%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63693 %T Testing a Machine Learning–Based Adaptive Motivational System for Socioeconomically Disadvantaged Smokers (Adapt2Quit): Protocol for a Randomized Controlled Trial %A Kamberi,Ariana %A Weitz,Benjamin %A Flahive,Julie %A Eve,Julianna %A Najjar,Reem %A Liaghat,Tara %A Ford,Daniel %A Lindenauer,Peter %A Person,Sharina %A Houston,Thomas K %A Gauvey-Kern,Megan E %A Lobien,Jackie %A Sadasivam,Rajani S %+ Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, United States, 1 774 317 1539, Ariana.Kamberi@umassmed.edu %K smoking cessation %K mHealth %K socioeconomically disadvantaged, biochemical verification %K machine learning %D 2025 %7 16.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Individuals who are socioeconomically disadvantaged have high smoking rates and face barriers to participating in smoking cessation interventions. Computer-tailored health communication, which is focused on finding the most relevant messages for an individual, has been shown to promote behavior change. We developed a machine learning approach (the Adapt2Quit recommender system), and our pilot work demonstrated the potential to increase message relevance and smoking cessation effectiveness among individuals who are socioeconomically disadvantaged. Objective: This study protocol describes our randomized controlled trial to test whether the Adapt2Quit recommender system will increase smoking cessation among individuals from socioeconomically disadvantaged backgrounds who smoke. Methods: Individuals from socioeconomically disadvantaged backgrounds who smoke were identified based on insurance tied to low income or from clinical settings (eg, community health centers) that provide care for low-income patients. They received text messages from the Adapt2Quit recommender system for 6 months. Participants received daily text messages for the first 30 days and every 14 days until the end of the study. Intervention participants also received biweekly texting facilitation messages, that is, text messages asking participants to respond (yes or no) if they were interested in being referred to the quitline. Interested participants were then actively referred to the quitline by study staff. Intervention participants also received biweekly text messages assessing their current smoking status. Control participants did not receive the recommender messages but received the biweekly texting facilitation and smoking status assessment messages. Our primary outcome is the 7-day point-prevalence smoking cessation at 6 months, verified by carbon monoxide testing. We will use an inverse probability weighting approach to test our primary outcome. This involves using a logistic regression model to predict nonmissingness, calculating the inverse probability of nonmissingness, and using it as a weight in a logistic regression model to compare cessation rates between the two groups. Results: The Adapt2Quit study was funded in April 2020 and is still ongoing. We have completed the recruitment of individuals (N=757 participants). The 6-month follow-up of all participants was completed in November 2024. The sample consists of 64% (486/757) female participants, 35% (265/757) Black or African American individuals, 51.1% (387/757) White individuals, and 16% (121/757) Hispanic or Latino individuals. In total, 52.6% (398/757) of participants reported having a high school education or being a high school graduate; 70% (529/757) smoked their first cigarette within 30 minutes of waking, and half (379/757, 50%) had stopped smoking for at least one day in the past year. Moreover, 16.6% (126/757) had called the quitline before study participation. Conclusions: We have recruited a diverse sample of individuals who are socioeconomically disadvantaged and designed a rigorous protocol to evaluate the Adapt2Quit recommender system. Future papers will present our main analysis of the trial. Trial Registration: ClinicalTrials.gov NCT04720625; https://clinicaltrials.gov/study/NCT04720625 International Registered Report Identifier (IRRID): DERR1-10.2196/63693 %M 40239194 %R 10.2196/63693 %U https://www.researchprotocols.org/2025/1/e63693 %U https://doi.org/10.2196/63693 %U http://www.ncbi.nlm.nih.gov/pubmed/40239194 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66301 %T Evaluating User Engagement With a Real-Time, Text-Based Digital Mental Health Support App: Cross-Sectional, Retrospective Study %A Coffield,Edward %A Kausar,Khadeja %+ , Department of Population Health, Hofstra University, 255 Hofstra University, 101 Oak Street Center, Room 100A, Hempstead, NY, 11549, United States, 1 516 463 7019, edward.coffield@hofstra.edu %K mental health support %K text %K app %K utilization %K mobile %K on demand %K scheduled %K mHealth %K mobile health %K app %K student %K university %K college %K mental health %K employee %K job %K work %K occupational health %K counselor %K counseling %K usage %K engagement %K self-reported %D 2025 %7 14.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 20% of US adults identify as having a mental illness. Structural and other barriers prevent many people from receiving mental health services. Digital mental health apps that provide 24-hour, real-time access to human support may improve access to mental health services. However, information is needed regarding how and why people engage with licensed counselors through a digital, real-time, text-based mental health support app in nonexperimental settings. Objective: This study aimed to evaluate how people engage with Counslr, a 24-hour, digital, mental health support app where users communicate in real time with human counselors through text messaging. Specifically, access patterns (eg, day of the week and time of session) and reasons for accessing the platform were examined. Furthermore, whether differences existed between session types (on-demand or scheduled) and membership types (education or noneducation) in regard to access patterns and why people accessed the platform were evaluated. Methods: The study population (users) consisted of students whose schools, universities, or colleges partnered with Counslr and employees whose organizations also partnered with Counslr. Users participated in text-based mental health support sessions. In these sessions, users engaged with licensed counselors through digital, text-based messaging in real time. Users could initiate an on-demand session or schedule a session 24 hours a day. User engagement patterns were evaluated through session length, session day, session time, and self-reported reasons for initiating the session. The data were stratified by membership type (education [students] or noneducation [employees]) and session type (on-demand or scheduled) to evaluate whether differences existed in usage patterns and self-reported reasons for initiating sessions by membership and session types. Results: Most students (178/283, 62.9%) and employees (28/44, 63.6%) accessed Counslr through on-demand sessions. The average and median session times were 40 (SD 15.3) and 45 minutes. On-demand sessions (37.9 minutes) were shorter (P=.001) than scheduled sessions (43.5 minutes). Most users (262/327, 80.1%) accessed Counslr between 7 PM and 5 AM. The hours that users accessed Counslr did not statistically differ by membership type (P=.19) or session type (P=.10). Primary self-reported reasons for accessing Counslr were relationship reasons, depression, and anxiety; however, users initiated sessions for a variety of reasons. Statistically significant differences existed between membership and session types (P<.05) for some of the reasons why people initiated sessions. Conclusions: The novel findings of this study illustrate that real-time, digital mental health support apps, which offer people the opportunity to engage with licensed counselors outside of standard office hours for a variety of mental health conditions, may help address structural barriers to accessing mental health support services. Additional research is needed to evaluate the effectiveness of human-based apps such as Counslr and whether such apps can also address disparities in access to mental health support services among different demographic groups. %M 40228290 %R 10.2196/66301 %U https://formative.jmir.org/2025/1/e66301 %U https://doi.org/10.2196/66301 %U http://www.ncbi.nlm.nih.gov/pubmed/40228290 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64023 %T Efficacy of a Personalized Mobile Health Intervention (BedTime) to Increase Sleep Duration Among Short-Sleeping Patients With Type 2 Diabetes: Protocol for a Pilot Randomized Controlled Trial %A Ban,Yuki %A Waki,Kayo %A Nakada,Ryohei %A Isogawa,Akihiro %A Miyoshi,Kengo %A Waki,Hironori %A Kato,Shunsuke %A Sawaki,Hideaki %A Murata,Takashi %A Hirota,Yushi %A Saito,Shuichiro %A Nishikage,Seiji %A Tone,Atsuhito %A Seno,Mayumi %A Toyoda,Masao %A Kajino,Shinichi %A Yokota,Kazuki %A Tsurutani,Yuya %A Yamauchi,Toshimasa %A Nangaku,Masaomi %A Ohe,Kazuhiko %+ Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, 7 Chome-3-1 Hongo, Bunkyo City, Tokyo, 113-8654, Japan, 81 358009129, kwaki-tky@m.u-tokyo.ac.jp %K digital therapeutics %K behavior change %K Theory of Planned Behavior %K sleep duration %K type 2 diabetes %K randomized controlled trial %D 2025 %7 14.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: A strong association exists between sleep duration and glycemic control in patients with type 2 diabetes (T2D), yet convincing evidence of a causal link remains lacking. Improving sleep is increasingly emphasized in clinical T2D treatment guidance, highlighting the need for effective, scalable sleep interventions that can affordably serve large populations through mobile health (mHealth). Objective: This study aims to pilot an intervention that extends sleep duration by modifying bedtime behavior, assessing its efficacy among short-sleeping (≤6 hours per night) patients with T2D, and establishing robust evidence that extending sleep improves glycemic control. Methods: This randomized, single-blinded, multicenter study targets 70 patients with T2D from 9 institutions in Japan over a 12-week intervention period. The sleep extension intervention, BedTime, is developed using the Theory of Planned Behavior (TPB) and focuses on TPB’s constructs of perceived and actual behavioral control (ABC). The pilot intervention combines wearable actigraphy devices with SMS text messaging managed by human operators. Both the intervention and control groups will use an actigraphy device to record bedtime, sleep duration, and step count, while time in bed (TIB) will be assessed via sleep diaries. In addition, the intervention group will receive weekly bedtime goals, daily feedback on their bedtime performance relative to those goals, identify personal barriers to an earlier bedtime, and select strategies to overcome these barriers. The 12-week intervention period will be followed by a 12-week observational period to assess the sustainability of the intervention’s effects. The primary outcome is the between-group difference in the change in hemoglobin A1c (HbA1c) at 12 weeks. Secondary outcomes include other health measures, sleep metrics (bedtime, TIB, sleep duration, total sleep time, and sleep quality), behavioral changes, and assessments of the intervention’s usability. The trial commenced on February 8, 2024, and is expected to conclude in February 2025. Results: Patient recruitment ended on August 29, 2024, with 70 participants enrolled. The intervention period concluded on December 6, 2024, and the observation period ended on February 26, 2025, with 70 participants completing the observation period. The data analysis is currently underway, and results are expected to be published in July 2025. Conclusions: This trial will provide important evidence on the causal link between increased sleep duration and improved glycemic control in short-sleeping patients with T2D. It will also evaluate the efficacy of our bedtime behavior change intervention in extending sleep duration, initially piloted with human operators, with the goal of future implementation via an mHealth smartphone app. If proven effective, this intervention could be a key step toward integrating sleep-focused mHealth into the standard treatment for patients with T2D in Japan. Trial Registration: Japan Registry of Clinical Trials jRCT1030230650; https://jrct.niph.go.jp/latest-detail/jRCT1030230650 International Registered Report Identifier (IRRID): DERR1-10.2196/64023 %M 40228289 %R 10.2196/64023 %U https://www.researchprotocols.org/2025/1/e64023 %U https://doi.org/10.2196/64023 %U http://www.ncbi.nlm.nih.gov/pubmed/40228289 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65268 %T Effect of a WeChat-Based Hybrid Intervention on the Adaptation Outcomes of People Living With HIV/AIDS: Pilot Randomized Controlled Trial %A Wang,Honghong %A Qin,Ziqi %A Li,Yixuan %A Duan,Yuqiong %A Lu,Qiaoyue %A Xiao,Xueling %+ Xiangya School of Nursing, Central South University, No. 172 Tongzipo Road, Changsha, 410083, China, 86 15286826132, xuelingxiao93@hotmail.com %K HIV/AIDS %K quality of life %K acceptance of illness %K mental health %K randomized controlled trial %K mobile phone %D 2025 %7 3.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: People living with HIV/AIDS face multiple challenges that collectively impede their adaptation outcomes. These outcomes include quality of life (QoL), acceptance of illness, mental health (including symptoms of anxiety and depression), and antiretroviral therapy (ART) adherence. While existing evidence addresses specific challenges, it often overlooks the interactions among the various problems people living with HIV/AIDS encounter. The comprehensive-task disease management framework and positive self-management framework provide a theoretical basis for understanding the adaptation process. A culturally tailored, theory-based intervention may be necessary and effective in facilitating better adaptation outcomes for people living with HIV/AIDS. Objective: This study aimed to evaluate the effect of a hybrid intervention called AiCare (Adaptation intervention with Comprehensive-task disease management framework to achieve renormal life) on improving QoL, acceptance of illness, mental health (anxiety and depression), and ART adherence among people living with HIV/AIDS in China. Methods: We conducted a 2-arm randomized controlled trial, recruiting 92 people living with HIV/AIDS from an HIV clinic in Hunan, China. Participants were randomly assigned in a 1:1 ratio to either the control group (receiving standard care) or the intervention group (receiving AiCare in addition to standard care). All analyses were performed from an intention-to-treat perspective. Sociodemographic and HIV-specific clinical characteristics, along with key adaptation outcomes—including QoL, acceptance of illness, mental health (anxiety and depression), and ART adherence—were assessed at baseline (T0), post intervention (T1), and 3 months post intervention (T2). We used generalized estimating equation models and difference-in-difference analysis to evaluate the interventions’ effects. Results: The difference-in-difference model showed that at T1, the intervention group experienced significant improvements compared to the control group. QoL increased by 6.35 (95% CI 2.62-10.93, P=.001), acceptance of illness improved by 4.49 (95% CI 2.29-6.68, P<.001), and anxiety decreased by 2.15 (95% CI 1.19-3.11; P=.01). At T2, the intervention group’s improvement in QoL was not statistically significant (β 3.62, 95% CI –1.53 to 8.77; P=.17). However, acceptance of illness remained significantly improved by 3.65 (95% CI 1.22-6.08; P=.003), and anxiety decreased by 1.58 (95% CI 0.42-2.74; P=.007). No significant changes were observed in depression or ART adherence between the intervention and control groups. Feedback regarding the AiCare program indicated its acceptability and feasibility. Conclusions: The AiCare program demonstrated promising effects in improving disease adaptation outcomes among people living with HIV/AIDS, notably in enhancing QoL, fostering acceptance of illness, and mitigating anxiety symptoms. These findings underscore the hybrid program’s potential clinical utility to facilitate the adaptation of people living with HIV/AIDS. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400087255; https://www.chictr.org.cn/showproj.html?proj=220729 %M 39988931 %R 10.2196/65268 %U https://www.jmir.org/2025/1/e65268 %U https://doi.org/10.2196/65268 %U http://www.ncbi.nlm.nih.gov/pubmed/39988931 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e62841 %T Impact of a 6-Week Postpartum Text Messaging Program (Essential Coaching for Every Mother) at 6 Months: Follow-Up Study to a Randomized Controlled Trial %A Dol,Justine %A Campbell-Yeo,Marsha %A Aston,Megan %A McMillan,Douglas %A Grant,Amy K %K mHealth %K mobile health %K SMS text message %K text messages %K messaging %K self-efficacy %K postpartum depression %K postpartum anxiety %K social support %K intervention %K postpartum %K postnatal %K mental health %K parenting %K mother %K depression %K anxiety %K RCT %K randomized controlled trial %D 2025 %7 2.4.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Essential Coaching for Every Mother is an SMS text messaging program that positively improved parenting self-efficacy and reduced postpartum anxiety when measured immediately after intervention at 6 weeks postpartum. However, the impact of a short-term postpartum intervention over time is unknown. Objective: This study aims to compare parenting self-efficacy, postpartum anxiety symptoms, postpartum depression symptoms, and perceived social support at 6 months postpartum for mothers in the Essential Coaching for Every Mother trial. Methods: Participants (n=150) were randomized to Essential Coaching for Every Mother or control (usual care). Data were collected on parenting self-efficacy (primary outcome, Karitane Parenting Confidence Scale), postpartum anxiety symptoms (Postpartum Specific Anxiety Scale), postpartum depressive symptoms (Edinburgh Postnatal Depression Scale), and perceived social support (Multidimensional Scale of Perceived Social Support) at enrollment and 6-months postpartum. Data were analyzed using analyses of covariance and chi-square analysis. Results: A total of 139 women completed the primary outcome at 6 months and 136 completed secondary outcomes. At 6 months, there were no statistically significant differences between mothers in the intervention group and mothers in the control group on any of the outcomes. More mothers in the intervention group had higher postpartum anxiety scores (31/68, 45.6%) than mothers in the control group (16/68, 23.5%; P=.007). Conclusions: At 6 months postpartum, all mothers had similar scores on parenting self-efficacy, postpartum anxiety symptoms, postpartum depression symptoms, and social support. Thus, Essential Coaching for Every Mother improved parenting self-efficacy and reduced postpartum anxiety at 6 weeks, with all mothers having similar scores at 6 months postpartum. Trial Registration: ClincialTrials.gov NCT04730570; https://clinicaltrials.gov/study/NCT04730570 International Registered Report Identifier (IRRID): RR2-10.2196/27138 %R 10.2196/62841 %U https://pediatrics.jmir.org/2025/1/e62841 %U https://doi.org/10.2196/62841 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66709 %T Using Text Messaging Ecological Momentary Assessment to Record Changes in e-Cigarette and Combustible Cigarette Use: Pilot Randomized Clinical Trial %A Morgan,Tucker %A He,Michelle %A Nicholson,Andrew %A El Shahawy,Omar %A Sherman,Scott E %A Stevens,Elizabeth R %K smoking %K electronic cigarette %K smoking cessation %K ecological momentary assessment %K EMA %K adherence %K real-time data %K mobile phone %K cigarette %K smoker %K e-cigarettes %K pilot randomized clinical trial %K clinical trial %K pilot study %K adult smoker %K chronic condition %D 2025 %7 21.3.2025 %9 %J JMIR Form Res %G English %X Background: Ecological momentary assessment (EMA) provides insight into the effectiveness and feasibility of smoking-related interventions. Objective: The objective of this paper was to assess adherence to an EMA protocol and compare EMA-derived responses with measures collected through multiple surveys. Methods: A subanalysis was conducted using data from a 12-week, open-label, and 2-arm pilot randomized clinical trial among adult smokers with chronic obstructive pulmonary disease, coronary artery disease, peripheral vascular disease, or asthma in the last 12 months (n=109). Participants were randomized to either electronic cigarette (EC) or nicotine replacement therapy (NRT) treatment arms. We compared EMA data collected through automated SMS text message prompts sent to participants 4 times daily for 12 weeks, including cigarettes smoked per day (CPD), craving, and satisfaction, to survey data collected at 12 weeks. Convergent validity between survey- and EMA-reported measures was evaluated using Pearson correlation and paired t tests. CPD was modeled using negative binomial regression. Relative rates (RRs) of reaching at least 50%, 75%, and 100% CPD reduction between two arms were calculated using both EMA and survey data. Results: The majority of participants were non-Hispanic White (63/109, 58%) and female (60/109, 55%), and had a median age of 60 (IQR 54‐65) years. Among the 109 participants, 59.6% (n=65) were consistently adherent to the EMA protocol over the 12-week period. Median weekly EMA response rate remained high over the 12-week study period even though a modest decline was observed (week 1, 97.8% and week 12, 89.4%). The mean CPD declined significantly (week 1, mean 14.2, SD 9.9 and week 12, mean 4.6, SD 6.7; P<.001). EMA-derived and survey-based CPD measurements were positively correlated (r=0.73, 95% CI 0.6-0.82) as were measures of craving (r=0.38, 95% CI 0.17-0.56). No significant paired difference in CPD was observed between EMA measurements and surveys. A significant effect of time on CPD EMA data (incidence rate ratio [IRR] 1-week change 0.93; P<.01) and survey data was found (IRR 12-week change 0.36; P<.01). However, the treatment effect was not significant, which aligned with the RR results. An increase in the EC consumption was observed over time in the EC arm, with 12.1% (7/58) fully switched to EC (defined as CPD=0 and EC use>0) and 20.7% (12/58) mostly switched (defined as a reduction in CPD>75% and EC use>0) in week 12. Conclusions: EMA is a suitable method to collect recall-based smoking-related data. Though results from mixed effect modeling and RR comparisons were similar using EMA or survey data, EMA provides unique advantages, namely greater granularity in the time and the capability to detect switching patterns in near real time. These findings provide the feasibility of using EMA in developing smoking cessation interventions in future tobacco harm reduction research. Trial Registration: ClinicalTrials.gov NCT04465318; https://clinicaltrials.gov/study/NCT04465318 International Registered Report Identifier (IRRID): RR2-10.1186/s13722-021-00284-0 %R 10.2196/66709 %U https://formative.jmir.org/2025/1/e66709 %U https://doi.org/10.2196/66709 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e57470 %T Effect of SMS Ward Round Notifications on Inpatient Experience in Acute Medical Settings: Retrospective Cohort Study %A Lee,Jongchan %A Ahn,Soyeon %A Ohn,Jung Hun %A Kim,Eun Sun %A Lim,Yejee %A Kim,Hye Won %A Park,Hee-Sun %A Cho,Jae Ho %A Kim,Sun-wook %A Ryu,Jiwon %A Kim,Jihye %A Jang,Hak Chul %A Kim,Nak-Hyun %K rounds %K round-time notification %K text messaging %K patient experience assessment %K patient experiences %K patient-centeredness %K patient participation %D 2025 %7 12.3.2025 %9 %J JMIR Hum Factors %G English %X Background: Ward rounds are an essential component of inpatient care. Patient participation in rounds is increasingly encouraged, despite the occasional complicated circumstances, especially in acute care settings. Objective: This study aimed to evaluate the effect of real-time ward round notifications using SMS text messaging on the satisfaction of inpatients in an acute medical ward. Methods: Since January 2021, a service implementing real-time ward round notifications via text messaging (WR-SMS) has been operational at a tertiary-care medical center in Korea. To assess its impact, we conducted a retrospective cohort study of patients admitted to the acute medical unit who participated in a patient experience survey. Patient satisfaction was compared between patients admitted in 2020 (pre–WR-SMS group) and 2021 (post–WR-SMS group). Results: From January 2020 to December 2021, a total of 100 patients were enrolled (53 patients in the pre–WR-SMS group and 47 patients in the post–WR-SMS group). Compared with the pre–WR-SMS group, the post–WR-SMS group showed significantly greater satisfaction about being informed about round schedules (mean 3.43, SD 0.910 vs mean 3.89, SD 0.375; P<.001) and felt more emotionally supported during admission (mean 3.49, SD 0.800 vs mean 3.87, SD 0.397; P<.001). Regarding other questionnaire scores, the post–WR-SMS group showed an overall, although statistically insignificant, improvement compared with the pre–WR-SMS group. Conclusions: Real-time round notifications using a user-friendly SMS may improve inpatient satisfaction effectively. %R 10.2196/57470 %U https://humanfactors.jmir.org/2025/1/e57470 %U https://doi.org/10.2196/57470 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55592 %T Utilization and Experiences of Using Quit Now, a Nicotine and Tobacco Smoking Cessation Website: Thematic Analysis %A Salaheddin,Tala %A Sharma,Ramona H %A Fajardo,Marcela %A Panter,Cameron %A De Souza,Lauren %A Matano,Sheila Kanyevu %A Struik,Laura %+ Doctor of Medicine Program, Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada, 1 6048222211, talasala@student.ubc.ca %K smoking cessation %K user experiences %K nicotine %K vaping %K web-based %K Google Analytics %K thematic analysis %K digital health %K nicotine replacement therapy %K quit attempts %K tobacco %K British Columbia %K behavioral support %K pharmacotherapy %K qualitative interview %K cessation support %K QuitNow %K mobile health %K mHealth %K intervention %D 2025 %7 4.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: British Columbia residents have access to a program called QuitNow that provides behavioral support and information about pharmacotherapy to nicotine and tobacco users. Web- or computer-based smoking cessation programs have been shown to yield an abstinence rate about 1.5 times higher when compared to a control. Although quantitative evidence reveals significant promise for web-based services like QuitNow, there is very little qualitative evidence available. Understanding website utilization and the experiences of end users is key to contextualizing the effectiveness of web-based cessation services and providing directions for enhancing these services. Objective: This qualitative interview study aims to delve into users’ utilization and experiences of QuitNow, which is supplemented by Google Analytics data. Methods: We interviewed 10 QuitNow users using semistructured interviews to understand what they liked the most and the least about QuitNow. We transcribed these interviews and conducted an inductive thematic analysis using NVivo (QSR International) software to extract common themes about user experiences. We also gathered utilization metrics via Google Analytics (n=13,856 users) to understand which aspects of QuitNow were used the most and which were used the least during the study period. Results: Thematic analysis yielded four major themes: (1) barriers to information access reduce opportunities to take action, (2) lack of clarity around pharmacological options is discouraging, (3) hearing from others is an important part of the journey, and (4) recognizing own agency throughout the quit process. These themes provided context and support for the Google Analytics data, which showed that end user activity, measured by indicators such as page views and average time spent on each page, was highest on pages about how to quit (10,393 page views), pharmacology information (1999 page views), and the community forum (11,560 page views). Conclusions: Results of this study point to several important implications for improving the website, as well as directions for enhancing cessation support services in general. %M 40053769 %R 10.2196/55592 %U https://www.jmir.org/2025/1/e55592 %U https://doi.org/10.2196/55592 %U http://www.ncbi.nlm.nih.gov/pubmed/40053769 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e56254 %T Daily Treatment Monitoring for Patients Receiving Home-Based Peritoneal Dialysis and Prediction of Heart Failure Risk: mHealth Tool Development and Modeling Study %A Wu,Jia %A Zeng,Youjia %A Yang,Jun %A Yao,Yutong %A Xu,Xiuling %A Song,Gaofeng %A Yi,Wuyong %A Wang,Taifen %A Zheng,Yihou %A Jia,Zhongwei %A Yan,Xiangyu %+ , School of Disaster and Emergency Medicine, Tianjin University, No 92 Weijin Road, Tianjin, 300072, China, 86 02287370177 ext 307, yanxiangyu1123@163.com %K peritoneal dialysis %K mHealth %K patient management %K heart failure %K prediction model %D 2025 %7 3.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Peritoneal dialysis is one of the major renal replacement modalities for patients with end-stage renal disease. Heart failure is a common adverse event among patients who undergo peritoneal dialysis treatment, especially for those who undergo continuous ambulatory peritoneal dialysis at home, because of the lack of professional input-output volume monitoring and management during treatment. Objective: This study aims to develop novel mobile health (mHealth) tools to improve the quality of home-based continuous ambulatory peritoneal dialysis treatment and to build a prediction model of heart failure based on the system’s daily treatment monitoring data. Methods: The mHealth tools with a 4-layer system were designed and developed using Spring Boot, MyBatis Plus, MySQL, and Redis as backend technology stack, and Vue, Element User Interface, and WeChat Mini Program as front-end technology stack. Patients were recruited to use the tool during daily peritoneal dialysis treatment from January 1, 2017, to April 20, 2023. Logistic regression models based on real-time treatment monitoring data were used for heart failure prediction. The sensitivity, specificity, accuracy, and Youden index were calculated to evaluate the performance of the prediction model. In the sensitivity analysis, the ratio of patients with and without heart failure was set to 1:4 and 1:10, respectively, to better evaluate the stability of the prediction model. Results: A WeChat Mini Program named Futou Bao for patients and a patient data management platform for doctors was developed. Futou Bao included an intelligent data upload function module and an auxiliary function module. The doctor’s data management platform consisted of 4 function modules, that is, patient management, data visualization and marking, data statistics, and system management. During the study period, the records of 6635 patients who received peritoneal dialysis treatment were uploaded in Futou Bao, with 0.71% (47/6635) of them experiencing heart failure. The prediction model that included sex, age, and diastolic blood pressure was considered as the optimal model, wherein the sensitivity, specificity, accuracy, and Youden index were 0.75, 0.91, 0.89, and 0.66, respectively, with an area under the curve value of 0.879 (95% CI 0.772-0.986) using the validation dataset. The sensitivity analysis showed stable results. Conclusions: This study provides a new home-based peritoneal dialysis management paradigm that enables the daily monitoring and early warning of heart failure risk. This novel paradigm is of great value for improving the efficiency, security, and personalization of peritoneal dialysis. %M 40053710 %R 10.2196/56254 %U https://formative.jmir.org/2025/1/e56254 %U https://doi.org/10.2196/56254 %U http://www.ncbi.nlm.nih.gov/pubmed/40053710 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65187 %T Text Messaging Interventions for Unhealthy Alcohol Use in Emergency Departments: Mixed Methods Assessment of Implementation Barriers and Facilitators %A O'Grady,Megan %A Harrison,Laura %A Suleiman,Adekemi %A Hutchison,Morica %A Kwon,Nancy %A Muench,Frederick %A Kapoor,Sandeep %K unhealthy alcohol use %K text messaging intervention %K emergency department %K barriers and facilitators %K implementation %K alcohol use %K unhealthy %K mixed methods assessment %K mixed methods %K assessment %K facilitators %K alcohol %K health care %K scalable supports %K text messaging %K patient outcomes %K health system %K electronic health record %K EHR %K alcohol screening %K acceptability %K feasibility %K survey %K health-related goals %D 2025 %7 3.3.2025 %9 %J JMIR Form Res %G English %X Background: Many patients with unhealthy alcohol use (UAU) access health care in emergency departments (EDs). Scalable supports, such as SMS text messaging interventions, are acceptable and feasible to enhance care delivery for many health issues, including substance use. Further, SMS text messaging interventions have been shown to improve patient outcomes related to alcohol consumption (eg, reduced consumption compared to no intervention, basic health information, or drink tracking), but they are rarely offered in clinical settings. Objective: This paper describes a mixed methods study using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. The goal of this study was to use a stakeholder-engaged mixed methods design to assess barriers and facilitators to the implementation of SMS text messaging interventions for UAU in EDs with a focus on the recipient’s characteristics, the innovation’s degree of fit within the existing practice, and the unique nature of the inner and outer context. Methods: This study was conducted in a large health system in the northeastern United States. We examined electronic health record data on alcohol screening in 17 EDs; surveyed 26 ED physician chairpersons on implementation feasibility, acceptability, and appropriateness; and interviewed 18 ED staff and 21 patients to understand barriers and facilitators to implementation. Interviews were analyzed according to the i-PARIHS framework to assess recipient characteristics, innovation degree of fit, and inner and outer context. Results: Electronic health record data revealed high variability in alcohol screening completion (mean 73%, range 35%‐93%), indicating potential issues in identifying patients eligible to offer the intervention. The 26 ED chair surveys revealed a relatively high level of implementation confidence (mean 4, SD 0.81), acceptability (mean 4, SD 0.71), and appropriateness (mean 3.75, SD 0.69) regarding the UAU SMS text messaging intervention; feasibility (mean 3.5, SD 0.55) had the lowest mean, indicating concerns about integrating the text intervention in the busy ED workflow. Staff were concerned about staff buy-in and adding additional discussion points to already overwhelmed patients during their ED visit but saw the need for additional low-threshold services for UAU. Patients were interested in the intervention to address drinking and health-related goals. Conclusions: ED visits involving UAU have increased in the United States. The results of this formative study on barriers and facilitators to the implementation of UAU SMS text messaging interventions in EDs indicate both promise and caution. In general, we found that staff viewed offering such interventions as appropriate and acceptable; however, there were concerns with feasibility (eg, low alcohol risk screening rates). Patients also generally viewed the SMS text messaging intervention positively, with limited drawbacks (eg, slight concerns about having time to read messages). The results provide information that can be used to develop implementation strategies that can be tested in future studies. Trial Registration: ClinicalTrials.gov NCT05350878; http://clinicaltrials.gov/ct2/show/NCT05350878 %R 10.2196/65187 %U https://formative.jmir.org/2025/1/e65187 %U https://doi.org/10.2196/65187 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e69602 %T Automated Digital Safety Planning Interventions for Young Adults: Qualitative Study Using Online Co-design Methods %A Meyerhoff,Jonah %A Popowski,Sarah A %A Lakhtakia,Tanvi %A Tack,Emily %A Kornfield,Rachel %A Kruzan,Kaylee P %A Krause,Charles J %A Nguyen,Theresa %A Rushton,Kevin %A Pisani,Anthony R %A Reddy,Madhu %A Van Orden,Kimberly A %A Mohr,David C %+ Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 North Lake Shore Drive, Chicago, IL, 60611, United States, 1 3125031232, jonah.meyerhoff@northwestern.edu %K mental health services %K technology %K therapy %K computer assisted %K SMS text messaging %D 2025 %7 26.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Young adults in the United States are experiencing accelerating rates of suicidal thoughts and behaviors but have the lowest rates of formal mental health care. Digital suicide prevention interventions have the potential to increase access to suicide prevention care by circumventing attitudinal and structural barriers that prevent access to formal mental health care. These tools should be designed in collaboration with young adults who have lived experience of suicide-related thoughts and behaviors to optimize acceptability and use. Objective: This study aims to identify the needs, preferences, and features for an automated SMS text messaging–based safety planning service to support the self-management of suicide-related thoughts and behaviors among young adults. Methods: We enrolled 30 young adults (age 18-24 years) with recent suicide-related thoughts and behaviors to participate in asynchronous remote focus groups via an online private forum. Participants responded to researcher-posted prompts and were encouraged to reply to fellow participants—creating a threaded digital conversation. Researcher-posted prompts centered on participants’ experiences with suicide-related thought and behavior-related coping, safety planning, and technologies for suicide-related thought and behavior self-management. Focus group transcripts were analyzed using thematic analysis to extract key needs, preferences, and feature considerations for an automated SMS text messaging–based safety planning tool. Results: Young adult participants indicated that an automated digital SMS text message–based safety planning intervention must meet their needs in 2 ways. First, by empowering them to manage their symptoms on their own and support acquiring and using effective coping skills. Second, by leveraging young adults’ existing social connections. Young adult participants also shared 3 key technological needs of an automated intervention: (1) transparency about how the intervention functions, the kinds of actions it does and does not take, the limits of confidentiality, and the role of human oversight within the program; (2) strong privacy practices—data security around how content within the intervention and how private data created by the intervention would be maintained and used was extremely important to young adult participants given the sensitive nature of suicide-related data; and (3) usability, convenience, and accessibility were particularly important to participants—this includes having an approachable and engaging message tone, customizable message delivery options (eg, length, number, content focus), and straightforward menu navigation. Young adult participants also highlighted specific features that could support core coping skill acquisition (eg, self-tracking, coping skill idea generation, reminders). Conclusions: Engaging young adults in the design process of a digital suicide prevention tool revealed critical considerations that must be addressed if the tool is to effectively expand access to evidence-based care to reach young people at risk for suicide-related thoughts and behaviors. Specifically, automated digital safety planning interventions must support building skillfulness to cope effectively with suicidal crises, deepening interpersonal connections, system transparency, and data privacy. %M 40009840 %R 10.2196/69602 %U https://formative.jmir.org/2025/1/e69602 %U https://doi.org/10.2196/69602 %U http://www.ncbi.nlm.nih.gov/pubmed/40009840 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63938 %T Effectiveness of Text Messaging Nudging to Increase Coverage of Influenza Vaccination Among Older Adults in Norway (InfluSMS Study): Protocol for a Randomized Controlled Trial %A Hansen,Bo T %A Klungsøyr,Ole %A Labberton,Angela S %A Sääksvuori,Lauri %A Rydland,Kjersti M %A Ødeskaug,Liz E %A Wisløff,Torbjørn %A Meijerink,Hinta %+ Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Postboks 222 Skøyen, Oslo, 0213, Norway, 47 21077000, boterning.hansen@fhi.no %K influenza vaccination %K coverage %K uptake %K behavioral nudging %K vaccine hesitancy %K randomized controlled trial %K undervaccination %K migrant health %K mobile health %K mHealth %K smartphones %K eHealth %K SMS %D 2025 %7 25.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The coverage of influenza vaccination among older adults in Norway is insufficient, especially in some immigrant groups. To improve public health, there is a need for an intervention that can increase influenza vaccination coverage. Further, interventions tailored to reduce potential barriers among immigrants can reduce health inequities. Objective: InfluSMS aims to determine if SMS nudging increases vaccination coverage among those aged 65 years or older (1) in Norway’s general population; (2) among immigrants born in Poland; and (3) among immigrants born in Ukraine; and evaluate the impact of SMS nudging in Norwegian versus in the official language of the native country of immigrants born in Poland or Ukraine. Methods: InfluSMS is a pragmatic randomized controlled trial conducted among people aged 65 years or older residing in Norway. Influenza vaccination coverage is the main outcome, measured in control and intervention arms for each of the 3 populations listed earlier. In all 3 populations, the control arm is standard care, that is, no individual reminder for influenza vaccination. All populations have an intervention arm that will receive an SMS nudge in the Norwegian language. In addition, the Polish and Ukrainian immigrant populations include a second intervention arm that will receive an SMS nudge in Polish or Ukrainian, respectively. In the general population, at least 23,485 individuals will be randomized to the SMS intervention arm while the rest of the population constitutes the control arm. In each of the 2 immigrant populations, we will randomize all eligible individuals 1:1:1 into the 3 arms. The intervention will take place at the start of the 2025-2026 influenza season. All eligible individuals will be passively followed up through the National Immunisation Registry, SYSVAK, from which individual influenza vaccination status 3 months after the SMS nudge will be collected. Coverage rates between arms within each population and effect sizes between the populations will be compared. The cost-effectiveness of SMS nudging will also be assessed. Results: The inclusion of participants will start in the third quarter of 2025, and the registry data will be available in the first quarter of 2026. Coverage rates of each strategy and coverage differences between strategies will be presented. Conclusions: SMS nudging is a scalable, inexpensive, and nonintrusive intervention that could be integrated into the national influenza vaccination program if the trial shows it effectively increases influenza vaccination coverage among older adults. Further, the trial will establish whether language is a barrier to influenza vaccination uptake among recent immigrant groups that have low influenza vaccination coverage, and to what extent this potential barrier can be diminished by SMS nudging in the official language of their native country. Trial Registration: ClinicalTrials.gov NCT06486766; https://clinicaltrials.gov/study/NCT06486766 International Registered Report Identifier (IRRID): PRR1-10.2196/63938 %M 39998878 %R 10.2196/63938 %U https://www.researchprotocols.org/2025/1/e63938 %U https://doi.org/10.2196/63938 %U http://www.ncbi.nlm.nih.gov/pubmed/39998878 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65026 %T Exploring the Acceptance of Just-in-Time Adaptive Lifestyle Support for People With Type 2 Diabetes: Qualitative Acceptability Study %A Hietbrink,Eclaire A G %A Middelweerd,Anouk %A d’Hollosy,Wendy %A Schrijver,Laura K %A Laverman,Gozewijn D %A Vollenbroek-Hutten,Miriam M R %+ Department of Biomedical Signals and Systems, University of Twente, Drienerlolaan 5, Enschede, 7500 AE, The Netherlands, 31 53 4892760, e.a.g.hietbrink@utwente.nl %K eHealth %K just-in-time adaptive intervention %K ecological momentary assessment %K type 2 diabetes %K behavior change %K physical activity %K nutrition %K acceptability %K formative evaluation %K mobile phone %D 2025 %7 19.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The management of type 2 diabetes (T2D) requires individuals to adopt and maintain a healthy lifestyle. Personalized eHealth interventions can help individuals change their lifestyle behavior. Specifically, just-in-time adaptive interventions (JITAIs) offer a promising approach to provide tailored support to encourage healthy behaviors. Low-effort self-reporting via ecological momentary assessment (EMA) can provide insights into individuals’ experiences and environmental factors and thus improve JITAI support, particularly for conditions that cannot be measured by sensors. We developed an EMA-driven JITAI to offer tailored support for various personal and environmental factors influencing healthy behavior in individuals with T2D. Objective: This study aimed to assess the acceptability of EMA-driven, just-in-time adaptive lifestyle support in individuals with T2D. Methods: In total, 8 individuals with T2D used the JITAI for 2 weeks. Participants completed daily EMAs about their activity, location, mood, overall condition, weather, and cravings and received tailored support via SMS text messaging. The acceptability of the JITAI was assessed through telephone-conducted, semistructured interviews. Interview topics included the acceptability of the EMA content and prompts, the intervention options, and the overall use of the JITAI. Data were analyzed using a hybrid approach of thematic analysis. Results: Participants with a mean age of 70.5 (SD 9) years, BMI of 32.1 (SD 5.3) kg/m², and T2D duration of 15.6 (SD 7.7) years had high self-efficacy scores in physical activity (ie, 32) and nutrition (ie, 29) and were mainly initiating or maintaining behavior changes. The identified themes were related to the intervention design, decision points, tailoring variables, intervention options, and mechanisms underlying adherence and retention. Participants provided positive feedback on several aspects of the JITAI, such as the motivating and enjoyable messages that appeared well tailored to some individuals. However, there were notable differences in individual experiences with the JITAI, particularly regarding intervention intensity and the perceived personalization of the EMA and messages. The EMA was perceived as easy to use and low in burden, but participants felt it provided too much of a snapshot and too little context, reducing the perceived tailoring of the intervention options. Challenges with the timing and frequency of prompts and the relevance of some tailoring variables were also observed. While some participants found the support relevant and motivating, others were less inclined to follow the advice. Participants expressed the need for even more personalized support tailored to their specific characteristics and circumstances. Conclusions: This study showed that an EMA-driven JITAI can provide motivating and tailored support, but more personalization is needed to ensure that the lifestyle support more closely fits each individual’s unique needs. Key areas for improvement include developing more individually tailored interventions, improving assessment methods to balance active and passive data collection, and integrating JITAIs within comprehensive lifestyle interventions. %M 39969969 %R 10.2196/65026 %U https://formative.jmir.org/2025/1/e65026 %U https://doi.org/10.2196/65026 %U http://www.ncbi.nlm.nih.gov/pubmed/39969969 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e39950 %T Swasthya Pahal (Health for All) Using a Sustainable, Multisector, Accessible, Affordable, Reimbursable, and Tailored Informatics Framework in Rural and Urban Areas of Chennai, Tamil Nadu: Protocol for a Quantitative Study %A Joshi,Ashish %A Surapaneni,Krishna Mohan %A Grover,Ashoo %A Kaur,Harpreet %A Saggu,Sofia Rani %A Oliveira,Doilyn %+ School of Public Health, University of Memphis, Robison Hall 3825 DeSoto Avenue, Memphis, TN, 38152-0001, United States, 1 4435706018, ashish1875@gmail.com %K interventions %K Swasthya Pahal %K acceptance %K health behavior %K NCDs risks %K self-management %K healthcare %K noncommunicable disease %D 2025 %7 6.