%0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e40 %T The Influence of User Characteristics and a Periodic Email Prompt on Exposure to an Internet-Delivered Computer-Tailored Lifestyle Program %A Schneider,Francine %A van Osch,Liesbeth %A Schulz,Daniela N %A Kremers,Stef PJ %A de Vries,Hein %+ CAPHRI, Department of Health Promotion, Maastricht University, P O Box 616, Maastricht, 6200 MD, Netherlands, 31 43 388 2397, francine.schneider@maastrichtuniversity.nl %K Internet interventions %K computer tailoring %K lifestyle %K behavior change %K program use %K user characteristics %K diffusion %K proactive strategy %K prompts %D 2012 %7 01.03.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet is a promising medium in the field of health promotion for offering tailored and targeted lifestyle interventions applying computer-tailored (CT) techniques to the general public. Actual exposure to CT interventions is not living up to its high expectations, as only a (limited) proportion of the target group is actually using these programs. Objective: To investigate exposure to an Internet-delivered, CT lifestyle intervention, targeting physical activity, fruit and vegetable intake, smoking behavior, and alcohol intake, we focused on three processes: first use, prolonged use, and sustained use. The first objectives were to identify user characteristics that predict initiation of an online CT lifestyle program (first use) and completion of this program (prolonged use). Furthermore, we studied the effect of using a proactive strategy, consisting of periodic email prompts, on program revisits (sustained use). Methods: The research population for this study consisted of Dutch adults participating in the Adult Health Monitor, offered by the regional public health services. We used a randomized controlled trial design to assess predictors of first use, prolonged use, and sustained use. Demographics and behavioral characteristics, as well as the strategy used for revisiting, were included as predictors in the model. Results: A total of 9169 participants indicated their interest in the new program and 5168 actually logged in to the program. Participants significantly more likely to initiate one of the CT modules were male, older, and employed, and had a lower income, higher body mass index, and relatively unhealthy lifestyle. Participants significantly more likely to complete one of the CT modules were older and had a higher income and a relatively healthier lifestyle. Finally, using a proactive strategy influenced sustained use, with people from the prompting condition being more likely to revisit the program (odds ratio 28.92, 95% confidence interval 10.65–78.52; P < .001). Conclusions: Older, male, and employed participants, and those with a lower income, higher body mass index, and a relatively unhealthy lifestyle were more likely to initiate a CT module. Module completers predominantly had a higher income and age. The current program therefore succeeded in reaching those people who benefit most from online lifestyle interventions. However, these people tended to disengage from the program. This underlines the importance of additional research into program adjustments and strategies that can be used to stimulate prolonged program use. Furthermore, sending periodic email prompts significantly increased revisits to the program. Though promising, this effect was modest and needs to be further examined, in order to maximize the potential of periodic email prompting. Trial Registration: Nederlands Trial Register (NTR: 1786) and Medical Ethics Committee of Maastricht University and the University Hospital Maastricht (NL2723506809/MEC0903016); http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1786 (Archived by WebCite at http://www.webcitation.org/65hBXA6V7) %M 22382037 %R 10.2196/jmir.1939 %U http://www.jmir.org/2012/2/e40/ %U https://doi.org/10.2196/jmir.1939 %U http://www.ncbi.nlm.nih.gov/pubmed/22382037 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e43 %T Initial and Sustained Participation in an Internet-delivered Long-term Worksite Health Promotion Program on Physical Activity and Nutrition %A Robroek,Suzan JW %A Lindeboom,Dennis EM %A Burdorf,Alex %+ Department of Public Health, Erasmus MC, PO Box 2040, Rotterdam, 3000CA, Netherlands, 31 107038469, a.burdorf@erasmusmc.nl %K Participation %K Retention %K Internet %K Physical activity %K Nutrition %K Workplace %K Health promotion %D 2012 %7 05.03.2012 %9 Original paper %J J Med Internet Res %G English %X Background: Determinants of participation in health promotion programs are largely unknown. To evaluate and implement interventions, information is needed regarding their reach as well as regarding the characteristics of program users and non-users. Objective: In this study, individual, lifestyle, and health indicators were investigated in relation to initial, and sustained participation in an Internet-delivered physical activity and healthy nutrition program in the workplace setting. In addition, determinants of program website use were studied. Methods: Determinants of participation were investigated in a longitudinal study among employees from six workplaces participating in a two-year cluster randomized controlled trial. The employees were invited by email to participate. At baseline, all participants visited a website to fill out the questionnaire on lifestyle, work, and health factors. Subsequently, a physical health check was offered, followed by face-to-face advice. Throughout the study period, all participants had access to a website with information on lifestyle and health, and to fully automated personalized feedback on the questionnaire results. Only participants in the intervention received monthly email messages to promote website visits during the first year and had access to additional Web-based tools (self-monitors, a food frequency questionnaire assessing saturated fat intake, and the possibility to ask questions) to support behavior change. Website use was monitored by website statistics measuring access. Logistic regression analyses were conducted to identify characteristics of employees who participated in the program and used the website. Results: Complete baseline data were available for 924 employees (intervention: n=456, reference: n=468). Lifestyle and health factors were not associated with initial participation. Employees aged 30 years and older were more likely to start using the program and to sustain their participation. Workers with a low intention to increase their physical activity level were less likely to participate (Odds Ratio (OR)=0.60, 95% Confidence interval (95%CI), 0.43-0.85) but more likely to sustain participation throughout the study period (ORs ranging from 1.40 to 2.06). Furthermore, it was found that smokers were less likely to sustain their participation in the first and second year (OR=0.54, 95%CI 0.35-0.82) and to visit the website (OR=0.72, 95%CI 0.54-0.96). Website use was highest in the periods immediately after the baseline (73%) and follow-up questionnaires (71% and 87%). Employees in the intervention were more likely to visit the website in the period they received monthly emails (OR=5.88, 95%CI 3.75-9.20) but less likely to visit the website in the subsequent period (OR=0.62, 95%CI 0.45-0.85). Conclusions: Modest initial participation and high attrition in program use were found. Workers with a low intention to change their behavior were less likely to participate, but once enrolled they were more likely to sustain their participation. Lifestyle and health indicators were not related to initial participation, but those with an unhealthy lifestyle were less likely to sustain. This might influence program effectiveness. Regular email messages prompted website use, but the use of important Web-based tools was modest. There is a need for more appealing techniques to enhance retention and to keep those individuals who need it most attracted to the program. Trial Registration: ISRCTN52854353; http://www.controlled-trials.com/ISRCTN52854353 %M 22390886 %R 10.2196/jmir.1788 %U http://www.jmir.org/2012/2/e43/ %U https://doi.org/10.2196/jmir.1788 %U http://www.ncbi.nlm.nih.gov/pubmed/22390886 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e26 %T Program Completion of a Web-Based Tailored Lifestyle Intervention for Adults: Differences between a Sequential and a Simultaneous Approach %A Schulz,Daniela N %A Schneider,Francine %A de Vries,Hein %A van Osch,Liesbeth ADM %A van Nierop,Peter WM %A Kremers,Stef PJ %+ CAPHRI School for Public Health and Primary Care, Department of Health Promotion, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, Netherlands, 31 43 3882832, dn.schulz@maastrichtuniversity.nl %K Internet %K dropout %K computer tailoring %K multiple health behavior change intervention %K sequential %K simultaneous %K lifestyle %D 2012 %7 08.03.2012 %9 Original paper %J J Med Internet Res %G English %X Background: Unhealthy lifestyle behaviors often co-occur and are related to chronic diseases. One effective method to change multiple lifestyle behaviors is web-based computer tailoring. Dropout from Internet interventions, however, is rather high, and it is challenging to retain participants in web-based tailored programs, especially programs targeting multiple behaviors. To date, it is unknown how much information people can handle in one session while taking part in a multiple behavior change intervention, which could be presented either sequentially (one behavior at a time) or simultaneously (all behaviors at once). Objectives: The first objective was to compare dropout rates of 2 computer-tailored interventions: a sequential and a simultaneous strategy. The second objective was to assess which personal characteristics are associated with completion rates of the 2 interventions. Methods: Using an RCT design, demographics, health status, physical activity, vegetable consumption, fruit consumption, alcohol intake, and smoking were self-assessed through web-based questionnaires among 3473 adults, recruited