetes.jmir.org/2017/2/e16/ UR - http://dx.doi.org/10.2196/diabetes.6751 UR - http://www.ncbi.nlm.nih.gov/pubmed/30291090 ID - info:doi/10.2196/diabetes.6751 ER - TY - JOUR AU - Manganello, A. Jennifer AU - Gerstner, Gena AU - Pergolino, Kristen AU - Graham, Yvonne AU - Strogatz, David PY - 2016/04/18 TI - Understanding Digital Technology Access and Use Among New York State Residents to Enhance Dissemination of Health Information JO - JMIR Public Health Surveill SP - e9 VL - 2 IS - 1 KW - media KW - New York KW - Internet KW - health information KW - eHealth N2 - Background: Many state and local health departments, as well as community organizations, have been using new technologies to disseminate health information to targeted populations. Yet little data exist that show access and use patterns, as well as preferences for receiving health information, at the state level. Objective: This study was designed to obtain information about media and technology use, and health information seeking patterns, from a sample of New York State (NYS) residents. Methods: A cross-sectional telephone survey (with mobile phones and landlines) was developed to assess media and technology access, use patterns, and preferences for receiving health information among a sample of 1350 residents in NYS. The survey used random digit dialing methodology. A weighted analysis was conducted utilizing Stata/SE software. Results: Data suggest that NYS residents have a high level of computer and Internet use; 82% have at least one working computer at home, and 85% use the Internet at least sometimes. Mobile phone use is also high; 90% indicated having a mobile phone, and of those 63% have a smartphone. When asked about preferences for receiving health information from an organization, many people preferred websites (49%); preferences for other sources varied by demographic characteristics. Conclusions: Findings suggest that the Internet and other technologies are viable ways to reach NYS residents, but agencies and organizations should still consider using traditional methods of communication in some cases, and determine appropriate channels based on the population of interest. UR - http://publichealth.jmir.org/2016/1/e9/ UR - http://dx.doi.org/10.2196/publichealth.4442 UR - http://www.ncbi.nlm.nih.gov/pubmed/27227163 ID - info:doi/10.2196/publichealth.4442 ER - TY - JOUR AU - Farach, Nasim AU - Faba, Gladys AU - Julian, Soroya AU - Mejía, Felipe AU - Cabieses, Báltica AU - D'Agostino, Marcelo AU - Cortinois, A. Andrea PY - 2015/03/17 TI - Stories From the Field: The Use of Information and Communication Technologies to Address the Health Needs of Underserved Populations in Latin America and the Caribbean JO - JMIR Public Health Surveill SP - e1 VL - 1 IS - 1 KW - eHealth KW - Latin America KW - vulnerable populations KW - qualitative research N2 - Background: As their availability grew exponentially in the last 20 years, the use of information and communication technologies (ICT) in health has been widely espoused, with many emphasizing their potential to decrease health inequities. Nonetheless, there is scarce availability of information regarding ICT as tools to further equity in health, specifically in Latin American and Caribbean settings. Objective: Our aim was to identify initiatives that used ICT to address the health needs of underserved populations in Latin America and Caribbean. Among these projects, explore the rationale behind the selection of ICT as a key component, probe perceptions regarding contributions to health equity, and describe the challenges faced during implementation. Methods: We conducted an exploratory qualitative study. Interviews were completed via Skype or face-to-face meetings using a semistructured interview guide. Following participant consent, interviews were audio recorded and verbatim transcriptions were developed. All transcriptions were coded using ATLASti7 software. The text was analyzed for patterns, shared themes, and diverging opinions. Emerging findings were reviewed by all interviewers and shared with participants for feedback. Results: We interviewed representatives from eight organizations in six Latin American and Caribbean countries that prominently employed ICT in health communication, advocacy, or surveillance projects. ICT expanded project's geographic coverage, increased their reach into marginalized or hard-to-reach groups, and allowed real-time data collection. Perceptions of contributions to health equity resided mainly in the provision of health information and linkage to health services to members of groups experiencing greater morbidity because of poverty, remote place of residence, lack of relevant public programs, and/or stigma and discrimination, and in more timely responses by authorities to the health needs of these groups as a result of the increased availability of strategic information on morbidity and its social determinants. Most projects faced initial resistance to implementation because of lack of precedents. Their financial and technical sustainability was threatened by reliance on external funding and weak transitional structures amidst key staff changes. Projects often experienced challenges in establishing meaningful communication with target audience members, mainly because of divergent motivations behind ICT use between projects and its target audience and the lack of access or familiarity with ICT among the most underserved members of such audiences. Conclusions: ICT can benefit projects focusing on the health needs of underserved populations by expanding the breadth and depth of target audience coverage and improving data management. Most projects tended to be small, short-term pilot interventions with limited engagement with the formal health sector and did not include health equity as an explicit component. Collaborative projects with government institutions, particularly those with health surveillance objectives, seemed to be the most optimistic about long-term sustainability. UR - http://publichealth.jmir.org/2015/1/e1/ UR - http://dx.doi.org/10.2196/publichealth.4108 UR - http://www.ncbi.nlm.nih.gov/pubmed/27227124 ID - info:doi/10.2196/publichealth.4108 ER -