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Noncommunicable diseases (NCDs) require a longer period of care, for which health care systems must acquire technologically advanced solutions to enhance patient care. Swasthya Pahal (health for all) is an innovative, interactive, multilingual, stand-alone, internet-enabled computer-based program that aims to improve the self-management of NCDs. Objective: This study aims to enhance the self-management of chronic NCDs (diabetes, hypertension, high cholesterol, and obesity) by determining the usefulness, acceptance, and effectiveness of the Swasthya Pahal program in hospital and community settings in both rural and urban areas of Chennai, Tamil Nadu. This objective can be met by generating risk factor profiles of individuals enrolled and enhancing their self-management of NCDs using a portable health information kiosk that uses the Sustainable, Multisector, Accessible, Affordable, Reimbursable, and Tailored (SMAART) model. Methods: A quantitative study will be conducted on a convenient sample of 2800 individuals from selected hospital and community settings in rural (n=1400) and urban areas (n=1400) in Chennai, Tamil Nadu. Data will be collected on sociodemographics, health behaviors, and clinical status, as well as knowledge, attitudes, and practices. Objective assessments such as weight, blood pressure, and random blood sugar levels will be measured. In addition, the usefulness, acceptance, and effectiveness of the Swasthya Pahal program will be determined. Results: Results will be summarized using descriptive analysis. Appropriate bivariate and multivariate regression analysis will be performed to determine the predictors of the outcome variables of usefulness, acceptance, and effectiveness of Swasthya Pahal in wider settings. All analyses will be performed using SAS (version 9.1; SAS Institute), and the results will be reported as 95% CI values and P<.05. Conclusions: The study proposes to enhance the self-management of NCDs in both rural and urban community settings through the implementation of the Swasthya Pahal program based on the SMAART informatics framework. The study aims to understand the implementation, acceptability, and usability of Swasthya Pahal among a diverse sample of people in urban and rural settings. International Registered Report Identifier (IRRID): PRR1-10.2196/39950 %M 39913916 %R 10.2196/39950 %U https://www.researchprotocols.org/2025/1/e39950 %U https://doi.org/10.2196/39950 %U http://www.ncbi.nlm.nih.gov/pubmed/39913916 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e69311 %T Evaluating the Impact of Pharmacotherapy in Augmenting Quit Rates Among Hispanic Adults in an App-Delivered Smoking Cessation Intervention: Secondary Analysis of a Randomized Controlled Trial %A Santiago-Torres,Margarita %A Mull,Kristin E %A Sullivan,Brianna M %A Cupertino,Ana Paula %A Salloum,Ramzi G %A Triplette,Matthew %A Zvolensky,Michael J %A Bricker,Jonathan B %+ Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Avenue North, Seattle, WA, 98109, United States, 1 206 667 4780, msantiag@fredhutch.org %K acceptance and commitment therapy %K Hispanic or Latino %K iCanQuit %K QuitGuide %K smartphone apps %K smoking cessation %K mobile phone %D 2025 %7 31.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Hispanic adults receive less advice to quit smoking and use fewer evidence-based smoking cessation treatments compared to their non-Hispanic counterparts. Digital smoking cessation interventions, such as those delivered via smartphone apps, provide a feasible and within-reach treatment option for Hispanic adults who smoke and want to quit smoking. While the combination of pharmacotherapy and behavioral interventions are considered best practices for smoking cessation, its efficacy among Hispanic adults, especially alongside smartphone app–based interventions, is uncertain. Objective: This secondary analysis used data from a randomized controlled trial that compared the efficacy of 2 smoking cessation apps, iCanQuit (based on acceptance and commitment therapy) and QuitGuide (following US clinical practice guidelines), to explore the association between pharmacotherapy use and smoking cessation outcomes among the subsample of 173 Hispanic participants who reported on pharmacotherapy use. Given the randomized design, we first tested the potential interaction of pharmacotherapy use and intervention arm on 12-month cigarette smoking abstinence. We then examined whether the use of any pharmacotherapy (ie, nicotine replacement therapy [NRT], varenicline, or bupropion) and NRT alone augmented each app-based intervention efficacy. Methods: Participants reported using pharmacotherapy on their own during the 3-month follow-up and cigarette smoking abstinence at the 12-month follow-up via web-based surveys. These data were used (1) to test the interaction effect of using pharmacotherapy to aid smoking cessation and intervention arm (iCanQuit vs QuitGuide) on smoking cessation at 12 months and (2) to test whether the use of pharmacotherapy to aid smoking cessation augmented the efficacy of each intervention arm to help participants successfully quit smoking. Results: The subsample of Hispanic participants was recruited from 30 US states. They were on average 34.5 (SD 9.3) years of age, 50.9% (88/173) were female, and 56.1% (97/173) reported smoking at least 10 cigarettes daily. Approximately 22% (38/173) of participants reported using pharmacotherapy to aid smoking cessation at the 3-month follow-up, including NRT, varenicline, or bupropion, with no difference between intervention arms. There was an interaction between pharmacotherapy use and intervention arm that marginally influenced 12-month quit rates at 12 months (P for interaction=.053). In the iCanQuit arm, 12-month missing-as-smoking quit rates were 43.8% (7/16) for pharmacotherapy users versus 28.8% (19/16) for nonusers (odds ratio 2.21, 95% CI 0.66-7.48; P=.20). In the QuitGuide arm, quit rates were 9.1% (2/22) for pharmacotherapy users versus 21.7% (15/69) for nonusers (odds ratio 0.36, 95% CI 0.07-1.72; P=.20). Results were similar for the use of NRT only. Conclusions: Combining pharmacotherapy to aid smoking cessation with a smartphone app–based behavioral intervention that teaches acceptance of cravings to smoke (iCanQuit) shows promise in improving quit rates among Hispanic adults. However, this combined approach was not effective with the US clinical guideline–based app (QuitGuide). Trial Registration: ClinicalTrials.gov NCT02724462; https://clinicaltrials.gov/study/NCT02724462 International Registered Report Identifier (IRRID): RR2-10.1001/jamainternmed.2020.4055 %R 10.2196/69311 %U https://formative.jmir.org/2025/1/e69311 %U https://doi.org/10.2196/69311 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e58938 %T Exploring the Impact of the Multimodal CAPABLE eHealth Intervention on Health-Related Quality of Life in Patients With Melanoma Undergoing Immune-Checkpoint Inhibition: Prospective Pilot Study %A Fraterman,Itske %A Sacchi,Lucia %A Mallo,Henk %A Tibollo,Valentina %A Glaser,Savannah Lucia Catherina %A Medlock,Stephanie %A Cornet,Ronald %A Gabetta,Matteo %A Hisko,Vitali %A Khadakou,Vadzim %A Barkan,Ella %A Del Campo,Laura %A Glasspool,David %A Kogan,Alexandra %A Lanzola,Giordano %A Leizer,Roy %A Ottaviano,Manuel %A Peleg,Mor %A Śniatała,Konrad %A Lisowska,Aneta %A Wilk,Szymon %A Parimbelli,Enea %A Quaglini,Silvana %A Rizzo,Mimma %A Locati,Laura Deborah %A Boekhout,Annelies %A van de Poll-Franse,Lonneke V %A Wilgenhof,Sofie %K eHealth %K melanoma %K cancer %K fatigue %K quality of life %K intervention %K pilot study %K exploratory %K health-related %K interventions %K symptom %K monitoring %K well-being %K immunotherapy %K immune-related %K immune-checkpoint inhibitor %K patient %K feasibility %K smartphone %K app %K smartwatch %K linear regression model %K mobile phone %D 2025 %7 30.1.2025 %9 %J JMIR Cancer %G English %X Background: Patients with melanoma receiving immunotherapy with immune-checkpoint inhibitors often experience immune-related adverse events, cancer-related fatigue, and emotional distress, affecting health-related quality of life (HRQoL) and clinical outcome to immunotherapy. eHealth tools can aid patients with cancer in addressing issues, such as adverse events and psychosocial well-being, from various perspectives. Objective: This study aimed to explore the effect of the Cancer Patients Better Life Experience (CAPABLE) system, accessed through a mobile app, on HRQoL compared with a matched historical control group receiving standard care. CAPABLE is an extensively tested eHealth app, including educational material, remote symptom monitoring, and well-being interventions. Methods: This prospective pilot study compared an exploratory cohort that received the CAPABLE smartphone app and a multisensory smartwatch for 6 months (intervention) to a 2:1 individually matched historical prospective control group. HRQoL data were measured with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 at baseline (T0), 3 months (T1), and 6 months (T2) after start of treatment. Mixed effects linear regression models were used to compare HRQoL between the 2 groups over time. Results: From the 59 eligible patients for the CAPABLE intervention, 31 (53%) signed informed consent to participate. Baseline HRQoL was on average 10 points higher in the intervention group compared with controls, although equally matched on baseline and clinical characteristics. When correcting for sex, age, disease stage, and baseline scores, an adjusted difference in fatigue of −5.09 (95% CI −15.20 to 5.02, P=.32) at month 3 was found. No significant nor clinically relevant adjusted differences on other HRQoL domains over time were found. However, information satisfaction was significantly higher in the CAPABLE group (β=8.71, 95% CI 1.54‐15.88, P=.02). Conclusions: The intervention showed a limited effect on HRQoL, although there was a small improvement in fatigue at 3 months, as well as information satisfaction. When aiming at personalized patient and survivorship care, further optimization and prospective investigation of eHealth tools is warranted. Trial Registration: ClinicalTrials NCT05827289; https://clinicaltrials.gov/study/NCT05827289 International Registered Report Identifier (IRRID): RR2-10.2196/49252 %R 10.2196/58938 %U https://cancer.jmir.org/2025/1/e58938 %U https://doi.org/10.2196/58938 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e57540 %T Effectiveness of an mHealth Intervention With Short Text Messages to Promote Treatment Adherence Among HIV-Positive Mexican Adults: Randomized Controlled Trial %A Del Moral Trinidad,Luis Eduardo %A Andrade Villanueva,Jaime Federico %A Martínez Ayala,Pedro %A Cabrera Silva,Rodolfo Ismael %A Herrera Godina,Melva Guadalupe %A González-Hernández,Luz Alicia %K HIV %K treatment adherence %K mobile health %K mHealth %K mHealth intervention %K randomized clinical trial %K text messages %K eHealth intervention %K sexual health %K randomized controlled trial %K RCT %D 2025 %7 28.1.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: HIV continues to be a public health concern in Mexico and Latin America due to an increase in new infections, despite a decrease being observed globally. Treatment adherence is a pillar for achieving viral suppression. It prevents the spread of the disease at a community level and improves the quality and survival of people living with HIV. Thus, it is important to implement strategies to achieve sustained treatment adherence. Objective: The objective of this study is to evaluate the effectiveness of a mobile health (mHealth) intervention based on SMS text messages to increase antiretroviral therapy (ART) adherence for HIV-positive adults. Methods: A randomized controlled trial was performed at the Hospital Civil de Guadalajara – Fray Antonio Alcalde on HIV-positive adults who had initiated ART. The mHealth intervention included the use of SMS text messages as a reminder system for upcoming medical examinations and ART resupply to increase adherence. This intervention was provided to 40 participants for a 6-month period. A control group (n=40) received medical attention by the standard protocol used in the hospital. Intervention effectiveness was assessed by quantifying CD4+ T cells and viral load, as well as a self-report of adherence by the patient. Results: The intervention group had greater adherence to ART than the control group (96% vs 92%; P<.001). In addition, the intervention group had better clinical characteristics, including a lower viral load (141 copies/mL vs 2413 copies/mL; P<.001) and a trend toward higher CD4+ T cells counts (399 cells/μL vs 290 cells/μL; P=.15). Conclusions: These results show that an mHealth intervention significantly improves ART adherence. Implementing mHealth programs could enhance the commitment of HIV-positive adults to their treatment. Trial Registration: ClinicalTrials.gov NCT05187741; https://clinicaltrials.gov/study/NCT05187741 %R 10.2196/57540 %U https://mhealth.jmir.org/2025/1/e57540 %U https://doi.org/10.2196/57540 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e47837 %T mHealth-Based Diabetes Prevention Program for Chinese Mothers With Abdominal Obesity: Randomized Controlled Trial %A Huang,Qinyuan %A Zhong,Qinyi %A Zeng,Yanjing %A Li,Yimeng %A Wiley,James %A Wang,Man Ping %A Chen,Jyu-Lin %A Guo,Jia %+ Xiangya School of Nursing, Central South University, No.172 Tongzipo Road, Yuelu District, Changsha, 410013, China, 86 13875947418, guojia621@163.com %K type 2 diabetes %K mHealth %K obesity %K prevention %K mothers %D 2025 %7 24.1.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Among people with abdominal obesity, women are more likely to develop diabetes than men. Mobile health (mHealth)–based technologies provide the flexibility and resource-saving opportunities to improve lifestyles in an individualized way. However, mHealth-based diabetes prevention programs tailored for busy mothers with abdominal obesity have not been reported yet. Objective: The aim of this study is to evaluate the feasibility and acceptability of an mHealth-based diabetes prevention program and its preliminary efficacy in reducing weight-related variables, behavioral variables, psychological variables, and diabetes risk among Chinese mothers with abdominal obesity over 6 months. Methods: A randomized controlled trial was conducted at health management centers in 2 tertiary hospitals in Changsha, China. The mHealth group (n=40) received 12 weekly web-based lifestyle modification modules for diabetes prevention, 6 biweekly individualized health education messages based on their goal settings, and a Fitbit tracker. The control group (n=40) received 12 weekly web-based general health education modules, 6 biweekly general health education messages, and a Fitbit tracker. Data were collected at baseline, 3 months, and 6 months on the feasibility and acceptability outcomes, weight-related variables (waist circumference and BMI), diabetes risk scores, glycemic levels, behavioral variables (daily step count, active minutes, fruit and vegetable intake, calorie consumption, and sleep duration), and psychological variables (self-efficacy and social support for physical activity and diet, perceived stress, and quality of life). Generalized estimating equations were used for data analysis. Results: Approximately 85% (68/80) of the participants completed 6 months of follow-up assessments. Regarding the feasibility and acceptance of the program in the mHealth group, the average number of modules reviewed was 7.9 out of 12, and the satisfaction score was 4.37 out of 5. Significant improvements at 6 months between the intervention and control groups were found in waist circumference (β=–2.24, 95% CI –4.12 to –0.36; P=.02), modifiable diabetes risk scores (β=–2.5, 95% CI –4.57 to –0.44; P=.02), daily steps (β=1.67, 95% CI 0.06-3.29; P=.04), self-efficacy for physical activity (β=1.93, 95% CI 0.44-3.43; P=.01), social support for physical activity (β=2.27, 95% CI 0.80-3.74; P=.002), and physical health satisfaction (β=0.82, 95% CI 0.08-1.55; P=.03). No differences were found in BMI, total diabetes risk score, daily active minutes, daily intake of fruits and vegetables, sleep duration, daily calorie consumption, self-efficacy, and social support for diet (P>.05). Conclusions: This study addresses the potential role of tailored lifestyle interventions based on mHealth technology by offering tailored web-based health modules and health information in managing diabetes risk among mothers with abdominal obesity. The mHealth diabetes prevention program provides a flexible, customized, and resource-saving model for busy mothers. Future research could further explore the efficacy improvement on dietary behaviors to better serve the health care needs of this population. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400090554; https://www.chictr.org.cn/showproj.html?proj=226411 %M 39854072 %R 10.2196/47837 %U https://mhealth.jmir.org/2025/1/e47837 %U https://doi.org/10.2196/47837 %U http://www.ncbi.nlm.nih.gov/pubmed/39854072 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e65313 %T Comparative- and Cost-Effectiveness Research Determining the Optimal Intervention for Advancing Transgender Women With HIV to Full Viral Suppression (Text Me, Alexis!): Protocol for a Randomized Controlled Trial %A Reback,Cathy J %A Blue,Thomas %A Jalali,Ali %A Landovitz,Raphael %A Li,Michael J %A Mata,Raymond P %A Ryan,Danielle %A Jeng,Philip J %A Murphy,Sean M %+ Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV, 575 Lexington Ave10FL, New York, New York, NY, 10022, United States, 1 6469622710, smm2010@med.cornell.edu %K HIV/AIDS %K transgender women %K SMS text messaging %K peer health navigation %K HIV Care Continuum %D 2025 %7 23.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Many transgender women with HIV achieve suboptimal advancement through the HIV Care Continuum, including poor HIV health care usage, retention in HIV medical care, and rates of viral suppression. These issues are exacerbated by comorbid conditions, such as substance use disorder, which is also associated with reduced quality of life, increased overdose deaths, usage of high-cost health care services, engagement in a street economy, and cycles of incarceration. Thus, it is critical that efforts to End the HIV Epidemic include effective interventions to link and retain transgender women in HIV care through full viral suppression. Objective: This study builds on the promising findings from our two Health Resources and Services Administration-funded demonstration projects, The Alexis Project and Text Me, Girl!, which used peer health navigation (PHN) and SMS text messaging, respectively, for advancing transgender women with HIV to full viral suppression. Though the effectiveness of both interventions has been established, their comparative effectiveness, required resources or costs, cost-effectiveness, and heterogeneous effects on subgroups, including those with substance use disorder, have not been evaluated. Given the many negative personal and public health consequences of untreated or undertreated HIV, and that HIV services for transgender women are frequently delivered in resource-limited, community-based settings, a comprehensive economic evaluation is critical to inform decisions of stakeholders, such as providers, insurers, and policy makers. Methods: Text Me, Alexis! is a 3-arm randomized controlled trial. Participants (N=195) will be randomized (1:1:1) into: PHN alone (n=65), SMS text messaging alone (n=65), or PHN+SMS text messaging (n=65). Using the same time points as the Health Resources and Services Administration demonstration projects, the repeated-measures design will assess participants at baseline, 3, 6, 12, and 18 months post randomization. Over the course of the 90 days, participants in the PHN arm will receive unlimited navigation sessions; participants in the SMS text messaging arm will receive 270 theory-based SMS text messages (3 messages daily) that are targeted, tailored, and personalized specifically for transgender women with HIV; and participants in the PHN+SMS text messaging arm will receive a combined PHN and SMS text message intervention. The desired outcome of Text Me, Alexis! is viral suppression and cost-effectiveness. Results: Recruitment began on April 10, 2024, and the first participant was enrolled on April 11, 2024. Data collection is expected to be completed in July 2027. Primary outcome analyses will begin immediately following the conclusion of the follow-up evaluations. Conclusions: Transgender women are a high-priority population for reaching End the HIV Epidemic goals. Findings have the potential to improve individual and population health outcomes by generating significant improvements in viral suppression among transgender women and guiding service provision and public policy. International Registered Report Identifier (IRRID): DERR1-10.2196/65313 %M 39847410 %R 10.2196/65313 %U https://www.researchprotocols.org/2025/1/e65313 %U https://doi.org/10.2196/65313 %U http://www.ncbi.nlm.nih.gov/pubmed/39847410 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55586 %T Patient-Centered mHealth Intervention to Improve Self-Care in Patients With Chronic Heart Failure: Phase 1 Randomized Controlled Trial %A Kitsiou,Spyros %A Gerber,Ben S %A Buchholz,Susan W %A Kansal,Mayank M %A Sun,Jiehuan %A Pressler,Susan J %+ University of Illinois Chicago, 1919 W Taylor Street, MC 530, Chicago, IL, 60612, United States, 1 312 355 3519, skitsiou@uic.edu %K mHealth %K app %K digital health %K telehealth %K text messaging %K smartphone %K wearable electronic devices %K heart failure %K self-care %K self-management %K randomized controlled trial %K cardiology %K SMS %D 2025 %7 15.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Heart failure (HF) is one of the most common causes of hospital readmission in the United States. These hospitalizations are often driven by insufficient self-care. Commercial mobile health (mHealth) technologies, such as consumer-grade apps and wearable devices, offer opportunities for improving HF self-care, but their efficacy remains largely underexplored. Objective: The objective of this study was to examine the feasibility, acceptability, safety, and preliminary efficacy of a patient-centered mHealth intervention (iCardia4HF) that integrates 3 consumer mHealth apps and devices (Heart Failure Health Storylines, Fitbit, and Withings) with a program of individually tailored SMS text messages to improve HF self-care. Methods: We conducted a phase 1 randomized controlled trial. Eligible patients had stage C HF, were aged ≥40 years, and had New York Heart Association (NYHA) class I, II, or III HF. Patients were randomly assigned to either iCardia4HF plus usual care or to usual care only and were observed for 8 weeks. Key feasibility measures were recruitment and retention rates. The primary efficacy outcome was change in HF self-care subscale scores (maintenance, symptom perception, and self-care management) at 8 weeks, assessed with the Self-Care Heart Failure Index (SCHFI; version 7.2). Key secondary outcomes were modifiable behaviors targeted by the intervention (health beliefs, self-efficacy, and HF knowledge), health status, and adherence to daily self-monitoring of 2 core vital signs (body weight and blood pressure). Results: A total of 27 patients were enrolled in the study and randomly assigned to iCardia4HF (n=13, 48%) or usual care (n=14, 52%). Of these 27 patients, 11 (41%) in the intervention group (iCardia4HF) and 14 (52%) in the usual care group started their assigned care and were included in the full analysis. Patients’ mean age was 56 (SD 8.3) years, 44% (11/25) were female, 92% (23/25) self-reported race as Black, 76% (19/25) had NYHA class II or III HF, and 60% (15/25) had HF with reduced left ventricular ejection fraction. Participant retention, completion of study visits, and adherence to using the mHealth apps and devices for daily self-monitoring were high (>80%). At 8 weeks, the mean group differences in changes in the SCHFI subscale scores favored the intervention over the control group: maintenance (Cohen d=0.19, 95% CI –0.65 to 1.02), symptom perception (Cohen d=0.33, 95% CI –0.51 to 1.17), and self-care management (Cohen d=0.25, 95% CI –0.55 to 1.04). The greatest improvements in terms of effect size were observed in self-efficacy (Cohen d=0.68) and health beliefs about medication adherence (Cohen d=0.63) and self-monitoring adherence (Cohen d=0.94). There were no adverse events due to the intervention. Conclusions: iCardia4HF was found to be feasible, acceptable, and safe. A larger trial with a longer follow-up duration is warranted to examine its efficacy among patients with HF. Trial Registration: ClinicalTrials.gov NCT03642275; https://clinicaltrials.gov/study/NCT03642275 %M 39813671 %R 10.2196/55586 %U https://www.jmir.org/2025/1/e55586 %U https://doi.org/10.2196/55586 %U http://www.ncbi.nlm.nih.gov/pubmed/39813671 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e57363 %T Enhancing HIV Cognitive Abilities and Self-Management Through Information Technology–Assisted Interventions: Scoping Review %A Huang,Hao %A Xie,MeiLian %A Yang,Zhen %A Wang,AiPing %+ First Hospital of China Medical University, The First Affiliated Hospital of China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001, China, 86 1399889 0800, apwang@cmu.edu.cn %K digital media %K self-management %K HIV %K AIDS %K scoping review %K technology-assisted interventions %K information technology %K behaviors %K patient %K electronic database %K information systems %K smartphone %K app %K SMS text messaging %K effectiveness %K mobile phone %D 2025 %7 13.1.2025 %9 Review %J J Med Internet Res %G English %X Background: HIV/AIDS remains a significant global challenge, and with the rapid advancement of technology, there has been an increasing number of interventions aimed at improving HIV/AIDS cognition and self-management behaviors among patients. However, there is still a lack of detailed literature integrating relevant evidence. Objective: This study aims to comprehensively review existing research on interventions using modern information methods to improve HIV/AIDS cognition and enhance self-management behaviors among patients. It systematically reports the theoretical frameworks and specific intervention strategies used in current research, providing a comprehensive overview of the development status of relevant studies. We aim to compile existing evidence through this scoping review to identify potential avenues for future research. Methods: We followed the scoping review framework proposed by the Joanna Briggs Institute for the synthesis and reporting of evidence. Relevant literature was searched using electronic databases, including PubMed, Web of Science, Embase, CINAHL, and Cochrane Library. The time frame for inclusion was from 2018 to December 1, 2023. Inclusion criteria were (1) interventions using modern information technology or new digital media, (2) studies focusing on improving HIV awareness or self-management behaviors among people living with HIV, (3) intervention studies or evaluations of intervention effects, and (4) studies published within the last five years. Two reviewers (HH and MX) independently assessed each study at both the title and abstract screening stage and the full-text review stage, resolving any disagreements through discussion. Results: A total of 55 studies that met the inclusion criteria were included. The Information-Motivation-Behavioral Skills model, Social Cognitive Theory, Health Belief Model, Theory of Planned Behavior, and Information Systems Research Framework are among the most commonly used theoretical frameworks. Modern information technology interventions are mainly constructed using smartphone apps, SMS text messaging, internet-based platforms, audiovisual materials, and digital health education platforms, with smartphone apps and SMS text messaging being the most widely used intervention media. Conclusions: Modern information technology is becoming an important tool for health interventions among people living with HIV/AIDS. However, future research should focus on integrating theoretical framework guidance with intervention design, further exploring the diversity of intervention implementations, the applicability of different technological methods, their long-term effects, and how to more effectively combine traditional intervention strategies to maximize intervention outcomes. %M 39805101 %R 10.2196/57363 %U https://www.jmir.org/2025/1/e57363 %U https://doi.org/10.2196/57363 %U http://www.ncbi.nlm.nih.gov/pubmed/39805101 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e64243 %T Text Messaging Versus Postal Reminders to Improve Participation in a Colorectal Cancer Screening Program: Randomized Controlled Trial %A Vives,Nuria %A Binefa,Gemma %A Travier,Noemie %A Farre,Albert %A Panera,Jon Aritz %A Casas,Berta %A Vidal,Carmen %A Ibáñez-Sanz,Gemma %A Garcia,Montse %A , %+ Catalan Institut of Oncology, Gran Via de L'Hospitalet 199-203, Hospitalet del Llobregat, 08908, Spain, 34 93 260 72 05, mgarcia@iconcologia.net %K text message %K mobile health %K colorectal cancer %K screening %K participation %K reminders %K text messaging %K colorectal cancer screening %K fecal immunochemical test %D 2025 %7 1.1.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone SMS text message reminders have shown moderate effects in improving participation rates in ongoing colorectal cancer screening programs. Objective: This study aimed to assess the effectiveness of SMS text messages as a replacement for routine postal reminders in a fecal immunochemical test–based colorectal cancer screening program in Catalonia, Spain. Methods: We conducted a randomized controlled trial among individuals aged 50 to 69 years who were invited to screening but had not completed their fecal immunochemical test within 6 weeks. The intervention group (n=12,167) received an SMS text message reminder, while the control group (n=12,221) followed the standard procedure of receiving a reminder letter. The primary outcome was participation within 18 weeks of the invitation. The trial was stopped early, and a recovery strategy was implemented for nonparticipants in the intervention group. We performed a final analysis to evaluate the impact of the recovery strategy on the main outcome of the trial. Participation was assessed using a logistic regression model adjusting for potential confounders (sex, age, and deprivation score index) globally and by screening behavior. Results: The trial was discontinued early in September 2022 due to the results of the interim analysis. The interim analysis included 5570 individuals who had completed 18 weeks of follow-up (intention-to-treat). The SMS text message group had a participation rate of 17.2% (477/2781), whereas the control group had a participation rate of 21.9% (610/2789; odds ratio 0.71, 95% CI 0.62-0.82; P<.001). As a recovery strategy, 7591 (72.7%) out of 10,442 nonparticipants in the SMS text message group had an open screening episode and received a second reminder by letter, reaching a participation rate of 23% (1748/7591). The final analysis (N=24,388) showed a participation rate of 29.3% (3561/12,167) in the intervention group, which received 2 reminders, while the participation rate was 26.5% (3235/12,221) in the control group (odds ratio 1.16, 95% CI 1.09-1.23; P<.001). Conclusions: Replacing SMS text messages with reminder letters did not increase the participation rate but also led to a decline in participation among nonparticipants 6 weeks after the invitation. However, sending a second reminder by letter significantly increased participation rates among nonparticipants within 6 weeks in the SMS text message group compared with those who received 1 postal reminder (control group). Additional research is essential to determine the best timing and frequency of reminders to boost participation without being intrusive in their choice of participation. Trial Registration: ClinicalTrials.gov NCT04343950; https://www.clinicaltrials.gov/study/NCT04343950 %M 39742454 %R 10.2196/64243 %U https://mhealth.jmir.org/2025/1/e64243 %U https://doi.org/10.2196/64243 %U http://www.ncbi.nlm.nih.gov/pubmed/39742454 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53613 %T Using Active and Passive Smartphone Data to Enhance Adolescents’ Emotional Awareness in Forensic Outpatient Setting: A Qualitative Feasibility and Usability Study %A Leijse,Merel M L %A van Dam,Levi %A Jambroes,Tijs %A Timmerman,Amber %A Popma,Arne %+ Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam UMC location Vrije Universiteit Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 020 8901000, m.m.l.leijse@amsterdamumc.nl %K emotion regulation %K emotion awareness %K smartphone data %K forensic outpatient youth care %K treatment motivation %K treatment alliance %K emotion %K behavioral %K interview %K mHealth %K app %K forensic %K usability %K feasibility %K delinquent %K pediatrics %K youth %K adolescent %K teenager %K experience %K attitude %K opinion %K perception %K perspective %K acceptance %K emoji %K behavioral data %K mobile phone %D 2024 %7 30.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Delinquent behavior in adolescence is a prevalent issue, often associated with difficulties across multiple life domains, which in turn perpetuates negative life outcomes. While current treatment programs show partial success in improving behavioral changes and reducing recidivism, comprehensive conclusions regarding the overall efficacy of these interventions have yet to be established. In forensic outpatient settings, the discrepancy between adolescents’ limited emotional awareness and the predominant emphasis on cognitive reflection, combined with low treatment adherence, may be factors that undermine treatment efficacy. New technologies, such as smartphone apps, may offer a solution by integrating real-life data into treatment to improve emotional and behavioral patterns. The low-threshold use of smartphone data can be useful in addressing these treatment challenges. Objective: This study aimed to explore the feasibility and usability of Feelee (Garage2020), a smartphone app that integrates active emoji and passive behavioral data, as a potential addition to treatment for adolescents in a forensic outpatient setting. Methods: We conducted a prepilot study with adolescents (n=4) who used the Feelee app over a 2-week period. App usage included completing a brief emoji survey 3 times a day (active data) and allowing Feelee to track the call logs, Bluetooth devices in proximity, cell tower IDs, app usage, and phone status (passive data). During treatment sessions, both adolescents and clinicians reviewed and discussed the active and passive data. Semistructured interviews were conducted with adolescents and clinicians (n=7) to gather experiences and feedback on the feasibility and usability of incorporating smartphone data into treatment. Results: The study showed that adolescents (n=3) succeeded in using Feelee for the full 2 weeks, and data were available for discussion in at least 1 session per participant. Both adolescents and clinicians (n=7) stated that Feelee was valuable for viewing, discussing, and gaining insight into their emotions, which facilitated targeted actions based on the Feelee data. However, neither adolescents nor clinicians reported increased engagement in treatment as a result of using Feelee. Despite technical issues, overall feedback on the Feelee app, in addition to treatment, was positive (n=7). However, further improvements are needed to address the high battery consumption and the inaccuracies in the accelerometer. Conclusions: This qualitative study provides an in-depth understanding of the potential benefits of integrating active and passive smartphone data for adolescents in a forensic outpatient setting. Feelee appears to contribute to a better understanding of emotions and behaviors, suggesting its potential value in enhancing emotional awareness in treatment. Further research is needed to assess Feelee’s clinical effectiveness and explore how it enhances emotional awareness. Recommendations from adolescents and clinicians emphasize the need for prepilot studies to address user issues, guiding technical improvements and future research in forensic outpatient settings. %M 39753211 %R 10.2196/53613 %U https://formative.jmir.org/2024/1/e53613 %U https://doi.org/10.2196/53613 %U http://www.ncbi.nlm.nih.gov/pubmed/39753211 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57774 %T mHealth Engagement for Antiretroviral Medication Adherence Among People With HIV and Substance Use Disorders: Observational Study %A Mi,Ranran Z %A Yang,Ellie Fan %A Tahk,Alexander %A Tarfa,Adati %A Cotter,Lynne M %A Lu,Linqi %A Yang,Sijia %A Gustafson Sr,David H %A Westergaard,Ryan %A Shah,Dhavan %+ School of Communication, Illinois State University, 4480 School Of Communication, FEL Fell Hall 434, Normal, IL, 61790, United States, 1 (309) 438 3671, fyang8@ilstu.edu %K information and communication technologies %K ICTs %K mHealth %K medication adherence %K HIV care %K antiretroviral therapy %K substance use %K social support %K patient management %K health disparities %K information technology %K communication technology %K mobile health %K app %K clinic %K United States %K participants %K mobile phone %D 2024 %7 20.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the increasing popularity of mobile health (mHealth) technologies, little is known about which types of mHealth system engagement might affect the maintenance of antiretroviral therapy among people with HIV and substance use disorders. Objective: This study aimed to use longitudinal and detailed system logs and weekly survey data to test a mediation model, where mHealth engagement indicators were treated as predictors, substance use and confidence in HIV management were treated as joint mediators, and antiretroviral therapy adherence was treated as the outcome. We further distinguished the initiation and intensity of system engagement by mode (expression vs reception) and by communication levels (intraindividual vs dyadic vs network). Methods: Tailored for people with HIV living with substance use disorders, the mHealth app was distributed among 208 participants aged >18 years from 2 US health clinics. Supervised by medical professionals, participants received weekly surveys through the app to report their health status and medication adherence data. System use was passively collected through the app, operationalized as transformed click-level data, aggregated weekly, and connected to survey responses with a 7-day lagged window. Using the weekly check-in record provided by participants as the unit of analysis (N=681), linear regression and structure equation models with cluster-robust SEs were used for analyses, controlling within-person autocorrelation and group-level error correlations. Racial groups were examined as moderators in the structure equation models. Results: We found that (1) intensity, not initiation, of system use; (2) dyadic message expression and reception; and (3) network expression positively predicted medication adherence through joint mediators (substance use and confidence in HIV management). However, intraindividual reception (ie, rereading saved entries for personal motivation) negatively predicts medication adherence through joint mediators. We also found Black participants have distinct usage patterns, suggesting the need to tailor mHealth interventions for this subgroup. Conclusions: These findings highlight the importance of considering the intensity of system engagement, rather than initiation alone, when designing mHealth interventions for people with HIV and tailoring these systems to Black communities. %M 39705693 %R 10.2196/57774 %U https://www.jmir.org/2024/1/e57774 %U https://doi.org/10.2196/57774 %U http://www.ncbi.nlm.nih.gov/pubmed/39705693 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51566 %T Effects of a Smartphone-Based Breastfeeding Coparenting Intervention Program on Breastfeeding-Related Outcomes in Couples During First Pregnancy: Randomized Controlled Trial %A Huang,Yi-Yan %A Wang,Rong %A Huang,Wei-Peng %A Wu,Tian %A Wang,Shi-Yun %A R. Redding,Sharon %A Ouyang,Yan-Qiong %+ School of Nursing, Wuhan University, 115 Donghu Rd, Wuchang District, Wuhan, 430072, China, 86 27 68759710, ouyangyq@whu.edu.cn %K breastfeeding %K co-parenting %K randomized controlled %K child %K efficacy %K depressive symptoms %D 2024 %7 17.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: A low breastfeeding rate causes an increased health care burden and negative health outcomes for individuals and society. Coparenting is an essential tactic for encouraging breastfeeding when raising a child. The efficacy of the coparenting interventions in enhancing breastfeeding-related outcomes is controversial. Objective: This study aimed to examine the effects of coparenting interventions on exclusive breastfeeding rates, exclusive breastfeeding duration, breastfeeding knowledge, parenting sense of competence, coparenting relationships, depressive symptoms in new couples at 1 and 6 months post partum, and the BMI of infants 42 days post partum. Methods: This was a randomized, single-blinded controlled clinical trial. Eligible couples in late pregnancy in a hospital in central China were randomly assigned to 2 groups. While couples in the control group received general care, couples in the intervention group had access to parenting classes, a fathers’ support group, and individual counseling. Data were collected at baseline (T0), 1 month post partum (T1), and 6 months post partum (T2). Data on exclusive breastfeeding rate and exclusive breastfeeding duration were analyzed using the chi-square, Fisher exact, or Mann-Whitney U tests; coparenting relationships and the infant’s BMI were analyzed using an independent samples t test; and breastfeeding knowledge, parenting sense of competence, and depressive symptoms were analyzed using a generalized estimation equation. Results: A total of 96 couples were recruited, and 79 couples completed the study. The intervention group exhibited significantly higher exclusive breastfeeding rates at T1 (90% vs 65%, P=.02) and T2 (43.6% vs 22.5%, P=.02), compared with the control group. Exclusive breastfeeding duration was extended in the intervention group than in the control group at T1 (30, range 30-30 days vs 30, range 26.5-30 days; P=.01) and T2 (108, range 60-180 days vs 89, range 28-149.3 days; P<.05). The intervention group exhibited greater improvements in maternal breastfeeding knowledge (β=.07, 95% CI 0.006-0.13; P=.03) and maternal parenting sense of competence (β=5.49, 95% CI 2.09-8.87; P<.01) at T1, enhanced coparenting relationships at T1 (P<.001) and T2 (P=.02), paternal breastfeeding knowledge at T2 (β=.25, 95% CI 0.15-0.35, P<.001), paternal parenting sense of competence at T1 (β=5.35, 95% CI 2.23-8.47, P<.01), and reduced paternal depressive symptoms at T2 (β=.25, 95% CI 0.15-0.35, P<.001), and there was a rise in infants’ BMI at 42 days post partum (β=.33, 95% CI 0.01-0.64, P=.04). Conclusions: An evidence-based breastfeeding coparenting intervention is effective in improving exclusive breastfeeding rate, prolonging exclusive breastfeeding duration within the initial 6 months post partum, enhancing parental breastfeeding knowledge, levels of parenting sense of competence and coparenting relationship, infant’s BMI, and reducing paternal depressive symptoms. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300069648; https://tinyurl.com/2p8st2p8 %M 39689308 %R 10.2196/51566 %U https://www.jmir.org/2024/1/e51566 %U https://doi.org/10.2196/51566 %U http://www.ncbi.nlm.nih.gov/pubmed/39689308 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59888 %T Don’t Forget the Humble Text Message: 25 Years of Text Messaging in Health %A Dobson,Rosie %A Whittaker,Robyn %A Abroms,Lorien C %A Bramley,Dale %A Free,Caroline %A McRobbie,Hayden %A Stowell,Melanie %A Rodgers,Anthony %+ School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand, 64 93737599, r.dobson@auckland.ac.nz %K text messaging %K messaging %K SMS %K texting %K mHealth %K mobile health %D 2024 %7 17.12.2024 %9 Viewpoint %J J Med Internet Res %G English %X Since the early studies exploring the use of SMS text messaging for health intervention, text messaging has played a pivotal role in the advancement of mobile health. As an intervention modality, text messaging has provided vital learnings for the design and delivery of interventions, particularly in low-resource settings. Despite the advances in technology over the last 25 years, text messaging is still being used in largely the same way to deliver health information, behavior change interventions, and support. The strong, consistent evidence for the benefits of this type of intervention has made text messaging a routine part of health interventions around the world. Key to its success is its simplicity, alongside the benefit of being arguably the most accessible form of consumer digital health intervention. Text message interventions are well suited for public health interventions due to their low cost, vast reach, frequent use, high read rates, and ability to be tailored and personalized. Furthermore, the nature of text messaging interventions makes them ideal for the delivery of multilingual, culturally tailored interventions, which is important in the context of increasing cultural diversity in many countries internationally. Indeed, studies assessing text message–based health interventions have shown them to be effective across sociodemographic and ethnic groups and have led to their adoption into national-level health promotion programs. With a growing focus on artificial intelligence, robotics, sensors, and other advances in digital health, there is an opportunity to integrate these technologies into text messaging programs. Simultaneously, it is essential that equity remains at the forefront for digital health researchers, developers, and implementers. Ensuring digital health solutions address inequities in health experienced across the world while taking action to maximize digital inclusion will ensure the true potential of digital health is realized. Text messaging has the potential to continue to play a pivotal role in the delivery of equitable digital health tools to communities around the world for many years to come. Further new technologies can build on the humble text message, leveraging its success to advance the field of digital health. This Viewpoint presents a retrospective of text messaging in health, drawing on the example of text message–based interventions for smoking cessation, and presents evidence for the continued relevance of this mobile health modality in 2025 and beyond. %M 39689299 %R 10.2196/59888 %U https://www.jmir.org/2024/1/e59888 %U https://doi.org/10.2196/59888 %U http://www.ncbi.nlm.nih.gov/pubmed/39689299 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e63416 %T Web-Based Parent Training With Telephone Coaching Aimed at Treating Child Disruptive Behaviors in a Clinical Setting During the COVID-19 Pandemic: Single-Group Study With 2-Year Follow-Up %A Sourander,Saana %A Westerlund,Minja %A Baumel,Amit %A Hinkka-Yli-Salomäki,Susanna %A Ristkari,Terja %A Kurki,Marjo %A Sourander,Andre %K parent training %K disruptive behavior %K child psychopathology %K child functioning %K behaviors %K behavioral %K coaching %K web-based %K family counseling %K child %K disruptive %K counseling %K training %K parents %K parenting %K telephone %K telehealth %K telemedicine %K pediatrics %K COVID-19 %D 2024 %7 16.12.2024 %9 %J JMIR Pediatr Parent %G English %X Background: There is a lack of studies examining the long-term outcomes of web-based parent training programs implemented in clinical settings during the COVID-19 pandemic. Objective: The aim is to study 2-year outcomes of families with 3‐ to 8-year-old children referred from family counseling centers to the Finnish Strongest Families Smart Website (SFSW), which provides digital parent training with telephone coaching aimed at treating child disruptive behaviors. Methods: Counseling centers in Helsinki identified fifty 3‐ to 8-year-old children with high levels of disruptive behavioral problems. Child psychopathology and functioning as well as parenting styles and parental mental health were collected from parents at baseline; posttreatment; and at 6-, 12-, and 24-month follow-ups. Results: The SFSW program had positive long-term changes in child psychopathology and parenting skills. Improvements in child psychopathology, including Strengths and Difficulties Questionnaire total score (Cohen d=0.47; P<.001), Strengths and Difficulties Questionnaire conduct scores (Cohen d=0.65; P<.001), and Affective Reactivity Index irritability scores (Cohen d=0.52; P<.001), were maintained until the 24-month follow-up. Similarly, changes in parenting skills measured with the Parenting Scale, including overreactivity (Cohen d=0.41; P=.001) and laxness (Cohen d=0.26; P=.02), were maintained until the 24-month follow-up. However, parental hostility changes were not maintained at long-term follow-up (Cohen d=−0.04; P=.70). Conclusions: The study shows that the SFSW parent training program can yield significant long-term benefits. Findings indicate that the benefits of the treatment may vary between different parenting styles, which is important to consider when developing more personalized parenting interventions. %R 10.2196/63416 %U https://pediatrics.jmir.org/2024/1/e63416 %U https://doi.org/10.2196/63416 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e66052 %T Evaluating the Effectiveness and Scalability of the World Health Organization MyopiaEd Digital Intervention: Mixed Methods Study %A Lee,Yeonsu %A Keel,Stuart %A Yoon,Sangchul %+ Department of Medical Humanities and Social Sciences, College of Medicine, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 2467, littleluke@yuhs.ac %K World Health Organization %K digital intervention %K MyopiaEd %K behavior change %K risk factor %K myopia %K refractive error %K mobile phone %D 2024 %7 16.12.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The rapid rise of myopia worldwide, particularly in East and Southeast Asia, has implied environmental influences beyond genetics. To address this growing public health concern, the World Health Organization and International Telecommunication Union launched the MyopiaEd program. South Korea, with its high rates of myopia and smartphone use, presented a suitable context for implementing and evaluating the MyopiaEd program. Objective: This is the first study to date to evaluate the effectiveness and scalability of the MyopiaEd program in promoting eye health behavior change among parents of children in South Korea. Methods: Parents of children aged 7 and 8 years were recruited through an open-access website with a recruitment notice distributed to public elementary schools in Gwangju Metropolitan City. Beginning in September 2022, parents received 42 SMS text messages from the MyopiaEd program over 6 months. This digital trial used a mixed methods approach combining both quantitative and qualitative data collection. Pre- and postintervention surveys were used to assess changes in parental knowledge and behavior regarding myopia prevention. Additionally, semistructured interviews were conducted to explore participants’ experiences in depth and receive feedback on program design. Prior to the intervention, the MyopiaEd program design and message libraries were adapted for the Korean context following World Health Organization and International Telecommunication Union guidelines. Results: A total of 133 parents participated in this study, including 60 parents whose children had myopia and 73 parents whose children did not. Both groups reported high engagement and satisfaction with the program. Significant increases in knowledge about myopia were observed in both groups (P<.001). While time spent on near-work activities did not change significantly, parents of children with myopia reported increased outdoor time for their children (P=.048). A substantial increase in eye checkups was observed, with 52 (86.7%) out of 60 children with myopia and 50 (68.5%) out of 73 children without myopia receiving eye examinations following the intervention. Qualitative analysis indicated a shift in parents’ attitudes toward outdoor activities, as increased recognition of their benefits prompted positive changes in behavior. However, reducing near-work activities posed challenges due to children’s preference for smartphone use during leisure periods and the demands of after-school academies. The credibility of the institution delivering the program enhanced parental engagement and children’s adoption of healthy behaviors. Messages that corrected common misconceptions about eye health and provided specific behavioral guidance were regarded as impactful elements of the program. Conclusions: This study demonstrates the MyopiaEd program’s potential as a scalable and innovative digital intervention to reduce myopia risk in children. The program’s effectiveness provides support for broader adoption and offers valuable insights to inform future myopia prevention policies. %M 39680893 %R 10.2196/66052 %U https://publichealth.jmir.org/2024/1/e66052 %U https://doi.org/10.2196/66052 %U http://www.ncbi.nlm.nih.gov/pubmed/39680893 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46860 %T Participant Adherence and Contact Behavior in a Guided Internet Intervention for Depressive Symptoms: Exploratory Study %A Bur,Oliver Thomas %A Berger,Thomas %K internet intervention %K depression %K guidance %K contact behavior %K messages %K adherence %K online %K intervention %K digital health %K therapy %K participant %D 2024 %7 16.12.2024 %9 %J JMIR Form Res %G English %X Background: The number of studies on internet-based guided self-help has rapidly increased during the last 2 decades. Guided self-help comprises 2 components: a self-help program that patients work through and usually weekly guidance from therapists who support patients using the self-management program. Little is known about participants' behavior patterns while interacting with therapists and their use of self-help programs in relation to intervention outcomes. Objective: This exploratory study aimed to investigate whether the number of messages sent to the therapist (ie, contact behavior) is an indicator of the outcome, that is, a reduction in depressive symptoms. Furthermore, we investigated whether adherence was associated with outcome. Most importantly, we investigated whether different combinations of adherence and contact behavior were associated with outcome. Methods: Drawing on a completer sample (n=113) from a randomized full factorial trial, participants were categorized into 4 groups. The groups were based on median splits of 2 variables, that is, the number of messages sent to therapists (low: groups 1 and 2; high: groups 3 and 4) and adherence (low: groups 1 and 3; high: groups 2 and 4). The 4 groups were compared in terms of change in depressive symptoms (measured with the Patient Health Questionnaire-9) from pre- to posttreatment and pretreatment to follow-up, respectively. Results: On average, participants sent 4.5 (SD 3.7) messages to their therapist and completed 18.2 (SD 5.2) pages of the program in 6.39 (SD 5.39) hours. Overall, analyses revealed no main effect for participants’ messages (H1=0.18, P=.67) but a significant main effect for adherence on changes in depressive symptoms from pre- to posttreatment (H1=5.10, P=.02). The combined consideration of adherence and messages sent to the therapist revealed group differences from pre- to posttreatment (H3=8.26, P=.04). Group 3 showed a significantly smaller improvement in symptoms compared with group 4 (Z=–2.84, P=.002). Furthermore, there were group differences from pretreatment to follow-up (H3=8.90, P=.03). Again, group 3 showed a significantly smaller improvement in symptoms compared with group 4 (Z=–2.62, P=.004) and group 2 (Z=–2.47, P=.007). All other group comparisons did not yield significant differences. Conclusion: This exploratory study suggests that participants characterized by low adherence and frequent messaging do not improve their symptoms as much as other participants. These participants might require more personalized support beyond the scope of guided internet interventions. The paper underscores the importance of considering individual differences in contact behavior when tailoring interventions. The results should be interpreted with caution and further investigated in future studies. Trial Registration: ClinicalTrials.gov NCT04318236; https://www.clinicaltrials.gov/study/NCT04318236 %R 10.2196/46860 %U https://formative.jmir.org/2024/1/e46860 %U https://doi.org/10.2196/46860 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e58920 %T Exploring and Predicting HIV Preexposure Prophylaxis Adherence Patterns Among Men Who Have Sex With Men: Randomized Controlled Longitudinal Study of an mHealth Intervention in Western China %A Lin,Bing %A Li,Jiayan %A Liu,Jiaxiu %A He,Wei %A Pan,Haiying %A Zhong,Xiaoni %K preexposure prophylaxis %K adherence %K trajectory analysis %K men who have sex with men %K mHealth %K mobile health %K mHealth intervention %K decision tree %D 2024 %7 12.12.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Preexposure prophylaxis (PrEP) is an effective strategy to reduce the risk of HIV infection. However, the efficacy of PrEP is highly dependent on adherence. Meanwhile, adherence changes over time, making it difficult to manage effectively. Objective: Our study aimed to explore and predict the patterns of change in PrEP adherence among men who have sex with men (MSM) and evaluate the impact of the WeChat-based reminder intervention on adherence, thus providing more information for PrEP implementation strategies. Methods: From November 2019 to June 2023, in a randomized controlled longitudinal study of the PrEP demonstration project in Western China (Chongqing, Sichuan, and Xinjiang) based on a mobile health (mHealth) reminder intervention, participants were randomly divided into reminder and no-reminder groups, with those in the reminder group receiving daily reminders based on the WeChat app. Participants were followed up and self-reported their medication adherence every 12 weeks for a total of 5 follow-up visits. We used the growth mixture model (GMM) to explore potential categories and longitudinal trajectories of adherence among MSM, and patterns of change in PrEP adherence were predicted and evaluated based on the decision tree. Results: A total of 446 MSM were included in the analysis. The GMM identified 3 trajectories of adherence: intermediate adherence group (n=34, 7.62%), low adherence ascending group (n=126, 28.25%), and high adherence decline group (n=286, 64.13%). We included 8 variables that were significant in the univariate analysis in the decision tree prediction model. We found 4 factors and 8 prediction rules, and the results showed that HIV knowledge score, education attainment, mHealth intervention, and HIV testing were key nodes in the patterns of change in adherence. After 10-fold cross-validation, the final prediction model had an accuracy of 75%, and the classification accuracy of low and intermediate adherence was 78.12%. Conclusions: The WeChat-based reminder intervention was beneficial for adherence. A short set of questions and prediction rules, which can be applied in future large-scale validation studies, aimed at developing and validating a short adherence assessment tool and implementing it in PrEP practices among MSM. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900026414; https://www.chictr.org.cn/showproj.html?proj=35077 %R 10.2196/58920 %U https://mhealth.jmir.org/2024/1/e58920 %U https://doi.org/10.2196/58920 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e57960 %T Results of a Digital Multimodal Motivational and Educational Program as Follow-Up Care for Former Cardiac Rehabilitation Patients: Randomized Controlled Trial %A Bretschneider,Maxi Pia %A Mayer-Berger,Wolfgang %A Weine,Jens %A Roth,Lena %A Schwarz,Peter E H %A Petermann,Franz %K mHealth %K apps %K digital technology %K digital interventions %K coronary heart disease %K lifestyle intervention %K cardiac rehabilitation %K quality of life %K cardiac care %D 2024 %7 11.12.2024 %9 %J JMIR Cardio %G English %X Background: Digital interventions are promising additions for both usual care and rehabilitation. Evidence and studies for the latter, however, are still rare. Objective: The aim of the study was to examine the app/web-based patient education program called “mebix” (previously called “Vision 2 – Gesundes Herz”) regarding its effectiveness in relation to the parameters of disease-specific quality of life (HeartQoL), cardiovascular risk profile (Cardiovascular Risk Management [CARRISMA]), and prognostic estimation of early retirement (Screening instrument work and occupation [SIBAR]) in 190 participants from a cardiological rehabilitation clinic. Methods: To evaluate mebix, 354 patients from the Roderbirken Clinic of the German Pension Insurance Rhineland (Germany) with a coronary heart diesase were recruited and randomized either to the intervention group (using mebix postrehabiliation for up to 12 months) or the control group (receiving standard care). The data collection took place at the end of inpatient rehabilitation (t0), as well as 6 months (t1) and 12 months (t2) after the end of rehabilitation. Analyses of variance are used to assess the overall significance of difference in outcome parameters between groups and over time. Results: The primary endpoint of disease-related quality of life shows a significant improvement of 7.35 points over the course of the intervention that is also more pronounced in the intervention group. Similarly, the 10-year risk of cardiovascular death and myocardial infarction showed significant improvements in the cardiovascular risk profile over time and between groups, indicating better results in the intervention group (ie, a reduction of −1.59 and −5.03, respectively). Positive effects on secondary outcomes like body weight, blood pressure, and number of smokers only showed time effects, indicating no difference between the groups. In addition, the SIBAR was significantly lower/better at the end of the observation period than at the beginning of the observation for both groups. Conclusions: Overall, the digital training program represents an effective follow-up offer after rehabilitation that could be incorporated into standard care to further improve disease-related quality of life and cardiovascular risk profiles. Trial Registration: German Clinical Trials Register DRKS00007569; https://drks.de/search/en/trial/DRKS00007569 %R 10.2196/57960 %U https://cardio.jmir.org/2024/1/e57960 %U https://doi.org/10.2196/57960 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56407 %T Text Messaging to Extend School-Based Suicide Prevention: Pilot Randomized Controlled Trial %A Pisani,Anthony R %A Wyman,Peter A %A Cero,Ian %A Kelberman,Caroline %A Gurditta,Kunali %A Judd,Emily %A Schmeelk-Cone,Karen %A Mohr,David %A Goldston,David %A Ertefaie,Ashkan %+ Department of Psychiatry, University of Rochester Medical Center, University of Rochester, 301 Crittenden Blvd, Rochester, NY, 14627, United States, 1 585 507 7177, anthony_pisani@urmc.rochester.edu %K suicide prevention %K text messaging %K self-violence %K self-harm %K suicidal behavior %K randomized controlled trial %K adolescent %K teenager %K student %K school %K United States %K Text4Strength %K help-seeking attitude %K coping %K awareness %K depression %K mood disorder %K mental health %D 2024 %7 6.12.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Suicide is the third-leading cause of death among US adolescents aged 10-19 years, and about 10% attempt suicide each year. School-based universal prevention may reduce youth suicidal behavior. Sources of Strength uses a peer leader network diffusion model to promote healthy norms across a school population. A key challenge within schoolwide programs is reaching a large and diverse array of students, especially those less engaged with their peers. Motivated by this challenge, we developed and field-tested Text4Strength—a program of automated text messages targeting help-seeking attitudes and norms, social coping resources, and emotion regulation skills. Objective: This study conducted a pilot randomized controlled trial of Text4Strength in 1 high school as an extension of an ongoing schoolwide program (Sources of Strength), to test its impact on targets that have the potential to reduce suicidal behavior. Methods: Students at an upstate New York high school (N=223) received 1-2 text messages per week for 9 weeks, targeting strategies for coping with difficult feelings and experiences through clarifying emotions and focusing on positive affect concepts, awareness, and strengthening of youth-adult relationships; and positive help-seeking norms, skills, and resources. Surveys were administered at baseline, immediately post intervention and 3 months after texting ended. We measured proximal intervention targets (methods of coping during stressful events, ability to make sense of their own emotions, feelings of powerlessness during emotion management and recovery, relations with trusted adults at school, and help-seeking behaviors), symptoms and suicide ideation, and student replies to messages. Results: No significant effects were observed for any outcome at either follow-up time point. Results showed that if there is a true (but undetected) intervention effect, it is small. Students with fewer friend nominations did not interact any more or less with the text messages. Exploratory moderation analyses observed no interaction between the intervention condition and the number of friends or baseline suicide ideation at any time point. Conclusions: In contrast to a promising previous field test, these results suggest that Text4Strength is unlikely to have impacted the outcomes of interest and that undetected moderate or large effects can be ruled out with high confidence. Although motivated by the need to reach more isolated students, students with fewer friends did not engage more or show a greater effect than other participants. This study was conducted in a single high school that was already implementing Sources of Strength, so the bar for showing a distinct effect from texting alone was high. Many further channels for reaching youth through private messaging remain unexplored. Alternative delivery systems should be investigated, such as embedding messaging in gaming chat systems and other media. More sophisticated systems drawing on chatbots may also achieve better outcomes. Trial Registration: ClinicalTrials.gov NCT03145363; https://clinicaltrials.gov/study/NCT03145363 %M 39642360 %R 10.2196/56407 %U https://mental.jmir.org/2024/1/e56407 %U https://doi.org/10.2196/56407 %U http://www.ncbi.nlm.nih.gov/pubmed/39642360 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e63454 %T Essential Coaching for Every Mother Tanzania (ECEM-TZ): Protocol for a Type 1 Hybrid Effectiveness-Implementation Randomized Controlled Trial %A Dol,Justine %A Mselle,Lilian Teddy %A Campbell-Yeo,Marsha %A Mbekenga,Columba %A Kohi,Thecla %A McMillan,Douglas %A Dennis,Cindy-Lee %A Tomblin Murphy,Gail %A Aston,Megan %+ IWK Health, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada, 1 9024707706, Justine.dol@dal.ca %K mobile health %K maternal health %K randomized controlled trial %K parenting self-efficacy %K self-efficacy %K maternal %K RCT %K mother %K text message %K coaching %K postnatal %K newborn %K child %K low-income country %K middle-income country %K Africa %K newborn care education %K nurse midwife %K Tanzania %D 2024 %7 5.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite global goals to improve maternal, newborn, and child health outcomes, mortality and morbidity continue to be a concern, particularly during the postnatal period in low- and middle-income countries. While mothers have the responsibility of providing ongoing care for newborns at home, they often receive insufficient newborn care education in Tanzania. Mobile health via text messaging is an ever-growing approach that may address this gap and provide timely education. Objective: We aim to evaluate a text message intervention called Essential Coaching for Every Mother Tanzania (ECEM-TZ) to improve maternal access to essential newborn care education during the immediate 6-week postnatal period. Methods: ECEM-TZ consists of standardized text messages from birth to 6 weeks post partum that provide evidence-based information on caring for their newborn and recognizing danger signs. Messages were developed and then reviewed by Tanzanian mothers and nurse midwives before implementation. A hybrid type 1 randomized controlled trial will compare ECEM-TZ to standard care among mothers (n=124) recruited from 2 hospitals in Dar es Salaam. The effectiveness outcomes include newborn care knowledge, maternal self-efficacy, breastfeeding self-efficacy, maternal mental health, attendance at the 6-week postnatal checkup, and newborn morbidity and mortality. The implementation outcomes include the reach and quality of implementation of the ECEM-TZ intervention. Results: Recruitment for this study occurred between June 13, 2024, and July 22, 2024. A total of 143 participants were recruited, 71 in the control and 72 in the intervention. The 6-week follow-up data collection began on July 30, 2024, and was completed on September 21, 2024. Conclusions: This study will generate evidence about the effectiveness of implementing text messaging during the early postnatal period and the feasibility of doing so in 2 hospitals in Dar es Salaam. The intervention has been designed in collaboration with mothers and nurse midwives in Tanzania. Trial Registration: ClinicalTrials.gov NCT05362305; https://clinicaltrials.gov/study/NCT05362305 International Registered Report Identifier (IRRID): DERR1-10.2196/63454 %M 39636672 %R 10.2196/63454 %U https://www.researchprotocols.org/2024/1/e63454 %U https://doi.org/10.2196/63454 %U http://www.ncbi.nlm.nih.gov/pubmed/39636672 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45763 %T Patient-Centric Mobile Medical Services Accessed Through Smartphones in the Top 100 Chinese Public Hospitals: Cross-Sectional Survey Study %A Huang,Xuan %A Wang,Ying %A Yang,Xixian %A Jiang,Ruo %A Liu,Yicheng %A Wang,Hui %+ Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China, 86 21 24058249, wangh2005@alumni.sjtu.edu.cn %K mobile health technology %K smartphones %K mobile phone %K internet hospital %K China %D 2024 %7 4.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphone-based technology has been used to enhance the delivery of health care services to the public in numerous countries. Objective: This study aims to investigate the application of patient-centric mobile medical services accessed through smartphones in the top 100 Chinese public hospitals. Methods: Data on 124 tertiary public hospitals, ranked among the top 100 by the China Hospital Science and Technology Evaluation Metrics of the Chinese Academy of Medical Sciences (2019) and China’s Hospital Rankings of the Hospital Management Institute of Fudan University (2019), were collected from the WeChat platform (Tencent Inc), mobile phone apps, and official websites until February 10, 2021. Results: A total of 124 tertiary public hospitals, all of which were among the top 100 hospitals according to the 2 ranking lists, were selected for this study. Almost all (122/124, 98.39%) of the hospitals offered basic services such as appointment scheduling, registration, and health education. The majority also provided online access to test reports (95/124, 76.61%), consultations (72/124, 58.06%), and prescriptions (61/124, 49.19%). Among the hospitals offering online prescriptions, the majority (54/61, 88.52%) supported home delivery through third-party carriers. Slightly less than half (57/124, 45.97%) used artificial intelligence for medical guidance. Only a small fraction (8/124, 6.45%) managed chronic diseases through online monitoring and supervision by experienced doctors. Approximately half (60/124, 48.39%) of the included hospitals were officially licensed as internet hospitals approved to provide full online services. Hospitals with official internet hospital licenses provided more extensive digital health offerings. A significantly higher proportion of approved hospitals offered online consultations (29.69% vs 88.33%, r=43.741; P<.001), test reports (62.5% vs 91.67%, r=14.703; P<.001), and chronic disease management (1.56% vs 11.67%, r=5.238; P<.05). These officially approved hospitals tended to provide over 6 mobile medical services, mainly in the regions of Shanghai and Guangdong. This geographic distribution aligned with the overall layout of hospitals included in the study. Conclusions: Patient-centric mobile medical services offered by the top 100 Chinese public hospitals accessed through smartphones primarily focus on online appointment scheduling, registration, health education, and accessing test reports. The most popular features include online consultations, prescriptions, medication delivery, medical guidance, and early-stage chronic disease management. Approved internet hospitals offer a significantly greater variety of patient-centric mobile medical services compared with unapproved ones. %M 39631758 %R 10.2196/45763 %U https://formative.jmir.org/2024/1/e45763 %U https://doi.org/10.2196/45763 %U http://www.ncbi.nlm.nih.gov/pubmed/39631758 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57708 %T Effectiveness and Acceptability of Asynchronous Digital Health in Asthma Care: Mixed Methods Systematic Review %A Uzzaman,Nazim %A Hammersley,Victoria %A McClatchey,Kirstie %A Sheringham,Jessica %A Singh,Diksha %A Habib,GM Monsur %A Pinnock,Hilary %+ Usher Institute, The University of Edinburgh, 5-7 Little France Road, The Usher Building, Edinburgh, EH16 4UX, United Kingdom, 44 01316517869, hilary.pinnock@ed.ac.uk %K digital health %K asthma %K asynchronous %K asthma care %K effectiveness %K acceptability %K mixed-methods review %K systematic review %K barrier %K remote synchronous %K chronic respiratory disease %K self-management %K digital technology %K asynchronous consultation %K caregiver %K PRISMA %D 2024 %7 3.12.2024 %9 Review %J J Med Internet Res %G English %X Background: Asynchronous digital health (eg, web-based portal, text, and email communication) can overcome practical barriers associated with in-person and remote synchronous (real-time) consultations. However, little is known about the effectiveness and acceptability of asynchronous digital health to support care for individuals with asthma (eg, asthma reviews). Objective: We aimed to systematically review the qualitative and quantitative evidence on the role of asynchronous digital health for asthma care. Methods: Following Cochrane methodology, we searched 6 databases (January 2001-July 2022; search update: September 2023) for quantitative, qualitative, or mixed methods studies supporting asthma care using asynchronous digital health. Screening and data extraction were duplicated. We assessed the risk of bias in the clinical outcomes of randomized controlled trials included in the meta-analysis using the revised Cochrane risk of bias tool. For the remaining studies, we evaluated the methodological quality using the Downs and Black checklist, critical appraisal skills program, and mixed methods appraisal tool for quantitative, qualitative, and mixed methods studies, respectively. We determined the confidence in the evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) criteria. We conducted a meta-analysis of trial data and a thematic analysis of qualitative data. Results: We included 30 studies (20 quantitative, 6 qualitative, and 4 mixed methods) conducted in 9 countries involving individuals with asthma, their caregivers, and health care professionals. Asynchronous digital consultations linked with other functionalities, compared to usual care, improved asthma control (standardized mean difference 0.32, 95% CI 0.02-0.63; P=.04) and reduced hospitalizations (risk ratio 0.36; 95% CI 0.14-0.94; P=.04). However, there were no significant differences in quality of life (standardized mean difference 0.16; 95% CI –0.12 to 0.43; P=.26) or emergency department visits (risk ratio 0.83; 95% CI 0.33-2.09; P=.69). Patients appreciated the convenience of asynchronous digital health, though health care professionals expressed concerns. Successful implementation necessitated an organizational approach. Integrative synthesis underscored the ease of asking questions, monitoring logs, and medication reminders as key digital functionalities. Conclusions: Despite low confidence in evidence, asynchronous consultation supported by digital functionalities is an effective and convenient option for nonemergency asthma care. This type of consultation, well accepted by individuals with asthma and their caregivers, offers opportunities for those facing challenges with traditional synchronous consultations due to lifestyle or geographic constraints. However, efficient organizational strategies are needed to manage the associated workload. Trial Registration: PROSPERO CRD42022344224; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=344224 International Registered Report Identifier (IRRID): RR2-10.1371/journal.pone.0281538 %M 39626243 %R 10.2196/57708 %U https://www.jmir.org/2024/1/e57708 %U https://doi.org/10.2196/57708 %U http://www.ncbi.nlm.nih.gov/pubmed/39626243 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e59630 %T An Ecological Momentary Assessment and Intervention Tool for Memory in Chronic Traumatic Brain Injury: Development and Usability of Memory Ecological Momentary Intervention %A Morrow,Emily L %A Nelson,Lyndsay A %A Duff,Melissa C %A Mayberry,Lindsay S %K chronic traumatic brain injury %K rehabilitation %K memory %K ecological momentary intervention %K text messaging %K mobile health %K mobile application %K digital health %K digital intervention %D 2024 %7 26.11.2024 %9 %J JMIR Rehabil Assist Technol %G English %X Background: Memory and learning deficits are among the most impactful and longest-lasting symptoms experienced by people with chronic traumatic brain injury (TBI). Despite the persistence of post-TBI memory deficits and their implications for community reintegration, memory rehabilitation is restricted to short-term care within structured therapy sessions. Technology shows promise to extend memory rehabilitation into daily life and to increase the number and contextual diversity of learning opportunities. Ecological momentary assessment and intervention frameworks leverage mobile phone technology to assess and support individuals’ behaviors across contexts and have shown benefits in other chronic conditions. However, few studies have used regular outreach via text messaging for adults with chronic TBI, and none have done so to assess and support memory. Objective: This study aimed to develop and test the usability of memory ecological momentary intervention (MEMI), a text message–based assessment and intervention tool for memory in daily life. MEMI is designed to introduce new information, cue retrieval of the information, and assess learning across time and contexts. We tested MEMI via an iterative, user-centered design process to ready it for a future trial. Methods: We developed MEMI by leveraging automated text messages for prompts using a REDCap (Research Electronic Data Capture)/Twilio interface linking to the Gorilla web-based behavioral experimental platform. We recruited 14 adults with chronic, moderate-severe TBI from the Vanderbilt Brain Injury Patient Registry to participate in 3 rounds of usability testing: one round of ThinkAloud sessions using the platform and providing real-time feedback to an experimenter (n=4) and 2 rounds of real-world usability testing in which participants used MEMI in their daily lives for a week and provided feedback (n=5/round). We analyzed engagement and quantitative and qualitative user feedback to assess MEMI’s usability and acceptability. Results: Participants were highly engaged with MEMI, completing an average of 11.8 out of 12 (98%) possible sessions. They rated MEMI as highly usable, with scores on the System Usability Scale across all rounds equivalent to an A+ on a standardized scale. In semistructured interviews, they stated that MEMI was simple and easy to use, that daily retrieval sessions were not burdensome, and that they perceived MEMI as helpful for memory. We identified a few small issues (eg, instruction wording) and made improvements between usability testing rounds. Conclusions: Testing MEMI with adults with chronic TBI revealed that this technology is highly usable and favorably rated for this population. We incorporated feedback regarding users’ preferences and plan to test the efficacy of this tool in a future clinical trial. %R 10.2196/59630 %U https://rehab.jmir.org/2024/1/e59630 %U https://doi.org/10.2196/59630 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e57328 %T The Development of Heart Failure Electronic-Message Driven Tips to Support Self-Management: Co-Design Case Study %A Ferguson,Caleb %A William,Scott %A Allida,Sabine M %A Fulcher,Jordan %A Jenkins,Alicia J %A Lattimore,Jo-Dee %A Loch,L-J %A Keech,Anthony %K heart failure %K co-design %K smartphone %K app design %K patient education %K e-TIPS %K electronic-message driven tips %D 2024 %7 7.11.2024 %9 %J JMIR Cardio %G English %X Background: Heart failure (HF) is a complex syndrome associated with high morbidity and mortality and increased health care use. Patient education is key to improving health outcomes, achieved by promoting self-management to optimize medical management. Newer digital tools like SMS text messaging and smartphone apps provide novel patient education approaches. Objective: This study aimed to partner with clinicians and people with lived experience of HF to identify the priority educational topic areas to inform the development and delivery of a bank of electronic-message driven tips (e-TIPS) to support HF self-management. Methods: We conducted 3 focus groups with cardiovascular clinicians, people with lived experience of HF, and their caregivers, which consisted of 2 stages: stage 1 (an exploratory qualitative study to identify the unmet educational needs of people living with HF; previously reported) and stage 2 (a co-design feedback session to identify educational topic areas and inform the delivery of e-TIPS). This paper reports the findings of the co-design feedback session. Results: We identified 5 key considerations in delivering e-TIPS and 5 relevant HF educational topics for their content. Key considerations in e-TIP delivery included (1) timing of the e-TIPS; (2) clear and concise e-TIPS; (3) embedding a feedback mechanism; (4) distinguishing actionable and nonactionable e-TIPS; and (5) frequency of e-TIP delivery. Relevant educational topic areas included the following: (1) cardiovascular risk reduction, (2) self-management, (3) food and nutrition, (4) sleep hygiene, and (5) mental health. Conclusions: The findings from this co-design case study have provided a foundation for developing a bank of e-TIPS. These will now be evaluated for usability in the BANDAIDS e-TIPS, a single-group, quasi-experimental study of a 24-week e-TIP program (personalized educational messages) delivered via SMS text messaging (ACTRN12623000644662). %R 10.2196/57328 %U https://cardio.jmir.org/2024/1/e57328 %U https://doi.org/10.2196/57328 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51527 %T Implementation of a Mobile Health Approach to a Long-Lasting Insecticidal Net Uptake Intervention for Malaria Prevention Among Pregnant Women in Tanzania: Process Evaluation of the Hati Salama (HASA) Randomized Controlled Trial Study %A Vey,Trinity %A Kinnicutt,Eleonora %A West,Nicola %A Sleeth,Jessica %A Nchimbi,Kenneth Bernard %A Yeates,Karen %+ Department of Medicine, Queen's University, 99 University Avenue, Kingston, ON, K7L 3P5, Canada, 1 6135332000, 16tv7@queensu.ca %K mHealth %K short message service %K behavior change communication %K pregnancy %K long-lasting insecticidal nets %K malaria %K protozoan infections %K parasitic diseases %K vector borne diseases %K insecticide %K intervention %K malaria prevention %D 2024 %7 5.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Malaria infection is associated with many adverse outcomes for pregnant women and neonates, yet pregnant women in East and Southern Africa remain frequently exposed to malaria. Long-lasting insecticidal nets (LLINs) can help prevent malarial infections and the associated adverse events. The Hati Salama (HASA) study was a cluster-randomized controlled trial implemented in 100 antenatal health facilities in urban and rural settings of Tanzania that provided pregnant women in both intervention and control groups with e-vouchers to redeem for LLINs for malaria prevention. The intervention group received behavior change communication mobile messages across a 14-day period while the e-voucher was active, and no significant difference between the rates of e-voucher redemption was found across the two groups. Objective: This study was a process evaluation of the HASA randomized controlled trial to determine barriers and facilitators to e-voucher reception and LLIN acquisition for pregnant women enrolled in the trial, as well as challenges and lessons learned by nurses who worked at the antenatal health facilities supporting the trial. Methods: Following the e-voucher’s expiration at 14 days, voluntary phone follow-up surveys were conducted for nurses who supported the trial, as well as participants in both intervention and control groups of the trial who did not redeem their e-vouchers. Survey questions asked nurses about workflow, training sessions, network connectivity, proxy phone use, and more. Surveys asked participants about reasons for not redeeming e-vouchers. Both surveys provided lists of preset answers to questions, as well as the option to provide open-ended responses. Nurses and trial participants were contacted between January and June 2016 on up to three occasions. Results: While nurses who supported the HASA trial seemed to recognize the value of the program in their communities, some barriers identified by nurses included network connectivity, workload increase, inadequate training and on-the-ground support, and difficulty following the workflow. Several barriers identified by trial participants included personal obligations preventing them from redeeming the e-voucher on time, network connectivity issues, losing the e-voucher number, no stock of LLINs at retailers when attended, inadequate explanation of where or how to redeem the e-voucher, or not receiving an SMS text message with the e-voucher number promptly or at all. Conclusions: Large-scale e-voucher platforms for health-related commodity interventions, such as LLIN distribution in sub-Saharan Africa, are feasible, but challenges, including network connectivity, must be addressed. Nurses identified issues to be considered in a future scale-up, such that the number of nurses trained should be increased and the e-voucher issuance workflow should be simplified. To address some of the key barriers impacting e-voucher redemption for trial participants, the network of retailers could be expanded and the e-voucher expiration period should be extended. Trial Registration: ClinicalTrials.gov NCT02561624; https://clinicaltrials.gov/ct2/show/NCT02561624 %M 39499551 %R 10.2196/51527 %U https://www.jmir.org/2024/1/e51527 %U https://doi.org/10.2196/51527 %U http://www.ncbi.nlm.nih.gov/pubmed/39499551 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e56475 %T Efficacy of a WeChat-Based, Multidisciplinary, Full-Course Nutritional Management Program on the Nutritional Status of Patients With Ovarian Cancer Undergoing Chemotherapy: Randomized Controlled Trial %A Tian,Xiaojuan %A Liu,Yan %A Zhang,Jiahua %A Yang,Lixiao %A Feng,Linyao %A Qi,Aidong %A Liu,Hanjiazi %A Liu,Pengju %A Li,Ying %K WeChat %K nutrition management %K ovarian cancer %K chemotherapy %K mobile health %D 2024 %7 4.11.