through Regional Health Authorities in the Netherlands in the autumn of 2009. First, a health risk appraisal was offered, indicating whether respondents were meeting the 5 national health guidelines. Second, psychosocial determinants of the lifestyle behaviors were assessed and personal advice was provided, about one or more lifestyle behaviors. Results: Our findings indicate a high non-completion rate for both types of intervention (71.0%; n = 2167), with more incompletes in the simultaneous intervention (77.1%; n = 1169) than in the sequential intervention (65.0%; n = 998). In both conditions, discontinuation was predicted by a lower age (sequential condition: OR = 1.04; P < .001; CI = 1.02-1.05; simultaneous condition: OR = 1.04; P < .001; CI = 1.02-1.05) and an unhealthy lifestyle (sequential condition: OR = 0.86; P = .01; CI = 0.76-0.97; simultaneous condition: OR = 0.49; P < .001; CI = 0.42-0.58). In the sequential intervention, being male (OR = 1.27; P = .04; CI = 1.01-1.59) also predicted dropout. When respondents failed to adhere to at least 2 of the guidelines, those receiving the simultaneous intervention were more inclined to drop out than were those receiving the sequential intervention. Conclusion: Possible reasons for the higher dropout rate in our simultaneous intervention may be the amount of time required and information overload. Strategies to optimize program completion as well as continued use of computer-tailored interventions should be studied. Trial Registration: Dutch Trial Register NTR2168 %M 22403770 %R 10.2196/jmir.1968 %U http://www.jmir.org/2012/2/e26/ %U https://doi.org/10.2196/jmir.1968 %U http://www.ncbi.nlm.nih.gov/pubmed/22403770 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e45 %T The Role of User Control in Adherence to and Knowledge Gained from a Website: Randomized Comparison Between a Tunneled Version and a Freedom-of-Choice Version %A Crutzen,Rik %A Cyr,Dianne %A de Vries,Nanne K %+ Department of Health Promotion, Maastricht University/CAPHRI, P.O. Box 616, Maastricht, 6200 MD, Netherlands, 31 433882828, rik.crutzen@maastrichtuniversity.nl %K website use %K user control %K user perceptions %K Internet %K interventions %D 2012 %7 09.03.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-delivered interventions can effectively change health risk behaviors and their determinants, but adherence to these interventions once they are accessed is very low. Therefore, it is relevant and necessary to systematically manipulate website characteristics to test their effect on website use. This study focuses on user control as a website characteristic. Objective: To test whether and how user control (the freedom of choice to skip pages) can increase website use and knowledge gained from the website. Methods: Participants older than 18 years were drawn from the Dutch Internet population (in June 2011) and completed a hepatitis knowledge questionnaire. Subsequently, they were randomly assigned to three groups: (1) a tunneled version of the website with less user control; (2) a high user control version of the website where visitors had the freedom of choice to skip pages; and (3) a control group that was not exposed to the website. Participants completed (1) a questionnaire of validated measures regarding user perceptions immediately after exposure to the website (except for the control group), and (2) a hepatitis knowledge questionnaire after one week to test whether participants in the experimental groups only clicked through the website or actually processed and learned its content. Server registrations were used to assess website use. Analyses of covariance (ANCOVA) using all available data were conducted to determine whether user control increases website use. Structural equation models (SEM) using all available data were constructed to test how user control increases website use—a latent variable derived from number of pages visited and time on website. Results: Of the 1044 persons invited to participate, 668 took part (668/1044, 64.0%). One half of participants (332/668 49.7%) were female and the mean age was 49 years (SD 16). A total of 571 participants completed the one-week follow-up measure regarding hepatitis knowledge (571/668, 85.5%). The findings demonstrate that having less user control (ie, a tunneled version of the website) had a negative effect on users’ perception of efficiency (F1,452 = 97.69, P < .001), but a positive effect on number of pages visited (F1,452 = 171.49, P < .001), time on the website (F1,452 = 6.32, P = .01), and knowledge gained from the website (F1,452 = 134.32, P < .001). The direct effect of having less user control appeared to surpass the effect mediated by efficiency, because website use was higher among participants exposed to the tunneled version of the website in comparison with those having the freedom of choice to skip pages. Conclusions: The key finding that visitors demonstrated increased website use in the tunneled version of the website indicates that visitors should be carefully guided through the intervention for future intervention websites. %M 22532074 %R 10.2196/jmir.1922 %U http://www.jmir.org/2012/2/e45/ %U https://doi.org/10.2196/jmir.1922 %U http://www.ncbi.nlm.nih.gov/pubmed/22532074 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e59 %T Design of a Website on Nutrition and Physical Activity for Adolescents: Results From Formative Research %A Thompson,Debbe %A Cullen,Karen Weber %A Boushey,Carol %A Konzelmann,Karen %+ USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Houston, TX, 77030, United States, 1 713 798 7076, dit@bcm.edu %K Internet %K intervention %K obesity prevention %K food %K physical activity %D 2012 %7 26.04.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Teens do not meet guidelines for healthy eating and physical activity. The Internet may be an effective method for delivering programs that help them adopt healthy behaviors. Objective: To collect information to design content and structure for a teen-friendly website promoting healthy eating and physical activity behaviors. Methods: Qualitative research, encompassing both focus group and interview techniques, were used to design the website. Participants were 12-17 year olds in Houston, Texas, and West Lafayette, Indiana. Results: A total of 133 participants took part in 26 focus groups while 15 participated in one-on-one interviews to provide guidance for the development of teen-friendly content and structure for an online behavior change program promoting healthy eating and physical activity to 12-17 year olds. The youth made suggestions to overcome common barriers to healthy eating and physical activity. Their feedback was used to develop “Teen Choice: Food & Fitness,” a 12-week online behavior change program, populated by 4 cartoon character role models. Conclusions: It is critical that members of the target audience be included in formative research to develop behavior change programs that are relevant, appealing, and address their needs and interests. %M 22538427 %R 10.2196/jmir.1889 %U http://www.jmir.org/2012/2/e59/ %U https://doi.org/10.2196/jmir.1889 %U http://www.ncbi.nlm.nih.gov/pubmed/22538427 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e44 %T Results from an Online Computer-Tailored Weight Management Intervention for Overweight Adults: Randomized Controlled Trial %A van Genugten,Lenneke %A van Empelen,Pepijn %A Boon,Brigitte %A Borsboom,Gerard %A Visscher,Tommy %A Oenema,Anke %+ Department of Public Health, Erasmus MC, Univserity Medical Center, PO Box 2040, Rotterdam, 3000 CA, Netherlands, 31 107043721, l.vangenugten@erasmusmc.nl %K Prevention %K Overweight %K Adults %K Randomized Controlled Trial %K Physical activity %K Dietary intake %K BMI %D 2012 %7 14.03.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Prevention of weight gain has been suggested as an important strategy in the prevention of obesity and people who are overweight are a specifically important group to target. Currently there is a lack of weight gain prevention interventions that can reach large numbers of people. Therefore, we developed an Internet-delivered, computer-tailored weight management intervention for overweight adults. The focus of the intervention was on making small (100 kcal per day), but sustained changes in dietary intake (DI) or physical activity (PA) behaviors in order to maintain current weight or achieve modest weight loss. Self-regulation theory was used as the basis of the intervention. Objective: This study aims to evaluate the efficacy of the computer-tailored intervention in weight-related anthropometric measures (Body Mass Index, skin folds and waist circumference) and energy balance-related behaviors (physical activity; intake of fat, snacks and sweetened drinks) in a randomized controlled trial. Methods: The tailored intervention (TI) was compared to a generic information website (GI). Participants were 539 overweight adults (mean age 47.8 years, mean Body Mass Index (BMI) 28.04, 30.9% male, 10.7% low educated) who where recruited among the general population and among employees from large companies by means of advertisements and flyers. Anthropometric measurements were measured by trained research assistants at baseline and 6-months post-intervention. DI and PA behaviors were assessed at baseline, 1-month and 6-month post-intervention, using self-reported questionnaires. Results: Repeated measurement analyses showed that BMI remained stable over time and that there were no statistically significant differences between the study groups (BMI: TI=28.09, GI=27.61, P=.09). Similar results were found for waist circumference and skin fold thickness. Amount of physical activity increased and intake of fat, snacks and sweetened drinks decreased during the course of the study, but there were no differences between the study groups (eg, fat intake: TI=15.4, GI=15.9, P=.74). The first module of the tailored intervention was visited by almost all participants, but only 15% completed all four modules of the tailored intervention, while 46% completed the three modules of the general information intervention. The tailored intervention was considered more personally relevant (TI=3.20, GI=2.83, P=.001), containing more new information (TI=3.11, GI=2.73, P=.003) and having longer texts (TI=3.20, GI=3.07, P=.01), while there were no group differences on other process measures such as attractiveness and comprehensibility of the information (eg, attractive design: TI=3.22, GI=3.16, P=.58). Conclusions: The online, computer-tailored weight management intervention resulted in changes in the desired direction, such as stabilization of weight and improvements in dietary intake, but the intervention was not more effective in preventing weight gain or modifying dietary and physical activity behaviors than generic information. A possible reason for the absence of intervention effects is sub-optimal use of the intervention and the self-regulation components. Further research is therefore needed to gain more insight into how the intervention and exposure to its contents can be improved. Trial Registration: NTR1862; http://apps.who.int/trialsearch/trial.aspx?trialid=NTR1862 %M 22417813 %R 10.2196/jmir.1901 %U http://www.jmir.org/2012/2/e44/ %U https://doi.org/10.2196/jmir.1901 %U http://www.ncbi.nlm.nih.gov/pubmed/22417813 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e53 %T Web-Based, Computer-Tailored, Pedometer-Based Physical Activity Advice: Development, Dissemination Through General Practice, Acceptability, and Preliminary Efficacy in a Randomized Controlled Trial %A De Cocker,Katrien %A Spittaels,Heleen %A Cardon,Greet %A De Bourdeaudhuij,Ilse %A Vandelanotte,Corneel %+ Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, Ghent, B-9000, Belgium, 32 92646323, Katrien.DeCocker@ugent.be %K Physical activity intervention %K step counts %K computer tailoring %D 2012 %7 24.04.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Computer tailoring is a relatively innovative and promising physical activity intervention approach. However, few computer-tailored physical activity interventions in adults have provided feedback based on pedometer use. Objectives: To (1) describe the development of a Web-based, pedometer-based, computer-tailored step advice intervention, (2) report on the dissemination of this tool through general practice, (3) report on its perceived acceptability, and (4) evaluate the preliminary efficacy of this tool in comparison with a standard intervention. Methods: We recruited 92 participants through general practitioners and randomly assigned them to a standard condition (receiving a pedometer-only intervention, n = 47) and a tailored condition (receiving a pedometer plus newly developed, automated, computer-tailored step advice intervention, n = 45). Step counts, self-reported data obtained via telephone interview on physical activity, time spent sitting, and body mass index were assessed at baseline and postintervention. The present sample was mostly female (54/92, 59%), highly educated (59/92, 64%), employed (65/92, 71%), and in good health (62/92, 67%). Results: Recruitment through general practitioners was poor (n = 107, initial response rate 107/1737, 6.2%); however, the majority of participants (50/69, 73%) believed it is useful that general practitioners help patients find ways to increase physical activity. In the tailored condition, 30/43 (70%) participants requested the computer-tailored step advice and the majority found it understandable (21/21, 100%), credible (17/18, 94%), relevant (15/18, 83%), not too long (13/18, 72%), instructive (13/18, 72%), and encouraging to increase steps (16/24, 67%). Daily step counts increased from baseline (mean 9237, SD 3749 steps/day) to postintervention (mean 11,876, SD 4574 steps/day) in the total sample (change of 2639, 95% confidence interval 105–5172; F1 = 5.0, P = .04). No interaction or other time effects were found. Conclusions : The majority of participants in the tailored condition accepted the step advice and indicated it was useful. However, in this selected sample of adults, the tailored condition did not show superior effects compared with the standard condition. %M 22532102 %R 10.2196/jmir.1959 %U http://www.jmir.org/2012/2/e53/ %U https://doi.org/10.2196/jmir.1959 %U http://www.ncbi.nlm.nih.gov/pubmed/22532102 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e57 %T A 12-Week Commercial Web-Based Weight-Loss Program for Overweight and Obese Adults: Randomized Controlled Trial Comparing Basic Versus Enhanced Features %A Collins,Clare E %A Morgan,Philip J %A Jones,Penelope %A Fletcher,Kate %A Martin,Julia %A Aguiar,Elroy J %A Lucas,Ashlee %A Neve,Melinda J %A Callister,Robin %+ Nutrition and Dietetics, School of Health Sciences, Faculty of Health, The University of Newcastle, HA 12 Hunter Building, University Drive, Callaghan, NSW, 2308, Australia, 61 2 49215646, clare.collins@newcastle.edu.au %K Intervention %K weight loss %K Web-based intervention %K randomized controlled trial %K reducing diet %K eHealth %D 2012 %7 25.04.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: The development and use of Web-based programs for weight loss is increasing rapidly, yet they have rarely been evaluated using randomized controlled trials (RCTs). Interestingly, most people who attempt weight loss use commercially available programs, yet it is very uncommon for commercial programs to be evaluated independently or rigorously. Objective: To compare the efficacy of a standard commercial Web-based weight-loss program (basic) versus an enhanced version of this Web program that provided additional personalized e-feedback and contact from the provider (enhanced) versus a wait-list control group (control) on weight outcomes in overweight and obese adults. Methods: This purely Web-based trial using a closed online user group was an assessor-blinded RCT with participants randomly allocated to the basic or enhanced 12-week Web-based program, based on social cognitive theory, or the control, with body mass index (BMI) as the primary outcome. Results: We enrolled 309 adults (129/309, 41.8% male, BMI mean 32.3, SD 4 kg/m2) with 84.1% (260/309) retention at 12 weeks. Intention-to-treat analysis showed that both intervention groups reduced their BMI compared with the controls (basic: –0.72, SD 1.1 kg/m2, enhanced: –1.0, SD 1.4, control: 0.15, SD 0.82; P < .001) and lost significant weight (basic: –2.1, SD 3.3 kg, enhanced: –3.0, SD 4.1, control: 0.4, SD 2.3; P < .001) with changes in waist circumference (basic: –2.0, SD 3.5 cm, enhanced: –3.2, SD 4.7, control: 0.5, SD 3.0; P < .001) and waist-to-height ratio (basic: –0.01, SD 0.02, enhanced: –0.02, SD 0.03, control: 0.0, SD 0.02; P < .001), but no differences were observed between the basic and enhanced groups. The addition of personalized e-feedback and contact provided limited additional benefits compared with the basic program. Conclusions: A commercial Web-based weight-loss program can be efficacious across a range of weight-related outcomes and lifestyle behaviors and achieve clinically important weight loss. Although the provision of additional personalized feedback did not facilitate greater weight loss after 12 weeks, the impact of superior participant retention on longer-term outcomes requires further study. Further research is required to determine the optimal mix of program features that lead to the biggest treatment impact over time. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): 12610000197033; http://www.anzctr.org.au/trial_view.aspx?id=335159 (Archived by WebCite at http://www.webcitation.org/66Wq0Yb7U) %M 22555246 %R 10.2196/jmir.1980 %U http://www.jmir.org/2012/2/e57/ %U https://doi.org/10.2196/jmir.1980 %U http://www.ncbi.nlm.nih.gov/pubmed/22555246 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e48 %T Internet-Based Computer Tailored Feedback on Sunscreen Use %A de Vries,Hein %A Logister,Matti %A Krekels,Gertruud %A Klaasse,Frits %A Servranckx,Verina %A van Osch,Liesbeth %+ School for Public Health and Primary Care (CAPHRI), Department of Health Promotion, Maastricht University, P Debyeplein 1, PO Box 616, Maastricht, 6200 MD, Netherlands, 31 433882415, hein.devries@maastrichtuniversity.nl %K Health communication, Computer tailoring %K Web-based interventions, Internet %D 2012 %7 30.04.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Skin cancer incidence rates signify the need for effective programs for the prevention of skin cancer and for helping skin cancer patients. Internet and computer tailored (CT) technology fosters the development of highly individualized health communication messages. Yet, reactions to Internet CT programs may differ per level of involvement and education level and remain understudied. Objective: First, we identified perceptions concerning sunscreen use in Dutch adults and assessed differences in differences between the general public and skin cancer patients, and between low and high educated respondents. Second, we assessed program evaluations of these groups about a new Dutch CT Internet-based program promoting sunscreen use, and potential differences between groups Methods: A cross-sectional research design was used. In total, 387 respondents participated and filled out an online questionnaire based on the I-Change Model assessing socio-demographics, history of skin cancer, sunscreen use, and beliefs about sunscreen use. The responses were fed into a computer program that generated personal tailored feedback on screen; next we assessed their program evaluations Results: Of the 132 patients, 92 were female (69.7%) and 40 were male (30.3%). In the general population (N = 225), 139 (54.5%) respondents were female and 116 (45.5%) were male. Men (50.9 years) were 8 years older than women (43.1 years). Most patients were diagnosed with basal cell carcinoma (N = 65; 49.2%), followed by melanoma (N = 28; 21.2%) and squamous cell carcinoma (N = 10; 7.6%); 22% (N = 29) did not remember their skin cancer type. Patients had higher knowledge levels, felt significantly more at risk, were more