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: As the most malignant type of cancer in the female reproductive system, ovarian cancer (OC) has become the second leading cause of death among Chinese women. Chemotherapy is the main treatment for patients with OC, and its numerous adverse effects can easily lead to malnutrition. It is difficult to centrally manage patients with OC in the intervals between chemotherapy. The use of WeChat, an effective mobile tool, in chronic disease management has been highlighted. Objective: This study aimed to implement a continuous follow-up strategy and health monitoring based on the WeChat platform for patients with OC undergoing chemotherapy to ensure that each phase of chemotherapy was delivered on schedule and to improve the survival rate of patients with OC. Methods: Participants were recruited and randomly assigned to either the WeChat-based nutrition intervention group or the usual care group. A self-administered general information questionnaire was used at enrollment to obtain basic information about the patients. The Patient-Generated Subjective Global Assessment (PG-SGA) Scale was used to investigate the nutritional status of the patients at 3 time points (T0=before the first admission to the hospital for chemotherapy, T1=2 weeks after the first chemotherapy, and T6=2 weeks after the sixth chemotherapy). The blood indices of patients were investigated through the inhospital health care system at 3 times（T0=before the first admission to the hospital for chemotherapy, T1=2 weeks after the first chemotherapy, and T6=2 weeks after the sixth chemotherapy). Patients in the intervention group were introduced to the nutrition applet, invited to join the nutrition management group chat, and allowed to consult on nutritional issues in private chats with nutrition management team members. Linear mixed models were used to analyze changes in each nutritional indicator in the 2 groups, with their baseline measurements as covariates; with group, time, and group-time interactions considered as fixed effects; and with patients considered as random effects. Results: A total of 96 patients with OC undergoing chemotherapy were recruited into the study. Distribution was based on a 1:1 ratio, with 48 patients each in the nutrition intervention group and the usual care group. The attrition rate after the first chemotherapy session was 18.75%. The mixed linear model revealed that the group-based effect and the group-time interaction effect on PG-SGA scores were significant (F38,38=4.763, P=.03; F37,37=6.368, P=.01), whereas the time-based effect on PG-SGA scores was not (F38,38=0.377; P=.54). The findings indicated that the group-based effect, the time-based effect, and the group-time interaction effect on nutrition-inflammation composite indices were significant (F38,38=7.653, P=.006; F38,38=13.309, P<.001; F37,37=92.304, P<.001; F37,38=110.675, P<.001; F38,38=10.379, P=.002; and F37,37=5.289, P=.02). Conclusions: This study provided evidence that a WeChat-based, multidisciplinary, full-course nutritional management program can significantly improve the nutritional status of patients with OC during chemotherapy. Trial Registration: ClinicalTrials.gov NCT06379191; https://clinicaltrials.gov/study/NCT06379191 %R 10.2196/56475 %U https://mhealth.jmir.org/2024/1/e56475 %U https://doi.org/10.2196/56475 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55706 %T Evaluating a WeChat-Based Intervention to Enhance Influenza Vaccination Knowledge, Attitude, and Behavior Among Chinese University Students Residing in the United Kingdom: Controlled, Quasi-Experimental, Mixed Methods Study %A Li,Lan %A Wood,Caroline E %A Kostkova,Patty %+ Centre for Digital Public Health in Emergencies, Department for Risk and Disaster Reduction, University College London, Gower Street, London, WC1E6BT, United Kingdom, 44 7529917633, lan.li.19@ucl.ac.uk %K influenza vaccination %K intervention study %K social media %K students %K health promotion %K mixed methods %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: University students, who often live in close quarters and engage in frequent social interaction, face a heightened risk of influenza morbidity. Still, vaccination rates among this group, particularly Chinese students, remain consistently low due to limited awareness and insufficient access to vaccinations. Objective: This study examines the effectiveness of a cocreated WeChat-based intervention that targets mainland Chinese university students in the United Kingdom, aiming to improve their knowledge, attitude, and behavior (KAB) toward seasonal influenza vaccination. Methods: A quasi-experimental mixed methods design was used, incorporating an intervention and comparison group, with baseline and follow-up self-reported surveys. The study was conducted from December 19, 2022, to January 16, 2023. The primary outcome is the KAB score, which was measured before and after the intervention phases. System-recorded data and user feedback were included in the analysis as secondary outcomes. A series of hypothesis testing methods were applied to test the primary outcomes, and path analysis was used to explore the relationships. Results: Our study included 596 students, of which 303 (50.8%) were in the intervention group and 293 (49.2%) were in the control group. The intervention group showed significant improvements in knowledge, attitude, and intended behavior scores over time, whereas the control group had only a slight increase in intended behavior scores. When comparing changes between the 2 groups, the intervention group displayed significant differences in knowledge and attitude scores compared to the control group, while intended behavior scores did not significantly differ. After the intervention, the actual vaccination rate was slightly higher in the intervention group (63/303, 20.8%) compared to the control group (54/293, 18.4%). Path analysis found that the intervention had a significant direct impact on knowledge but not on attitudes; knowledge strongly influenced attitudes, and both knowledge and attitudes significantly influenced intended behavior; and there was a strong correlation between intended and actual behavior. In the intervention group, participants expressed a high level of satisfaction and positive review of the content and its use. Conclusions: This study demonstrates how a WeChat intervention effectively improves KAB related to seasonal influenza vaccination among Chinese students, highlighting the potential of social media interventions to drive vaccination behavior change. It contributes to the broader research on digital health intervention effectiveness and lays the groundwork for tailoring similar interventions to different health contexts and populations. %M 39447171 %R 10.2196/55706 %U https://formative.jmir.org/2024/1/e55706 %U https://doi.org/10.2196/55706 %U http://www.ncbi.nlm.nih.gov/pubmed/39447171 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e60961 %T Preparing for the Implementation of Long-Acting Injectable Cabotegravir for HIV Pre-Exposure Prophylaxis Within the Brazilian Public Health System (ImPrEP CAB Brasil): Qualitative Study %A Pimenta,M Cristina %A Torres,Thiago Silva %A Hoagland,Brenda %A Cohen,Mirian %A Mann,Claudio Gruber %A Jalil,Cristina M %A Carvalheira,Eduardo %A Freitas,Lucilene %A Fernandes,Nilo %A Castanheira,Debora %A Benedetti,Marcos %A Moreira,Julio %A Simpson,Keila %A Trefiglio,Roberta %A O’Malley,Gabrielle %A Veloso,Valdilea G %A Grinsztejn,Beatriz %+ Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av Brasil 4365 Manguinhos, Rio de Janeiro, RJ 21040-900, Brazil, 55 21 38659623, thiago.torres@ini.fiocruz.br %K pre-exposure prophylaxis %K PrEP %K implementation %K public health system %K cabotegravir %K HIV prevention %K Latin America %K long-acting PrEP %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although long-acting, injectable cabotegravir (CAB-LA) pre-exposure prophylaxis (PrEP) has proven efficacious for HIV prevention in clinical trials, research is needed to guide effective implementation in real-world settings. Formative work with community members and health care providers (HCPs) is important to provide insight into the needs and contexts of specific populations and reveal potential barriers and facilitators for implementation projects. Objective: We aimed to describe the results from formative work to develop an implementation package for CAB-LA PrEP within the ImPrEP CAB Brasil study. Methods: ImPrEP CAB Brasil is an implementation study of same-day delivery of CAB-LA PrEP for young sexual and gender minority (SGM) groups (aged 18-30 years) in 6 existing oral PrEP public health clinics. We conducted formative research to prepare for the implementation of ImPrEP CAB Brasil through community mobilization, process mapping with HCPs with experience in CAB-LA, and focus group discussions (FGDs) with young SGM groups (n=92) and HCPs (n=20) to identify initial perceptions of facilitators and barriers for CAB-LA PrEP implementation, refine the mobile health (mHealth) educational tool, and evaluate the acceptability of using a text message appointment reminder intervention through WhatsApp. FGDs were recorded, transcribed, systematically coded, and analyzed with thematic categorization by trained researchers using a qualitative data analysis program ATLAS.ti (version 7). Results: A community mobilization team comprising 34 SGM community leaders collaborated in creating a prototype for an mHealth educational tool and contributed to the planning of peer education activities. We created 3 process maps for each site to describe the initial visit, follow-up visits, and laboratory flow. The main challenge identified for same-day CAB-LA PrEP delivery was the extended duration of clinic visits due to the numerous laboratory tests and HIV counseling steps required. Proposed solutions included having point-of-care HIV rapid tests instead of laboratory tests and additional counseling staff. Barriers for CAB-LA PrEP implementation identified through FGDs were the training of HCPs, support for adherence to injection appointments, and stigma or discrimination against SGM groups and persons using PrEP. The mHealth educational tool and WhatsApp reminders were highly acceptable by SGM groups and HCPs, indicating their potential to support PrEP choice and adherence. Content analysis on the cultural appropriateness of the language and overall clarity of the material contributed to the refinement of the mHealth tool. Conclusions: Structured formative work with SGM persons and HCPs generated important refinements to context-specific materials and plans to launch ImPrEP CAB Brasil in public health clinics. Ongoing implementation monitoring will use the process maps to identify additional barriers and potential solutions to same-day delivery of CAB-LA PrEP. Summative evaluations are needed to measure the effectiveness of the mHealth educational tool to support PrEP choice and the use of WhatsApp appointment reminders. %M 39446416 %R 10.2196/60961 %U https://publichealth.jmir.org/2024/1/e60961 %U https://doi.org/10.2196/60961 %U http://www.ncbi.nlm.nih.gov/pubmed/39446416 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e65692 %T Assessing the Usage and Usability of a Mental Health Advice Telephone Service in Uganda: Mixed Methods Study %A Kabukye,Johnblack K %A Nakku,Juliet %A Niwemuhwezi,Jackline %A Nsereko,James %A Namagembe,Rosemary %A Groen,Iris Dorothee Emilie %A Neumbe,Ritah %A Mubiru,Denis %A Kisakye,Caroline %A Nanyonga,Roseline %A Sjölinder,Marie %A Nilsson,Susanne %A Wamala-Larsson,Caroline %+ Swedish Program for ICT in Developing Regions (SPIDER), Department of Computer and Systems Science, Stockholm University, Borgarfjordsgatan 12, Kista, Stockholm, 164 55, Sweden, 46 8162000, kabukye@dsv.su.se %K mHealth %K mental health %K telephone service %K usability %K satisfaction %K evaluation %K mixed method %K Uganda %K Africa %D 2024 %7 21.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Harnessing mobile health (mHealth) solutions could improve the delivery of mental health services and mitigate their impact in Uganda and similar low-resource settings. However, successful adoption requires that mHealth solutions have good usability. We have previously implemented a telephone service to provide mental health information and advice in English and Luganda, utilizing an automated interactive voice response (IVR) system linked to live agents, including mental health care workers and peer support workers. Objective: This study aims to assess the usage and usability of this mental health telephone service. Methods: We obtained usage data from the system’s call logs over 18 months to study call volumes and trends. We then surveyed callers to gather their characteristics and assess usability using the Telehealth Usability Questionnaire. Additionally, call recordings were evaluated for conversation quality by 3 independent health care professionals, using the Telephone Nursing Dialogue Process, and correlations between quality and usability aspects were investigated. Results: Over 18 months, the system received 2863 meaningful calls (ie, calls that went past the welcome message) from 1125 unique telephone numbers. Of these, 1153 calls (40.27%) stopped at the prerecorded IVR information, while 1710 calls (59.73%) opted to speak to an agent. Among those who chose to speak with an agent, 1292 calls (75.56%) were answered, 393 calls (22.98%) went to voicemail and were returned in the following working days, and 25 calls (1.46%) were not answered. Usage was generally sustained over time, with spikes in call volume corresponding to marketing events. The survey (n=240) revealed that most callers were caregivers of patients with mental health issues (n=144, 60.0%) or members of the general public (n=46, 19.2%), while a few were patients with mental health issues (n=44, 18.3%). Additionally, the majority were male (n=143, 59.6%), spoke English (n=180, 75.0%), had postsecondary education (n=164, 68.3%), lived within 1 hour or less from Butabika Hospital (n=187, 77.9%), and were aged 25-44 years (n=160, 66.7%). The overall usability score for the system was 4.12 on a 5-point scale, significantly higher than the recommended target usability score of 4 (P=.006). The mean scores for usability components ranged from 3.66 for reliability to 4.41 for ease of use, with all components, except reliability, scoring higher than 4 or falling within its CI. Usability scores were higher for Luganda speakers compared with English speakers, but there was no association with other participant characteristics such as sex, distance from the hospital, age, marital status, duration of symptoms, or treatment status. The quality of call conversations (n=50) was rated at 4.35 out of 5 and showed a significant correlation with usability (Pearson r=0.34, P=.02). Conclusions: We found sustained usage of the mental health telephone service, along with a positive user experience and high satisfaction across various user characteristics. mHealth solutions like this should be embraced and replicated to enhance the delivery of health services in Uganda and similar low-resource settings. %M 39432895 %R 10.2196/65692 %U https://www.jmir.org/2024/1/e65692 %U https://doi.org/10.2196/65692 %U http://www.ncbi.nlm.nih.gov/pubmed/39432895 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e62762 %T WhatsApp Versus SMS for 2-Way, Text-Based Follow-Up After Voluntary Medical Male Circumcision in South Africa: Exploration of Messaging Platform Choice %A Fabens,Isabella %A Makhele,Calsile %A Igaba,Nelson Kibiribiri %A Hlongwane,Sizwe %A Phohole,Motshana %A Waweru,Evelyn %A Oni,Femi %A Khwepeya,Madalitso %A Sardini,Maria %A Moyo,Khumbulani %A Tweya,Hannock %A Wafula,Mourice Barasa %A Pienaar,Jacqueline %A Ndebele,Felex %A Setswe,Geoffrey %A Dong,Tracy Qi %A Feldacker,Caryl %+ International Training and Education Center for Health (I-TECH), Departments of Global Health and Medicine, University of Washington, 13th Floor, 908 Jefferson Street, Seattle, WA, 98104, United States, 1 206 221 4970, cfeld@uw.edu %K 2-way texting %K text messages %K WhatsApp %K digital health innovations %K male circumcision %K South Africa %K quality improvement %D 2024 %7 16.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Telehealth is growing, especially in areas where access to health facilities is difficult. We previously used 2-way texting (2wT) via SMS to improve the quality of postoperative care after voluntary medical male circumcision in South Africa. In this study, we offered males aged 15 years and older WhatsApp or SMS as their message delivery and interaction platform to explore user preferences and behaviors. Objective: The objectives of this process evaluation embedded within a larger 2wT expansion trial were to (1) explore 2wT client preferences, including client satisfaction, with WhatsApp or SMS; (2) examine response rates (participation) by SMS and WhatsApp; and (3) gather feedback from the 2wT implementation team on the WhatsApp approach. Methods: Males aged 15 years and older undergoing voluntary medical male circumcision in program sites could choose their follow-up approach, selecting 2wT via SMS or WhatsApp or routine care (in-person postoperative visits). The 2wT system provided 1-way educational messages and an open 2-way communication channel between providers and clients. We analyzed quantitative data from the 2wT database on message delivery platforms (WhatsApp vs SMS), response rates, and user behaviors using chi-square tests, z tests, and t tests. The team conducted short phone calls with WhatsApp and SMS clients about their perceptions of this 2wT platform using a short, structured interview guide. We consider informal reflections from the technical team members on the use of WhatsApp. We applied an implementation science lens using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to focus results on practice and policy improvement. Results: Over a 2-month period—from August to October, 2023—337 males enrolled in 2wT and were offered WhatsApp or SMS and were included in the analysis. For 2wT reach, 177 (53%) participants chose WhatsApp as their platform (P=.38). Mean client age was 30 years, and 253 (75%) participants chose English for automated messages. From quality assurance calls, almost all respondents (87/89, 98%) were happy with the way they were followed up. For effectiveness, on average for the days on which responses were requested, 58 (33%) WhatsApp clients and 44 (28%) SMS clients responded (P=.50). All 2wT team members believed WhatsApp limited the automated message content, language choices, and inclusivity as compared with the SMS-based 2wT approach. Conclusions: When presented with a choice of 2wT communication platform, clients appear evenly split between SMS and WhatsApp. However, WhatsApp requires a smartphone and data plan, potentially reducing reach at scale. Clients using both platforms responded to 2wT interactive prompts, demonstrating similar effectiveness in engaging clients in follow-up. For telehealth interventions, digital health designers should maintain an SMS-based platform and carefully consider adding WhatsApp as an option for clients, using an implementation science approach to present evidence that guides the best implementation approach for their setting. %M 39412842 %R 10.2196/62762 %U https://formative.jmir.org/2024/1/e62762 %U https://doi.org/10.2196/62762 %U http://www.ncbi.nlm.nih.gov/pubmed/39412842 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e58991 %T A Texting- and Internet-Based Self-Reporting System for Enhanced Vaccine Safety Surveillance With Insights From a Large Integrated Health Care System in the United States: Prospective Cohort Study %A Malden,Debbie E %A Gee,Julianne %A Glenn,Sungching %A Li,Zhuoxin %A Ryan,Denison S %A Gu,Zheng %A Bezi,Cassandra %A Kim,Sunhea %A Jazwa,Amelia %A McNeil,Michael M %A Weintraub,Eric S %A Tartof,Sara Y %+ Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA, 91101, United States, 1 310 456 4324, d.malden.11@aberdeen.ac.uk %K digital health %K survey participation %K vaccine safety monitoring %K COVID-19 vaccines %K vaccine %K vaccine safety %K vaccine monitoring %K text %K text message %K USA %K US %K surveillance %K internet based %K survey %K monitoring %K cohort study %K self-reporting %K vaccination %K COVID-19 vaccination %K medical records %K text-based surveys %K survey %K surveys %K surveillance system %K data collection %K disparity %K vulnerable %K EHR %K electronic health records %K mobile phone %D 2024 %7 11.10.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: SMS text messaging- and internet-based self-reporting systems can supplement existing vaccine safety surveillance systems, but real-world participation patterns have not been assessed at scale. Objective: This study aimed to describe the participation rates of a new SMS text messaging- and internet-based self-reporting system called the Kaiser Permanente Side Effect Monitor (KPSEM) within a large integrated health care system. Methods: We conducted a prospective cohort study of Kaiser Permanente Southern California (KPSC) patients receiving a COVID-19 vaccination from April 23, 2021, to July 31, 2023. Patients received invitations through flyers, SMS text messages, emails, or patient health care portals. After consenting, patients received regular surveys to assess adverse events up to 5 weeks after each dose. Linkage with medical records provided demographic and clinical data. In this study, we describe KPSEM participation rates, defined as providing consent and completing at least 1 survey within 35 days of COVID-19 vaccination. Results: Approximately, 8% (164,636/2,091,975) of all vaccinated patients provided consent and completed at least 1 survey within 35 days. The lowest participation rates were observed for parents of children aged 12-17 years (1349/152,928, 0.9% participation rate), and the highest participation was observed among older adults aged 61-70 years (39,844/329,487, 12.1%). Persons of non-Hispanic White race were more likely to participate compared with other races and ethnicities (13.1% vs 3.9%-7.5%, respectively; P<.001). In addition, patients residing in areas with a higher neighborhood deprivation index were less likely to participate (5.1%, 16,503/323,122 vs 10.8%, 38,084/352,939 in the highest vs lowest deprivation quintiles, respectively; P<.001). Invitations through the individual's Kaiser Permanente health care portal account and by SMS text message were associated with the highest participation rate (19.2%, 70,248/366,377 and 10.5%, 96,169/914,793, respectively), followed by email (19,464/396,912, 4.9%) and then QR codes on flyers (25,882/2,091,975, 1.2%). SMS text messaging–based surveys demonstrated the highest sustained daily response rates compared with internet-based surveys. Conclusions: This real-world prospective study demonstrated that a novel digital vaccine safety self-reporting system implemented through an integrated health care system can achieve high participation rates. Linkage with participants’ electronic health records is another unique benefit of this surveillance system. We also identified lower participation among selected vulnerable populations, which may have implications when interpreting data collected from similar digital systems. %M 39393058 %R 10.2196/58991 %U https://mhealth.jmir.org/2024/1/e58991 %U https://doi.org/10.2196/58991 %U http://www.ncbi.nlm.nih.gov/pubmed/39393058 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50748 %T 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 %A Hichborn,Emily %A Turner,Avery %A Moore,Sarah %A Gauthier,Phoebe %A Bell,Kathleen %A Montgomery,LaTrice %A Boggis,Jesse %A Lambert-Harris,Chantal %A Saunders,Elizabeth %A Dallery,Jesse %A McLeman,Bethany %A Marsch,Lisa %+ Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Suite 315, 46 Centerra Parkway, Lebanon, NH, 03766, United States, 1 603 646 7000, Emily.G.Hichborn@KU.Edu %K health disparities %K underrepresented %K social determinants of health %K tobacco use %K technology-based interventions %K scoping review %K mobile phone %D 2024 %7 10.10.2024 %9 Review %J J Med Internet Res %G English %X 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 %M 39388699 %R 10.2196/50748 %U https://www.jmir.org/2024/1/e50748 %U https://doi.org/10.2196/50748 %U http://www.ncbi.nlm.nih.gov/pubmed/39388699 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60171 %T Design of a Temporally Augmented Text Messaging Bot to Improve Adolescents’ Physical Activity and Engagement: Proof-of-Concept Study %A Ortega,Adrian %A Cushing,Christopher C %+ Center for Behavior Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Floor 10, 750 N Lakeshore Dr, Chicago, IL, 60611, United States, 1 8137326019, adrian.ortega@northwestern.edu %K digital intervention %K youth %K exercise %K SMS %K mHealth %K augmented text messaging %K bot %K adolescents %K adolescent %K physical activity %K engagement %K reliability %K physical activity intervention %K digital health %K digital support %K community %D 2024 %7 10.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital interventions hold promise for improving physical activity in adolescents. However, a lack of empirical decision points (eg, timing of intervention prompts) is an evidence gap in the optimization of digital physical activity interventions. Objective: The study examined the feasibility and acceptability, as well as the technical and functional reliability, of and participant engagement with a digital intervention that aligned its decision points to occur during times when adolescents typically exercise. This study also explored the impact of the intervention on adolescents’ moderate to vigorous physical activity (MVPA) levels. Consistent with the Obesity-Related Behavioral Interventions Trials (ORBIT) model, the primary goal of the study was to identify opportunities to refine the intervention for preparation for future trials. Methods: Ten adolescents completed a 7-day baseline monitoring period and Temporally Augmented Goal Setting (TAGS), a 20-day digital physical activity intervention that included a midday self-monitoring message that occurred when adolescents typically start to exercise (3 PM). Participants wore an accelerometer to measure their MVPA during the intervention. Participants completed questionnaires about the acceptability of the platform. Rates of recruitment and attrition (feasibility), user and technological errors (reliability), and engagement (average number of text message responses to the midday self-monitoring message) were calculated. The investigation team performed multilevel models to explore the effect of TAGS on MVPA levels from preintervention to intervention. In addition, as exploratory analyses, participants were matched to adolescents who previously completed a similar intervention, Network Underwritten Dynamic Goals Engine (NUDGE), without the midday self-monitoring message, to explore differences in MVPA between interventions. Results: The TAGS intervention was mostly feasible, acceptable, and technically and functionally reliable. Adolescents showed adequate levels of engagement. Preintervention to intervention changes in MVPA were small (approximately a 2-minute change). Exploratory analyses revealed no greater benefit of TAGS on MVPA compared with NUDGE. Conclusions: TAGS shows promise for future trials with additional refinements given its feasibility, acceptability, technical and functional reliability, participants’ rates of engagement, and the relative MVPA improvements. Opportunities to strengthen TAGS include reducing the burden of wearing devices and incorporating of other strategies at the 3 PM decision point. Further optimization of TAGS will inform the design of a Just-in-Time Adaptive Intervention for adolescent physical activity and prepare the intervention for more rigorous testing. %M 39388222 %R 10.2196/60171 %U https://formative.jmir.org/2024/1/e60171 %U https://doi.org/10.2196/60171 %U http://www.ncbi.nlm.nih.gov/pubmed/39388222 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60834 %T 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 %A Aguilera,Adrian %A Arévalo Avalos,Marvyn %A Xu,Jing %A Chakraborty,Bibhas %A Figueroa,Caroline %A Garcia,Faviola %A Rosales,Karina %A Hernandez-Ramos,Rosa %A Karr,Chris %A Williams,Joseph %A Ochoa-Frongia,Lisa %A Sarkar,Urmimala %A Yom-Tov,Elad %A Lyles,Courtney %+ School of Social Welfare, University of California Berkeley, 205 Haviland Hall, Berkeley, CA, 94709, United States, 1 510 642 8564, aguila@berkeley.edu %K digital health %K physical activity %K mobile phone %K text messages %K SMS %K steps %K walking %K diabetes %K depression %K reinforcement learning %K exercise %K machine learning %D 2024 %7 8.10.2024 %9 Original Paper %J J Med Internet Res %G English %X 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 %M 39378080 %R 10.2196/60834 %U https://www.jmir.org/2024/1/e60834 %U https://doi.org/10.2196/60834 %U http://www.ncbi.nlm.nih.gov/pubmed/39378080 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e53786 %T Predictors of Participation in a Perinatal Text Message Screening Protocol for Maternal Depression and Anxiety: Prospective Cohort Study %A Barnwell,Julia %A Hénault Robert,Cindy %A Nguyen,Tuong-Vi %A Davis,Kelsey P %A Gratton,Chloé %A Elgbeili,Guillaume %A Pham,Hung %A Meaney,Michael J %A Montreuil,Tina C %A O'Donnell,Kieran J %+ Yale Child Study Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT, 06520, United States, 1 203 785 2540, kieran.odonnell@yale.edu %K perinatal mental health %K digital screening %K maternal depression %K maternal anxiety %K text messaging %K mHealth %K mobile health %K pregnancy %K mobile phone %D 2024 %7 3.10.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Universal screening for depression and anxiety in pregnancy has been recommended by several leading medical organizations, but the implementation of such screening protocols may overburden health care systems lacking relevant resources. Text message screening may provide a low-cost, accessible alternative to in-person screening assessments. However, it is critical to understand who is likely to participate in text message–based screening protocols before such approaches can be implemented at the population level. Objective: This study aimed to examine sources of selection bias in a texting–based screening protocol that assessed symptoms of depression and anxiety across pregnancy and into the postpartum period. Methods: Participants from the Montreal Antenatal Well-Being Study (n=1130) provided detailed sociodemographic information and completed questionnaires assessing symptoms of depression (Edinburgh Postnatal Depression Scale [EPDS]) and anxiety (State component of the State-Trait Anxiety Inventory [STAI-S]) at baseline between 8 and 20 weeks of gestation (mean 14.5, SD 3.8 weeks of gestation). Brief screening questionnaires, more suitable for delivery via text message, assessing depression (Whooley Questions) and anxiety symptoms (Generalized Anxiety Disorder 2-Item questionnaire) were also collected at baseline and then via text message at 14-day intervals. Two-tailed t tests and Fisher tests were used to identify maternal characteristics that differed between participants who responded to the text message screening questions and those who did not. Hurdle regression models were used to test if individuals with a greater burden of depression and anxiety at baseline responded to fewer text messages across the study period. Results: Participants who responded to the text messages (n=933) were more likely than nonrespondents (n=114) to self-identify as White (587/907, 64.7% vs 39/96, 40.6%; P<.001), report higher educational attainment (postgraduate: 268/909, 29.5% vs 15/94, 16%; P=.005), and report higher income levels (CAD $150,000 [a currency exchange rate of CAD $1=US $0.76 is applicable] or more: 176/832, 21.2% vs 10/84, 11.9%; P<.001). There were no significant differences in symptoms of depression and anxiety between the 2 groups at baseline or postpartum. However, baseline depression (EPDS) or anxiety (STAI-S) symptoms did predict the total number of text message time points answered by participants, corresponding to a decrease of 1% (eβ=0.99; P<.001) and 0.3% (eβ=0.997; P<.001) in the number of text message time points answered per point increase in EPDS or STAI-S score, respectively. Conclusions: Findings from this study highlight the feasibility of text message–based screening protocols with high participation rates. However, our findings also highlight how screening and service delivery via digital technology could exacerbate disparities in mental health between certain patient groups. %M 39361419 %R 10.2196/53786 %U https://pediatrics.jmir.org/2024/1/e53786 %U https://doi.org/10.2196/53786 %U http://www.ncbi.nlm.nih.gov/pubmed/39361419 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55883 %T Efficacy of WeChat-Based Digital Intervention Versus Metformin in Women With Polycystic Ovary Syndrome: Randomized Controlled Trial %A Dilimulati,Diliqingna %A Shao,Xiaowen %A Wang,Lihua %A Cai,Meili %A Zhang,Yuqin %A Lu,Jiayi %A Wang,Yao %A Liu,Hongying %A Kuang,Ming %A Chen,Haibing %A Zhang,Manna %A Qu,Shen %+ Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China, 86 13774448495, mannazhang@126.com %K polycystic ovary syndrome %K insulin resistance %K digital intervention %K metformin %K women’s health %D 2024 %7 2.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The first-line treatment for polycystic ovary syndrome (PCOS) is lifestyle modification. However, it is currently unknown whether digital medicine can assist patients with PCOS in maintaining a healthy lifestyle while alleviating PCOS symptoms. Objective: This study aims to evaluate the efficacy of WeChat-based digital intervention versus metformin treatment in women with PCOS and insulin resistance. Methods: A total of 80 women with PCOS and insulin resistance were recruited from an endocrinology clinic and randomly assigned to receive either a WeChat-based digital intervention (n=40, 50%) or metformin (n=40, 50%) for 12 weeks. The WeChat-based digital intervention consisted of 3 modules; a coach assisted the patients in using the intervention. The primary outcome was the change in a homeostatic model assessment for insulin resistance. At baseline and after the 12-week intervention, anthropometric parameters, menstruation frequency, sex hormone levels, metabolic factors, and body fat distribution were measured in the clinic. Furthermore, self-assessed web-based questionnaires on diet, exercise, sleep, anxiety, and depression were obtained. Results: A total of 72 participants completed the follow-up (for a 90% follow-up rate), including 35 of 40 (88%) participants from the digital intervention group and 37 of 40 (93%) participants from the metformin group. The homeostatic model assessment for insulin resistance in the digital intervention group was significantly improved after 12 weeks of treatment with a mean change of –0.93 (95% CI –1.64 to –0.23), but no statistical difference was observed between the groups (least squares mean difference –0.20; 95% CI –0.98 to 0.58; P=.62). Both digital intervention and metformin treatment significantly improved menstruation frequency (digital intervention: P<.001; metformin: P<.001) and reduced body weight (digital intervention: P<.001; metformin: P<.001) and total fat mass (digital intervention: P<.001; metformin: P<.001). Furthermore, the digital intervention had a significant advantage over metformin in improving waist circumference (least squares mean difference –1.84; 95% CI –3.44 to –0.24; P=.03), waist-to-hip ratio (least squares mean difference –0.02; 95% CI –0.03 to 0.00; P=.03), total fat mass (least squares mean difference –1.59; 95% CI –2.88 to –0.30; P=.02), and dehydroepiandrosterone sulfate (least squares mean difference –69.73; 95% CI –129.70 to –9.75; P=.02). In terms of safety, the main adverse events were sensations of hunger in the digital intervention group (2/40, 5%) and gastrointestinal adverse events in the metformin group (12/40, 30%). Conclusions: Our data suggest that digital intervention is an effective treatment option for patients with PCOS, with an efficacy comparable to that of metformin, and that it can also alleviate the negative effects of medications and make it easier and more efficient to adhere to lifestyle treatments. WeChat-based digital interventions have the potential to provide a new path for the improvement and health of women with PCOS in China. Trial Registration: ClinicalTrials.gov NCT05386706; https://clinicaltrials.gov/study/NCT05386706 %M 39357046 %R 10.2196/55883 %U https://www.jmir.org/2024/1/e55883 %U https://doi.org/10.2196/55883 %U http://www.ncbi.nlm.nih.gov/pubmed/39357046 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e64092 %T Retention in HIV Primary Care Using a Web-Based Patient Engagement Platform: Multistate Case-Control Study %A Sukhija-Cohen,Adam Carl %A Patani,Henna %A Blasingame,Michael Foxworth %A Vu,Kathy Linh %A Bastani,Ramin %+ Sutter Health, Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, United States, 1 (650) 330 5963, adam.sukhija-cohen@sutterhealth.org %K HIV %K primary health care %K retention in care %K digital technology %K appointments and schedules %D 2024 %7 2.10.2024 %9 Short Paper %J J Med Internet Res %G English %X Background: Digital interventions to improve retention in HIV care are critical to ensure viral suppression and prevent further transmission. AIDS Healthcare Foundation Healthcare Centers are centers across the United States that provide primary HIV care. Traditionally, the Healthcare Centers conduct phone calls with patients to schedule and confirm appointments, as well as share laboratory results. In 2017, Healthvana piloted a digital platform at AIDS Healthcare Foundation Healthcare Centers to send patients SMS text message appointment reminders and allow patients to review their upcoming appointment and view their laboratory results in the web-based patient portal. Objective: A national implementation in 15 US states and Washington, DC, of this digital intervention pilot by Healthvana aims to determine whether SMS appointment reminders and web-based patient portal logins improved retention in care compared to traditional methods. Methods: A retrospective analysis of 40,028 patients living with HIV was conducted at the 61 AIDS Healthcare Foundation Healthcare Centers between January 2, 2017, and May 22, 2018. Patients were invited to enroll in Healthvana’s digital intervention pilot, allowing for a natural, organization-wide case-control study. Separate binary logistic regression models evaluated the relationship between receiving SMS appointment reminders and completing scheduled appointments, as well as the relationship between logging into the web-based patient portal and completing scheduled appointments. Four scheduled consecutive appointments for each patient were included in the analysis to account for 1 full year of data per patient. Results: Patients who received the SMS appointment reminder were 1.7 times more likely to complete appointment 1 compared to patients who did not receive the SMS appointment reminder (P<.001). In addition, patients who received the SMS appointment reminder were 1.6 times more likely to complete appointment 2 (P<.001), 1.7 times more likely to complete appointment 3 (P<.001), and 1.8 times more likely to complete appointment 4 (P<.001) compared to patients who did not receive the SMS appointment reminder. Patients who logged in to the web-based patient portal prior to their scheduled appointment were 7.4 times more likely to complete appointment 1 compared to patients who did not log in (P<.001). In addition, patients who logged in to the web-based patient portal prior to their scheduled appointment were 3.6 times more likely to complete appointment 2 (P<.001), 3.2 times more likely to complete appointment 3 (P<.001), and 2.8 times more likely to complete appointment 4 (P<.001) compared to patients who did not log in. Conclusions: HIV primary care appointment completion was higher when patients engaged with Healthvana’s digital platform. Digital technology interventions to ensure patients complete their scheduled HIV care appointments are imperative to curb the HIV epidemic. %M 39357049 %R 10.2196/64092 %U https://www.jmir.org/2024/1/e64092 %U https://doi.org/10.2196/64092 %U http://www.ncbi.nlm.nih.gov/pubmed/39357049 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e57635 %T Patient Engagement in a Mobile App–Based Rehabilitation Program for Total Hip or Knee Arthroplasty: Secondary Data Analysis of a Randomized Controlled Trial %A Wang,Qingling %A Lee,Regina Lai-Tong %A Hunter,Sharyn %A Zhu,Aiyong %A Chan,Sally Wai-Chi %+ School of Nursing and Health Management, Shanghai University of Medicine and Health Sciences, No. 279 Zhouzhu Highway, Pudong New Area, Shanghai, 201318, China, 86 13918170613, my_wql0719@163.com %K total hip arthroplasty %K total knee arthroplasty %K rehabilitation %K mobile health %K social media application %K patient engagement %D 2024 %7 1.10.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health care professionals use mobile apps to support patients’ rehabilitation after total hip or knee arthroplasty. Understanding patient engagement in such mobile health interventions can help tailor these interventions to better support patients. Objective: This study aimed to investigate patient engagement in a mobile app–based arthroplasty rehabilitation program and to investigate the association between patient engagement and their characteristics. Methods: Data were extracted from a pool of 42 participants in the experimental arm of a randomized controlled trial that used a mobile app (WeChat [Tencent Holdings Limited])–based program to support patients’ rehabilitation after total hip or knee arthroplasty. The primary outcomes were the number of days the participants accessed the program and completed recommended rehabilitation tasks. Secondary outcomes included data on the participants’ posts on a discussion forum, messages sent by the participants, access to the program components, and reading and sharing the program content. Generalized linear models were used to analyze the association between patient engagement and personal characteristics. Results: The participants reported in a rehabilitation diary accessing the program on a mean of 5.2 (SD 2) days per week and completing recommended rehabilitation tasks on a mean of 6.5 (SD 0.8) days per week. The majority (31/42, 74%) posted on the discussion forum, with a mean of 18.1 (SD 21.2) posts. Most participants (37/42, 88%) sent messages to health care professionals, with a mean of 14 (SD 15.9) messages. The program components were visited for a total of 525 times. The program content was read 898 times and shared 82 times in total. Generalized linear models showed that both primary outcomes, the number of days the participants accessed the program (B=6.46, 95% CI 1.98-15.35; χ21=11.1, P=.001) and the number of days they completed rehabilitation tasks (B=2.65, 95% CI 0.45-5.48; χ21=5.7, P=.02), were positively associated with having a high school education or above. In addition, the number of posts on the discussion forum was positively associated with living with family, having a high school education or above, undergoing total knee arthroplasty, having comorbidities, and the score of self-efficacy but was negatively associated with age. The number of messages sent by the participants was positively associated with having a high school education or above, having comorbidities, and the score of self-efficacy. Conclusions: Patient engagement in mobile arthroplasty rehabilitation is associated with their education level, cohabitation status, age, type of surgery, presence of comorbidities, and sense of self-efficacy. Program developers can consider these characteristics and use strategies, such as family involvement, in the design of mobile arthroplasty rehabilitation programs to enhance patient engagement in such interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000867897; https://tinyurl.com/mtdw25fp %M 39353187 %R 10.2196/57635 %U https://mhealth.jmir.org/2024/1/e57635 %U https://doi.org/10.2196/57635 %U http://www.ncbi.nlm.nih.gov/pubmed/39353187 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e44368 %T Psychological Health and Wellness and the Impact of a Supportive Text Messaging Program (Wellness4MDs) Among Physicians and Medical Learners in Canada: Protocol for a Longitudinal Study %A Shalaby,Reham %A Agyapong,Belinda %A Dias,Raquel %A Obuobi-Donkor,Gloria %A Adu,Medard K %A Spicer,Sharron %A Yanchar,Natalie L %A Agyapong,Vincent I O %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 780 215 7771, agyapong@ualberta.ca %K wellness %K doctors %K Canada %K depression %K burnout %K anxiety %K supportive text messages %K eHealth %D 2024 %7 16.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Burnout, anxiety, and depression continue to affect physicians, postgraduate medical trainees, and medical students globally and in Canada particularly after the COVID-19 pandemic. Objective: The primary goal of this project is to design, implement, monitor, and evaluate a daily supportive SMS text messaging program (Wellness4MDs, Global Psychological e-Health Foundation). The program aims to reduce the prevalence and severity of burnout, anxiety, and depression symptoms among physicians, postgraduate medical trainees, and medical students in Canada. Methods: This longitudinal study represents a multistakeholder, mixed methods, multiyear implementation science project. Project evaluation will be conducted through a quantitative prospective longitudinal approach using a paired sample comparison, a naturalistic cross-sectional controlled design, and satisfaction surveys. Prevalence estimates for psychological problems would be based on baseline data from self-completed validated rating scales. Additional data will be collected at designated time points for paired comparison. Outcome measures will be assessed using standardized rating scales, including the Maslach Burnout Inventory for burnout symptoms, the 9-item Patient Health Questionnaire for depression symptoms, the 7-item Generalized Anxiety Disorder scale for anxiety symptoms, and the World Health Organization–Five Well-Being Index. Results: The project launched in the last quarter of 2023, and program evaluation results will become available within 36 months. The Wellness4MDs program is expected to reduce the prevalence and severity of psychological problems among physicians in Canada and achieve high subscriber satisfaction. Conclusions: The results from the Wellness4MDs project evaluation will provide key information regarding the effectiveness of daily supportive SMS text messages and links to mental health resources on these mental health parameters in Canadian physicians, postgraduate trainees, and medical students. Information will be useful for informing policy and decision-making concerning psychological interventions for physicians in Canada. International Registered Report Identifier (IRRID): PRR1-10.2196/44368 %M 39283660 %R 10.2196/44368 %U https://www.researchprotocols.org/2024/1/e44368 %U https://doi.org/10.2196/44368 %U http://www.ncbi.nlm.nih.gov/pubmed/39283660 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56486 %T Nutrition Management Miniprograms in WeChat: Evaluation of Functionality and Quality %A Sun,Hui %A Wu,Yanping %A Sun,Jia %A Zhou,Wu %A Xu,Qian %A Hu,Dandan %K nutrition management %K WeChat mini-program %K User Version of the Mobile Application Rating Scale %K uMARS %K function and quality evaluation %D 2024 %7 12.9.2024 %9 %J JMIR Hum Factors %G English %X Background: With the rise in people’s living standards and aging populations, a heightened emphasis has been placed in the field of medical and health care. In recent years, there has been a drastic increase in nutrition management in domestic research circles. The mobile nutritional health management platform based on WeChat miniprograms has been widely used to promote health and self-management and to monitor individual nutritional health status in China. Nevertheless, there has been a lack of comprehensive scientific evaluation regarding the functionality and quality of the diverse range of nutritional miniprograms that have surfaced in the market. Objective: This study aimed to evaluate the functionality and quality of China’s WeChat nutrition management miniprogram by using the User Version of the Mobile Application Rating Scale (uMARS). Methods: This observational study involves quantitative methods. A keyword search for “nutrition,” “diet,” “food,” and “meal” in Chinese or English was conducted on WeChat, and all miniprograms pertaining to these keywords were thoroughly analyzed. Then, basic information including name, registration date, update date, service type, user scores, and functional scores was extracted from January 2017 to November 2023. Rating scores were provided by users based on their experience and satisfaction with the use of the WeChat miniprogram, and functional scores were integrated and summarized for the primary functions of each miniprogram. Moreover, the quality of nutrition management applets was evaluated by 3 researchers independently using the uMARS. Results: Initially, 27 of 891 miniprograms identified were relevant to nutrition management. Among them, 85.2% (23/27) of them offered features for diet management, facilitating recording of daily dietary intake to evaluate nutritional status; 70.4% (19/27) provided resources for nutrition education and classroom instruction; 59.3% (16/27) included functionalities for exercise management, allowing users to record daily physical activity; and only 44.4% (12/27) featured components for weight management. The total quality score on the uMARS ranged 2.85-3.88 (median 3.38, IQR 3.14-3.57). Engagement scores on the uMARS varied from 2.00 to 4.33 (median 3.00, IQR 2.67-3.67). Functional dimension scores ranged from 3.00 to 4.00 (median 3.33, IQR 3.33-3.67), with a lower score of 2.67 and a higher score of 4.33 outside the reference range. Aesthetic dimension scores ranged from 2.33 to 4.67 (median 3.67, IQR 3.33-4.00). Informational dimension scores ranged from 2.33 to 4.67 (median 3.33, IQR 2.67-3.67). Conclusions: Our findings from the uMARS highlight a predominant emphasis on health aspects over nutritional specifications in the app supporting WeChat miniprograms related to nutrition management. The quality of these miniprograms is currently at an average level, with considerable room for functional improvements in the future. %R 10.2196/56486 %U https://humanfactors.jmir.org/2024/1/e56486 %U https://doi.org/10.2196/56486 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59003 %T Comparing Email Versus Text Messaging as Delivery Platforms for Supporting Patients With Major Depressive Disorder: Noninferiority Randomized Controlled Trial %A Adu,Medard K %A Eboreime,Oghenekome %A Shalaby,Reham %A Eboreime,Ejemai %A Agyapong,Belinda %A da Luz Dias,Raquel %A Sapara,Adegboyega O %A Agyapong,Vincent I O %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor, Abbie J Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 17802157771, vn602367@dal.ca %K major depressive disorder %K Text4Support %K SMS text messaging %K email messaging %K digital health %K mental health %K mobile phone %K depressive disorder %K health communication %K global health %K treatments %K patient %K text messaging-based %K cognitive behavioral therapy %K communication %K effectiveness %K mental health support %K digital intervention %K digital interventions %K mental health care %K well-being %K depression symptoms %D 2024 %7 9.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of major depressive disorder (MDD) poses significant global health challenges, with available treatments often insufficient in achieving remission for many patients. Digital health technologies, such as SMS text messaging–based cognitive behavioral therapy, offer accessible alternatives but may not reach all individuals. Email communication presents a secure avenue for health communication, yet its effectiveness compared to SMS text messaging in providing mental health support for patients with MDD remains uncertain. Objective: This study aims to compare the efficacy of email versus SMS text messaging as delivery platforms for supporting patients with MDD, addressing a critical gap in understanding optimal digital interventions for mental health care. Methods: A randomized noninferiority pilot trial was conducted, comparing outcomes for patients receiving 6-week daily supportive messages via email with those receiving messages via SMS text message. This duration corresponds to a minimum of 180 days of message delivery. The supportive messages maintained consistent length and structure across both delivery methods. Participants (N=66) were recruited from the Access 24/7 clinic in Edmonton, Alberta, among those who were diagnosed with MDD. The outcomes were measured at baseline and 6 months after enrollment using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the World Health Organization Well-Being Index (WHO-5). Results: Most of the participants were females (n=43, 65%), aged between 26 and 40 years (n=34, 55%), had high school education (n=35, 58%), employed (n=33, 50%), and single (n=24, 36%). Again, most participants had had no history of any major physical illness (n=56, 85%) and (n=61, 92%) responded “No” to having a history of admission for treatment of mood disorders. There was no statistically significant difference in the mean changes in PHQ-9, GAD-7, and WHO-5 scores between the email and SMS text messaging groups (mean difference, 95% CI: –1.90, 95% CI –6.53 to 2.74; 5.78, 95% CI –1.94 to 13.50; and 11.85, 95% CI –3.81 to 27.51), respectively. Both supportive modalities showed potential in reducing depressive symptoms and improving quality of life. Conclusions: The study’s findings suggest that both email and SMS text messaging interventions have equivalent effectiveness in reducing depression symptoms among individuals with MDD. As digital technology continues to evolve, harnessing the power of multiple digital platforms for mental health interventions can significantly contribute to bridging the existing treatment gaps and improving the overall well-being of individuals with depressive conditions. Further research is needed with a larger sample size to confirm and expand upon these findings. Trial Registration: ClinicalTrials.gov NCT04638231; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552095/ %M 39250182 %R 10.2196/59003 %U https://formative.jmir.org/2024/1/e59003 %U https://doi.org/10.2196/59003 %U http://www.ncbi.nlm.nih.gov/pubmed/39250182 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55354 %T Using Text Messaging Surveys in General Practice Research to Engage With People From Low-Income Groups: Multi-Methods Study %A Sturgiss,Elizabeth %A Advocat,Jenny %A Barton,Christopher %A Walker,Emma N %A Nielsen,Suzanne %A Wright,Annemarie %A Lam,Tina %A Gunatillaka,Nilakshi %A Oad,Symrin %A Wood,Christopher %+ School of Primary and Allied Health Care, Monash University, Peninsula Campus, Moorooduc Highway, Frankston, 3199, Australia, 61 412233119, liz.sturgiss@monash.edu %K SMS %K data collection %K research methods %K disadvantaged population %K priority populations %K message %K messages %K messaging %K disadvantaged %K underserved %K survey %K surveys %K digital divide %K marginalized %K access %K accessibility %K barrier %K barriers %K smartphone %K smartphones %K digital health %K underrepresented %K data collection %K mobile phone %K short message service %D 2024 %7 5.9.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: SMS text messages through mobile phones are a common means of interpersonal communication. SMS text message surveys are gaining traction in health care and research due to their feasibility and patient acceptability. However, challenges arise in implementing SMS text message surveys, especially when targeting marginalized populations, because of barriers to accessing phones and data as well as communication difficulties. In primary care, traditional surveys (paper-based and online) often face low response rates that are particularly pronounced among disadvantaged groups due to financial limitations, language barriers, and time constraints. Objective: This study aimed to investigate the potential of SMS text message–based patient recruitment and surveys within general practices situated in lower socioeconomic areas. This study was nested within the Reducing Alcohol-Harm in General Practice project that aimed to reduce alcohol-related harm through screening in Australian general practice. Methods: This study follows a 2-step SMS text message data collection process. An initial SMS text message with an online survey link was sent to patients, followed by subsequent surveys every 3 months for consenting participants. Interviews were conducted with the local primary health network organization staff, the participating practice staff, and the clinicians. The qualitative data were analyzed using constructs from the Consolidated Framework for Implementation Research. Results: Out of 6 general practices, 4 were able to send SMS text messages to their patients. The initial SMS text message was sent to 8333 patients and 702 responses (8.2%) were received, most of which were not from a low-income group. This low initial response was in contrast to the improved response rate to the ongoing 3-month SMS text message surveys (55/107, 51.4% at 3 months; 29/67, 43.3% at 6 months; and 44/102, 43.1% at 9 months). We interviewed 4 general practitioners, 4 nurses, and 4 administrative staff from 5 of the different practices. Qualitative data uncovered barriers to engaging marginalized groups including limited smartphone access, limited financial capacity (telephone, internet, and Wi-Fi credit), language barriers, literacy issues, mental health conditions, and physical limitations such as manual dexterity and vision issues. Practice managers and clinicians suggested strategies to overcome these barriers, including using paper-based surveys in trusted spaces, offering assistance during survey completion, and offering honoraria to support participation. Conclusions: While SMS text message surveys for primary care research may be useful for the broader population, additional efforts are required to ensure the representation and involvement of marginalized groups. More intensive methods such as in-person data collection may be more appropriate to capture the voice of low-income groups in primary care research. International Registered Report Identifier (IRRID): RR2-10.3399/BJGPO.2021.0037 %M 39235843 %R 10.2196/55354 %U https://mhealth.jmir.org/2024/1/e55354 %U https://doi.org/10.2196/55354 %U http://www.ncbi.nlm.nih.gov/pubmed/39235843 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58726 %T Deceptively Simple yet Profoundly Impactful: Text Messaging Interventions to Support Health %A Suffoletto,Brian %+ Department of Emergency Medicine, Stanford University, 3145 Porter Drive Wing B, Palo Alto, CA, 94035, United States, 1 412 901 6892, suffbp@stanford.edu %K SMS intervention %K behavior %K intervention %K review %K text messaging %K SMS %K interventions %K behaviors %K behaviour %K behaviours %K effectiveness %K development %K impact %K narrative review %K physical activity %K diet %K weight loss %K mental health %K substance use %K meta-analysis %K chatbot %K chatbots %K large language model %K LLM %K large language models %K mobile phone %D 2024 %7 27.8.2024 %9 Viewpoint %J J Med Internet Res %G English %X This paper examines the use of text message (SMS) interventions for health-related behavioral support. It first outlines the historical progress in SMS intervention research publications and the variety of funds from US government agencies. A narrative review follows, highlighting the effectiveness of SMS interventions in key health areas, such as physical activity, diet and weight loss, mental health, and substance use, based on published meta-analyses. It then outlines advantages of text messaging compared to other digital modalities, including the real-time capability to collect information and deliver microdoses of intervention support. Crucial design elements are proposed to optimize effectiveness and longitudinal engagement across communication strategies, psychological foundations, and behavior change tactics. We then discuss advanced functionalities, such as the potential for generative artificial intelligence to improve user interaction. Finally, major challenges to implementation are highlighted, including the absence of a dedicated commercial platform, privacy and security concerns with SMS technology, difficulties integrating SMS interventions with medical informatics systems, and concerns about user engagement. Proposed solutions aim to facilitate the broader application and effectiveness of SMS interventions. Our hope is that these insights can assist researchers and practitioners in using SMS interventions to improve health outcomes and reducing disparities. %M 39190427 %R 10.2196/58726 %U https://www.jmir.org/2024/1/e58726 %U https://doi.org/10.2196/58726 %U http://www.ncbi.nlm.nih.gov/pubmed/39190427 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51690 %T Preferences for Text Messaging Supports During Youth Transition to Adult Mental Health Services: Theory-Informed Modified e-Delphi Study %A Vakili,Negar %A Curran,Janet A %A Walls,Roisin %A Phillips,Debbie %A Miller,Alanna %A Cassidy,Christine %A Wozney,Lori %+ Mental Health and Addictions, IWK Health, 5850/5980 University Avenue, Halifax, NS, PO Box 9700, Canada, 1 902 719 9285, lori.wozney@iwk.nshealth.ca %K patient satisfaction %K satisfaction %K cross-sectional %K survey %K surveys %K engagement %K usage %K technology use %K transitional %K transition %K coordinated care %K service %K services %K feature %K features %K need %K needs %K transitional care %K information science %K human-computer interaction %K health behavior %K text-messaging %K messaging %K text messages %K text message %K SMS %K mental health %K persuasive system design %K youth %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %D 2024 %7 27.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: For many young people, the transition from child to adult mental health services is a vulnerable time associated with treatment disengagement and illness progression. Providing service information and options to youth, appealing to them, and tailoring to their needs during this period could help overcome systematic barriers to a successful transition. We know little about how SMS text message–based interventions might be leveraged to support the motivational, informational, and behavioral needs of youth during this time. Ascertaining youth preferences for the content and functionality of an SMS text message service could inform prototype development. Objective: This study investigated consensus preferences among youth on important content, technology features, and engagement supports to inform a transition-focused SMS text message service. Methods: A modified e-Delphi survey design was used to collect demographics, current levels of technology use, importance ratings on message content, preferred technical features, and barriers and enablers to engagement for youth in Canada aged 16-26 years who have accessed mental health services within the past 5 years. Survey items on content were categorized according to the information-motivation-behavioral skills (IMB) model. Survey items on technical features were categorized according to the persuasive system design (PSD) model. A predefined consensus rating matrix and descriptive statistics were used to characterize the sample. The high consensus threshold was 70%. Results: A total of 100 participants, predominantly non-White (n=47, 47%), aged 20-26 years (n=59, 59%), and who had first accessed mental health services between the ages of 13 and 19 years (n=60, 60%), were selected. The majority (n=90, 90%) identified as daily SMS text message users. A high level of consensus on importance ratings was reported in 45% (9/20) of content items based on the IMB model. There were higher levels of consensus on importance ratings related to behavior domain items (3/3, 100%) than information domain items (4/9, 44%) or motivation domain items (2/8, 25%). A high level of consensus on importance ratings was reported in only 19% (4/21) of feature and functionality items based on the PSD model. Among PSD model categories, there was a high level of consensus on importance ratings in 8% (1/12) of the primary task support domain items and 100% (3/3) of the system credibility support domain items. None of the dialogue-support and social-support domain items met the high level of consensus thresholds. In total, 27% (27/100) of youth indicated that the most significant enabler for engaging with a transition-focused SMS text message intervention was the personalization of text messages. Conclusions: Scientists developing next-generation SMS text messaging interventions for this population need to consider how levels of consensus on different features may impact feasibility and personalization efforts. Youth can (and should) play an integral role in the development of these interventions. %M 39190437 %R 10.2196/51690 %U https://formative.jmir.org/2024/1/e51690 %U https://doi.org/10.2196/51690 %U http://www.ncbi.nlm.nih.gov/pubmed/39190437 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55625 %T Development and Use of Mobile Messaging for Individuals With Musculoskeletal Pain Conditions: Scoping Review %A Armfield,Nigel %A Elphinston,Rachel %A Liimatainen,Jenna %A Scotti Requena,Simone %A Eather,Chloe-Emily %A Edirippulige,Sisira %A Ritchie,Carrie %A Robins,Sarah %A Sterling,Michele %+ RECOVER Injury Research Centre, The University of Queensland, Level 7, Surgical, Treatment and Rehabilitation Service, 296 Herston Road, Brisbane, 4029, Australia, 61 733655560, N.R.Armfield@uq.edu.au %K musculoskeletal %K pain %K SMS text messaging %K mobile health %K mHealth %K intervention design %K design %K scoping review %K musculoskeletal pain %K development %K mobile messaging %K behavior change %K efficacy %K effectiveness %K messaging %K implementation %K sustainability %K mobile phone %D 2024 %7 14.8.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Population studies show that musculoskeletal conditions are a leading contributor to the total burden of healthy life lost, second only to cancer and with a similar burden to cardiovascular disease. Prioritizing the delivery of effective treatments is necessary, and with the ubiquity of consumer smart devices, the use of digital health interventions is increasing. Messaging is popular and easy to use and has been studied for a range of health-related uses, including health promotion, encouragement of behavior change, and monitoring of disease progression. It may have a useful role to play in the management and self-management of musculoskeletal conditions. Objective: Previous reviews on the use of messaging for people with musculoskeletal conditions have focused on synthesizing evidence of effectiveness from randomized controlled trials. In this review, our objective was to map the musculoskeletal messaging literature more broadly to identify information that may inform the design of future messaging interventions and summarize the current evidence of efficacy, effectiveness, and economics. Methods: Following a prepublished protocol developed using the Joanna Briggs Institute Manual for Evidence Synthesis, we conducted a comprehensive scoping review of the literature (2010-2022; sources: PubMed, CINAHL, Embase, and PsycINFO) related to SMS text messaging and app-based messaging for people with musculoskeletal conditions. We described our findings using tables, plots, and a narrative summary. Results: We identified a total of 8328 papers for screening, of which 50 (0.6%) were included in this review (3/50, 6% previous reviews and 47/50, 94% papers describing 40 primary studies). Rheumatic diseases accounted for the largest proportion of the included primary studies (19/40, 48%), followed by studies on multiple musculoskeletal conditions or pain sites (10/40, 25%), back pain (9/40, 23%), neck pain (1/40, 3%), and “other” (1/40, 3%). Most studies (33/40, 83%) described interventions intended to promote positive behavior change, typically by encouraging increased physical activity and exercise. The studies evaluated a range of outcomes, including pain, function, quality of life, and medication adherence. Overall, the results either favored messaging interventions or had equivocal outcomes. While the theoretical underpinnings of the interventions were generally well described, only 4% (2/47) of the papers provided comprehensive descriptions of the messaging intervention design and development process. We found no relevant economic evaluations. Conclusions: Messaging has been used for the care and self-management of a range of musculoskeletal conditions with generally favorable outcomes reported. However, with few exceptions, design considerations are poorly described in the literature. Further work is needed to understand and disseminate information about messaging content and message delivery characteristics, such as timing and frequency specifically for people with musculoskeletal conditions. Similarly, further work is needed to understand the economic effects of messaging and practical considerations related to implementation and sustainability. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-048964 %M 39141913 %R 10.2196/55625 %U https://mhealth.jmir.org/2024/1/e55625 %U https://doi.org/10.2196/55625 %U http://www.ncbi.nlm.nih.gov/pubmed/39141913 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e51570 %T Development and Implementation of Postdischarge Text Messages to Adolescents With Suicidal Thoughts and Behaviors Through Caring Contacts: Implementation Study %A Thomas,Glenn V %A Camacho,Elena %A Masood,Fatimah A %A Huang,Yungui %A Valleru,Jahnavi %A Bridge,Jeffrey A %A Ackerman,John %+ Behavioral Health Services, Nationwide Children’s Hospital, 444 Butterfly Gardens Dr., 2nd Fl., Columbus, OH, 43215, United States, 1 6143550814, John.Ackerman@nationwidechildrens.org %K mental health %K suicide prevention %K adolescent %K caring contacts %K mHealth %K Zero Suicide %K quality improvement %K care transitions %K safety plan %K behavioral health %K mobile phone %D 2024 %7 13.8.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Youth suicide is a pressing public health concern, and transitions in care after a suicidal crisis represent a period of elevated risk. Disruptions in continuity of care and emotional support occur frequently. “Caring contacts” validating messages post discharge have the potential to enhance connections with patients and have been shown to improve outcomes. More recently, positive outcomes have been noted using caring contact text messages (SMS and MMS), which hold promise for engaging patients in a pediatric setting, but there are few studies describing the large-scale implementation of such an approach. Objective: This study aims to describe the process of developing and implementing automated caring contacts within a quality improvement framework, using a standardized series of supportive texts and images, for adolescents discharged from high-acuity programs at a large midwestern pediatric hospital. We describe lessons learned, including challenges and factors contributing to success. Methods: We implemented the caring contacts intervention in 3 phases. Phase 1 entailed developing supportive statements and images designed to promote hope, inclusivity, and connection in order to create 2 sets of 8 text messages and corresponding images. Phase 2 included piloting caring contacts manually in the hospital’s Psychiatric Crisis Department and Inpatient Psychiatry Unit and assessing the feasibility of implementation in other services, as well as developing workflows and addressing legal considerations. Phase 3 consisted of implementing an automated process to scale within 4 participating hospital services and integrating enrollment into the hospital’s electronic medical records. Process outcome measures included staff compliance with approaching and enrolling eligible patients and results from an optional posttext survey completed by participants. Results: Compliance data are presented for 4062 adolescent patients eligible for caring contacts. Overall, 88.65% (3601/4062) of eligible patients were approached, of whom 52.43% (1888/3601) were enrolled. In total, 94.92% (1792/1888) of enrolled participants completed the program. Comparisons of the patients eligible, approached, enrolled, and completed are presented. Primary reasons for eligible patients declining include not having access to a mobile phone (686/1705, 40.23%) and caregivers preferring to discuss the intervention at a later time (754/1705, 44.22%). The majority of patients responding to the optional posttext survey reported that the texts made them feel moderately to very hopeful (219/264, 83%), supported (232/264, 87.9%), that peers would be helped by these texts (243/264, 92%), and that they would like to keep receiving texts given the option (227/264, 86%). Conclusions: This study describes the successful implementation of automated postdischarge caring contacts texts to scale with an innovative use of images and demonstrates how a quality improvement methodology resulted in a more effective and efficient process. This paper also highlights the potential for technology to enhance care for at-risk youth and create more accessible, inclusive, and sustainable prevention strategies. %M 39137019 %R 10.2196/51570 %U https://pediatrics.jmir.org/2024/1/e51570 %U https://doi.org/10.2196/51570 %U http://www.ncbi.nlm.nih.gov/pubmed/39137019 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59224 %T An Automated Text Messaging Intervention to Reduce Substance Use Self-Stigma (Project RESTART): Protocol for a Feasibility and Acceptability Pilot Study %A Sibley,Adams L %A Noar,Seth M %A Muessig,Kathryn E %A O'Shea,Nisha G %A Paquette,Catherine E %A Spears,Abby G %A Miller,William C %A Go,Vivian F %+ Department of Health Behavior, University of North Carolina-Chapel Hill, 302 Rosenau Hall CB# 7400, 135 Dauer Dr., Chapel Hill, NC, 27599, United States, 1 919 966 3761, asibley@live.unc.edu %K substance use %K harm reduction %K stigma %K self-stigma %K stigma resistance %K mobile health %K mHealth %K SMS text messaging %K mobile phone %D 2024 %7 9.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Stigma is a barrier to treatment and harm reduction seeking in people who use drugs. Most stigma reduction interventions offer psychotherapy or psychoeducation in group-based clinical settings, failing to reach people who are not in treatment. SMS text messaging is an effective and acceptable modality for delivering health information to people who use drugs and may be a suitable conduit for providing information and advice to understand and cope with stigma. Objective: This paper presents the protocol for a study that aims to determine the feasibility, acceptability, and preliminary effectiveness of a 4-week automated SMS text message intervention to increase stigma resistance and reduce self-stigma in people who use drugs. Methods: We designed a novel automated SMS text message intervention to address the four personal-level constructs of stigma resistance: (1) not believing stigma and catching and challenging stigmatizing thoughts, (2) empowering oneself through learning about substance use and one’s recovery, (3) maintaining one’s recovery and proving stigma wrong, and (4) developing a meaningful identity and purpose apart from one’s substance use. Theory-based messages were developed and pilot-tested in qualitative elicitation interviews with 22 people who use drugs, resulting in a library of 56 messages. In a single-group, within-subjects, community-based pilot trial, we will enroll 30 participants in the Resisting Stigma and Revaluating Your Thoughts (RESTART) intervention. Participants will receive 2 daily SMS text messages for 4 weeks. Implementation feasibility will be assessed through recruitment, enrollment, retention, and message delivery statistics. User feasibility and acceptability will be assessed at follow-up using 23 survey items informed by the Theoretical Framework of Acceptability. Primary effectiveness outcomes are changes in self-stigma (Substance Abuse Self-Stigma Scale) and stigma resistance (Stigma Resistance Scale) from baseline to follow-up measured via a self-administered survey. Secondary outcomes are changes in hope (Adult Dispositional Hope Scale) and self-esteem (Rosenberg Self-Esteem Scale). Feasibility and acceptability will be assessed with descriptive statistics; effectiveness outcomes will be assessed with paired 2-tailed t tests, and group differences will be explored using ANOVA. Overall, 12 participants will also be selected to complete acceptability interviews. Results: This pilot study was funded by the National Institute on Drug Abuse in April 2023 and received regulatory approval in January 2024 by the University of North Carolina-Chapel Hill Institutional Review Board. Recruitment and enrollment began in March 2024. Follow-up visits are expected to conclude by May 2024. Results will be disseminated in relevant peer-reviewed journals. Conclusions: To the best of our knowledge, this is the first study to address substance use stigma via a self-help SMS text messaging program. Results will add to the nascent literature on stigma reduction in people who use drugs. This protocol may interest researchers who are considering text messaging to address psychosocial needs in hard-to-reach populations. Trial Registration: ClinicalTrials.gov NCT06281548; https://clinicaltrials.gov/ct2/show/NCT06281548 International Registered Report Identifier (IRRID): DERR1-10.2196/59224 %M 39121478 %R 10.2196/59224 %U https://www.researchprotocols.org/2024/1/e59224 %U https://doi.org/10.2196/59224 %U http://www.ncbi.nlm.nih.gov/pubmed/39121478 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57959 %T Effectiveness and Acceptability of Targeted Text Message Reminders in Colorectal Cancer Screening: Randomized Controlled Trial (M-TICS Study) %A Vives,Nuria %A Travier,Noemie %A Farre,Albert %A Binefa,Gemma %A Vidal,Carmen %A Pérez Lacasta,Maria Jose %A Ibáñez-Sanz,Gemma %A Niño de Guzmán,Ena Pery %A Panera,Jon Aritz %A Garcia,Montse %A , %+ Cancer Screening Unit, Institut Català d’Oncologia (ICO), Gran Via de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Spain, 34 932607210 ext 3104, mgarcia@iconcologia.net %K text message %K mobile health %K mHealth %K colorectal cancer screening %K participation %K colon %K rectum %K cancer %K mobile phone %K mobile phones %K randomized controlled trial %K RCT %K text messages %K screening %K Spain %K adult %K adults %K elder %K elderly %K gerontology %K intention-to-treat analysis %K telephone survey %K intervention %K cost-effectiveness %K SMS %K digital health %D 2024 %7 31.7.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Mobile phone–based SMS text message reminders have the potential to improve colorectal cancer screening participation rates. Objective: This study assessed the effectiveness and acceptability of adding targeted SMS text message reminders to the standard procedure for those who picked up but did not return their screening kit at the pharmacy within 14 days in a colorectal cancer screening program in Catalonia, Spain. Methods: We performed a randomized control trial among individuals who picked up a fecal immunochemical test (FIT) kit for colorectal cancer screening at the pharmacy but did not return it within 14 days. The intervention group (n=4563) received an SMS text message reminder on the 14th day of kit pick up and the control group (n=4806) received no reminder. A 30-day reminder letter was sent to both groups if necessary. The main primary outcome was the FIT completion rate within 30, 60, and 126 days from FIT kit pick up (intention-to-treat analysis). A telephone survey assessed the acceptability and appropriateness of the intervention. The cost-effectiveness of adding an SMS text message reminder to FIT completion was also performed. Results: The intervention group had higher FIT completion rates than the control group at 30 (64.2% vs 53.7%; P<.001), 60 (78.6% vs 72.0%; P<.001), and 126 (82.6% vs 77.7%; P<.001) days. Participation rates were higher in the intervention arm independent of sex, age, socioeconomic level, and previous screening behavior. A total of 339 (89.2%) interviewees considered it important and useful to receive SMS text message reminders for FIT completion and 355 (93.4%) preferred SMS text messages to postal letters. We observed a reduction of US $2.4 per participant gained in the intervention arm for invitation costs compared to the control arm. Conclusions: Adding an SMS text message reminder to the standard procedure significantly increased FIT kit return rates and was a cost-effective strategy. SMS text messages also proved to be an acceptable and appropriate communication channel for cancer screening programs. Trial Registration: ClinicalTrials.gov NCT04343950; https://www.clinicaltrials.gov/study/NCT04343950 International Registered Report Identifier (IRRID): RR2-10.1371/journal.pone.0245806 %M 39083331 %R 10.2196/57959 %U https://publichealth.jmir.org/2024/1/e57959 %U https://doi.org/10.2196/57959 %U http://www.ncbi.nlm.nih.gov/pubmed/39083331 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54723 %T Impact of a Health Coach–Led, Text-Based Digital Behavior Change Intervention on Weight Loss and Psychological Well-Being in Patients Receiving a Procedureless Intragastric Balloon Program: Prospective Single-Arm Study %A Sacher,Paul M %A Fulton,Emily %A Rogers,Victoria %A Wilson,Julia %A Gramatica,Marco %A Dent,Jennifer E %A Aarts,Edo O %A Eccleston,David %A Greve,Jan Willem %A Palm-Meinders,Inge %A Chuttani,Ram %+ Allurion Technologies Inc, 11 Huron Dr, Natick, MA, 01760, United States, 1 508 647 4000, psacher@icloud.com %K intragastric balloon %K obesity %K behavior change %K health coaching %K digital health %K weight management %K well-being %K mobile phone %D 2024 %7 31.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health interventions show promise for weight management. However, few text-based behavior change interventions have been designed to support patients receiving intragastric balloons, and none have simultaneously evaluated weight loss, psychological well-being, and behavior change despite the crucial interplay of these factors in weight management. Objective: This study aims to assess whether a health coach–led, asynchronous, text-based digital behavior change coaching intervention (DBCCI) delivered to participants receiving an intragastric balloon and its aftercare program was feasible and acceptable to participants and supported improved outcomes, including weight loss, psychological well-being, and lifestyle behavior change conducive to weight loss maintenance. Methods: This 12-month, single-arm prospective study enrolled adults aged 21 to 65 years with BMI ≥27 kg/m2 receiving a procedureless intragastric balloon (PIGB) at 5 bariatric clinics in the United Kingdom and the Netherlands. Participants received the DBCCI and the clinic-led PIGB aftercare program (remotely delivered) for 6 months after PIGB placement and then no intervention for an additional 6 months. The DBCCI was an evidence-based, personalized intervention wherein health coaches supported participants via exchanged asynchronous in-app text-based messages. Over the 12-month study, we assessed percentage of total body weight loss and psychological well-being via self-administered validated questionnaires (Warwick-Edinburgh Mental Wellbeing Scale, Generalized Anxiety Disorder Scale, Impact of Weight on Quality of Life–Lite–Clinical Trials Version, Loss of Control Over Eating Scale–Brief, Weight Efficacy Lifestyle Questionnaire–Short Form, and Barriers to Being Active Quiz). Participant engagement with and acceptability of the intervention were assessed via self-reported surveys. Results: Overall, 107 participants (n=96, 89.7% female; mean baseline BMI 35.4, SD 5.4 kg/m2) were included in the analysis. Mean total body weight loss was 13.5% (SEM 2.3%) at the end of the DBCCI and 11.22% (SEM 2.3%) at the 12-month follow-up (P<.001). Improvements were observed for all psychological well-being measures throughout the 12 months except for the Generalized Anxiety Disorder Scale (improvement at month 1) and Barriers to Being Active Quiz (improvements at months 3 and 6). Surveys showed high levels of engagement with and acceptability of the DBCCI. Conclusions: This study provides evidence that the health coach–led, asynchronous, text-based DBCCI was engaging and acceptable to participants with overweight and obesity. The DBCCI, delivered alongside the PIGB and its aftercare program, supported improved weight loss outcomes and psychological well-being versus baseline and was associated with lifestyle behavior changes known to help achieve and maintain long-term weight loss and improved health outcomes. Follow-up findings suggest a potential need for longer-term, more intense coaching to focus on weight loss maintenance and support ongoing self-coaching. This could be achieved by leveraging generative artificial intelligence to provide ongoing automated behavior change coaching support to augment human-led care. Trial Registration: ClinicalTrials.gov NCT05884606; https://clinicaltrials.gov/study/NCT05884606 %M 39083340 %R 10.2196/54723 %U https://formative.jmir.org/2024/1/e54723 %U https://doi.org/10.2196/54723 %U http://www.ncbi.nlm.nih.gov/pubmed/39083340 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e43894 %T Investigating How the Use of Technology Can Reduce Missed Appointments: Quantitative Case Study at a General Practitioner Surgery %A Sides,Teresa %A Kbaier,Dhouha %+ The Open University, Walton Hall, Kents Hill, Milton Keynes, MK7 6AA, United Kingdom, 44 0300 303 5303, Teresa.Sides@open.ac.uk %K National Health Service %K primary care %K SMS text messaging %K SMS reminders %K missed appointments %K quantitative research %K Kruskal-Wallis test %K Mann-Whitney test %D 2024 %7 29.7.2024 %9 Short Paper %J J Med Internet Res %G English %X Background: SMS texting systems have been considered a potential solution to reduce missed appointments in primary care. Existing research in this area focuses on qualitative studies investigating the attitudes of SMS text users and receivers. Objective: This study aimed to examine appointment data from an independent general practitioner (GP) surgery in Wrexham, United Kingdom, with approximately 15,000 patients, to determine the impact of text messaging systems on reducing missed appointments. The objective of this study was to investigate whether the use of text messages can effectively reduce missed appointments. Methods: To collect data for the study, SQL reports were run on EMIS Web, the United Kingdom’s most widely used clinical system. The data spanned 10 years, from September 1, 2010, to March 31, 2020. Data accuracy was verified by cross-referencing with appointment diary records. Mann-Whitney and Kruskal-Wallis tests, chosen for their suitability in comparing groups in nonparametric settings, were conducted in Microsoft Excel due to its accessibility. Results: Statistical analyses were conducted to compare data before and after implementation of the text messaging system. The results revealed a significant 42.8% reduction in missed appointments (before: 5848; after: 3343; P<.001). Further analysis of demographic characteristics revealed interesting trends, with no significant difference in missed appointments between genders, and variations observed across different age groups. The median number of missed appointments was not significantly different between genders (women: 1.55, IQR 1.11-2.16; men: 1.61, IQR 1.08-2.12; P=.73). Despite the prevalence of mobile phone use among young adults aged 20-25 years, the highest rates of missed appointments (848/7256, 11.7%) were noted in this group, whereas the lowest rates were noted in the 75-80 years age group (377/7256; 5.2%; P<.001). Analysis by age and gender indicated inconsistencies: women aged 20-25 years (571/4216) and men aged 35-40 years (306/3040) had the highest rates of missed appointments, whereas women aged 70-75 years (177/4216) and men aged 75-80 years (129/3040) had the lowest rates (P<.001 for both). Conclusions: This study demonstrates that SMS text messaging in primary care can significantly reduce missed appointments. Implementing technology such as SMS text messaging systems enables patients to cancel appointments on time, leading to improved efficiency in primary care settings. %M 39073855 %R 10.2196/43894 %U https://www.jmir.org/2024/1/e43894 %U https://doi.org/10.2196/43894 %U http://www.ncbi.nlm.nih.gov/pubmed/39073855 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52395 %T Effectiveness of a Mobile Phone Messaging–Based Message Framing Intervention for Improving Maternal Health Service Uptake and Newborn Care Practice in Rural Jimma Zone, Ethiopia: Protocol for a Cluster Randomized Controlled Trial %A Bulcha,Gebeyehu %A Abdissa,Hordofa Gutema %A Noll,Josef %A Sori,Demisew Amenu %A Koricha,Zewdie Birhanu %+ Department of Health, Behavior, and Society, Faculty of Public Health, Institutes of Health, Jimma University, Aba Jifar Palas, 1000, Jimma, 16202, Ethiopia, 251 0911801923, gebeyehubulcha@gmail.com %K message framing %K mHealth %K digital health %K SMS %K maternal health %K newborn health %K cluster randomized controlled trials %K RCT %K Ethiopia %K mobile phone %K effectiveness %K SMS-based interventions %K text messaging %K maternal %K newborn care practice %K randomized %K controlled trial %K controlled trials %K mobile phone messaging %K phone-based intervention %D 2024 %7 23.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Ethiopia has high rates of maternal and neonatal mortality. In 2019 and 2020, the maternal and newborn mortality rates were estimated at 412 per 1,000,000 births and 30 per 10,000 births, respectively. While mobile health interventions to improve maternal and neonatal health management have shown promising results, there are still insufficient scientific studies to assess the effectiveness of mobile phone messaging–based message framing for maternal and newborn health. Objective: This research aims to examine the effectiveness of mobile phone messaging–based message framing for improving the use of maternal and newborn health services in the Jimma Zone, Ethiopia. Methods: A 3-arm cluster-randomized trial design was used to evaluate the effects of mobile phone–based intervention on maternal and newborn health service usage. The trial arms were (1) gain-framed messages (2) loss-framed messages, and (3) usual care. A total of 21 health posts were randomized, and 588 pregnant women who had a gestational age of 16-20 weeks, irrespective of their antenatal care status, were randomly assigned to the trial arms. The intervention consisted of a series of messages dispatched from the date of enrolment until 6-8 months. The control group received existing care without messages. The primary outcomes were maternal health service usage and newborn care practice, while knowledge, attitude, self-efficacy, iron supplementation, and neonatal and maternal morbidity were secondary outcomes. The outcomes will be analyzed using a generalized linear mixed model and the findings will be reported according to the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth) statement for randomized controlled trials. Results: Recruitment of participants was conducted and the baseline survey was administered in March 2023. The intervention was rolled out from May 2023 till December 2023. The end-line assessment was conducted in February 2024. Conclusions: This trial was carried out to understand how mobile phone–based messaging can improve maternal and newborn health service usage. It provides evidence for policy guidelines around mobile health strategies to improve maternal and newborn health. Trial Registration: Pan African Clinical Trials Registry PACTR202201753436676; https://tinyurl.com/ykhnpc49 International Registered Report Identifier (IRRID): DERR1-10.2196/52395 %M 39042451 %R 10.2196/52395 %U https://www.researchprotocols.org/2024/1/e52395 %U https://doi.org/10.2196/52395 %U http://www.ncbi.nlm.nih.gov/pubmed/39042451 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e59496 %T Feasibility and Preliminary Effects of a Social Media–Based Peer-Group Mobile Messaging Smoking Cessation Intervention Among Chinese Immigrants who Smoke: Pilot Randomized Controlled Trial %A Jiang,Nan %A Zhao,Ariel %A Rogers,Erin S %A Cupertino,Ana Paula %A Zhao,Xiaoquan %A Cartujano-Barrera,Francisco %A Siu,Katherine %A Sherman,Scott E %+ Department of Population Health, New York University Grossman School of Medicine, 17th Fl, 180 Madison Ave, New York, NY, 10016, United States, 1 646 501 3553, Nan.Jiang@nyulangone.org %K smoking cessation %K tobacco %K mHealth %K social media %K Chinese American %K immigrant %K smoking %K smoker %K mobile messaging %K randomized controlled trial %K tobacco use %K feasibility %K acceptability %K nicotine replacement therapy %D 2024 %7 22.7.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chinese immigrants experience significant disparities in tobacco use. Culturally adapted tobacco treatments targeting this population are sparse and the use is low. The low use of these treatment programs is attributed to their exclusive focus on individuals who are ready to quit and the wide range of barriers that Chinese immigrants face to access these programs. To support Chinese immigrant smokers at all levels of readiness to quit and address their access barriers, we developed the WeChat Quit Coach, a culturally and linguistically appropriate WeChat (Tencent Holdings Limited)–based peer group mobile messaging smoking cessation intervention. Objective: This study aims to assess the feasibility, acceptability, and preliminary effects of WeChat Quit Coach. Methods: We enrolled a total of 60 Chinese immigrant smokers in 2022 in New York City for a pilot randomized controlled trial (RCT) and a single-arm pilot test. The first 40 participants were randomized to either the intervention arm (WeChat Quit Coach) or the control arm (self-help print material) using 1:1 block randomization stratified by sex. WeChat Quit Coach lasted 6 weeks, featuring small peer groups moderated by a coach, daily text messages with text questions, and chat-based instant messaging support from the coach in response to peer questions. The next 20 participants were enrolled in the single-arm pilot test to further assess intervention feasibility and acceptability. All 60 participants were offered a 4-week supply of complimentary nicotine replacement therapy. Surveys were administered at baseline and 6 weeks, with participants in the pilot RCT completing an additional survey at 6 months and biochemical verification of abstinence at both follow-ups. Results: Of 74 individuals screened, 68 (92%) were eligible and 60 (88%) were enrolled. The majority of participants, with a mean age of 42.5 (SD 13.8) years, were male (49/60, 82%) and not ready to quit, with 70% (42/60) in the precontemplation or contemplation stage at the time of enrollment. The pilot RCT had follow-up rates of 98% (39/40) at 6 weeks and 93% (37/40) at 6 months, while the single-arm test achieved 100% follow-up at 6 weeks. On average, participants responded to daily text questions for 25.1 days over the 42-day intervention period and 23% (9/40) used the chat-based instant messaging support. Most participants were satisfied with WeChat Quit Coach (36/39, 92%) and would recommend it to others (32/39, 82%). At 6 months, self-reported 7-day point prevalence abstinence rates were 25% (5/20) in the intervention arm and 15% (3/20) in the control arm, with biochemically verified abstinence rates of 25% (5/20) and 5% (1/20), respectively. Conclusions: WeChat Quit Coach was feasible and well-received by Chinese immigrants who smoke and produced promising effects on abstinence. Large trials are warranted to assess its efficacy in promoting abstinence in this underserved population. Trial Registration: ClinicalTrials.gov NCT05130788; https://clinicaltrials.gov/study/NCT05130788 %M 39037756 %R 10.2196/59496 %U https://mhealth.jmir.org/2024/1/e59496 %U https://doi.org/10.2196/59496 %U http://www.ncbi.nlm.nih.gov/pubmed/39037756 %0 Journal Article %@ 2369-2960 %I %V 10 %N %P e54623 %T Improving Parental Health Literacy in Primary Caregivers of 0- to 3-Year-Old Children Through a WeChat Official Account: Cluster Randomized Controlled Trial %A Li,Yun %A Xiao,Qiuli %A Chen,Min %A Jiang,Chunhua %A Kang,Shurong %A Zhang,Ying %A Huang,Jun %A Yang,Yulin %A Li,Mu %A Jiang,Hong %K health literacy %K WeChat %K cluster randomized controlled trial %K RCT %K randomized %K controlled trial %K controlled trials %K parental %K parenting %K parents %K parent %K China %K Chinese %K mHealth %K mobile health %K app %K apps %K applications %K pediatric %K pediatrics %K paediatric %K paediatrics %K infant %K infants %K infancy %K baby %K babies %K neonate %K neonates %K neonatal %K newborn %K newborns %K toddler %K toddlers %D 2024 %7 4.7.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Parental health literacy is important to children’s health and development, especially in the first 3 years. However, few studies have explored effective intervention strategies to improve parental literacy. Objective: This study aimed to determine the effects of a WeChat official account (WOA)–based intervention on parental health literacy of primary caregivers of children aged 0-3 years. Methods: This cluster randomized controlled trial enrolled 1332 caregiver-child dyads from all 13 community health centers (CHCs) in Minhang District, Shanghai, China, between April 2020 and April 2021. Participants in intervention CHCs received purposefully designed videos via a WOA, which automatically recorded the times of watching for each participant, supplemented with reading materials from other trusted web-based sources. The contents of the videos were constructed in accordance with the comprehensive parental health literacy model of WHO (World Health Organization)/Europe (WHO/Europe). Participants in control CHCs received printed materials similar to the intervention group. All the participants were followed up for 9 months. Both groups could access routine child health services as usual during follow-up. The primary outcome was parental health literacy measured by a validated instrument, the Chinese Parental Health Literacy Questionnaire (CPHLQ) of children aged 0-3 years. Secondary outcomes included parenting behaviors and children’s health outcomes. We used the generalized linear mixed model (GLMM) for data analyses and performed different subgroup analyses. The β coefficient, risk ratio (RR), and their 95% CI were used to assess the intervention’s effect. Results: After the 9-month intervention, 69.4% (518/746) of caregivers had watched at least 1 video. Participants in the intervention group had higher CPHLQ total scores (β=2.51, 95% CI 0.12-4.91) and higher psychological scores (β=1.63, 95% CI 0.16-3.10) than those in the control group. The intervention group also reported a higher rate of exclusive breastfeeding (EBF) at 6 months (38.9% vs 23.44%; RR 1.90, 95% CI 1.07-3.38) and a higher awareness rate of vitamin D supplementation for infants younger than 6 months (76.7% vs 70.5%; RR 1.39, 95% CI 1.06-1.82). No significant effects were detected for the physical score on the CPHLQ, breastfeeding rate, routine checkup rate, and children’s health outcomes. Furthermore, despite slight subgroup differences in the intervention’s effects on the total CPHLQ score and EBF rate, no interaction effect was observed between these subgroup factors and intervention factors. Conclusions: Using a WHO literacy model–based health intervention through a WOA has the potential of improving parental health literacy and EBF rates at 6 months. However, innovative strategies and evidence-based content are required to engage more participants and achieve better intervention outcomes. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000031711; https://www.chictr.org.cn/showproj.aspx?proj=51740 %R 10.2196/54623 %U https://publichealth.jmir.org/2024/1/e54623 %U https://doi.org/10.2196/54623 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55722 %T Applying Meaning and Self-Determination Theory to the Development of a Web-Based mHealth Physical Activity Intervention: Proof-of-Concept Pilot Study %A Hooker,Stephanie A %A Crain,A Lauren %A Muegge,Jule %A Rossom,Rebecca C %A Pronk,Nicolaas P %A Pasumarthi,Dhavan Prasad %A Kunisetty,Gopikrishna %A Masters,Kevin S %+ Division of Research and Evaluation, HealthPartners Institute, 8170 33rd Ave S MS21112R, Minneapolis, MN, 55425, United States, 1 9529675056, stephanie.a.hooker@healthpartners.com %K physical activity %K midlife %K digital health %K SMS text messaging %K theory-based %K meaning in life %K mobile phone %D 2024 %7 25.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Meaning in life is positively associated with health, well-being, and longevity, which may be partially explained by engagement in healthier behaviors, including physical activity (PA). However, promoting awareness of meaning is a behavior change strategy that has not been tested in previous PA interventions. Objective: This study aims to develop, refine, and pilot-test the Meaningful Activity Program (MAP; MAP to Health), a web-based mobile health PA intervention, theoretically grounded in meaning and self-determination theory, for insufficiently active middle-aged adults. Methods: Following an iterative user-testing and refinement phase, we used a single-arm double baseline proof-of-concept pilot trial design. Participants included 35 insufficiently active adults in midlife (aged 40-64 years) interested in increasing their PA. After a 4-week baseline period, participants engaged in MAP to Health for 8 weeks. MAP to Health used a web-based assessment and just-in-time SMS text messaging to individualize the intervention; promote meaning salience; support the basic psychological needs of autonomy, competence, and relatedness; and increase PA. Participants completed measures of the hypothesized mechanisms of behavior change, including meaning salience, needs satisfaction, and autonomous motivation at pretest (−4 weeks), baseline (0 weeks), midpoint (4 weeks), and posttest (8 weeks) time points, and wore accelerometers for the study duration. At the end of the intervention, participants completed a qualitative interview. Mixed models compared changes in behavioral mechanisms during the intervention to changes before the intervention. Framework matrix analyses were used to analyze qualitative data. Results: Participants were aged 50.8 (SD 8.2) years on average; predominantly female (27/35, 77%); and 20% (7/35) Asian, 9% (3/35) Black or African American, 66% (23/35) White, and 6% (2/35) other race. Most (32/35, 91%) used MAP to Health for ≥5 of 8 weeks. Participants rated the intervention as easy to use (mean 4.3, SD 0.8 [out of 5.0]) and useful (mean 4.3, SD 0.6). None of the hypothesized mechanisms changed significantly during the preintervention phase (Cohen d values <0.15). However, autonomy (P<.001; Cohen d=0.76), competence (P<.001; Cohen d=0.65), relatedness (P=.004; Cohen d=0.46), autonomous motivation (P<.001; Cohen d=0.37), and meaning salience (P<.001; Cohen d=0.40) increased significantly during the intervention. Comparison of slopes before the intervention versus during the intervention revealed that increases during the intervention were significantly greater for autonomy (P=.002), competence (P<.001), and meaning salience (P=.001); however, slopes were not significantly different for relatedness (P=.10) and autonomous motivation (P=.17). Qualitative themes offered suggestions for improvement. Conclusions: MAP to Health was acceptable to participants, feasible to deliver, and associated with increases in the target mechanisms of behavior change. This is the first intervention to use meaning as a behavior change strategy in a PA intervention. Future research will test the efficacy of the intervention in increasing PA compared to a control condition. %M 38917457 %R 10.2196/55722 %U https://formative.jmir.org/2024/1/e55722 %U https://doi.org/10.2196/55722 %U http://www.ncbi.nlm.nih.gov/pubmed/38917457 %0 Journal Article %@ 2291-5222 %I %V 12 %N %P e54946 %T Engagement in mHealth-Prompted Self-Measured Blood Pressure Monitoring Among Participants Recruited From a Safety-Net Emergency Department: Secondary Analysis of the Reach Out Trial %A Skolarus,Lesli E %A Lin,Chun Chieh %A Mishra,Sonali %A Meurer,William %A Dinh,Mackenzie %A Whitfield,Candace %A Bi,Ran %A Brown,Devin %A Oteng,Rockefeller %A Buis,Lorraine R %A Kidwell,Kelley %K hypertension %K self-measured blood pressure %K mobile health %K blood pressure %K emergency %K blood pressure monitoring %K risk factor %K cardiovascular %K cardiovascular disease %K utilization %K feedback %K care %K systolic blood pressure %K emergency department %K mHealth %K health disparities %K engagement %D 2024 %7 12.6.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Hypertension, a key modifiable risk factor for cardiovascular disease, is more prevalent among Black and low-income individuals. To address this health disparity, leveraging safety-net emergency departments for scalable mobile health (mHealth) interventions, specifically using text messaging for self-measured blood pressure (SMBP) monitoring, presents a promising strategy. This study investigates patterns of engagement, associated factors, and the impact of engagement on lowering blood pressure (BP) in an underserved population. Objective: We aimed to identify patterns of engagement with prompted SMBP monitoring with feedback, factors associated with engagement, and the association of engagement with lowered BP. Methods: This is a secondary analysis of data from Reach Out, an mHealth, factorial trial among 488 hypertensive patients recruited from a safety-net emergency department in Flint, Michigan. Reach Out participants were randomized to weekly or daily text message prompts to measure their BP and text in their responses. Engagement was defined as a BP response to the prompt. The k-means clustering algorithm and visualization were used to determine the pattern of SMBP engagement by SMBP prompt frequency—weekly or daily. BP was remotely measured at 12 months. For each prompt frequency group, logistic regression models were used to assess the univariate association of demographics, access to care, and comorbidities with high engagement. We then used linear mixed-effects models to explore the association between engagement and systolic BP at 12 months, estimated using average marginal effects. Results: For both SMBP prompt groups, the optimal number of engagement clusters was 2, which we defined as high and low engagement. Of the 241 weekly participants, 189 (78.4%) were low (response rate: mean 20%, SD 23.4) engagers, and 52 (21.6%) were high (response rate: mean 86%, SD 14.7) engagers. Of the 247 daily participants, 221 (89.5%) were low engagers (response rate: mean 9%, SD 12.2), and 26 (10.5%) were high (response rate: mean 67%, SD 8.7) engagers. Among weekly participants, those who were older (>65 years of age), attended some college (vs no college), married or lived with someone, had Medicare (vs Medicaid), were under the care of a primary care doctor, and took antihypertensive medication in the last 6 months had higher odds of high engagement. Participants who lacked transportation to appointments had lower odds of high engagement. In both prompt frequency groups, participants who were high engagers had a greater decline in BP compared to low engagers. Conclusions: Participants randomized to weekly SMBP monitoring prompts responded more frequently overall and were more likely to be classed as high engagers compared to participants who received daily prompts. High engagement was associated with a larger decrease in BP. New strategies to encourage engagement are needed for participants with lower access to care. Trial Registration: ClinicalTrials.gov NCT03422718; https://clinicaltrials.gov/study/NCT03422718 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-04340-z %R 10.2196/54946 %U https://mhealth.jmir.org/2024/1/e54946 %U https://doi.org/10.2196/54946 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e49040 %T Doctors’ Personal Preference and Adoption of Mobile Apps to Communicate with Patients in China: Qualitative Study %A Chen,Dongjin %A Han,Wenchao %A Yang,Yili %A Pan,Jay %+ West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, 610041, China, 86 28 85501096, panjie.jay@scu.edu.cn %K medical platforms %K doctor-patient communication %K social networking apps %K thematic content analysis %K China %D 2024 %7 10.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Different kinds of mobile apps are used to promote communications between patients and doctors. Studies have investigated patients’ mobile app adoption behavior; however, they offer limited insights into doctors’ personal preferences among a variety of choices of mobile apps. Objective: This study aimed to investigate the nuanced adoption behaviors among doctors in China, which has a robust adoption of mobile apps in health care, and to explore the constraints influencing their selection of specific mobile apps. This paper addressed 3 research questions: (1) Which doctors opt to adopt mobile apps to communicate with patients? (2) What types of mobile apps do they choose? (3) To what degree do they exercise personal choice in adopting specific mobile apps? Methods: We used thematic content analysis of qualitative data gathered from semistructured interviews with 11 doctors in Hangzhou, which has been recognized for its advanced adoption of mobile technology in social services, including health care services. The selection of participants was purposive, encompassing diverse departments and hospitals. Results: In total, 5 themes emerged from the data analysis. First, the interviewees had a variety of options for communicating with patients via mobile apps, with the predominant ones being social networking apps (eg, WeChat) and medical platforms (eg, Haodf). Second, all interviewees used WeChat to facilitate communication with patients, although their willingness to share personal accounts varied (they are more likely to share with trusty intermediaries). Third, fewer than half of the doctors adopted medical platforms, and they were all from tertiary hospitals. Fourth, the preferences for in-person, WeChat, or medical platform communication reflected the interviewees’ perceptions of different patient cohorts. Lastly, the selection of a particular kind of mobile app was significantly influenced by the doctors’ affiliation with hospitals, driven by their professional obligations to fulfill multiple tasks assigned by the hospitals or the necessity of maintaining social connections with their colleagues. Conclusions: Our findings contribute to a nuanced understanding of doctors’ adoption behavior regarding specific types of mobile apps for patient communication, instead of addressing such adoption behavior of a wide range of mobile apps as equal. Their choices of a particular kind of app were positioned within a social context where health care policies (eg, limited funding for public hospitals, dominance of public health care institutions, and absence of robust referral systems) and traditional culture (eg, trust based on social connections) largely shape their behavioral patterns. %M 38857491 %R 10.2196/49040 %U https://mhealth.jmir.org/2024/1/e49040 %U https://doi.org/10.2196/49040 %U http://www.ncbi.nlm.nih.gov/pubmed/38857491 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48520 %T mHealth Intervention for Elevated Blood Pressure Among College Students: Single-Arm Intervention Study %A Tran,Dieu-My %A Dingley,Catherine %A Bonilla,Roger %+ School of Nursing, University of Nevada, Las Vegas, 4505 S. Maryland Parkway, Box 453018, Las Vegas, NV, 89154, United States, 1 7028951220, dieu-my.tran@unlv.edu %K blood pressure %K mHealth %K self-management %K students %K intervention %K elevated blood pressure %K college %K hypertension %K young adult %K mobile app %K smartphone %K monitoring %K text messaging %K text mining %D 2024 %7 7.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Current evidence reveals a growing pattern of hypertension among young adults, significantly increasing their risk for cardiovascular disease later in life. Young adults, particularly those of college age, often develop risk factors related to lifestyle choices in diet, exercise, and alcohol consumption. Developing useful interventions that can assist with screening and possible behavioral modifications that are suitable and appealing to college-aged young adults could help with early identification and intervention for hypertension. Recent studies indicate mobile health (mHealth) apps are acceptable and effective for communication and message delivery among this population. Objective: The purpose of this study was to examine the feasibility of using a mobile smartphone delivery system that provides tailored messages based on participant self-measured blood pressure (BP) with college-aged young adults. Methods: Using a single-arm intervention, pilot study design, the mHealth to Optimize BP Improvement (MOBILE) intervention was implemented with college students aged 18 years to 39 years who had systolic BP >120 mm Hg and diastolic BP ≥80 mm Hg. Participants were required to measure their BP daily for 28 days, submit the readings to the app, and receive preset educational text messages tailored to their BP value and related to encouraging healthy lifestyle modifications. Changes in a participant’s BP was evaluated using a mixed regression model, and a postintervention survey evaluated their perspectives on the mHealth intervention. Results: The participants’ (N=9) mean age was 22.64 (SD 4.54) years; 56% (5/9) were overweight, and 11% (1/9) were obese. The average daily participation rate was 86%. Of the 9 participants, 8 completed the survey, and all indicated the intervention was easy to use, found it increased awareness of their individual BP levels, indicated the text messages were helpful, and reported making lifestyle changes based on the study intervention. They also provided suggestions for future implementation of the intervention and program. Overall, no significant changes were noted in BP over the 28 days. Conclusions: The mHealth-supported MOBILE intervention for BP monitoring and tailored text messaging was feasible to implement, as our study indicated high rates of participation and acceptability. These encouraging findings support further development and testing in a larger sample over a longer time frame and hold the potential for early identification and intervention among college-aged adults, filling a gap in current research. %M 38848120 %R 10.2196/48520 %U https://formative.jmir.org/2024/1/e48520 %U https://doi.org/10.2196/48520 %U http://www.ncbi.nlm.nih.gov/pubmed/38848120 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50783 %T Effects of the “AI-TA” Mobile App With Intelligent Design on Psychological and Related Symptoms of Young Survivors of Breast Cancer: Randomized Controlled Trial %A Jiang,Lulu %A Xu,Jiehui %A Wu,Yanwei %A Liu,Yanyan %A Wang,Xiyi %A Hu,Yun %+ School of Nursing, Shanghai Jiao Tong University, No.277 Chongqing South Roud, Huangpu District, Shanghai, 200025, China, 86 021 63546078, huyunsy@shsmu.edu.cn %K mobile app %K artificial intelligence %K interactivity %K breast cancer %K psychological symptoms %K self-efficacy %K social support %K quality of life %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Young women often face substantial psychological challenges in the initial years following cancer diagnosis, leading to a comparatively lower quality of life than older survivors. While mobile apps have emerged as potential interventions, their effectiveness remains inconclusive due to the diversity in intervention types and variation in follow-up periods. Furthermore, there is a particular dearth of evidence regarding the efficacy of these apps’ intelligent features in addressing psychological distress with these apps. Objective: This study aims to evaluate the effectiveness of a mobile app with intelligent design called “AI-TA” on cancer-related psychological health and ongoing symptoms with a randomized controlled design. Methods: Women aged 18 to 45 years diagnosed with breast cancer were randomly assigned to the intervention or control group. The intervention was AI-TA, which included 2-way web-based follow-up every 2 weeks. Both intention-to-treat (ITT) and per-protocol (PP) analyses employed repeated measurement analysis of variance. The participants’ background features, primary outcomes (psychological distress and frequency, self-efficacy, and social support), and secondary outcomes (quality of life) were measured using multiple instruments at 3 time points (baseline, 1-month intervention, and 3-month intervention). Results: A total of 124 participants were randomly allocated to the control group (n=62, 50%) or intervention group (n=62, 50%). In total, 92.7% (115/124) of the participants completed the intervention. Significant improvements in psychological symptoms (Memorial Symptom Assessment Scale-Short Form) were observed in the ITT group from baseline to 1-month intervention relative to the control group (ITT vs control: 1.17 vs 1.23; P<.001), which persisted at 3-month follow-up (ITT vs control: 0.68 vs 0.91; P<.001). Both the ITT and PP groups exhibited greater improvements in self-efficacy (Cancer Behavior Inventory-Brief Version) than the control group at 1-month (ITT vs PP vs control: 82.83 vs 77.12 vs 65.35; P<.001) and 3-month intervention (ITT vs PP vs control: 92.83 vs 89.30 vs 85.65; P<.001). However, the change in social support (Social Support Rating Scale) did not increase significantly until 3-month intervention (ITT vs control: 50.09 vs 45.10; P=.002) (PP vs control: 49.78 vs 45.10; P<.001). All groups also experienced beneficial effects on quality of life (Functional Assessment of Cancer Therapy-Breast), which persisted at 3-month follow-up (P<.001). Conclusions: The intelligent mobile app AI-TA incorporating intelligent design shows promise for reducing psychological and cancer-related symptoms among young survivors of breast cancer. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200058823; https://www.chictr.org.cn/showproj.html?proj=151195 %M 38833298 %R 10.2196/50783 %U https://mhealth.jmir.org/2024/1/e50783 %U https://doi.org/10.2196/50783 %U http://www.ncbi.nlm.nih.gov/pubmed/38833298 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e40275 %T The Use of Text Messaging as an Adjunct to Internet-Based Cognitive Behavioral Therapy for Major Depressive Disorder in Youth: Secondary Analysis %A Walters,Clarice %A Gratzer,David %A Dang,Kevin %A Laposa,Judith %A Knyahnytska,Yuliya %A Ortiz,Abigail %A Gonzalez-Torres,Christina %A Moore,Lindsay P %A Chen,Sheng %A Ma,Clement %A Daskalakis,Zafiris %A Ritvo,Paul %+ School of Kinesiology and Health Sciences, York University, 4700 Keele St, Toronto, ON, M3J1P3, Canada, 1 4165808021, paul.ritvo@gmail.com %K online intervention %K randomized controlled trial %K major depressive disorder %K text message %K online %K cognitive %K behavior therapy %K treatment %K depression %K disorder %K symptoms %K young adults %K wellness %K procedure %K anxiety %K model %D 2024 %7 31.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: As an established treatment for major depressive disorder (MDD), cognitive behavioral therapy (CBT) is now implemented and assessed in internet-based formats that, when combined with smartphone apps, enable secure text messaging. As an adjunct to such internet-based CBT (ICBT) approaches, text messaging has been associated with increased adherence and therapeutic alliance. Objective: This study analyzed data from the intervention arm of a randomized control trial evaluating 24-week ICBT for MDD (intervention arm) against standard-care psychiatry (waitlist control). The aim of this secondary analysis was to assess MDD symptom improvement in relation to the frequency and content of text messages sent by ICBT participants to Navigator-Coaches during randomized control trial participation. Higher text frequency in general and in 3 conceptual categories (appreciating alliance, alliance building disclosures, and agreement confirmation) was hypothesized to predict larger MDD symptom improvement. Methods: Participants were young adults (18-30 years) from the Centre for Addiction and Mental Health. The frequencies of categorized texts from 20 ICBT completers were analyzed with respect to MDD symptom improvement using linear regression models. Texts were coded by 2 independent coders and categorized using content analysis. MDD symptoms were measured using the Beck Depression Inventory-II (BDI-II). Results: Participants sent an average of 136 text messages. Analyses indicated that BDI-II improvement was negatively associated with text messaging frequency in general (β=–0.029, 95% CI –0.11 to 0.048) and in each of the 3 categories: appreciating alliance (β=–0.096, 95% CI –0.80 to 0.61), alliance building disclosures (β=–0.098, 95% CI –0.28 to 0.084), and agreement confirmation (β=–0.076, 95% CI –0.40 to 0.25). Altogether, the effect of text messaging on BDI-II improvement was uniformly negative across statistical models. More text messaging appeared associated with less MDD symptom improvement. Conclusions: The hypothesized positive associations between conceptually categorized text messages and MDD symptom improvement were not supported in this study. Instead, more text messaging appeared to indicate less treatment benefit. Future studies with larger samples are needed to discern the optimal use of text messaging in ICBT approaches using adjunctive modes of communication. Trial Registration: Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052 %M 38820586 %R 10.2196/40275 %U https://formative.jmir.org/2024/1/e40275 %U https://doi.org/10.2196/40275 %U http://www.ncbi.nlm.nih.gov/pubmed/38820586 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e47996 %T Digital Adherence Technologies Linked to Mobile Money Incentives for Medication Adherence Among People Living With Tuberculosis: Mixed Methods Feasibility and Acceptability Study %A Musiimenta,Angella %A Tumuhimbise,Wilson %A Atukunda,Esther %A Mugaba,Aaron %A Linnemayr,Sebastian %A Haberer,Jessica %+ Faculty of Computing and Informatics, Mbarara University of Science and Technology, Plot 8-19 Mbarara Kabale Road, Mbarara, P.O. Box 653, Uganda, 256 776820598, amusiimenta@must.ac.ug %K digital adherence technologies %K real-time monitoring %K SMS text message reminders %K mobile money %K financial incentives %K tuberculosis %K medication adherence %K user-centered approach %D 2024 %7 31.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Complementing digital adherence technologies (DATs) with mobile money incentives may improve their utility in supporting tuberculosis medication adherence, yet the feasibility and acceptability of this integrated approach remain unclear. Objective: This study aims to describe the feasibility and acceptability of a novel DAT intervention called My Mobile Wallet composed of real-time adherence monitoring, SMS text message reminders, and mobile money incentives for tuberculosis medication adherence in a low-income setting. Methods: We purposively recruited people living with tuberculosis from the Mbarara Regional Referral Hospital in Mbarara, Uganda, who (1) were starting tuberculosis treatment at enrollment or within the past 4 weeks, (2) owned a mobile phone, (3) were able to use SMS test messaging, (4) were aged ≥18 years, and (5) were living in Mbarara district. At study exit (month 6), we used interviews and questionnaires informed by the unified theory of acceptance and use of technology (UTAUT) to collect feasibility and acceptability data, reflecting patients’ experiences of using each component of My Mobile Wallet. Feasibility also included tracking the functionality of the adherence monitor (ie, an electronic pillbox) as well as SMS text message and mobile money delivery. We used a content analytical approach to inductively analyze qualitative data and Stata (version 13; StataCorp LLC) to analyze quantitative data. Results: All 39 participants reported that the intervention was feasible because it was easy for them to use (eg, access and read SMS text messages) and worked as expected. Almost all SMS text messages (6880/7064, 97.4%) were sent as planned. The transmission of adherence data from the monitor worked well, with 98.37% (5682/5776) of the data transmitted as planned. All participants additionally reported that the intervention was acceptable because it helped them take their tuberculosis medication as prescribed; the mobile money incentives relieved them of tuberculosis-related financial burdens; SMS text message reminders and electronic pillbox–based alarms reminded them to take their medication on time; and participants perceived real-time adherence monitoring as “being watched” while taking their medication, which encouraged them to take their medication on time to demonstrate their commitment. The intervention was perceived as a sign of care, which eventually created emotional support and a sense of connectedness to health care. Participants preferred daily SMS text message reminders (32/39, 82%) to reminders linked to missed doses (7/39, 18%), citing the fact that tuberculosis medication is taken daily. Conclusions: The use of real-time adherence monitoring linked to SMS text message reminders and mobile money incentives for tuberculosis medication adherence was feasible and acceptable in a low-resource setting where poverty-based structural barriers heavily constrain tuberculosis treatment and care. %M 38819905 %R 10.2196/47996 %U https://humanfactors.jmir.org/2024/1/e47996 %U https://doi.org/10.2196/47996 %U http://www.ncbi.nlm.nih.gov/pubmed/38819905 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50976 %T Tracking and Profiling Repeated Users Over Time in Text-Based Counseling: Longitudinal Observational Study With Hierarchical Clustering %A Xu,Yucan %A Chan,Christian Shaunlyn %A Chan,Evangeline %A Chen,Junyou %A Cheung,Florence %A Xu,Zhongzhi %A Liu,Joyce %A Yip,Paul Siu Fai %+ Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong, China (Hong Kong), 852 91401568, sfpyip@hku.hk %K web-based counseling %K text-based counseling %K repeated users %K frequent users %K hierarchical clustering %K service effectiveness %K risk profiling %K psychological profiles %K psycholinguistic analysis %D 2024 %7 30.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Due to their accessibility and anonymity, web-based counseling services are expanding at an unprecedented rate. One of the most prominent challenges such services face is repeated users, who represent a small fraction of total users but consume significant resources by continually returning to the system and reiterating the same narrative and issues. A deeper understanding of repeated users and tailoring interventions may help improve service efficiency and effectiveness. Previous studies on repeated users were mainly on telephone counseling, and the classification of repeated users tended to be arbitrary and failed to capture the heterogeneity in this group of users. Objective: In this study, we aimed to develop a systematic method to profile repeated users and to understand what drives their use of the service. By doing so, we aimed to provide insight and practical implications that can inform the provision of service catering to different types of users and improve service effectiveness. Methods: We extracted session data from 29,400 users from a free 24/7 web-based counseling service from 2018 to 2021. To systematically investigate the heterogeneity of repeated users, hierarchical clustering was used to classify the users based on 3 indicators of service use behaviors, including the duration of their user journey, use frequency, and intensity. We then compared the psychological profile of the identified subgroups including their suicide risks and primary concerns to gain insights into the factors driving their patterns of service use. Results: Three clusters of repeated users with clear psychological profiles were detected: episodic, intermittent, and persistent-intensive users. Generally, compared with one-time users, repeated users showed higher suicide risks and more complicated backgrounds, including more severe presenting issues such as suicide or self-harm, bullying, and addictive behaviors. Higher frequency and intensity of service use were also associated with elevated suicide risk levels and a higher proportion of users citing mental disorders as their primary concerns. Conclusions: This study presents a systematic method of identifying and classifying repeated users in web-based counseling services. The proposed bottom-up clustering method identified 3 subgroups of repeated users with distinct service behaviors and psychological profiles. The findings can facilitate frontline personnel in delivering more efficient interventions and the proposed method can also be meaningful to a wider range of services in improving service provision, resource allocation, and service effectiveness. %M 38815258 %R 10.2196/50976 %U https://www.jmir.org/2024/1/e50976 %U https://doi.org/10.2196/50976 %U http://www.ncbi.nlm.nih.gov/pubmed/38815258 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e52156 %T Evaluating the Quality of Cancer-Related WeChat Public Accounts: Cross-Sectional Study %A Pan,Peng %A Yu,Changhua %A Li,Tao %A Dai,Tingting %A Tian,Hanhan %A Xiong,Yaozu %A Lv,Jie %A Hu,Xiaochu %A Ma,Weidong %A Yin,Wenda %+ Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Radiotherapy Department Building, 4th floor, 1 Huanghexilu, Huai'an, 223300, China, 86 517 8490 7286, 1131603215@qq.com %K cancer %K big data %K social media %K health literacy %K WeChat %K China %K public health %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: WeChat (Tencent) is one of the most important information sources for Chinese people. Relevantly, various health-related data are constantly transmitted among WeChat users. WeChat public accounts (WPAs) for health are rapidly emerging. Health-related WeChat public accounts have a significant impact on public health. Because of the rise in web-based health-seeking behavior, the general public has grown accustomed to obtaining cancer information from WPAs. Although WPAs make it easy for people to obtain health information, the quality of the information is questionable. Objective: This study aims to assess the quality and suitability of cancer-related WeChat public accounts (CWPAs). Methods: The survey was conducted from February 1 to 28, 2023. Based on the WPA monthly list provided by Qingbo Big Data, 28 CWPAs in the WeChat communication index were selected as the survey sample. Quality assessment of the included CWPAs was performed using the HONcode instrument. Furthermore, suitability was measured by using the Suitability Assessment of Materials. A total of 2 researchers conducted the evaluations independently. Results: Of the 28 CWPAs, 12 (43%) were academic and 16 (57%) were commercial. No statistical difference was found regarding the HONcode scores between the 2 groups (P=.96). The quality of the academic and commercial CWPAs evaluated using the HONcode instrument demonstrated mean scores of 5.58 (SD 2.02) and 5.63 (SD 2.16), respectively, corresponding to a moderate class. All CWPAs’ compliance with the HONcode principles was unsatisfactory. A statistically significant difference between the 2 groups was observed in the Suitability Assessment of Materials scores (P=.04). The commercial WPAs reached an overall 55.1% (SD 5.5%) score versus the 50.2% (SD 6.4%) score reached by academic WPAs. The suitability of academic and commercial CWPAs was considered adequate. Conclusions: This study revealed that CWPAs are not sufficiently credible. WPA owners must endeavor to create reliable health websites using approved tools such as the HONcode criteria. However, it is necessary to educate the public about the evaluation tools of health websites to assess their credibility before using the provided content. In addition, improving readability will allow the public to read and understand the content. %M 38814688 %R 10.2196/52156 %U https://cancer.jmir.org/2024/1/e52156 %U https://doi.org/10.2196/52156 %U http://www.ncbi.nlm.nih.gov/pubmed/38814688 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45561 %T The Development of a Text Messaging Platform to Enhance a Youth Diabetes Prevention Program: Observational Process Study %A Sapre,Manali %A Elaiho,Cordelia R %A Brar Prayaga,Rena %A Prayaga,Ram %A Constable,Jeremy %A Vangeepuram,Nita %+ Department of General Pediatrics, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1198, New York, NY, 10029, United States, 1 917 478 2106, nita.vangeepuram@mssm.edu %K community-based participatory research %K youth %K diabetes prevention %K peer education %K mobile health technology %K SMS text messaging %K mobile phone %K artificial intelligence %K AI %D 2024 %7 29.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 1 in 5 adolescents in the United States has prediabetes, and racially and ethnically minoritized youths are disproportionately impacted. Unfortunately, there are few effective youth diabetes prevention programs, and in-person interventions are challenging because of barriers to access and engagement. Objective: We aimed to develop and assess the preliminary feasibility and acceptability of a youth-informed SMS text messaging platform to provide additional support and motivation to adolescents with prediabetes participating in a diabetes prevention workshop in East Harlem, New York City, New York, United States. We collaborated with our youth action board and a technology partner (mPulse Mobile) to develop and pilot-test the novel interactive platform. Methods: The technology subcommittee of our community action board (comprising youths and young adults) used the results from focus groups that we had previously conducted with youths from our community to develop 5 message types focused on healthy eating and active living: goal setting, behavior tracking, individually tailored guidance, motivational messages, and photo diary. We used an iterative process to develop and pilot the program with our internal study team, including youths from our community action board and mPulse Mobile developers. We then conducted a pilot of the 12-week SMS text messaging program with 13 youths with prediabetes. Results: Participants (aged 15-21 years; 10/13, 77% female; 3/10, 23% Black and 10/13, 77% Hispanic or Latinx) received an average of 2 automated messages per day. The system correctly sent 84% (2231/2656) of the messages at the time intended; the remaining 16% (425/2656) of the messages were either sent at the incorrect time, or the system did not recognize a participant response to provide the appropriate reply. The level of engagement with the program ranged from 1 (little to no response) to 5 (highly responsive) based on how frequently participants responded to the interactive (2-way) messages. Highly responsive participants (6/13, 46%) responded >75% (1154/1538) of the time to interactive messages sent over 12 weeks, and 69% (9/13) of the participants were still engaged with the program at week 12. During a focus group conducted after program completion, the participants remarked that the message frequency was appropriate, and those who had participated in our in-person workshops reflected that the messages were reminiscent of the workshop content. Participants rated goal setting, behavior tracking, and tailored messages most highly and informed planned adaptations to the platform. Participants described the program as: “interactive, informative, enjoyable, very convenient, reliable, motivational, productive, and reflective.” Conclusions: We partnered with youths in the initial content development and pilot testing of a novel SMS text messaging platform to support diabetes prevention. This study is unique in the triple partnership we formed among researchers, technology experts, and diverse youths to develop a mobile health platform to address diabetes-related disparities. %M 38809599 %R 10.2196/45561 %U https://formative.jmir.org/2024/1/e45561 %U https://doi.org/10.2196/45561 %U http://www.ncbi.nlm.nih.gov/pubmed/38809599 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54595 %T Feasibility of Fit24, a Digital Diabetes Prevention Program for Hispanic Adolescents: Qualitative Evaluation Study %A Soltero,Erica G %A Musaad,Salma M %A O’Connor,Teresia M %A Thompson,Debbe %A Norris,Keith %A Beech,Bettina M %+ USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Ave, Houston, TX, 77030, United States, 1 602 496 0909, soltero@bcm.edu %K health disparities %K diabetes prevention %K Mexican youth %K physical activity %K sleep %K digital health %D 2024 %7 17.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health interventions are promising for reaching and engaging high-risk youth in disease prevention opportunities; however, few digital prevention interventions have been developed for Hispanic youth, limiting our knowledge of these strategies among this population. Objective: This study qualitatively assessed the feasibility and acceptability of Fit24, a 12-week goal-setting intervention that uses a Fitbit watch (Fitbit Inc) and theoretically grounded SMS text messages to promote physical activity and sleep among Hispanic adolescents (aged between 14 and 16 years) with obesity. Methods: After completing the intervention, a subsample of youth (N=15) participated in an in-depth interview. We categorized the themes into dimensions based on participant perspectives using the Practical, Robust Implementation, and Sustainability Model (PRISM) framework. Results: Participants shared positive perceptions of wearing the Fitbit and receiving SMS text messages. Youth were highly engaged in monitoring their behaviors and perceived increased activity and sleep. Almost all youth organically received social support from a peer or family member and suggested the use of a group chat or team challenge for integrating peers into future interventions. However, most youth also expressed the need to take personal responsibility for the change in their behavior. Barriers that impacted the feasibility of the study included the skin-irritating material on the Fitbit watch band and environmental barriers (eg, lack of resources and school schedules), that limited participation in activity suggestions. Additionally, sync issues with the Fitbit limited the transmission of data, leading to inaccurate feedback. Conclusions: Fit24 is a promising approach for engaging Hispanic youth in a diabetes prevention program. Strategies are needed to address technical issues with the Fitbit and environmental issues such as message timing. While integrating peer social support may be desired by some, peer support strategies should be mindful of youth’s desire to foster personal motivation for behavior change. Findings from this study will inform future diabetes prevention trials of Fit24 and other digital health interventions for high-risk pediatric populations. %M 38758584 %R 10.2196/54595 %U https://formative.jmir.org/2024/1/e54595 %U https://doi.org/10.2196/54595 %U http://www.ncbi.nlm.nih.gov/pubmed/38758584 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e42049 %T Rapport Building in Written Crisis Services: Qualitative Content Analysis %A Schwab-Reese,Laura %A Short,Caitlyn %A Jacobs,Larel %A Fingerman,Michelle %+ Department of Public Health, Purdue University, MTHW 214F, West Lafayette, IN, 47907, United States, 1 765 496 6723, lschwabr@purdue.edu %K empathy %K crisis hotline %K child maltreatment %K text hotline %K chat hotline %K telehealth %K digital empathy %K counseling %K child abuse %K family violence %K crisis %K hotline %K chat %K tele %K emotional dynamics %K therapeutic relationships %K therapy %K content analysis %K text %K inductive %K deductive %K emotion %K affect %K emotional dynamic %K counseling psychology %D 2024 %7 15.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Building therapeutic relationships and social presence are challenging in digital services and maybe even more difficult in written services. Despite these difficulties, in-person care may not be feasible or accessible in all situations. Objective: This study aims to categorize crisis counselors’ efforts to build rapport in written conversations by using deidentified conversation transcripts from the text and chat arms of the National Child Abuse Hotline. Using these categories, we identify the common characteristics of successful conversations. We defined success as conversations where help-seekers reported the hotline was a good way to seek help and that they were a lot more hopeful, a lot more informed, a lot more prepared to address the situation, and experiencing less stress, as reported by help-seekers. Methods: The sample consisted of transcripts from 314 purposely selected conversations from of the 1153 text and chat conversations during July 2020. Hotline users answered a preconversation survey (ie, demographics) and a postconversation survey (ie, their perceptions of the conversation). We used qualitative content analysis to process the conversations. Results: Active listening skills, including asking questions, paraphrasing, reflecting feelings, and interpreting situations, were commonly used by counselors. Validation, unconditional positive regard, and evaluation-based language, such as praise and apologies, were also often used. Compared with less successful conversations, successful conversations tended to include fewer statements that attend to the emotional dynamics. There were qualitative differences in how the counselors applied these approaches. Generally, crisis counselors in positive conversations tended to be more specific and tailor their comments to the situation. Conclusions: Building therapeutic relationships and social presence are essential to digital interventions involving mental health professionals. Prior research demonstrates that they can be challenging to develop in written conversations. Our work demonstrates characteristics associated with successful conversations that could be adopted in other written help-seeking interventions. %M 38748472 %R 10.2196/42049 %U https://www.jmir.org/2024/1/e42049 %U https://doi.org/10.2196/42049 %U http://www.ncbi.nlm.nih.gov/pubmed/38748472 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e44973 %T Effect of Adding Personalized Instant Messaging Apps to a Brief Smoking Cessation Model in Community Smokers in Hong Kong: Pragmatic Randomized Clinical Trial %A Wu,Yongda Socrates %A Cheung,Yee Tak Derek %A Lee,Jay Jung Jae %A Wong,Carlos King Ho %A Ho,Sai Yin %A Li,William Ho Cheung %A Yao,Ying %A Lam,Tai Hing %A Wang,Man Ping %+ School of Nursing, The University of Hong Kong, 5/F, Academic Building, 3 Sassoon Road, Pokfulam, Hong Kong, China (Hong Kong), 852 39176636, mpwang@hku.hk %K instant messaging %K text messaging %K chatting %K smoking cessation %K COVID-19 %K community smoker %D 2024 %7 13.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: While text messaging has proven effective for smoking cessation (SC), engagement in the intervention remains suboptimal. Objective: This study aims to evaluate whether using more interactive and adaptive instant messaging (IM) apps on smartphones, which enable personalization and chatting with SC advisors, can enhance SC outcomes beyond the provision of brief SC advice and active referral (AR) to SC services. Methods: From December 2018 to November 2019, we proactively recruited 700 adult Chinese daily cigarette users in Hong Kong. Participants were randomized in a 1:1 ratio. At baseline, all participants received face-to-face brief advice on SC. Additionally, they were introduced to local SC services and assisted in selecting one. The intervention group received an additional 26 personalized regular messages and access to interactive chatting through IM apps for 3 months. The regular messages aimed to enhance self-efficacy, social support, and behavioral capacity for quitting, as well as to clarify outcome expectations related to cessation. We developed 3 sets of messages tailored to the planned quit date (within 30 days, 60 days, and undecided). Participants in the intervention group could initiate chatting with SC advisors on IM themselves or through prompts from regular messages or proactive inquiries from SC advisors. The control group received 26 SMS text messages focusing on general health. The primary outcomes were smoking abstinence validated by carbon monoxide levels of <4 parts per million at 6 and 12 months after the start of the intervention. Results: Of the participants, 505/700 (72.1%) were male, and 450/648 (69.4%) were aged 40 or above. Planning to quit within 30 days was reported by 500/648 (77.2%) participants, with fewer intervention group members (124/332, 37.3%) reporting previous quit attempts compared with the control group (152/335, 45.4%; P=.04). At the 6- and 12-month follow-ups (with retention rates of 456/700, 65.1%, and 446/700, 63.7%, respectively), validated abstinence rates were comparable between the intervention (14/350, 4.0%, and 19/350, 5.4%) and control (11/350, 3.1% and 21/350, 6.0%) groups. Compared with the control group, the intervention group reported greater utilization of SC services at 12 months (RR 1.26, 95% CI 1.01-1.56). Within the intervention group, engaging in chat sessions with SC advisors predicted better validated abstinence at 6 months (RR 3.29, 95% CI 1.13-9.63) and any use of SC services (RR 1.66, 95% CI 1.14-2.43 at 6 months; RR 1.67, 95% CI 1.26-2.23 at 12 months). Conclusions: An IM-based intervention, providing support and assistance alongside brief SC advice and AR, did not yield further increases in quitting rates but did encourage the utilization of SC services. Future research could explore whether enhanced SC service utilization leads to improved long-term SC outcomes. Trial Registration: ClinicalTrials.gov NCT03800719; https://clinicaltrials.gov/ct2/show/NCT03800719 %M 38739429 %R 10.2196/44973 %U https://www.jmir.org/2024/1/e44973 %U https://doi.org/10.2196/44973 %U http://www.ncbi.nlm.nih.gov/pubmed/38739429 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55238 %T Evaluating and Enhancing an Educational Intervention to Reduce Smallholder Farmers’ Exposure to Pesticides in Uganda Through a Digital, Systematic Approach to Behavior Change: Protocol for a Cluster-Randomized Controlled Trial %A Ssekkadde,Peter %A Tomberge,Vica Marie Jelena %A Brugger,Curdin %A Atuhaire,Aggrey %A Dalvie,Mohamed Aqiel %A Rother,Hanna-Andrea %A Röösli,Martin %A Inauen,Jennifer %A Fuhrimann,Samuel %+ Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Switzerland, 41 762010833, samuel.fuhrimann@swisstph.ch %K smallholder farmers %K knowledge %K attitude %K practice %K behavior change %K psychosocial determinants of behavior %K health %K education %K pesticide exposure %K SMS text messages %D 2024 %7 8.