convinced of the pros of sunscreen, experienced more social support to use sunscreen, had higher self-efficacy, and made more plans to use sunscreen than respondents without skin cancer (N=255; all P’s< .01). Low (N=196) educated respondents scored lower on knowledge (P<.003) but made more action plans (P<.03) than higher educated respondents (N=191). The CT feedback was evaluated positively by all respondents, and scored a 7.8 on a 10 point scale. Yet, patients evaluated the CT program slightly more (P<.05) positive (8.1) than non-patients. (7.6). Lower educated respondents were significantly (P<.05) more positive about the advantages of the program. Conclusions: First, involvement with skin cancer was reflected in more positive beliefs toward sunscreen use in patients in comparison with non-patients. Second, the CT Internet program was well accepted by both patients and non-patients, and low and high educated respondents, perhaps because higher educated respondents were more knowledgeable about sunscreen use and skin cancer. Third, a pro-active approach as conducted in our study is very well suited to reach various groups of people and is more likely to be successful than a reactive approach %M 22547528 %R 10.2196/jmir.1902 %U http://www.jmir.org/2012/2/e48/ %U https://doi.org/10.2196/jmir.1902 %U http://www.ncbi.nlm.nih.gov/pubmed/22547528 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e58 %T Novel Technologies for Assessing Dietary Intake: Evaluating the Usability of a Mobile Telephone Food Record Among Adults and Adolescents %A Daugherty,Bethany L %A Schap,TusaRebecca E %A Ettienne-Gittens,Reynolette %A Zhu,Fengqing M %A Bosch,Marc %A Delp,Edward J %A Ebert,David S %A Kerr,Deborah A %A Boushey,Carol J %+ Epidemiology Program, University of Hawaii Cancer Center, 1236 Lauhala Street, Honolulu, HI, 96813, United States, 1 808 564 5915, cjboushey@cc.hawaii.edu %K Mobile telephone food record %K dietary assessment %K technology %K image analysis %K volume estimation %D 2012 %7 13.04.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: The development of a mobile telephone food record has the potential to ameliorate much of the burden associated with current methods of dietary assessment. When using the mobile telephone food record, respondents capture an image of their foods and beverages before and after eating. Methods of image analysis and volume estimation allow for automatic identification and volume estimation of foods. To obtain a suitable image, all foods and beverages and a fiducial marker must be included in the image. Objective: To evaluate a defined set of skills among adolescents and adults when using the mobile telephone food record to capture images and to compare the perceptions and preferences between adults and adolescents regarding their use of the mobile telephone food record. Methods: We recruited 135 volunteers (78 adolescents, 57 adults) to use the mobile telephone food record for one or two meals under controlled conditions. Volunteers received instruction for using the mobile telephone food record prior to their first meal, captured images of foods and beverages before and after eating, and participated in a feedback session. We used chi-square for comparisons of the set of skills, preferences, and perceptions between the adults and adolescents, and McNemar test for comparisons within the adolescents and adults. Results: Adults were more likely than adolescents to include all foods and beverages in the before and after images, but both age groups had difficulty including the entire fiducial marker. Compared with adolescents, significantly more adults had to capture more than one image before (38% vs 58%, P = .03) and after (25% vs 50%, P = .008) meal session 1 to obtain a suitable image. Despite being less efficient when using the mobile telephone food record, adults were more likely than adolescents to perceive remembering to capture images as easy (P < .001). Conclusions: A majority of both age groups were able to follow the defined set of skills; however, adults were less efficient when using the mobile telephone food record. Additional interactive training will likely be necessary for all users to provide extra practice in capturing images before entering a free-living situation. These results will inform age-specific development of the mobile telephone food record that may translate to a more accurate method of dietary assessment. %M 22504018 %R 10.2196/jmir.1967 %U http://www.jmir.org/2012/2/e58/ %U https://doi.org/10.2196/jmir.1967 %U http://www.ncbi.nlm.nih.gov/pubmed/22504018 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e51 %T Improving Adherence to Antiretroviral Therapy for Youth Living with HIV/AIDS: A Pilot Study Using Personalized, Interactive, Daily Text Message Reminders %A Dowshen,Nadia %A Kuhns,Lisa M %A Johnson,Amy %A Holoyda,Brian James %A Garofalo,Robert %+ Craig-Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia, 3535 Market St, Rm 1542, Philadelphia, PA, 19104, United States, 1 267 426 2591, dowshenn@email.chop.edu %K Adolescents %K HIV/AIDS %K adherence %K text messaging %K short message service %K SMS %K mobile health intervention %D 2012 %7 05.04.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: For youth living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), nonadherence to antiretroviral therapy (ART) can lead to poor health outcomes and significantly decreased life expectancy. Objective: To evaluate the feasability, acceptability, and preliminary efficacy of short message service (SMS) or text message reminders to improve adherence to ART for youth living with HIV/AIDS. Methods: We conducted this prospective pilot study using a pre–post design from 2009 to 2010 at a community-based health center providing clinical services to youth living with HIV/AIDS. Eligibility criteria included HIV-positive serostatus, age 14–29 years, use of a personal cell phone, English-speaking, and being on ART with documented poor adherence. During the 24-week study period, participants received personalized daily SMS reminders and a follow-up message 1 hour later assessing whether they took the medication, and asking participants to respond via text message with the number 1 if they took the medication and 2 if they did not. Outcome measures were feasibility, acceptability, and adherence. Self-reported adherence was determined using the visual analog scale (VAS) and AIDS Clinical Trial Group (ACTG) questionnaire 4-day recall. Viral load and CD4 cell count were followed as biomarkers of adherence and disease progression at 0, 12, and 24 weeks. Results: Participants (N = 25) were mean age 23 (range 14–29) years, 92% (n = 23) male, 60% (n = 15) black, and 84% (n = 21) infected through unprotected sex. Mean VAS scores significantly increased at 12 and 24 weeks in comparison with baseline (week 0: 74.7, week 12: 93.3, P < .001; week 24: 93.1, P < .001). ACTG questionnaire 4-day recall also improved (week 0: 2.33, week 12: 3.24, P = .002; week 24: 3.19, P = .005). There was no significant difference in CD4 cell count or viral load between baseline and 12- or 24-week follow-up, although there was a trend toward improvement of these biomarkers and a small to moderate standardized effect size (range of Cohen d: –0.51 to 0.22). Of 25 participants, 21 (84%) were retained, and 20 of the 21 (95%) participants who completed the study found the intervention helpful to avoid missing doses. Conclusions: In this pilot study, personalized, interactive, daily SMS reminders were feasible and acceptable, and they significantly improved self-reported adherence. Larger controlled studies are needed to determine the impact of this intervention on ART adherence and other related health outcomes for youth living with HIV/AIDS. %M 22481246 %R 10.2196/jmir.2015 %U http://www.jmir.org/2012/2/e51/ %U https://doi.org/10.2196/jmir.2015 %U http://www.ncbi.nlm.nih.gov/pubmed/22481246 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e55 %T Using Smartphone Technology to Monitor Physical Activity in the 10,000 Steps Program: A Matched Case–Control Trial %A Kirwan,Morwenna %A Duncan,Mitch J %A Vandelanotte,Corneel %A Mummery,W Kerry %+ Centre for Physical Activity Studies, Institute for Health and Social Sciences Research, CQUniversity, Building 18, Bruce Highway, North Rockhampton, 4702, Australia, 61 749232546, m.kirwan@cqu.edu.au %K smartphone %K health behavior %K physical activity %K matched case-control study %K intervention %D 2012 %7 20.04.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Website-delivered physical activity interventions are successful in producing short-term behavior change. However, problems with engagement and retention of participants in these programs prevent long-term behavior change. New ways of accessing online content (eg, via smartphones) may enhance engagement in these interventions, which in turn may improve the effectiveness of the programs. Objective: To measure the potential of a newly developed smartphone application to improve health behaviors in existing members of a website-delivered physical activity program (10,000 Steps, Australia). The aims of the study were to (1) examine the effect of the smartphone application on self-monitoring and self-reported physical activity levels, (2) measure the perceived usefulness and usability of the application, and (3) examine the relationship between the perceived usefulness and usability of the application and its actual use. Methods: All participants were existing members of the 10,000 Steps program. We recruited the intervention group (n = 50) via email and instructed them to install the application on their smartphone and use it for 3 months. Participants in this group were able to log their steps by using either the smartphone application or the 10,000 Steps website. Following the study, the intervention group completed an online questionnaire assessing perceived usability and usefulness of the smartphone application. We selected control group participants (n = 150), matched for age, gender, level of