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smallholder farmers receive educational interventions on safe pesticide handling by governmental agencies, industries, or nongovernmental organizations to reduce exposure risks. However, existing educational interventions have limited effects on changing behaviors. Targeting psychosocial determinants of behavior change in educational interventions through theory- and evidence-based approaches may enhance their effectiveness. Objective: We aim at describing the intervention development and study design of a 3-arm cluster-randomized controlled trial to assess the effects in improving safe pesticide handling and reducing pesticide exposure of (1) an existing educational intervention and (2) a newly developed SMS text messaging intervention based on the Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) behavior change approach. Methods: We enrolled 539 Ugandan smallholder farmers in 12 clusters (subcounties). The clusters, each with 45 farmers, were randomly allocated to one of the three arms: (1) educational intervention, (2) educational intervention+RANAS-based SMS text messages, or (3) control group. The educational intervention comprised a 2-day workshop that targeted multiple aspects of safe pesticide handling, whereas the SMS text messages targeted the use of personal protective equipment (PPE) and were based on the RANAS approach. For intervention development in this study, this approach includes identifying psychosocial determinants of PPE use at baseline and selecting behavior change techniques to target them in SMS text messages. The primary outcomes of the study are (1) pesticide knowledge, attitude, and practice scores indicating performance throughout the educational intervention; and (2) frequency of PPE use. Secondary outcomes are the RANAS-based behavioral determinants of PPE use, the frequency of glove use, algorithm-based pesticide exposure intensity scores, and signs and symptoms of pesticide poisoning. The outcomes were assessed in structured interviews before the intervention (baseline) and at the 12-month follow-up. The effect of the interventions among the arms will be analyzed using the intervention arms and baseline measures as predictors and the follow-up measures as outcomes in linear multivariable mixed models including the clusters as random effects. The mediating psychosocial determinants of the interventions will be assessed in multiple mediation models. Results: The study was conducted from 2020 to 2021—baseline interviews were conducted in October 2020, and the educational intervention was delivered in November 2020. The RANAS-based SMS text messages were developed based on the baseline data for relevant behavioral determinants of PPE use and sent between February 2021 and September 2021. Follow-up interviews were conducted in October 2021. Overall, 539 farmers were enrolled in the study at baseline; 8.3% (45/539) were lost to follow-up by the end of the study. Conclusions: This study will contribute to a better understanding of the effectiveness and behavior change mechanisms of educational interventions by using an experimental, cluster-randomized study design to improve pesticide handling among smallholder farmers. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) 18237656; https://doi.org/10.1186/ISRCTN18237656 International Registered Report Identifier (IRRID): DERR1-10.2196/55238 %M 38718387 %R 10.2196/55238 %U https://www.researchprotocols.org/2024/1/e55238 %U https://doi.org/10.2196/55238 %U http://www.ncbi.nlm.nih.gov/pubmed/38718387 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53668 %T Cancer Care Supportive Text Messaging Program (Text4Hope) for People Living With Cancer and Their Caregivers During the COVID-19 Pandemic: Longitudinal Observational Study %A Shalaby,Reham %A Vuong,Wesley %A Agyapong,Belinda %A Gusnowski,April %A Surood,Shireen %A Agyapong,Vincent %+ Department of Psychiatry, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor Abbie J Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 7802157771, vn602367@dal.ca %K Text4Hope Cancer Care %K COVID-19 %K cancer %K caregivers %K mental health %K anxiety %K depression %K cancer care %K Canada %K Canadian %K treatment %K stress %D 2024 %7 24.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cancer is the leading cause of death in Canada, and living with cancer generates psychological demands, including depression and anxiety among cancer survivors and caregivers. Text4Hope-Cancer Care SMS text messaging–based service was provided to people with cancer and caregivers during the COVID-19 pandemic to support their mental health. Objective: The aim of this study is to examine the clinical effectiveness of and satisfaction with Text4Hope-Cancer Care in addressing mental health conditions among people living with cancer and caregivers. Methods: The study was conducted in Alberta, Canada. People who were diagnosed or receiving cancer treatment and caregivers self-subscribed to receive 3-months daily supportive cognitive behavioral therapy–based SMS text messages and a web-based survey was sent at designated time points to collect clinical and nonclinical data. The Hospital Anxiety and Depression scale (HADS) was used to examine changes in anxiety and depression symptoms after receiving the service. Satisfaction with the service was assessed using a survey with a Likert scale. Descriptive and inferential statistics were used, and test significance was considered with P≤.05. Results: Overall, 107 individuals subscribed to the service, and 93 completed the program (completion rate 93/107, 86.9%). A significant improvement in the anxiety symptoms (HADS-Anxiety [HADS-A] subscale) was reported after 3 months of Text4Hope-Cancer Care (t11=2.62; P=.02), with medium effect size (Hedges g=0.7), but not depression symptoms (HADS-Depression [HADS-D] subscale). Subscribers expressed high satisfaction and agreed that the service has helped them to cope with mental health symptoms and improve their quality of life. Most subscribers read the SMS text messages more than once (30/30, 100%); took time to reflect or took a beneficial action after reading the messages (27/30, 90%); and highly agreed (27/30, >80%) with the value of the received supportive SMS text messages as being relevant, succinct, affirmative, and positive. All subscribers recommended SMS text messaging for stress, anxiety, and depression and for cancer care support (30/30, 100%). Conclusions: Text4Hope-Cancer Care was well-perceived and effectively addressed anxiety symptoms among people living with cancer and caregivers during the peak of the COVID-19 pandemic. This study provides evidence-based support and insight for policy and stakeholders to implement similar convenient, economic, and accessible mental health services that support vulnerable populations during crises. International Registered Report Identifier (IRRID): RR2-10.2196/20240 %M 38657234 %R 10.2196/53668 %U https://formative.jmir.org/2024/1/e53668 %U https://doi.org/10.2196/53668 %U http://www.ncbi.nlm.nih.gov/pubmed/38657234 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55509 %T Effectiveness and Implementation of a Text Messaging mHealth Intervention to Prevent Childhood Obesity in Mexico in the COVID-19 Context: Mixed Methods Study %A Lozada-Tequeanes,Ana Lilia %A Théodore,Florence L %A Kim-Herrera,Edith %A García-Guerra,Armando %A Quezada-Sánchez,Amado D %A Alvarado-Casas,Rocio %A Bonvecchio,Anabelle %+ National Institute of Public Health, Instituto Nacional de Salud Pública de México, Avenida Universidad 655, Cuernavaca, 62100, Mexico, 52 +527773293000, ftheodore@insp.mx %K effectiveness %K feasibility %K mHealth %K SMS text message %K mixed methods %K infant obesity %K physical activity %K healthy feeding %K children %K COVID-19 %K Mexico %D 2024 %7 9.4.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Promoting physical activity (PA) and healthy feeding (HF) is crucial to address the alarming increase in obesity rates in developing countries. Leveraging mobile phones for behavior change communication to encourage infant PA and promote HF is particularly significant within the Mexican context. Objective: This study aims to explore the effectiveness and feasibility of mHealth interventions aimed at promoting PA and HF among primary caregivers (PCs) of Mexican children under the age of 5 years. Additionally, the study aims to disseminate insights gained from intervention implementation amidst the COVID-19 pandemic and assess the potential of behavior change mHealth interventions on a broader population scale. Methods: NUTRES, an mHealth intervention, underwent an effectiveness-implementation hybrid trial. Over 36 weeks, participants in the intervention group (IG), totaling 230 individuals, received approximately 108 SMS text messages tailored to their children’s age. These messages covered topics such as PA and HF and emphasized the significance of proper child nutrition amidst the COVID-19 pandemic. NUTRES participants were recruited from both urban and rural health units across 2 states in Mexico. Given the COVID-19 context, both baseline and follow-up surveys were conducted via mobile or fixed telephone. The evaluation of effectiveness and implementation used a mixed methods approach. Qualitative analysis delved into participants’ experiences with NUTRES and various implementation indicators, including acceptance, relevance, and coverage. Grounded theory was used for coding and analysis. Furthermore, difference-in-differences regression models were used to discern disparities between groups (comparison group [CG] versus IG) concerning knowledge and practices pertaining to infant PA and HF. Results: Of the total 494 PCs enrolled in NUTRES, 334 persisted until the end of the study, accounting for 67.6% (334/494) participation across both groups. A majority of PCs (43/141, 30.5%, always; and 97/141, 68.8%, sometimes) used the SMS text message information. Satisfaction and acceptability toward NUTRES were notably high, reaching 98% (96/98), with respondents expressing that NUTRES was “good,” “useful,” and “helpful” for enhancing child nutrition. Significant differences after the intervention were observed in PA knowledge, with social interaction favored (CG: 8/135, 5.9% vs IG: 20/137, 14.6%; P=.048), as well as in HF practice knowledge. Notably, sweetened beverage consumption, associated with the development of chronic diseases, showed divergence (CG: 92/157, 58.6% vs IG: 110/145, 75.9%; P=.003). In the difference-in-differences model, a notable increase of 0.03 in knowledge regarding the benefits of PA was observed (CG: mean 0.13, SD 0.10 vs IG: mean 0.16, SD 0.11; P=.02). PCs expressed feeling accompanied and supported, particularly amidst the disruption of routine health care services during the COVID-19 pandemic. Conclusions: While NUTRES exhibited a restricted impact on targeted knowledge and behaviors, the SMS text messages functioned effectively as both a reminder and a source of new knowledge for PCs of Mexican children under 5 years of age. The key lessons learned were as follows: mHealth intervention strategies can effectively maintain communication with individuals during emergencies, such as the COVID-19 pandemic; methodological and implementation barriers can constrain the effectiveness of mHealth interventions; and using mixed methods approaches ensures the complementary nature of results. The findings contribute valuable evidence regarding the opportunities and constraints associated with using mobile phones to enhance knowledge and practices concerning PA and HF among PCs of children under 5 years old. Trial Registration: ClinicalTrials.gov NCT04250896; https://clinicaltrials.gov/ct2/show/NCT04250896 %M 38592753 %R 10.2196/55509 %U https://mhealth.jmir.org/2024/1/e55509 %U https://doi.org/10.2196/55509 %U http://www.ncbi.nlm.nih.gov/pubmed/38592753 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e53006 %T Development of a Health Behavioral Digital Intervention for Patients With Hypertension Based on an Intelligent Health Promotion System and WeChat: Randomized Controlled Trial %A Sun,Ting %A Xu,Xuejie %A Ding,Zenghui %A Xie,Hui %A Ma,Linlin %A Zhang,Jing %A Xia,Yuxin %A Zhang,Guoli %A Ma,Zuchang %+ Hefei Institutes of Physical Science, Chinese Academy of Sciences, #350 Shushan Lake Road, Shushan District, Hefei, 230031, China, 86 13956984669, ZCMa121@126.com %K adherence %K hypertension %K health behavior %K mHealth %K digital health %D 2024 %7 5.4.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The effectiveness of timely medication, physical activity (PA), a healthy diet, and blood pressure (BP) monitoring for promoting health outcomes and behavioral changes among patients with hypertension is supported by a substantial amount of literature, with “adherence” playing a pivotal role. Nevertheless, there is a lack of consistent evidence regarding whether digital interventions can improve adherence to healthy behaviors among individuals with hypertension. Objective: The aim was to develop a health behavioral digital intervention for hypertensive patients (HBDIHP) based on an intelligent health promotion system and WeChat following the behavior change wheel (BCW) theory and digital micro-intervention care (DMIC) model and assess its efficacy in controlling BP and improving healthy behavior adherence. Methods: A 2-arm, randomized trial design was used. We randomly assigned 68 individuals aged >60 years with hypertension in a 1:1 ratio to either the control or experimental group. The digital intervention was established through the following steps: (1) developing digital health education materials focused on adherence to exercise prescriptions, Dietary Approaches to Stop Hypertension (DASH), prescribed medication, and monitoring of BP; (2) using the BCW theory to select behavior change techniques; (3) constructing the intervention's logic following the guidelines of the DMIC model; (4) creating an intervention manual including the aforementioned elements. Prior to the experiment, participants underwent physical examinations at the community health service center's intelligent health cabin and received intelligent personalized health recommendations. The experimental group underwent a 12-week behavior intervention via WeChat, while the control group received routine health education and a self-management manual. The primary outcomes included BP and adherence indicators. Data analysis was performed using SPSS, with independent sample t tests, chi-square tests, paired t tests, and McNemar tests. A P value <.05 was considered statistically significant. Results: The final analysis included 54 participants with a mean age of 67.24 (SD 4.19) years (n=23 experimental group, n=31 control group). The experimental group had improvements in systolic BP (–7.36 mm Hg, P=.002), exercise time (856.35 metabolic equivalent [MET]-min/week, P<.001), medication adherence (0.56, P=.001), BP monitoring frequency (P=.02), and learning performance (3.23, P<.001). Both groups experienced weight reduction (experimental: 1.2 kg, P=.002; control: 1.11 kg, P=.009) after the intervention. The diet types and quantities for both groups (P<.001) as well as the subendocardial viability ratio (0.16, P=.01) showed significant improvement. However, there were no statistically significant changes in other health outcomes. Conclusions: The observations suggest our program may have enhanced specific health outcomes and adherence to health behaviors in older adults with hypertension. However, a longer-term, larger-scale trial is necessary to validate the effectiveness. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200062643; https://www.chictr.org.cn/showprojEN.html?proj=172782 International Registered Report Identifier (IRRID): RR2-10.2196/46883 %M 38578692 %R 10.2196/53006 %U https://mhealth.jmir.org/2024/1/e53006 %U https://doi.org/10.2196/53006 %U http://www.ncbi.nlm.nih.gov/pubmed/38578692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52695 %T Nurse-Led Brief Intervention for Enhancing Safe Sex Practice Among Emerging Adults in Hong Kong Using Instant Messaging: Feasibility Study %A Pak,Sharon Hoi Lam %A Wang,Man Ping %A Teitelman,Anne M %A Wong,Janet Yuen Ha %A Fong,Daniel Yee Tak %A Choi,Edmond Pui Hang %+ School of Nursing and Health Studies, Hong Kong Metropolitan University, 11/F, 1 Sheung Shing Street, Homantin, Kowloon, Hong Kong, China (Hong Kong), 852 39702988, jyhwong@hkmu.edu.hk %K condom use %K emerging adults %K HIV prevention %K IM intervention %K mHealth %K nurse-led intervention %K safer sex practice %K sexual health %K sexually transmitted infections %K text-messaging %D 2024 %7 20.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The incidence of sexually transmitted infections has been increasing throughout the world. Additionally, substantial changes in emerging adults’ attitudes toward sex and the popularization of premarital sex could further affect the diagnosis and treatment of sexually transmitted infections. With the high acceptability and effectiveness of instant messaging (IM) interventions for health promotion, there is potential for such interventions to improve condom use knowledge and promote safer sex practice. Objective: The study evaluates the feasibility of a nurse-led IM intervention to promote safer sex practices in emerging adults. Methods: A 30-minute adaptive IM intervention and a 5-day booster dose of daily messages after 2 weeks through WhatsApp (Meta Platforms, Inc) were conducted with emerging adults in local universities in Hong Kong aged between 18 and 29 years with previous sexual experience. A questionnaire was distributed 1 week after the intervention that measured the consistency in condom use, the change in condom use knowledge and attitudes, and the acceptability of the intervention. The feasibility of the intervention was assessed by Bowen’s feasibility framework. Results: A total of 20 participants completed the intervention and questionnaire. Results showed (1) high satisfaction level (mean satisfaction score: 9.10/10), (2) high demand of the intervention (retention rate: 95%), (3) smooth implementation of the intervention, (4) high practicality (13/20, 65% of the participants viewed IM to be an effective means of intervention), (5) potential integration of the intervention, and (6) significant mean increase in condom use knowledge and attitudes (mean increase 9.05; t19=3.727; 95% CI 3.97-14.13; P=.001). Conclusions: The IM intervention was feasible, acceptable, and had potential impacts on improving safer sex practices. These findings will support the future development of IM interventions in the arena of sexual health promotion. %M 38506897 %R 10.2196/52695 %U https://formative.jmir.org/2024/1/e52695 %U https://doi.org/10.2196/52695 %U http://www.ncbi.nlm.nih.gov/pubmed/38506897 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55041 %T Developing a Text Messaging Intervention to Prevent Binge and Heavy Drinking in a Military Population: Mixed Methods Development Study %A Aycock,Chase A %A Mallawaarachchi,Indika %A Wang,Xin-Qun %A Cassidy,Daniel G %A Ellis,Jordan M %A Klesges,Robert C %A Talcott,G Wayne %A Wiseman,Kara %+ Department of Public Health Sciences, University of Virginia, P.O. Box 800717, Charlottesville, VA, 22908, United States, 1 4342348126, kara.wiseman@virginia.edu %K text messaging %K alcohol reduction %K binge drinking %K US %K United States %K US military %K alcohol misuse %K military %K functioning %K readiness %K health %K career %K careers %K text message %K text messages %K short message service %K SMS %K SMS intervention %K drinking %K Air Force %K Airmen %K mixed methods approach %K message %K messages %K development study %K qualitative coding %K drinking alcohol %K alcohol consumption %K survey %K descriptive statistics %D 2024 %7 19.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol misuse is the fourth leading cause of death in the United States and a significant problem in the US military. Brief alcohol interventions can reduce negative alcohol outcomes in civilian and military populations, but additional scalable interventions are needed to reduce binge and heavy drinking. SMS text messaging interventions could address this need, but to date, no programs exist for military populations. Objective: We aimed to develop an SMS text messaging intervention to address binge and heavy drinking among Airmen in Technical Training in the US Air Force. Methods: We implemented a 2-phase, mixed methods study to develop the SMS text messaging intervention. In phase 1, a total of 149 respondents provided feedback about the persuasiveness of 49 expert-developed messages, preferences regarding message frequency, timing and days to receive messages, and suggested messages, which were qualitatively coded. In phase 2, a total of 283 respondents provided feedback about the persuasiveness of 77 new messages, including those developed through the refinement of messages from phase 1, which were coded and assessed based on the Behavior Change Technique Taxonomy (BCTT). For both phases, mean persuasiveness scores (range 1-5) were calculated and compared according to age (aged <21 or ≥21 years) and gender. Top-ranking messages from phase 2 were considered for inclusion in the final message library. Results: In phase 1, top-rated message themes were about warnings about adverse outcomes (eg, impaired judgment and financial costs), recommendations to reduce drinking, and invoking values and goals. Through qualitative coding of suggested messages, we identified themes related to warnings about adverse outcomes, recommendations, prioritizing long-term goals, team and belonging, and invoking values and goals. Respondents preferred to receive 1 to 3 messages per week (124/137, 90.5%) and to be sent messages on Friday, Saturday, and Sunday (65/142, 45.8%). In phase 2, mean scores for messages in the final message library ranged from 3.31 (SD 1.29) to 4.21 (SD 0.90). Of the top 5 highest-rated messages, 4 were categorized into 2 behavior change techniques (BCTs): valued self-identity and information about health consequences. The final message library includes 28 BCTT-informed messages across 13 BCTs, with messages having similar scores across genders. More than one-fourth (8/28, 29%) of the final messages were informed by the suggested messages from phase 1. As Airmen aged <21 years face harsher disciplinary action for alcohol consumption, the program is tailored based on the US legal drinking age. Conclusions: This study involved members from the target population throughout 2 formative stages of intervention development to design a BCTT-informed SMS text messaging intervention to reduce binge and heavy drinking, which is now being tested in an efficacy trial. The results will determine the impact of the intervention on binge drinking and alcohol consumption in the US Air Force. %M 38502165 %R 10.2196/55041 %U https://formative.jmir.org/2024/1/e55041 %U https://doi.org/10.2196/55041 %U http://www.ncbi.nlm.nih.gov/pubmed/38502165 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53391 %T Health Care Professionals’ Perspectives Before and After Use of eDialogue for Team-Based Digital Communication Across Settings: Qualitative Study %A Jensen,Lili Worre Høpfner %A Rahbek,Ole %A Lauritsen,Rikke Emilie Kildahl %A Kold,Søren %A Dinesen,Birthe %+ Interdisciplinary Othopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Hobrovej 18-22, Aalborg, 9000, Denmark, 45 60229406, lili.jensen@rn.dk %K CFIR %K Consolidated Framework for Implementation Research %K digital communication %K hospital discharge %K implementation science %K interdisciplinary communication %K orthopedic surgery %K patient-provider communication %K postoperative care %K qualitative research %K text messaging %D 2024 %7 8.3.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Orthopedic surgical treatment is a transversal task that requires the active involvement of patients, relatives, and health care professionals (HCPs) across various settings. However, after hospital discharge, communication is challenged and undertaken primarily by phone. New digital communication solutions have the potential to create a space for seamless and patient-centered dialogue across discipline and sector boundaries. When evaluating new communication solutions, knowledge about HCPs’ needs and perspectives of use must be explored, as it is they who are responsible for implementing changes in practice. Objective: This study aimed to (1) investigate HCPs’ perceptions of current communication pathways (phase 1) and (2) explore their experiences of using a simple messenger-like solution (eDialogue) for team-based digital communication across settings (phase 2). Methods: We used a triangulation of qualitative data collection techniques, including document analysis, observations, focus groups, and individual interviews of HCPs before (n=28) and after (n=12) their use of eDialogue. Data collection and analysis were inspired by the Consolidated Framework for Implementation Research (CFIR) to specifically understand facilitators and barriers to implementation as perceived by HCPs. Results: HCPs perceive current communication pathways as insufficient for both patients and themselves. Phone calls are disruptive, and there is a lack of direct communication modalities when communication crosses sector boundaries. HCPs experienced the use of eDialogue as a quick and easy way for timely interdisciplinary interaction with patients and other HCPs across settings; however, concerns were raised about time consumption. Conclusions: eDialogue can provide needed support for interdisciplinary and cross-sectoral patient-centered communication. However, future studies of this solution should address its impact and the use of resources. %M 38457798 %R 10.2196/53391 %U https://humanfactors.jmir.org/2024/1/e53391 %U https://doi.org/10.2196/53391 %U http://www.ncbi.nlm.nih.gov/pubmed/38457798 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46195 %T Evaluation of the Effectiveness of Suicide.ca, Quebec’s Digital Suicide Prevention Strategy Platform: Cross-Sectional Descriptive Study %A Côté,Louis-Philippe %A Lane,Julie %+ Centre for Research and Intervention on Suicide, Ethical Issues and End-of-life practices, Université du Québec à Montréal, 100 rue Sherbrooke Ouest, Montreal, QC, H2X 3P2, Canada, 1 (514) 987 4832, cote.louis-philippe.3@courrier.uqam.ca %K suicide prevention %K public health %K information and communication technology %K digital mental health %K helpline %K digital strategy %K communication technology %K information technology %K suicide %K psychoeducation %K mobile app %K suicide risk %K risk factor %K users %K mental health %K text %K website %K prevention strategy %K prevention %K Google Analytics %K Canada %K Quebec %K questionnaire %K mobile phone %D 2024 %7 6.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In 2017, the Quebec government assigned the Association québécoise de prévention du suicide (AQPS) to develop a digital suicide prevention strategy (DSPS). The AQPS responded by creating a centralized website that provides information on suicide and mental health, identifies at-risk individuals on the internet, and offers direct crisis intervention support via chat and text. Objective: This study aims to evaluate the effectiveness of suicide.ca, Quebec’s DSPS platform. Methods: This study used a cross-sectional descriptive design. The study population comprised internet users from Quebec, Canada, who visited the suicide.ca platform between October 2020 and October 2021. Various data sources, such as Google Analytics, Firebase Console, and Customer Relation Management data, were analyzed to document the use of the platform. To understand the profile of suicide.ca users, frequency analyses were conducted using data from the self-assessment module questionnaires, the intervention service’s triage questionnaire, and the counselors’ intervention reports. The effectiveness of the platform’s promotional activities on social media was assessed by examining traffic peaks. Google Analytics was used to evaluate the effectiveness of AQPS’ strategy for identifying at-risk internet users. The impact of the intervention service was evaluated through an analysis of counselors’ intervention reports and postintervention survey results. Results: The platform received traffic from a diverse range of sources, with promotional efforts on social media directly contributing to the increased traffic. The requirement of a user account posed a barrier to the use of the mobile app, and a triage question that involved personal information led to a substantial number of dropouts during the intervention service triage. AdWords campaigns and fact sheets addressing suicide risk factors played a crucial role in driving traffic to the platform. With regard to the profile of suicide.ca users, the findings revealed that the platform engaged individuals with diverse levels of suicidal risk. Notably, users of the chat service displayed a higher suicide risk than those who used the self-assessment module. Crisis chat counselors reported a positive impact on approximately half of the contacts, and overall, intervention service users expressed satisfaction with the support they received. Conclusions: A centralized digital platform can be used to implement a DSPS, effectively reaching the general population, individuals with risk factors for suicide, and those facing suicidal issues. %M 38446536 %R 10.2196/46195 %U https://formative.jmir.org/2024/1/e46195 %U https://doi.org/10.2196/46195 %U http://www.ncbi.nlm.nih.gov/pubmed/38446536 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52583 %T Tailoring of Health-Promotion Video Messaging for Reproductive-Aged Women at Risk for Developing Cardiometabolic Disease: Qualitative Focus-Groups Study %A Kent-Marvick,Jacqueline %A Gibson,Bryan %A Bristol,Alycia A %A St Clair,Stephanie %A Simonsen,Sara E %+ College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, United States, 1 4356686932, jacqueline.kent-marvick@utah.edu %K cardiometabolic disease %K type 2 diabetes mellitus %K gestational diabetes mellitus %K hypertensive disorder of pregnancy %K prediabetes %K obesity %K women’s health %K lifestyle change %K health promotion technology %K qualitative research %D 2024 %7 5.3.2024 %9 Short Paper %J JMIR Form Res %G English %X Background: Targeting reproductive-aged women at high risk for type 2 diabetes (T2D) provides an opportunity for prevention earlier in the life course. A woman’s experiences during her reproductive years may have a large impact on her future risk of T2D. Her risk is 7 to 10 times higher if she has had gestational diabetes (GDM). Despite these risks, T2D is preventable. Evidence-based programs, such as the National Diabetes Prevention Program (DPP), can reduce the risk of developing T2D by nearly 60%. However, only 0.4% of adults with prediabetes have participated in the DPP to date and reproductive-aged women are 50% less likely to participate than older women. In prior work, our team developed a mobile 360° video to address diabetes risk awareness and promote DPP enrollment among at-risk adults; this video was not designed, however, for reproductive-aged women. Objective: This study aims to obtain feedback from reproductive-aged women with cardiometabolic disease risk about a 360° video designed to promote enrollment in the DPP, and to gather suggestions about tailoring video messages to reproductive-aged women. Methods: Focus groups and a qualitative descriptive approach were used. Women with at least 1 previous pregnancy, aged 18 to 40 years, participated in one of three focus groups stratified by the following health risks: (1) a history of GDM or a hypertensive disorder of pregnancy, (2) a diagnosis of prediabetes, or (3) a BMI classified as obese. Focus-group questions addressed several topics; this report shared findings regarding video feedback. The 3 focus-group discussions were conducted via Zoom and were recorded and transcribed for analysis. Deductive codes were used to identify concepts related to the research question and inductive codes were created for novel insights shared by participants. The codes were then organized into categories and themes. Results: The main themes identified were positive feedback, negative feedback, centering motherhood, and the importance of storytelling. While some participants said the video produced a sense of urgency for health-behavior change, all participants agreed that design changes could improve the video’s motivating effect on health-behavior change in reproductive-aged women. Participants felt a tailored video should recognize the complexities of being a mother and how these dynamics contribute to women’s difficulty engaging in healthy behaviors without stirring feelings of guilt. Women desired a video with a positive, problem-solving perspective, and recommended live links as clickable resources for practical solutions promoting health behavior change. Women suggested using storytelling, both to describe how complications experienced during pregnancy impact long-term health and to motivate health behavior change. Conclusions: Reproductive-aged women require tailored lifestyle-change messaging that addresses barriers commonly encountered by this population (eg, parenting or work responsibilities). Moreover, messaging should prioritize a positive tone that harnesses storytelling and human connection while offering realistic solutions. %M 38441920 %R 10.2196/52583 %U https://formative.jmir.org/2024/1/e52583 %U https://doi.org/10.2196/52583 %U http://www.ncbi.nlm.nih.gov/pubmed/38441920 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e44861 %T What Adolescents Say in Text Messages to Motivate Peer Networks to Access Health Care and Sexually Transmitted Infection Testing: Qualitative Thematic Analysis %A Lightfoot,Marguerita %A Campbell,Chadwick %A Maragh-Bass,Allysha C %A Jackson-Morgan,Joi %A Taylor,Kelly %+ School of Public Health, Oregon Health & Science University – Portland State University, 1810 SW 5th Ave., Suite 510, Portland, OR, 97201, United States, 1 503 494 4345, lightfom@ohsu.edu %K adolescents %K clinics %K HIV/STI testing %K intervention %K mobile health %K peer %K screening %K sexually active %K STI %K text messaging %K young adult %D 2024 %7 28.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: While rates of HIV and sexually transmitted infections (STIs) are extremely high among adolescents and young adults in the United States, rates of HIV and STI testing remain low. Given the ubiquity of mobile phones and the saliency of peers for youths, text messaging strategies may successfully promote HIV or STI testing among youths. Objective: This study aimed to understand the types of messages youths believe were motivating and persuasive when asked to text friends to encourage them to seek HIV or STI testing services at a neighborhood clinic. Methods: We implemented an adolescent peer-based text messaging intervention to encourage clinic attendance and increase STI and HIV testing among youths (n=100) at an adolescent clinic in San Francisco, California. Participants were asked to send a text message to 5 friends they believed were sexually active to encourage their friends to visit the clinic and receive STI or HIV screening. Thematic analysis was used to analyze the content of the text messages sent and received during the clinic visit. Member checking and consensus coding were used to ensure interrater reliability and significance of themes. Results: We identified four themes in the messages sent by participants: (1) calls to action to encourage peers to get tested, (2) personalized messages with sender-specific information, (3) clinic information such as location and hours, and (4) self-disclosure of personal clinic experience. We found that nearly all text messages included some combination of 2 or more of these broad themes. We also found that youths were inclined to send messages they created themselves, as opposed to sending the same message to each peer, which they tailored to each individual to whom they were sent. Many (40/100, 40%) received an immediate response to their message, and most participants reported receiving at least 1 positive response, while a few reported that they had received at least 1 negative response. There were some differences in responses depending on the type of message sent. Conclusions: Given the high rates of STI and HIV and low rates of testing among adolescents, peer-driven text messaging interventions to encourage accessing care may be successful at reaching this population. This study suggests that youths are willing to text message their friends, and there are clear types of messages they develop and use. Future research should use these methods with a large, more diverse sample of youths and young adults for long-term evaluation of care seeking and care retention outcomes to make progress in reducing HIV and STI among adolescents and young adults. %M 38416541 %R 10.2196/44861 %U https://www.jmir.org/2024/1/e44861 %U https://doi.org/10.2196/44861 %U http://www.ncbi.nlm.nih.gov/pubmed/38416541 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e49317 %T HealthySMS Text Messaging System Adjunct to Adolescent Group Cognitive Behavioral Therapy in the Context of COVID-19 (Let’s Text!): Pilot Feasibility and Acceptability Study %A Haack,Lauren M %A Armstrong,Courtney C %A Travis,Kate %A Aguilera,Adrian %A Darrow,Sabrina M %+ Department of Psychiatry and Behavioral Sciences, University of California San Francisco, 675 18th Street, San Francisco, CA, 94107, United States, 1 415 502 8060, lauren.haack@ucsf.edu %K depression %K adolescents %K evidence-based intervention %K texting %K SMS text message %K cognitive behavioral therapy %K CBT %K group CBT %K shelter-in-place %K COVID-19 %K mobile health %K mHealth %K therapy %K cognitive %K behavior %K web-based therapy %K e-therapy %K youth %K young adults %K mobile phone %D 2024 %7 19.2.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: The widespread occurrence and devastating impact of adolescent depression warrant health service research focused on feasible and acceptable digital health tools to supplement evidence-based intervention (EBI) efforts, particularly in the context of shelter-in-place guidelines disrupting youth socialization and service use in the wake of the COVID-19 pandemic. Given the promise of SMS text message interventions to enhance EBI engagement, our team developed the HealthySMS system as an adjunct to one of the most empirically supported interventions for adolescent depression: cognitive behavioral therapy (CBT) group services. The system sends daily SMS text messages requesting responses assessing mood, thoughts, and activities; weekly attendance reminder messages; daily tips about adherence (eg, a prompt for activity completion); and personalized responses based on participants’ texts. Objective: This study aims to evaluate the feasibility and acceptability of HealthySMS in a real-world setting and explore potential mechanisms of change in EBI engagement, before evaluating the system’s impact on adolescents’ group CBT engagement and, ultimately, depression outcomes. Methods: Over the course of 2020, we invited all 20 adolescents receiving CBT group services for depression at an outpatient psychiatry clinic to enroll in our HealthySMS study; ultimately, 17 (85%) adolescents agreed to participate. We tracked participant initiation and engagement with the HealthySMS system as well as the content of SMS text message responses to HealthySMS. We also invited each participant to engage in a semistructured interview to gather additional qualitative inputs on the system. Results: All (n=17, 100%) research participants invited agreed to receive HealthySMS messages, and 94% (16/17) of the participants maintained use during the first month without opting out. We uncovered meaningful qualitative themes regarding the feasibility and acceptability of HealthySMS, as well as its potential impact on EBI engagement. Conclusions: Taken together, the results of this pilot study suggest that HealthySMS adjunct to adolescent CBT group depression services is feasible and acceptable, as evidenced by high rates of HealthySMS initiation and low rates of dropout, as well as meaningful themes uncovered from participants’ qualitative feedback. In addition, the findings provide evidence regarding iterative improvements to the HealthySMS system and research protocol, as well as potential mechanisms of change for enhanced EBI engagement and, ultimately, adolescent depression outcomes, which can be used in future effectiveness research. %M 38373030 %R 10.2196/49317 %U https://mental.jmir.org/2024/1/e49317 %U https://doi.org/10.2196/49317 %U http://www.ncbi.nlm.nih.gov/pubmed/38373030 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e50863 %T A Digital Intervention to Promote Self-Management Self-Efficacy Among Community-Dwelling Individuals With Stroke: Pilot Randomized Controlled Trial %A Li,Zhaoying %A Lei,Yating %A Bui,Quoc %A DePaul,Olivia %A Nicol,Ginger E %A Mohr,David C %A Lee,Sunghoon I %A Fong,Mandy W M %A Metts,Christopher L %A Tomazin,Stephanie E %A Wong,Alex W K %+ Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, 355 E. Erie Street, Chicago, IL, 60611, United States, 1 312 238 1742, wwong@sralab.org %K digital intervention %K feasibility %K mobile health %K participation %K rehabilitation %K self-efficacy %K self-management %K stroke %K technology %K telehealth %K telemedicine %K text messaging %D 2024 %7 19.2.2024 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Digital interventions provided through smartphones or the internet that are guided by a coach have been proposed as promising solutions to support the self-management of chronic conditions. However, digital intervention for poststroke self-management is limited; we developed the interactive Self-Management Augmented by Rehabilitation Technologies (iSMART) intervention to address this gap. Objective: This study aimed to examine the feasibility and initial effects of the iSMART intervention to improve self-management self-efficacy in people with stroke. Methods: A parallel, 2-arm, nonblinded, randomized controlled trial of 12-week duration was conducted. A total of 24 participants with mild-to-moderate chronic stroke were randomized to receive either the iSMART intervention or a manual of stroke rehabilitation (attention control). iSMART was a coach-guided, technology-supported self-management intervention designed to support people managing chronic conditions and maintaining active participation in daily life after stroke. Feasibility measures included retention and engagement rates in the iSMART group. For both the iSMART intervention and active control groups, we used the Feasibility of Intervention Measure, Acceptability of Intervention Measure, and Intervention Appropriateness Measure to assess the feasibility, acceptability, and appropriateness, respectively. Health measures included the Participation Strategies Self-Efficacy Scale and the Patient-Reported Outcomes Measurement Information System’s Self-Efficacy for Managing Chronic Conditions. Results: The retention rate was 82% (9/11), and the engagement (SMS text message response) rate was 78% for the iSMART group. Mean scores of the Feasibility of Intervention Measure, Acceptability of Intervention Measure, and Intervention Appropriateness Measure were 4.11 (SD 0.61), 4.44 (SD 0.73), and 4.36 (SD 0.70), respectively, which exceeded our benchmark (4 out of 5), suggesting high feasibility, acceptability, and appropriateness of iSMART. The iSMART group showed moderate-to-large effects in improving self-efficacy in managing emotions (r=0.494), symptoms (r=0.514), daily activities (r=0.593), and treatments and medications (r=0.870), but the control group showed negligible-to-small effects in decreasing self-efficacy in managing emotions (r=0.252), symptoms (r=0.262), daily activities (r=0.136), and treatments and medications (r=0.049). In addition, the iSMART group showed moderate-to-large effects of increasing the use of participation strategies for management in the home (r=0.554), work (r=0.633), community (r=0.673), and communication activities (r=0.476). In contrast, the control group showed small-to-large effects of decreasing the use of participation strategies for management in the home (r=0.567), work (r=0.342, community (r=0.215), and communication activities (r=0.379). Conclusions: Our findings support the idea that iSMART was feasible to improve poststroke self-management self-efficacy. Our results also support using a low-cost solution, such as SMS text messaging, to supplement traditional therapeutic patient education interventions. Further evaluation with a larger sample of participants is still needed. Trial Registration: ClinicalTrials.gov 202004137; https://clinicaltrials.gov/study/NCT04743037?id=202004137&rank=1 %M 38373029 %R 10.2196/50863 %U https://rehab.jmir.org/2024/1/e50863 %U https://doi.org/10.2196/50863 %U http://www.ncbi.nlm.nih.gov/pubmed/38373029 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e54530 %T Feasibility of Using Text Messaging to Identify and Assist Patients With Hypertension With Health-Related Social Needs: Cross-Sectional Study %A Kormanis,Aryn %A Quinones,Selina %A Obermiller,Corey %A Denizard-Thompson,Nancy %A Palakshappa,Deepak %+ Department of Internal Medicine, Wake Forest University School of Medicine, Medical Center Blvd, Winston Salem, NC, 27157, United States, 1 3367161795, dpalaksh@wakehealth.edu %K social determinants of health %K health-related social needs %K mobile health %K health information technology %K feasibility %K mobile phone %K SMS text messaging %K message %K pilot study %K patients %K patient %K hypertension %K screening %D 2024 %7 13.2.2024 %9 Original Paper %J JMIR Cardio %G English %X Background: Health-related social needs are associated with poor health outcomes, increased acute health care use, and impaired chronic disease management. Given these negative outcomes, an increasing number of national health