self-monitoring, preintervention physical activity level, and length of membership in the 10,000 Steps program, after the intervention was completed. We collected website and smartphone usage statistics during the entire intervention period. Results: Over the study period (90 days), the intervention group logged steps on an average of 62 days, compared with 41 days in the matched group. Intervention participants used the application 71.22% (2210/3103) of the time to log their steps. Logistic regression analyses revealed that use of the application was associated with an increased likelihood to log steps daily during the intervention period compared with those not using the application (odds ratio 3.56, 95% confidence interval 1.72–7.39). Additionally, use of the application was associated with an increased likelihood to log greater than 10,000 steps on each entry (odds ratio 20.64, 95% confidence interval 9.19–46.39). Linear regression analysis revealed a nonsignificant relationship between perceived usability (r = .216, P = .21) and usefulness (r = .229, P = .17) of the application and frequency of logging steps in the intervention group. Conclusion: Using a smartphone application as an additional delivery method to a website-delivered physical activity intervention may assist in maintaining participant engagement and behavior change. However, due to study design limitations, these outcomes should be interpreted with caution. More research, using larger samples and longer follow-up periods, is needed to replicate the findings of this study. %M 22522112 %R 10.2196/jmir.1950 %U http://www.jmir.org/2012/2/e55/ %U https://doi.org/10.2196/jmir.1950 %U http://www.ncbi.nlm.nih.gov/pubmed/22522112 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e46 %T Crowdsourced Health Research Studies: An Important Emerging Complement to Clinical Trials in the Public Health Research Ecosystem %A Swan,Melanie %+ MS Futures Group, PO Box 61258, Palo Alto, CA, 94306, United States, 1 6506819482, m@melanieswan.com %K Community-Based Participatory Research %K Preventive Medicine %K Personalized Medicine %K Individualized Medicine %K Consumer Participation %K Health Services Research %K Health Care Research %K Public Health %K Genomics %K Medicine %D 2012 %7 07.03.2012 %9 Viewpoint %J J Med Internet Res %G English %X Background: Crowdsourced health research studies are the nexus of three contemporary trends: 1) citizen science (non-professionally trained individuals conducting science-related activities); 2) crowdsourcing (use of web-based technologies to recruit project participants); and 3) medicine 2.0 / health 2.0 (active participation of individuals in their health care particularly using web 2.0 technologies). Crowdsourced health research studies have arisen as a natural extension of the activities of health social networks (online health interest communities), and can be researcher-organized or participant-organized. In the last few years, professional researchers have been crowdsourcing cohorts from health social networks for the conduct of traditional studies. Participants have also begun to organize their own research studies through health social networks and health collaboration communities created especially for the purpose of self-experimentation and the investigation of health-related concerns. Objective: The objective of this analysis is to undertake a comprehensive narrative review of crowdsourced health research studies. This review will assess the status, impact, and prospects of crowdsourced health research studies. Methods: Crowdsourced health research studies were identified through a search of literature published from 2000 to 2011 and informal interviews conducted 2008-2011. Keyword terms related to crowdsourcing were sought in Medline/PubMed. Papers that presented results from human health studies that included crowdsourced populations were selected for inclusion. Crowdsourced health research studies not published in the scientific literature were identified by attending industry conferences and events, interviewing attendees, and reviewing related websites. Results: Participatory health is a growing area with individuals using health social networks, crowdsourced studies, smartphone health applications, and personal health records to achieve positive outcomes for a variety of health conditions. PatientsLikeMe and 23andMe are the leading operators of researcher-organized, crowdsourced health research studies. These operators have published findings in the areas of disease research, drug response, user experience in crowdsourced studies, and genetic association. Quantified Self, Genomera, and DIYgenomics are communities of participant-organized health research studies where individuals conduct self-experimentation and group studies. Crowdsourced health research studies have a diversity of intended outcomes and levels of scientific rigor. Conclusions: Participatory health initiatives are becoming part of the public health ecosystem and their rapid growth is facilitated by Internet and social networking influences. Large-scale parameter-stratified cohorts have potential to facilitate a next-generation understanding of disease and drug response. Not only is the large size of crowdsourced cohorts an asset to medical discovery, too is the near-immediate speed at which medical findings might be tested and applied. Participatory health initiatives are expanding the scope of medicine from a traditional focus on disease cure to a personalized preventive approach. Crowdsourced health research studies are a promising complement and extension to traditional clinical trials as a model for the conduct of health research. %M 22397809 %R 10.2196/jmir.1988 %U http://www.jmir.org/2012/2/e46/ %U https://doi.org/10.2196/jmir.1988 %U http://www.ncbi.nlm.nih.gov/pubmed/22397809 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e50 %T Online Doctor Reviews: Do They Track Surgeon Volume, a Proxy for Quality of Care? %A Segal,Jeffrey %A Sacopulos,Michael %A Sheets,Virgil %A Thurston,Irish %A Brooks,Kendra %A Puccia,Ryan %+ Medical Justice Services, Inc., PO Box 49669, Greensboro, NC, 27419, United States, 1 336 691 1286, jsegal@medicaljustice.com %K Doctor review %K rating websites %K physician reviews %K online reputation %K clinical outcomes %K selection of physicians %K surgical volume %K surgeon volume %D 2012 %7 10.04.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Increasingly, consumers are accessing the Internet seeking health information. Consumers are also using online doctor review websites to help select their physician. Such websites tally numerical ratings and comments from past patients. To our knowledge, no study has previously analyzed whether doctors with positive online reputations on doctor review websites actually deliver higher quality of care typically associated with better clinical outcomes and better safety records. Objective: For a number of procedures, surgeons who perform more procedures have better clinical outcomes and safety records than those who perform fewer procedures. Our objective was to determine if surgeon volume, as a proxy for clinical outcomes and patient safety, correlates with online reputation. Methods: We investigated the numerical ratings and comments on 9 online review websites for high- and low-volume surgeons for three procedures: lumbar surgery, total knee replacement, and bariatric surgery. High-volume surgeons were randomly selected from the group within the highest quartile of claims submitted for reimbursement using the procedures’ relevant current procedural terminology (CPT) codes. Low-volume surgeons were randomly selected from the lowest quartile of submitted claims for the procedures’ relevant CPT codes. Claims were collated within the Normative Health Information Database, covering multiple payers for more than 25 million insured patients. Results: Numerical ratings were found for the majority of physicians in our sample (547/600, 91.2%) and comments were found for 385/600 (64.2%) of the physicians. We found that high-volume (HV) surgeons could be differentiated from low-volume (LV) surgeons independently by analyzing: (1) the total number of numerical ratings per website (HV: mean = 5.85; LV: mean = 4.87, P<.001); (2) the total number of text comments per website (HV: mean = 2.74; LV: mean = 2.30, P=.05); (3) the proportion of glowing praise/total comments about quality of care (HV: mean = 0.64; LV: mean = 0.51, P=.002); and (4) the proportion of scathing criticism/total comments about quality of care (HV: mean = 0.14; LV: mean = 0.23, P= .005). Even when these features were combined, the effect size, although significant, was still weak. The results revealed that one could accurately identify a physician’s patient volume via discriminant and classification analysis 61.6% of the time. We also found that high-volume surgeons could not be differentiated from low-volume surgeons by analyzing (1) standardized z score numerical ratings (HV: mean = 0.07; LV: mean = 0, P=.27); (2) proportion of glowing praise/total comments about customer service (HV: mean = 0.24; LV: mean = 0.22, P=.52); and (3) proportion of scathing criticism/total comments about customer service (HV: mean = 0.19; LV: mean = 0.21, P=.48). Conclusions: Online review websites provide a rich source of data that may be able to track quality of care, although the effect size is weak and not consistent for all review website metrics. %M 22491423 %R 10.2196/jmir.2005 %U http://www.jmir.org/2012/2/e50/ %U https://doi.org/10.2196/jmir.2005 %U http://www.ncbi.nlm.nih.gov/pubmed/22491423 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e41 %T Internet-Based HIV and Sexually Transmitted Infection Testing in British Columbia, Canada: Opinions and Expectations of Prospective Clients %A Hottes,Travis Salway %A Farrell,Janine %A Bondyra,Mark %A Haag,Devon %A Shoveller,Jean %A Gilbert,Mark %+ BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada, 1 604 707 5615, mark.gilbert@bccdc.ca %K HIV %K human immunodeficiency virus %K sexually transmitted diseases %D 2012 %7 06.03.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: The feasibility and acceptability of Internet-based sexually transmitted infection (STI) testing have been demonstrated; however, few programs have included testing for human immunodeficiency virus (HIV). In British Columbia, Canada, a new initiative will offer online access to chlamydia, gonorrhea, syphilis, and HIV testing, integrated with existing clinic-based services. We presented the model to gay men and other men who have sex with men (MSM) and existing clinic clients through a series of focus groups. Objective: To identify perceived benefits, concerns, and expectations of a new model for Internet-based STI and HIV testing among potential end users. Methods: Participants were recruited through email invitations, online classifieds, and flyers in STI clinics. A structured interview guide was used. Focus groups were audio recorded, and an observer took detailed field notes. Analysts then listened to audio recordings to validate field notes. Data were coded and analyzed using a scissor-and-sort technique. Results: In total, 39 people participated in six focus groups. Most were MSM, and all were active Internet users and experienced with STI/HIV testing. Perceived benefits of Internet-based STI testing included anonymity, convenience, and client-centered control. Salient concerns were reluctance to provide personal information online, distrust of security of data provided online, and the need for comprehensive pretest information and support for those receiving positive results, particularly for HIV. Suggestions emerged for mitigation of these concerns: provide up-front and detailed information about the model, ask only the minimal information required for testing, give positive results only by phone or in person, and ensure that those testing positive are referred for counseling and support. End users expected Internet testing to offer continuous online service delivery, from booking appointments, to transmitting information to the laboratory, to getting prescriptions. Most participants said they would use the service or recommend it to others. Those who indicated they would be unlikely to use it generally either lived near an STI clinic or routinely saw a family doctor with whom they were comfortable testing. Participants expected that the service would provide the greatest benefit to individuals who do not already have access to sensitive sexual health services, are reluctant to test due to stigma, or want to take immediate action (eg, because of a recent potential STI/HIV exposure). Conclusions: Internet-based STI/HIV testing has the potential to reduce barriers to testing, as a complement to existing clinic-based services. Trust in the new online service, however, is a prerequisite to client uptake and may be engendered by transparency of information about the model, and by accounting for concerns related to confidentiality, data usage, and provision of positive (especially HIV) results. Ongoing evaluation of this new model will be essential to its success and to the confidence of its users. %M 22394997 %R 10.2196/jmir.1948 %U http://www.jmir.org/2012/2/e41/ %U https://doi.org/10.2196/jmir.1948 %U http://www.ncbi.nlm.nih.gov/pubmed/22394997 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e42 %T Validation of an Informant-Reported Web-Based Data Collection to Assess Dementia Symptoms %A Rockwood,Kenneth %A Zeng,An %A Leibman,Chris %A Mucha,Lisa %A Mitnitski,Arnold %+ DGI Clinical Inc, 1344 Summer Street, Suite 208, Halifax, NS, B3H 0A8, Canada, 1 902 421 5710 ext 5, KRockwood@dgiclinical.com %K Dementia %K online survey %K symptoms %K Dependence Scale %K staging %K cognitive impairment not dementia %K mild cognitive impairment %K validation %K World Wide Web %D 2012 %7 12.03.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: The Web offers unprecedented access to the experience of people with dementia and their care partners, but data gathered online need to be validated to be useful. Objective: To test the construct validity of an informant Web-based data collection to assess dementia symptoms in relation to the 15-point Dependence Scale (DS). Methods: In an online survey posted on the DementiaGuide website, care partners of people with dementia built individualized profiles from the 60-item SymptomGuide and completed a questionnaire, which included the DS and a staging tool. Results: In the 250 profilees (155, 62% women, mean age 77 years), increasing dependence was associated with a greater chance of institutionalization. For example, no one at the lowest levels of dependence (DS score < 5, n = 33) was in long-term care, compared with half (13/25) of the profilees at the highest levels of dependence (DS score > 12) being in institutions (χ24 = 27.9, P < .001). The Web-based DS was correlated with the number of symptoms: higher DS scores were associated with a higher stage of dementia (F > 50, P < .001). Conclusion: In an online survey, the Web-based DS showed good construct validity, potentially demonstrating how the Web can be used to learn more about dementia progression and how it relates to symptoms experienced by patients across the course of dementing illnesses. Even so, caution is needed to assure the validity of data collected online. %M 22411293 %R 10.2196/jmir.1941 %U http://www.jmir.org/2012/2/e42/ %U https://doi.org/10.2196/jmir.1941 %U http://www.ncbi.nlm.nih.gov/pubmed/22411293 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 3 %P e62 %T Online Schools and Children With Special Health and Educational Needs: Comparison With Performance in Traditional Schools %A Thompson,Lindsay A %A Ferdig,Rick %A Black,Erik %+ Department of Pediatrics, University of Florida, 1701 SW 16th Avenue, Building A, Gainesville, FL, 32608, United States, 1 352 334 1357, ewblack@peds.ufl.edu %K Virtual schooling %K schools %K K-12 %K children with special health care needs %K online learning %K education, adolescent health services, special education %D 2012 %7 30.04.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: In the United States, primary and secondary online schools are institutions that deliver online curricula for children enrolled in kindergarten through 12th grade (K-12). These institutions commonly provide opportunities for online instruction in conjunction with local schools for students who may need remediation, have advanced needs, encounter unqualified local instructors, or experience scheduling conflicts. Internet-based online schooling may potentially help children from populations known to have educational and health disadvantages, such as those from certain racial or ethnic backgrounds, those of low socioeconomic status, and children with special health care needs (CSHCN). Objective: To describe the basic and applied demographics of US online-school users and to compare student achievement in traditional versus online schooling environments. Methods: We performed a brief parental survey in three states examining basic demographics and educational history of the child and parents, the child’s health status as measured by the CSHCN Screener, and their experiences and educational achievement with online schools and class(es). Results were compared with state public-school demographics and statistical analyses controlled for state-specific independence. Results: We analyzed responses from 1971 parents with a response rate of 14.7% (1971/13,384). Parents of online-school participants were more likely to report having a bachelor’s degree or higher than were parents of students statewide in traditional schools, and more of their children were white and female. Most notably, the prevalence of CSHCN was high (476/1971, 24.6%) in online schooling. Children who were male, black, or had special health care needs reported significantly lower grades in both traditional and online schools. However, when we controlled for age, gender, race, and parental education, parents of CSHCN or black children reported significantly lower grades in online than in traditional schooling (adjusted odds ratio [aOR] 1.45, 95% confidence interval [CI] 1.29–1.62 for CSHCN, P < .001; aOR 2.73, 95% CI 2.11–3.53 for black children, P < .001.) In contrast, parents with a bachelor’s degree or higher reported significantly higher online-school grades than traditional-school grades for their children (aOR 1.45, 95% CI 1.15–1.82, P < .001). Conclusions: The demographics of children attending online schools do not mirror those of the state-specific school populations. CSHCN seem to opt into online schools at a higher rate. While parents report equivalent educational achievement in online and traditional classrooms, controlling for known achievement risks suggests that CSHCN and black children have lower performance in online than in traditional schools. Given the millions of students now in online schools, future studies must test whether direct assistance in online schools, such as taking individualized education plans into consideration, will narrow known disparities in educational success. Only then can online schools emerge as a true educational alternative for at-risk populations. %M 22547538 %R 10.2196/jmir.1947 %U http://www.jmir.org/2012/3/e62/ %U https://doi.org/10.2196/jmir.1947 %U http://www.ncbi.nlm.nih.gov/pubmed/22547538 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e56 %T How is an Electronic Screening and Brief Intervention Tool on Alcohol Use Received in a Student Population? A Qualitative and Quantitative Evaluation %A Fraeyman,Jessica %A Van Royen,Paul %A Vriesacker,Bart %A De Mey,Leen %A Van Hal,Guido %+ Epidemiology and Social Medicine, Medical Sociology and Health Policy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk (Antwerp), 2610, Belgium, 32 32652855, jessica.fraeyman@ua.ac.be %K Alcohol %K students %K intervention %D 2012 %7 23.04.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: A previous study among Antwerp college and university students showed that more male (10.2%–11.1%) than female (1.8%–6.2%) students are at risk for problematic alcohol use. The current literature shows promising results in terms of feasibility and effectiveness for the use of brief electronic interventions to address this health problem in college and university students. We evaluated this type of intervention and cite existing literature on the topic. Objective: To develop a website, www.eentjeteveel.be, to motivate college and university students with problematic alcohol use to reduce alcohol consumption and increase their willingness to seek help. Method: The website contained a questionnaire (Alcohol Use Disorders Identification Test [AUDIT]) for students to test their alcohol use. According to their answers, the students immediately received personalized feedback (personal AUDIT score and additional information on risks associated with alcohol use) and a suggestion for further action. Afterward, students could send an email to a student counselor for questions, guidance, or advice. To obtain in-depth qualitative information on the opinions and experiences of students, we held 5 focus group discussions. The topics were publicity, experiences, impressions, and effects of the website. We analyzed the quantitative results of the online test in SPSS 15.0. Results: More than 3500 students visited www.eentjeteveel.be; over half were men (55.0%). A total of 34 students participated in the focus group discussions. The mixture of quantitative and qualitative methods to evaluate the intervention allowed a thorough analysis and provided complementary results. The intervention was well received by the student population. However, some minor aspects should be reconsidered, such as website publicity and providing students with options that were added after intermediate evaluation. The intervention increased the motivation of students to think about their alcohol use but could not stimulate them to change their behavior. The website attracted relatively more male than female students and more students in the high-risk group than in the low-risk group. The high-risk group was more inclined to seek advice or guidance (23/400, 6%; χ22 = 32.4, P < .001) than the low-risk group (34/1714, 2%; χ22 = 32.4, P < .001). Conclusions: We gained unique insight into students’ experiences, opinions, and perceptions with regard to the intervention. The results show that the intervention was positively received in the population, and the willingness to seek help was increased. However, real behavior change needs further research. The results of this study can assist health providers and researchers in better understanding college and university students’ perceptions of eHealth initiatives. %M 22525340 %R 10.2196/jmir.1869 %U http://www.jmir.org/2012/2/e56/ %U https://doi.org/10.2196/jmir.1869 %U http://www.ncbi.nlm.nih.gov/pubmed/22525340 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e47 %T Breakeven, Cost Benefit, Cost Effectiveness, and Willingness to Pay for Web-Based Versus Face-to-Face Education Delivery for Health Professionals %A Maloney,Stephen %A Haas,Romi %A Keating,Jenny L %A Molloy,Elizabeth %A Jolly,Brian %A Sims,Jane %A Morgan,Prue %A Haines,Terry %+ Physiotherapy, Monash University, PO Box 527, Frankston, Melbourne, 3199, Australia, 61 990 44240, stephen.maloney@monash.edu %K Economics %K education %K training programs %K teaching methods %K performance %D 2012 %7 02.04.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: The introduction of Web-based education and open universities has seen an increase in access to professional development within the health professional education marketplace. Economic efficiencies of Web-based education and traditional face-to-face educational approaches have not been compared under randomized controlled trial conditions. Objective: To compare costs and effects of Web-based and face-to-face short courses in falls prevention education for health professionals. Methods: We designed two short courses to improve the clinical performance of health professionals in exercise prescription for falls prevention. One was developed for delivery in face-to-face mode and the other for online learning. Data were collected on learning outcomes including participation, satisfaction, knowledge acquisition, and change in practice, and combined with costs, savings, and benefits, to enable a break-even analysis from the perspective of the provider, cost-effectiveness analysis from the perspective of the health service, and cost-benefit analysis from the perspective of the participant. Results: Face-to-face and Web-based delivery modalities produced comparable outcomes for participation, satisfaction, knowledge acquisition, and change in practice. Break-even analysis identified the Web-based educational approach to be robustly superior to face-to-face education, requiring a lower number of enrollments for the program to reach its break-even point. Cost-effectiveness analyses from the perspective of the health service and cost-benefit analysis from the perspective of the participant favored face-to-face education, although the outcomes were contingent on the sensitivity analysis applied (eg, the fee structure used). Conclusions: The Web-based educational approach was clearly more efficient from the perspective of the education provider. In the presence of relatively equivocal results for comparisons from other stakeholder perspectives, it is likely that providers would prefer to deliver education via a Web-based medium. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN): 12610000135011; http://www.anzctr.org.au/trial_view.aspx?id=335135 (Archived by WebCite at http://www.webcitation.org/668POww4L) %M 22469659 %R 10.2196/jmir.2040 %U http://www.jmir.org/2012/2/e47/ %U https://doi.org/10.2196/jmir.2040 %U http://www.ncbi.nlm.nih.gov/pubmed/22469659 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e52 %T A Conceptual Framework and Principles for Trusted Pervasive Health %A Ruotsalainen,Pekka Sakari %A Blobel,Bernd Gerhard %A Seppälä,Antto Veikko %A Sorvari,Hannu Olavi %A Nykänen,Pirkko Anneli %+ National Instutute for Health and Welfare, Department of Information, PL 30, Helsinki, 00271, Finland, 358 0505004046, pekka.ruotsalainen@thl.fi %K pervasive health %K ubiquitous computing %K privacy %K trustworthiness %K digital bubbles %K conceptual modeling %D 2012 %7 06.04.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Ubiquitous computing technology, sensor networks, wireless communication and the latest developments of the Internet have enabled the rise of a new concept—pervasive health—which takes place in an open, unsecure, and highly dynamic environment (ie, in the information space). To be successful, pervasive health requires implementable principles for privacy and trustworthiness. Objective: This research has two interconnected objectives. The first is to define pervasive health as a system and to understand its trust and privacy challenges. The second goal is to build a conceptual model for pervasive health and use it to develop principles and polices which can make pervasive health trustworthy. Methods: In this study, a five-step system analysis method is used. Pervasive health is defined using a metaphor of digital bubbles. A conceptual framework model focused on trustworthiness and privacy is then developed for pervasive health. On that model, principles and rules for trusted information management in pervasive health are defined. Results: In the first phase of this study, a new definition of pervasive health was created. Using this model, differences between pervasive health and health care are stated. Reviewed publications demonstrate that the widely used principles of predefined and static trust cannot guarantee trustworthiness and privacy in pervasive health. Instead, such an environment requires personal dynamic and context-aware policies, awareness, and transparency. A conceptual framework model focused on information processing in pervasive health is developed. Using features of pervasive health and relations from the framework model, new principles for trusted pervasive health have been developed. The principles propose that personal health data should be under control of the data subject. The person shall have the right to verify the level of trust of any system which collects or processes his or her health information. Principles require that any stakeholder or system collecting or processing health data must support transparency and shall publish its trust and privacy attributes and even its domain specific policies. Conclusions: The developed principles enable trustworthiness and guarantee privacy in pervasive health. The implementation of principles requires new infrastructural services such as trust verification and policy conflict resolution. After implementation, the accuracy and usability of principles should be analyzed. %M 22481297 %R 10.2196/jmir.1972 %U http://www.jmir.org/2012/2/e52/ %U https://doi.org/10.2196/jmir.1972 %U http://www.ncbi.nlm.nih.gov/pubmed/22481297 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e60 %T Analysis of eHealth Search Perspectives Among Female College Students in the Health Professions Using Q Methodology %A Stellefson,Michael %A Hanik,Bruce %A Chaney,J. Don %A Tennant,Bethany %+ Center for Digital Health and Wellness, Department of Health Education and Behavior, University of Florida, P.O. Box 118210, Gainesville, FL, 32611, United States, 1 352 294 1805, mstellefson@ufl.edu %K eHealth literacy %K college students %K Q methodology %K Internet search %K health professionals %K medical education %D 2012 %7 27.04.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: The current “Millennial Generation” of college students majoring in the health professions has unprecedented access to the Internet. Although some research has been initiated among medical professionals to investigate the cognitive basis for health information searches on the Internet, little is known about Internet search practices among health and medical professional students. Objective: To systematically identify health professional college student perspectives of personal eHealth search practices. Methods: Q methodology was used to examine subjective perspectives regarding personal eHealth search practices among allied health students majoring in a health education degree program. Thirteen (n = 13) undergraduate students were interviewed about their attitudes and experiences conducting eHealth searches. From the interviews, 36 statements were used in a structured ranking task to identify clusters and determine which specific perceptions of eHealth search practices discriminated students into different groups. Scores on an objective measure of eHealth literacy were used to help categorize participant perspectives. Results: Q-technique factor analysis of the rankings identified 3 clusters of respondents with differing views on eHealth searches that generally coincided with participants’ objective eHealth literacy scores. The proficient resourceful students (pattern/structure coefficient range 0.56-0.80) described themselves as using multiple resources to obtain eHealth information, as opposed to simply relying on Internet search engines. The intermediate reluctant students (pattern/structure coefficient range 0.75-0.90) reported engaging only Internet search engines to locate eHealth information, citing undeveloped evaluation skills when considering sources of information located on the Internet. Both groups of advanced students reported not knowing how to use Boolean operators to conduct Internet health searches. The basic hubristic students (pattern/structure coefficient range 0.54-0.76) described themselves as independent procrastinators when searching for eHealth information. Interestingly, basic hubristic students represented the only cluster of participants to describe themselves as (1) having received instruction on using the Internet to conduct eHealth searches, and (2) possessing relative confidence when completing a search task. Conclusions: Subjective perspectives of eHealth search practices differed among students possessing different levels of eHealth literacy. These multiple perspectives present both challenges and opportunities for empowering college students in the health professions to use the Internet to obtain and appraise evidence-based health information using the Internet. %M 22543437 %R 10.2196/jmir.1969 %U http://www.jmir.org/2012/2/e60/ %U https://doi.org/10.2196/jmir.1969 %U http://www.ncbi.nlm.nih.gov/pubmed/22543437 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e49 %T Health Care Professionals’ Beliefs About Using Wiki-Based Reminders to Promote Best Practices in Trauma Care %A Archambault,Patrick Michel %A Bilodeau,Andrea %A Gagnon,Marie-Pierre %A Aubin,Karine %A Lavoie,André %A Lapointe,Jean %A Poitras,Julien %A Croteau,Sylvain %A Pham-Dinh,Martin %A Légaré,France %+ Centre de santé et de services sociaux Alphonse-Desjardins (Centre hospitalier affilié universitaire de Lévis), 143, rue Wolfe, Lévis, QC, G6V 3Z1, Canada, 1 418 835 7121 ext 3905, patrick.m.archambault@gmail.com %K Wiki %K Collaborative writing applications %K Web 2.0 %K traumatic brain injury %K interprofessional collaboration %K reminders %K computerized clinical decision-support system %K knowledge translation %K evidence-based medicine %K theory of planned behavior %D 2012 %7 19.04.2012 %9 Original Paper %J J Med Internet Res %G English %X Background : Wikis are knowledge translation tools that could help health professionals implement best practices in acute care. Little is known about the factors influencing professionals’ use of wikis. Objectives : To identify and compare the beliefs of emergency physicians (EPs) and allied health professionals (AHPs) about using a wiki-based reminder that promotes evidence-based care for traumatic brain injuries. Methods : Drawing on the theory of planned behavior, we conducted semistructured interviews to elicit EPs’ and AHPs’ beliefs about using a wiki-based reminder. Previous studies suggested a sample of 25 EPs and 25 AHPs. We purposefully selected participants from three trauma centers in Quebec, Canada, to obtain a representative sample. Using univariate analyses, we assessed whether our participants’ gender, age, and level of experience were similar to those of all eligible individuals. Participants viewed a video showing a clinician using a wiki-based reminder, and we interviewed participants about their behavioral, control, and normative beliefs—that is, what they saw as advantages, disadvantages, barriers, and facilitators to their use of a reminder, and how they felt important referents would perceive their use of a reminder. Two reviewers independently analyzed the content of the interview transcripts. We considered the 75% most frequently mentioned beliefs as salient. We retained some less frequently mentioned beliefs as well. Results : Of 66 eligible EPs and 444 eligible AHPs, we invited 55 EPs and 39 AHPs to participate, and 25 EPs and 25 AHPs (15 nurses, 7 respiratory therapists, and 3 pharmacists) accepted. Participating AHPs had more experience than eligible AHPs (mean 14 vs 11 years; P = .04). We noted no other significant differences. Among EPs, the most frequently reported advantage of using a wiki-based reminder was that it refreshes the memory (n = 14); among AHPs, it was that it provides rapid access to protocols (n = 16). Only 2 EPs mentioned a disadvantage (the wiki added stress). The most frequently reported favorable referent was nurses for EPs (n = 16) and EPs for AHPs (n = 19). The most frequently reported unfavorable referents were people resistant to standardized care for EPs (n = 8) and people less comfortable with computers for AHPs (n = 11). The most frequent facilitator for EPs was ease of use (n = 19); for AHPs, it was having a bedside computer (n = 20). EPs’ most frequently reported barrier was irregularly updated wiki-based reminders (n = 18); AHPs’ was undetermined legal responsibility (n = 10). Conclusions : We identified EPs’ and AHPs’ salient beliefs about using a wiki-based reminder. We will draw on these beliefs to construct a questionnaire to measure the importance of these determinants to EPs’ and AHPs’ intention to use a wiki-based reminder promoting evidence-based care for traumatic brain injuries. %M 22515985 %R 10.2196/jmir.1983 %U http://www.jmir.org/2012/2/e49/ %U https://doi.org/10.2196/jmir.1983 %U http://www.ncbi.nlm.nih.gov/pubmed/22515985 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e39 %T Development of Web-Based Computer-Tailored Advice to Promote Physical Activity Among People Older Than 50 Years %A Peels,Denise A %A van Stralen,Maartje M %A Bolman,Catherine %A Golsteijn,Rianne HJ %A de Vries,Hein %A Mudde,Aart N %A Lechner,Lilian %+ Department of Psychology, Open University of the Netherlands, Valkenburgerweg 177, PO Box 2960, Heerlen, 6419 AT, Netherlands, 31 45 576 22 96, denise.peels@ou.nl %K Computer-tailored advice %K physical activity %K Web-based intervention %K older adults %K exercise %K environment %K RE-AIM model %D 2012 %7 02.03.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: The Active Plus project is a systematically developed theory- and evidence-based, computer-tailored intervention, which was found to be effective in changing physical activity behavior in people aged over 50 years. The process and effect outcomes of the first version of the Active Plus project were translated into an adapted intervention using the RE-AIM framework. The RE-AIM model is often used to evaluate the potential public health impact of an intervention and distinguishes five dimensions: reach, effectiveness, adoption, implementation, and maintenance. Objective: To gain insight into the systematic translation of the first print-delivered version of the Active Plus project into an adapted (Web-based) follow-up project. The focus of this study was on the reach and effectiveness dimensions, since these dimensions are most influenced by the results from the original Active Plus project. Methods: We optimized the potential reach and effect of the interventions by extending the delivery mode of the print-delivered intervention into an additional Web-based intervention. The interventions were adapted based on results of the process evaluation, analyses of effects within subgroups, and evaluation of the working mechanisms of the original intervention. We pretested the new intervention materials and the Web-based versions of the interventions. Subsequently, the new intervention conditions were implemented in a clustered randomized controlled trial. Results: Adaptations resulted in four improved tailoring interventions: (1) a basic print-delivered intervention, (2) a basic Web-based intervention, (3) a print-delivered intervention with an additional environmental component, and (4) a Web-based version with an additional environmental component. Pretest results with participants showed that all new intervention materials had modest usability and relatively high appreciation, and that filling in an online questionnaire and performing the online tasks was not problematic. We used the pretest results to improve the usability of the different interventions. Implementation of the new interventions in a clustered randomized controlled trial showed that the print-delivered interventions had a higher response rate than the Web-based interventions. Participants of both low and high socioeconomic status were reached by both print-delivered and Web-based interventions. Conclusions: Translation of the (process) evaluation of an effective intervention into an adapted intervention is challenging and rarely reported. We discuss several major lessons learned from our experience. Trial Registration: Nederlands Trial Register (NTR): 2297; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2297 (Archived by WebCite at http://www.webcitation.org/65TkwoESp). %M 22390878 %R 10.2196/jmir.1742 %U http://www.jmir.org/2012/2/e39/ %U https://doi.org/10.2196/jmir.1742 %U http://www.ncbi.nlm.nih.gov/pubmed/22390878