care organizations have recommended that the health system screen and address unmet health-related social needs as a routine part of clinical care, but there are limited data on how to implement social needs screening in clinical settings to improve the management of chronic diseases such as hypertension. SMS text messaging could be an effective and efficient approach to screen patients; however, there are limited data on the feasibility of using it. Objective: We conducted a cross-sectional study of patients with hypertension to determine the feasibility of using SMS text messaging to screen patients for unmet health-related social needs. Methods: We randomly selected 200 patients (≥18 years) from 1 academic health system. Patients were included if they were seen at one of 17 primary care clinics that were part of the academic health system and located in Forsyth County, North Carolina. We limited the sample to patients seen in one of these clinics to provide tailored information about local community-based resources. To ensure that the participants were still patients within the clinic, we only included those who had a visit in the previous 3 months. The SMS text message included a link to 6 questions regarding food, housing, and transportation. Patients who screened positive and were interested received a subsequent message with information about local resources. We assessed the proportion of patients who completed the questions. We also evaluated for the differences in the demographics between patients who completed the questions and those who did not using bivariate analyses. Results: Of the 200 patients, the majority were female (n=109, 54.5%), non-Hispanic White (n=114, 57.0%), and received commercial insurance (n=105, 52.5%). There were no significant differences in demographics between the 4446 patients who were eligible and the 200 randomly selected patients. Of the 200 patients included, the SMS text message was unable to be delivered to 9 (4.5%) patients and 17 (8.5%) completed the social needs questionnaire. We did not observe a significant difference in the demographic characteristics of patients who did versus did not complete the questionnaire. Of the 17, a total of 5 (29.4%) reported at least 1 unmet need, but only 2 chose to receive resource information. Conclusions: We found that only 8.5% (n=17) of patients completed a SMS text message–based health-related social needs questionnaire. SMS text messaging may not be feasible as a single modality to screen patients in this population. Future research should evaluate if SMS text message–based social needs screening is feasible in other populations or effective when paired with other screening modalities. %M 38349714 %R 10.2196/54530 %U https://cardio.jmir.org/2024/1/e54530 %U https://doi.org/10.2196/54530 %U http://www.ncbi.nlm.nih.gov/pubmed/38349714 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55930 %T Authors' Reply: Concerns About the Generalizability Associated With a South African Randomized Controlled Trial on Prenatal Mothers %A Adam,Maya %A Nguyễn,Vān Kính %+ Department of Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, United States, 1 6508393600, madam@stanford.edu %K maternal child health %K mHealth %K mobile health %K randomized controlled trial %K short animated storytelling %K South Africa %K video health messaging %D 2024 %7 12.2.2024 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 38345840 %R 10.2196/55930 %U https://www.jmir.org/2024/1/e55930 %U https://doi.org/10.2196/55930 %U http://www.ncbi.nlm.nih.gov/pubmed/38345840 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53861 %T Concerns About the Generalizability Associated With a South African Randomized Controlled Trial on Prenatal Mothers %A Lin,Yongjian %+ Department of Gastrointestinal and Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 22, Shuangyou Road, Qingxiu District, Nanning, 530021, China, 86 13878870525, linyongjian@stu.gxmu.edu.cn %K letter %K maternal child health %K mHealth %K mobile health %K randomized controlled trial %K short animated storytelling %K South Africa %K video health messaging %D 2024 %7 12.2.2024 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 38345847 %R 10.2196/53861 %U https://www.jmir.org/2024/1/e53861 %U https://doi.org/10.2196/53861 %U http://www.ncbi.nlm.nih.gov/pubmed/38345847 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 9 %N %P e49491 %T Care Partner Engagement in Secure Messaging Between Patients With Diabetes and Their Clinicians: Cohort Study %A Semere,Wagahta %A Karter,Andrew J %A Lyles,Courtney R %A Reed,Mary E %A Karliner,Leah %A Kaplan,Celia %A Liu,Jennifer Y %A Livaudais-Toman,Jennifer %A Schillinger,Dean %+ Department of Medicine, University of California San Francisco, Pride Hall, 2540 23rd Street, 4th Floor, Box 1364, San Francisco, CA, 94110, United States, 1 6282068494, wagahta.semere@ucsf.edu %K caregivers %K diabetes %K telehealth %K secure messaging %K patient portal %K messaging %K diabetes outcomes %K family care %K clinical care %D 2024 %7 9.2.2024 %9 Original Paper %J JMIR Diabetes %G English %X Background: Patient engagement with secure messaging (SM) via digital patient portals has been associated with improved diabetes outcomes, including increased patient satisfaction and better glycemic control. Yet, disparities in SM uptake exist among older patients and racial and ethnic underserved groups. Care partners (family members or friends) may provide a means for mitigating these disparities; however, it remains unclear whether and to what extent care partners might enhance SM use. Objective: We aim to examine whether SM use differs among older patients with diabetes based on the involvement of care partner proxies. Methods: This is a substudy of the ECLIPPSE (Employing Computational Linguistics to Improve Patient-Provider Secure Emails) project, a cohort study taking place in a large, fully integrated health care delivery system with an established digital patient portal serving over 4 million patients. Participants included patients with type 2 diabetes aged ≥50 years, newly registered on the patient portal, who sent ≥1 English-language message to their clinician between July 1, 2006, and December 31, 2015. Proxy SM was identified by having a registered proxy. To identify nonregistered proxies, a computational linguistics algorithm was applied to detect words and phrases more likely to appear in proxy messages compared to patient-authored messages. The primary outcome was the annual volume of secure messages (sent or received); secondary outcomes were the length of time to the first SM sent by patient or proxy and the number of annual SM exchanges (unique message topics generating ≥1 reply). Results: The mean age of the cohort (N=7659) at this study’s start was 61 (SD 7.16) years; 75% (n=5573) were married, 15% (n=1089) identified as Black, 10% (n=747) Chinese, 12% (n=905) Filipino, 13% (n=999) Latino, and 30% (n=2225) White. Further, 49% (n=3782) of patients used a proxy to some extent. Compared to nonproxy users, proxy users were older (P<.001), had lower educational attainment (P<.001), and had more comorbidities (P<.001). Adjusting for patient sociodemographic and clinical characteristics, proxy users had greater annual SM volume (20.7, 95% CI 20.2-21.2 vs 10.9, 95% CI 10.7-11.2; P<.001), shorter time to SM initiation (hazard ratio vs nonusers: 1.30, 95% CI 1.24-1.37; P<.001), and more annual SM exchanges (6.0, 95% CI 5.8-6.1 vs 2.9, 95% CI 2.9-3.0, P<.001). Differences in SM engagement by proxy status were similar across patient levels of education, and racial and ethnic groups. Conclusions: Among a cohort of older patients with diabetes, proxy SM involvement was independently associated with earlier initiation and increased intensity of messaging, although it did not appear to mitigate existing disparities in SM. These findings suggest care partners can enhance patient-clinician telecommunication in diabetes care. Future studies should examine the effect of care partners’ SM involvement on diabetes-related quality of care and clinical outcomes. %M 38335020 %R 10.2196/49491 %U https://diabetes.jmir.org/2024/1/e49491 %U https://doi.org/10.2196/49491 %U http://www.ncbi.nlm.nih.gov/pubmed/38335020 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47360 %T Exploring User Perspectives on Brief Reflective Questioning Activities for Stress Management: Mixed Methods Study %A Bhattacharjee,Ananya %A Chen,Pan %A Mandal,Abhijoy %A Hsu,Anne %A O'Leary,Katie %A Mariakakis,Alex %A Williams,Joseph Jay %+ Department of Computer Science, University of Toronto, 40 St George St, Toronto, ON, M5S 2E4, Canada, 1 647 619 6982, ananya@cs.toronto.edu %K reflection %K mental health %K stress %K reflective questioning activity %K RQA %K brief intervention %K computer-mediated communication %K email %K SMS text messaging %K mobile phone %D 2024 %7 8.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Current online interventions dedicated to assisting individuals in managing stress and negative emotions often necessitate substantial time commitments. This can be burdensome for users, leading to high dropout rates and reducing the effectiveness of these interventions. This highlights an urgent need for concise digital activities that individuals can swiftly access during instances of negative emotions or stress in their daily lives. Objective: The primary aim of this study was to investigate the viability of using a brief digital exercise, specifically a reflective questioning activity (RQA), to help people reflect on their thoughts and emotions about a troubling situation. The RQA is designed to be quick, applicable to the general public, and scalable without requiring a significant support structure. Methods: We conducted 3 simultaneous studies. In the first study, we recruited 48 participants who completed the RQA and provided qualitative feedback on its design through surveys and semistructured interviews. In the second study, which involved 215 participants from Amazon Mechanical Turk, we used a between-participants design to compare the RQA with a single-question activity. Our hypotheses posited that the RQA would yield greater immediate stress relief and higher perceived utility, while not significantly altering the perception of time commitment. To assess these, we measured survey completion times and gathered multiple self-reported scores. In the third study, we assessed the RQA’s real-world impact as a periodic intervention, exploring engagement via platforms such as email and SMS text messaging, complemented by follow-up interviews with participants. Results: In our first study, participants appreciated the RQA for facilitating structured reflection, enabling expression through writing, and promoting problem-solving. However, some of the participants experienced confusion and frustration, particularly when they were unable to find solutions or alternative perspectives on their thoughts. In the second study, the RQA condition resulted in significantly higher ratings (P=.003) for the utility of the activity and a statistically significant decrease (P<.001) in perceived stress rating compared with the single-question activity. Although the RQA required significantly more time to be completed (P<.001), there was no statistically significant difference in participants’ subjective perceived time commitment (P=.37). Deploying the RQA over 2 weeks in the third study identified some potential challenges to consider for such activities, such as the monotony of doing the same activity several times, the limited affordances of mobile phones, and the importance of having the prompts align with the occurrence of new troubling situations. Conclusions: This paper describes the design and evaluation of a brief online self-reflection activity based on cognitive behavioral therapy principles. Our findings can inform practitioners and researchers in the design and exploration of formats for brief interventions to help people with everyday struggles. %M 38329800 %R 10.2196/47360 %U https://formative.jmir.org/2024/1/e47360 %U https://doi.org/10.2196/47360 %U http://www.ncbi.nlm.nih.gov/pubmed/38329800 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55700 %T Physical Activity Intervention for Urban Black Women With Asthma: Protocol for a Randomized Controlled Efficacy Study %A Davis,Ellen %A Townsend,Elizabeth %A Cavalier,Aero %A Chen,Yi-Fan %A Edwards-Hart,Dameka %A Kitsiou,Spyros %A Kowalczyk,Wiktoria %A Mansur,Iliana %A Okpara,Ebere %A Powell,Karen %A Press,Valerie G %A Ramirez,Toni %A Salvo,Deborah %A Sharp,Lisa K %A Wright,Brittani %A Nyenhuis,Sharmilee Maria %+ Section of Allergy and Immunology, Department of Pediatrics, University of Chicago, 5837 S Maryland Ave, Chicago, IL, 60637, United States, 1 7738347121, snyenhuis@bsd.uchicago.edu %K asthma %K physical activity %K lifestyle %K Black women %D 2024 %7 7.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Black women experience a higher prevalence of poor asthma outcomes and physical inactivity than their White counterparts. Black women comprise a particularly vulnerable group of patients with asthma, with some of the highest rates of asthma in adults, high health care use (emergency department visits and hospitalizations), and the highest crude asthma mortality rate of all race or ethnicity groups. Despite recommendations to engage in regular physical activity, fewer than 15% of Black women meet the 2008 National Physical Activity Guidelines, the lowest of all racial subgroups of adults. Given the connection between physical inactivity and poor asthma outcomes, addressing physical activity among Black women with asthma is imperative. Objective: This 2-arm randomized controlled trial aims to (1) determine the efficacy of a lifestyle walking intervention on asthma control compared to an education (control) group over 24 weeks, (2) examine the maintenance effects of the lifestyle walking intervention on asthma control at 48 weeks, (3) explore the behavioral mediators (eg, self-efficacy, social support, self-regulation, and daily physical activity levels) and contextual moderators (eg, baseline asthma severity, neighborhood environment, comorbid conditions, and social determinants of health) that contribute to treatment responsiveness, and (4) assess the reach and implementation potential of the intervention. Methods: The proposed study (ACTION [A Lifestyle Physical Activity Intervention for Minority Women with Asthma]) delivers a 24-week lifestyle walking intervention designed for and by urban Black women with asthma. Participants (n=224) will be recruited through 2 urban health care systems that care for a diverse Black population. Patients will be randomized to one of two groups: (1) ACTION intervention (group sessions, physical activity self-monitoring—Fitbit, and text-based support for step goal setting) or (2) education control (an individual asthma education session and SMS text messages related to asthma education). Outcome assessments will take place at baseline, 12, 24, and 48 weeks. The primary outcome is a change in asthma control from baseline to week 24 as assessed by the asthma control questionnaire-6 (ACQ-6). Secondary outcomes include asthma-related quality of life, health care use, and asthma exacerbations and behavioral outcomes such as self-efficacy, self-regulation, social support, and physical activity. Results: This study was funded by the National Institute of Minority Health Disparities in August 2022. We pilot-tested our recruitment and intervention procedures and began recruitment in April 2023, with the enrollment of our first participant in May 2023. The anticipated completion of the study is April 2027. Conclusions: This study will deliver a new approach to physical activity interventions in Black women with asthma and help to provide guidance for addressing physical activity within this subgroup. This study will also provide a potential framework for future studies in minoritized populations with other disease conditions associated with low levels of physical activity. Trial Registration: ClinicalTrials.gov NCT05726487; https://clinicaltrials.gov/study/NCT05726487 International Registered Report Identifier (IRRID): DERR1-10.2196/55700 %M 38324365 %R 10.2196/55700 %U https://www.researchprotocols.org/2024/1/e55700 %U https://doi.org/10.2196/55700 %U http://www.ncbi.nlm.nih.gov/pubmed/38324365 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e49590 %T Comparing the Efficacy of Targeted and Blast Portal Messaging in Message Opening Rate and Anticoagulation Initiation in Patients With Atrial Fibrillation in the Preventing Preventable Strokes Study II: Prospective Cohort Study %A Kapoor,Alok %A Patel,Parth %A Chennupati,Soumya %A Mbusa,Daniel %A Sadiq,Hammad %A Rampam,Sanjeev %A Leung,Robert %A Miller,Megan %A Vargas,Kevin Rivera %A Fry,Patrick %A Lowe,Mary Martin %A Catalano,Christina %A Harrison,Charles %A Catanzaro,John Nicholas %A Crawford,Sybil %A Smith,Anne Marie %+ University of Massachusetts Chan Medical School, 55 N Lake Ave, Worcester, MA, 01655, United States, 1 9178564538, alok.kapoor@umassmemorial.org %K anticoagulants %K atrial fibrillation %K humans %K outpatients %K patient education as topic %K patient portals %D 2024 %7 24.1.2024 %9 Original Paper %J JMIR Cardio %G English %X Background: The gap in anticoagulation use among patients with atrial fibrillation (AF) is a major public health threat. Inadequate patient education contributes to this gap. Patient portal–based messaging linked to educational materials may help bridge this gap, but the most effective messaging approach is unknown. Objective: This study aims to compare the responsiveness of patients with AF to an AF or anticoagulation educational message between 2 portal messaging approaches: sending messages targeted at patients with upcoming outpatient appointments 1 week before their scheduled appointment (targeted) versus sending messages to all eligible patients in 1 blast, regardless of appointment scheduling status (blast), at 2 different health systems: the University of Massachusetts Chan Medical School (UMass) and the University of Florida College of Medicine-Jacksonville (UFL). Methods: Using the 2 approaches, we sent patient portal messages to patients with AF and grouped patients by high-risk patients on anticoagulation (group 1), high-risk patients off anticoagulation (group 2), and low-risk patients who may become eligible for anticoagulation in the future (group 3). Risk was classified based on the congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke, vascular disease, age between 65 and 74 years, and sex category (CHA2DS2-VASc) score. The messages contained a link to the Upbeat website of the Heart Rhythm Society, which displays print and video materials about AF and anticoagulation. We then tracked message opening, review of the website, anticoagulation use, and administered patient surveys across messaging approaches and sites using Epic Systems (Epic Systems Corporation) electronic health record data and Google website traffic analytics. We then conducted chi-square tests to compare potential differences in the proportion of patients opening messages and other evaluation metrics, adjusting for potential confounders. All statistical analyses were performed in SAS (version 9.4; SAS Institute). Results: We sent 1686 targeted messages and 1450 blast messages. Message opening was significantly higher with the targeted approach for patients on anticoagulation (723/1156, 62.5% vs 382/668, 57.2%; P=.005) and trended the same in patients off anticoagulation; subsequent website reviews did not differ by messaging approach. More patients off anticoagulation at baseline started anticoagulation with the targeted approach than the blast approach (adjusted percentage 9.3% vs 2.1%; P<.001). Conclusions: Patients were more responsive in terms of message opening and subsequent anticoagulation initiation with the targeted approach. %M 38265849 %R 10.2196/49590 %U https://cardio.jmir.org/2024/1/e49590 %U https://doi.org/10.2196/49590 %U http://www.ncbi.nlm.nih.gov/pubmed/38265849 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51795 %T Linguistic Variables and Gender Differences Within a Messenger-Based Psychosocial Chat Counseling Service for Children and Adolescents: Cross-Sectional Study %A Efe,Zeki %A Baldofski,Sabrina %A Kohls,Elisabeth %A Eckert,Melanie %A Saee,Shadi %A Thomas,Julia %A Wundrack,Richard %A Rummel-Kluge,Christine %+ Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Semmelweisstr 10, Haus 13, Leipzig, 04103, Germany, 49 341 9724464, Christine.Rummel-Kluge@medizin.uni-leipzig.de %K e-mental health %K chat counseling %K crisis %K helpline %K linguistic %K language %K Linguistic Inquiry and Word Count %K LIWC %K psychiatric symptoms %D 2024 %7 12.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Text messaging is widely used by young people for communicating and seeking mental health support through chat-based helplines. However, written communication lacks nonverbal cues, and language usage is an important source of information about a person’s mental health state and is known to be a marker for psychopathology. Objective: The aim of the study was to investigate language usage, and its gender differences and associations with the presence of psychiatric symptoms within a chat counseling service for adolescents and young adults. Methods: For this study, the anonymized chat content of a German messenger–based psychosocial chat counseling service for children and adolescents (“krisenchat”) between May 2020 and July 2021 was analyzed. In total, 661,131 messages from 6962 users were evaluated using Linguistic Inquiry and Word Count, considering the following linguistic variables: first-person singular and plural pronouns, negations, positive and negative emotion words, insight words, and causation words. Descriptive analyses were performed, and gender differences of those variables were evaluated. Finally, a binary logistic regression analysis examined the predictive value of linguistic variables on the presence of psychiatric symptoms. Results: Across all analyzed chats, first-person singular pronouns were used most frequently (965,542/8,328,309, 11.6%), followed by positive emotion words (408,087/8,328,309, 4.9%), insight words (341,460/8,328,309, 4.1%), negations (316,475/8,328,309, 3.8%), negative emotion words (266,505/8,328,309, 3.2%), causation words (241,520/8,328,309, 2.9%), and first-person plural pronouns (499,698/8,328,309, 0.6%). Female users and users identifying as diverse used significantly more first-person singular pronouns and insight words than male users (both P<.001). Negations were significantly more used by female users than male users or users identifying as diverse (P=.007). Similar findings were noted for negative emotion words (P=.01). The regression model of predicting psychiatric symptoms by linguistic variables was significant and indicated that increased use of first-person singular pronouns (odds ratio [OR] 1.05), negations (OR 1.11), and negative emotion words (OR 1.15) was positively associated with the presence of psychiatric symptoms, whereas increased use of first-person plural pronouns (OR 0.39) and causation words (OR 0.90) was negatively associated with the presence of psychiatric symptoms. Suicidality, self-harm, and depression showed the most significant correlations with linguistic variables. Conclusions: This study highlights the importance of examining linguistic features in chat counseling contexts. By integrating psycholinguistic findings into counseling practice, counselors may better understand users’ psychological processes and provide more targeted support. For instance, certain linguistic features, such as high use of first-person singular pronouns, negations, or negative emotion words, may indicate the presence of psychiatric symptoms, particularly among female users and users identifying as diverse. Further research is needed to provide an in-depth look into language processes within chat counseling services. %M 38214955 %R 10.2196/51795 %U https://formative.jmir.org/2024/1/e51795 %U https://doi.org/10.2196/51795 %U http://www.ncbi.nlm.nih.gov/pubmed/38214955 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48958 %T Developing Mood-Based Computer-Tailored Health Communication for Smoking Cessation: Feasibility Randomized Controlled Trial %A Lee,Donghee N %A Sadasivam,Rajani S %A Stevens,Elise M %+ Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, UMass Chan Medical School, 368 Plantation St, Worcester, MA, 01605, United States, 1 774 455 4871, donghee.lee10@umassmed.edu %K mood %K smoking cessation messages %K computer-tailored health communication %K innovation %K smoking %K cessation %K digital intervention %K effectiveness %K text mining %K adult %K motivation %D 2023 %7 22.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Computer-tailored health communication (CTHC), a widely used strategy to increase the effectiveness of smoking cessation interventions, is focused on selecting the best messages for an individual. More recently, CTHC interventions have been tested using contextual information such as participants’ current stress or location to adapt message selection. However, mood has not yet been used in CTCH interventions and may increase their effectiveness. Objective: This study aims to examine the association of mood and smoking cessation message effectiveness among adults who currently smoke cigarettes. Methods: In January 2022, we recruited a web-based convenience sample of adults who smoke cigarettes (N=615; mean age 41.13 y). Participants were randomized to 1 of 3 mood conditions (positive, negative, or neutral) and viewed pictures selected from the International Affective Picture System to induce an emotional state within the assigned condition. Participants then viewed smoking cessation messages with topics covering five themes: (1) financial costs or rewards, (2) health, (3) quality of life, (4) challenges of quitting, and (5) motivation or reasons to quit. Following each message, participants completed questions on 3 constructs: message receptivity, perceived relevance, and their motivation to quit. The process was repeated 30 times. We used 1-way ANOVA to estimate the association of the mood condition on these constructs, controlling for demographics, cigarettes per day, and motivation to quit measured during the pretest. We also estimated the association between mood and outcomes for each of the 5 smoking message theme categories. Results: There was an overall statistically significant effect of the mood condition on the motivation to quit outcome (P=.02) but not on the message receptivity (P=.16) and perceived relevance (P=.86) outcomes. Participants in the positive mood condition reported significantly greater motivation to quit compared with those in the negative mood condition (P=.005). Participants in the positive mood condition reported higher motivation to quit after viewing smoking cessation messages in the financial (P=.03), health (P=.01), quality of life (P=.04), and challenges of quitting (P=.03) theme categories. We also compared each mood condition and found that participants in the positive mood condition reported significantly greater motivation to quit after seeing messages in the financial (P=.01), health (P=.003), quality of life (P=.01), and challenges of quitting (P=.01) theme categories than those in the negative mood condition. Conclusions: Our findings suggest that considering mood may be important for future CTHC interventions. Because those in the positive mood state at the time of message exposure were more likely to have greater quitting motivations, smoking cessation CTHC interventions may consider strategies to help improve participants’ mood when delivering these messages. For those in neutral and negative mood states, focusing on certain message themes (health and motivation to quit) may be more effective than other message themes. %M 38133916 %R 10.2196/48958 %U https://formative.jmir.org/2023/1/e48958 %U https://doi.org/10.2196/48958 %U http://www.ncbi.nlm.nih.gov/pubmed/38133916 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e47250 %T Phone-Based Text Therapy for Youth Mental Health: Rapid Review %A Karnik,Varun %A Henderson,Hamish %A Khan,Urooj Raza %A Boyd,James %+ La Trobe University, 360 Collins Street, Melbourne, 3086, Australia, 61 3 9479 6000, varun.karnik@griffithuni.edu.au %K text therapy %K mHealth %K adolescent health %K distance counseling %K mental illness %K mobile health intervention %K adolescent %K health promotion %K digital mental health intervention %D 2023 %7 14.12.2023 %9 Review %J Interact J Med Res %G English %X Background: Mental illness has become a prevalent issue impacting adolescents worldwide. Many barriers, including stigma and poor health literacy, prevent this population group from accessing reliable mental health care services. Synchronous text–therapy counseling is an underused therapeutic approach in combating adolescent mental illness. Phone-based text therapy is uniquely placed to offer personalized counseling to adolescents through a familiar and engaging treatment modality. Objective: This rapid review aims to understand the clinical effectiveness, usability, and accessibility of phone-based text therapy for youth mental health. Methods: Cochrane CENTRAL, Embase, PubMed, and PsycINFO were used to search for suitable literature. Five groups of keywords were used: those related to (1) “therapy,” (2) “text,” (3) “phone,” (4) “youth,” and (5) “mental health.” Eligibility criteria were formed through the PICO (Population, Intervention, Control, and Outcome) framework. Studies were included if a synchronous phone-based text therapy intervention was used in an adolescent population, with an age range of 12-24 years. Only literature available in full-text, English, and a peer-reviewed journal was considered. Furthermore, a date limit of 5 years was set to reflect the recent development of digital interventions for mental health. Pertinent information from each study was tabulated, and a narrative synthesis was used to assess, describe, and organize the included studies comprehensively and concisely. Results: Of the 771 studies dual screened, 7 studies were included in this rapid review. Most of the exclusions occurred due to the use of the wrong intervention, such as asynchronous messaging. The selected studies had a low risk of bias and were suitable for the review. All interventional trials demonstrated reductions in mental health symptoms, primarily depression and anxiety. Most studies displayed high usability among participants, while data were unclear regarding accessibility. Conclusions: This review reveals the high potential of phone-based text therapy as an intervention for adolescents experiencing mental illness. We hope that this review promotes further refinement of text-based phone therapies and encourages future research on this subject matter. %M 38096012 %R 10.2196/47250 %U https://www.i-jmr.org/2023/1/e47250 %U https://doi.org/10.2196/47250 %U http://www.ncbi.nlm.nih.gov/pubmed/38096012 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51277 %T Secure Messaging Intervention in Patients Starting New Antidepressant to Promote Adherence: Pilot Randomized Controlled Trial %A Turvey,Carolyn %A Fuhrmeister,Lindsey %A Klein,Dawn %A McCoy,Kimberly %A Moeckli,Jane %A Stewart Steffensmeier,Kenda R %A Suiter,Natalie %A Van Tiem,Jen %+ Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Highway 6 West, Iowa City, IA, 52246, United States, 1 3193216799, Carolyn.Turvey@va.gov %K depression %K text messaging %K medication adherence %K medication %K medications %K adherence %K antidepressant %K antidepressants %K depressive %K text message %K text messages %K messaging %K SMS %K veteran %K veterans %K military %K randomized controlled trial %K RCT %K controlled trials %K mental health %K psychiatry %K mobile phone %D 2023 %7 8.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There are a range of effective pharmacological and behavioral treatments for depression. However, approximately one-third of patients discontinue antidepressants within the first month of treatment and 44% discontinue them by the third month of treatment. The major reasons reported for discontinuation were side effect burden, patients experiencing that the medications were not working, and patients wanting to resolve their depression without using medication. Objective: This study tested the acceptability, feasibility, and preliminary effectiveness of an SMS messaging intervention designed to improve antidepressant adherence and depression outcomes in veterans. The intervention specifically targeted the key reasons for antidepressant discontinuation. For example, the secure message included reminders that it can take up to 6 weeks for an antidepressant to work, or prompts to call their provider should the side effect burden become significant. Methods: This pilot was a 3-armed randomized controlled trial of 53 veterans undergoing depression treatment at the Iowa City Veterans Affairs Health Care System. Veterans starting a new antidepressant were randomized to secure messaging only (SM-Only), secure messaging with coaching (SM+Coach), or attention control (AC) groups. The intervention lasted 12 weeks with follow-up assessments of key outcomes at 6 and 12-weeks. This included a measure of antidepressant adherence, depressive symptom severity, and side effect burden. Results: The 2 active interventions (SM-Only and SM+Coach) demonstrated small to moderate effect sizes (ESs) in improving antidepressant adherence and reducing side effect burden. They did not appear to reduce the depressive symptom burden any more than in the AC arm. Veteran participants in the SM arms demonstrated improved medication adherence from baseline to 12 weeks on the Medication Adherence Rating Scale compared with those in the AC arm, who had a decline in adherence (SM-Only: ES=0.09; P=.19; SM+Coach: ES=0.85; P=.002). Depression scores on the 9-Item Patient Health Questionnaire decreased for all 3 treatment arms, although the decline was slightly larger for the SM-Only (ES=0.32) and the SM+Coach (ES=0.24) arms when compared with the AC arm. The 2 intervention arms indicated a decrease in side effects on the Frequency, Intensity, and Burden of Side Effects Ratings, whereas the side effect burden for the AC arm increased. These differences indicated moderate ES (SM-Only vs AC: ES=0.40; P=.07; SM+Coach: ES=0.54; P=.07). Conclusions: A secure messaging program targeting specific reasons for antidepressant discontinuation had small-to-moderate ES in improving medication adherence. Consistent with prior research, the intervention that included brief synchronic meetings with a coach appeared to have a greater benefit than the SMS-alone intervention. Veterans consistently engaged with the SMS messaging in both treatment arms throughout the study period. They additionally provided feedback on which texts were most helpful, tending to prefer messages providing overall encouragement rather than specific wellness recommendations. Trial Registration: ClinicalTrials.gov NCT03930849; https://clinicaltrials.gov/study/NCT03930849 %M 38064267 %R 10.2196/51277 %U https://formative.jmir.org/2023/1/e51277 %U https://doi.org/10.2196/51277 %U http://www.ncbi.nlm.nih.gov/pubmed/38064267 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 7 %N %P e51316 %T Automated Messaging Program to Facilitate Systematic Home Blood Pressure Monitoring: Qualitative Analysis of Provider Interviews %A Einhorn,Julian %A Murphy,Andrew R %A Rogal,Shari S %A Suffoletto,Brian %A Irizarry,Taya %A Rollman,Bruce L %A Forman,Daniel E %A Muldoon,Matthew F %+ Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, 4015 OHara Street, Old Engineering Hall, Room 506, University of Pittsburgh, Pittsburgh, PA, 15213, United States, 1 4126248798, mfm10@pitt.edu %K mHealth %K digital intervention %K qualitative research %K provider stakeholders %K hypertension %K home blood pressure monitoring %K implementation research %K short-messaging system %K remote monitoring %K qualitative analysis %K messaging program %K blood pressure %K monitoring %K cardiovascular %K disease %K text messaging %K text mining %K self-management %K mobile phone %D 2023 %7 4.12.2023 %9 Original Paper %J JMIR Cardio %G English %X Background: Hypertension is a leading cause of cardiovascular and kidney disease in the United States, yet blood pressure (BP) control at a population level is poor and worsening. Systematic home BP monitoring (HBPM) programs can lower BP, but programs supporting HBPM are not routinely used. The MyBP program deploys automated bidirectional text messaging for HBPM and disease self-management support. Objective: We aim to produce a qualitative analysis of input from providers and staff regarding implementation of an innovative HBPM program in primary care practices. Methods: Semistructured interviews (average length 31 minutes) were conducted with physicians (n=11), nurses, and medical assistants (n=6) from primary care settings. The interview assessed multiple constructs in the Consolidated Framework for Implementation Research domains of intervention characteristics, outer setting, inner setting, and characteristics of individuals. Interviews were transcribed verbatim and analyzed using inductive coding to organize meaningful excerpts and identify salient themes, followed by mapping to the updated Consolidated Framework for Implementation Research constructs. Results: Health care providers reported that MyBP has good ease of use and was likely to engage patients in managing their high BP. They also felt that it would directly support systematic BP monitoring and habit formation in the convenience of the patient’s home. This could increase health literacy and generate concrete feedback to raise the day-to-day salience of BP control. Providers expressed concern that the cost of BP devices remains an encumbrance. Some patients were felt to have overriding social or emotional barriers, or lack the needed technical skills to interact with the program, use good measurement technique, and input readings accurately. With respect to effects on their medical practice, providers felt MyBP would improve the accuracy and frequency of HBPM data, and thereby improve diagnosis and treatment management. The program may positively affect the patient-provider relationship by increasing rapport and bidirectional accountability. Providers appreciated receiving aggregated HBPM data to increase their own efficiency but also expressed concern about timely routing of incoming HBPM reports, lack of true integration with the electronic health record, and the need for a dedicated and trained staff member. Conclusions: In this qualitative analysis, health care providers perceived strong relative advantages of using MyBP to support patients. The identified barriers suggest the need for corrective implementation strategies to support providers in adopting the program into routine primary care practice, such as integration into the workflow and provider education. Trial Registration: ClinicalTrials.gov NCT03650166; https://tinyurl.com/bduwn6r4 %M 38048147 %R 10.2196/51316 %U https://cardio.jmir.org/2023/1/e51316 %U https://doi.org/10.2196/51316 %U http://www.ncbi.nlm.nih.gov/pubmed/38048147 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48271 %T Designing Mobile Phone Text Messages Using the Behavior Change Wheel Framework to Influence Food Literacy in Adults With Type 2 Diabetes in Kenya: Protocol for a Systematic Development Study %A Mokaya,Moses %A Kyallo,Florence %A Yiga,Peter %A Koole,Janna Lena %A Boedt,Tessy %A Vangoitsenhoven,Roman %A Matthys,Christophe %+ Experimental and Clinical Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, Leuven, 3000, Belgium, 32 16 347000, christophe.matthys@uzleuven.be %K behavior change techniques %K Behavior Change Wheel %K type 2 diabetes %K low-income populations %K mHealth %K mobile health %K glycemic control %K adults %K diabetes %K Africa %K mobile phone %K support care %K care %K support %K behavior %K diabetes %D 2023 %7 4.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The worldwide prevalence of type 2 diabetes (T2D) has increased in the past decade, and it is projected to increase by 126% by 2045 in Africa. At the same time, mobile phone use has increased in Africa, providing a potential for innovative mobile health interventions to support diabetes care. Objective: This study aimed to apply the Behavior Change Wheel (BCW) framework to develop text messages to influence food literacy in adults with T2D in urban Kenya. Methods: The 8 steps of the BCW framework guided the development of text messages: (1) Define the problem in behavioral terms; (2) select target behaviors; (3) specify the target behaviors based on who needs to perform the behaviors, what needs to change, and when, where, how often, and with whom; (4) identify what needs to change; (5) identify intervention functions; (6) select policy categories; (7) select behavior change techniques (BCTs); and (8) select the mode of delivery. Recent exploratory studies in Kenya and other low- and middle-income countries provided information that was used to contextualize the intervention. Results: In step 1, the behavioral problem was defined as unhealthy dietary patterns among adults with T2D. In step 2, based on a qualitative study in the target population, the target behavior was selected to be evaluation of reliable sources of information, and selection and preparation of healthy food. In step 3, unhealthy dietary patterns were selected. In step 4, 10 domains of the Theoretical Domains Framework were identified, and in step 5, 5 intervention functions were linked to the domains and unhealthy dietary patterns were specified. In step 6, communication and regulations were identified as policy categories, while in step 7, 9 BCTs were selected from the Behavior Change Technique Taxonomy version 1. In step 8, the most suitable mode of delivery was determined to be mobile text messages. A total of 36 mobile text messages were developed based on the 9 BCTs. Conclusions: This study shows the step-by-step application of the BCW framework to develop mobile text messages to influence food literacy in adults with T2D. International Registered Report Identifier (IRRID): RR1-10.2196/48271 %M 38048150 %R 10.2196/48271 %U https://www.researchprotocols.org/2023/1/e48271 %U https://doi.org/10.2196/48271 %U http://www.ncbi.nlm.nih.gov/pubmed/38048150 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47312 %T Personalized Coaching via Texting for Behavior Change to Understand a Healthy Lifestyle Intervention in a Naturalistic Setting: Mixed Methods Study %A Bäccman,Charlotte %A Bergkvist,Linda %A Wästlund,Erik %+ Service Research Center (CTF), Karlstad University, Universitetsgatan 2, Karlstad, 65188, Sweden, 46 547002519, charlotte.baccman@kau.se %K digital health intervention %K behavior change %K personalized SMS coaching %K Capability, Opportunity, Motivation–Behavior %K COM-B %K physical activity %K mixed methods design %K mobile phone %D 2023 %7 15.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health interventions, such as personalized SMS coaching, are considered affordable and scalable methods to support healthy lifestyle changes. SMS, or texting, is a readily available service to most people in Sweden, and personalized SMS coaching has shown great promise in supporting behavior changes. Objective: This study aims to explore the effectiveness of highly personalized SMS coaching for behavior change according to the Capability, Opportunity, Motivation–Behavior (COM-B) model on a sample of physically inactive adults in a nonprofit fitness organization in Sweden. Methods: The study used a mixed methods design in which clients acted as their own controls. The participants were clients (n=28) and fitness consultants (n=12). Three types of data were collected: (1) quantitative data at baseline and after the SMS intervention and the waitlist from the clients, (2) qualitative data from semistructured interviews with the fitness consultants, and (3) pseudonymized texting conversations between the fitness consultants and clients. Results: Overall, the results showed that personalized SMS coaching was effective in supporting the clients’ behavior changes. The quantitative analysis showed how the clients’ capabilities (Cohen d=0.50), opportunities (Cohen d=0.43), and relationship with the fitness consultants (Cohen d=0.51) improved during the SMS intervention in comparison with baseline. Furthermore, the qualitative analysis revealed how personalized texts added value to existing work methods (eg, increasing continuity and flexibility) and how the relationship between the clients and fitness consultants changed during the intervention, which helped motivate the clients. Conclusions: Personalized SMS coaching is an effective method for supporting healthy behavior changes. The human connection that emerged in this study needs to be further explored to fully understand the effectiveness of a digital health intervention. %M 37966893 %R 10.2196/47312 %U https://formative.jmir.org/2023/1/e47312 %U https://doi.org/10.2196/47312 %U http://www.ncbi.nlm.nih.gov/pubmed/37966893 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49174 %T Facilitated WhatsApp Support Groups for Youth Living With HIV in Nairobi, Kenya: Single-Arm Pilot Intervention Study %A Ronen,Keshet %A Mugo,Cyrus %A Kaggiah,Anne %A Seeh,David %A Kumar,Manasi %A Guthrie,Brandon L %A Moreno,Megan A %A John-Stewart,Grace %A Inwani,Irene %+ Department of Global Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, United States, 1 206 685 4363, keshet@uw.edu %K HIV %K mHealth %K social media %K youth %K adolescent %K social support %D 2023 %7 13.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile technology can support HIV care, but studies in youth are limited. In 2014, youth receiving HIV care at several health care facilities in Nairobi, Kenya spontaneously formed peer support groups using the social media platform WhatsApp. Objective: Inspired by youth-initiated groups, we aimed to evaluate the use of WhatsApp to deliver a social support intervention to improve HIV treatment and psychosocial outcomes in youth. We developed a facilitated WhatsApp group intervention (named Vijana-SMART), which was grounded in social support theory and guided by the design recommendations of youth living with HIV. This paper evaluates the intervention’s acceptability and pre-post changes in health outcomes. Methods: The intervention involved interactive WhatsApp groups facilitated by study staff for 6 months, with each group having approximately 25 members. Study staff sent weekly structured messages, and the message content was based on social support theory and encouraged unstructured peer-to-peer messaging and support. We conducted a single-arm pilot among 55 youth living with HIV aged 14-24 years recruited from a government health care facility serving a mixed-income area of Nairobi. At enrollment and follow-up, self-report questionnaires assessed acceptability; antiretroviral therapy (ART) information, motivation, and behavioral skills (IMB); depression; social support; stigma; resilience; and ART adherence. All participants received the intervention. We used generalized estimating equations (GEEs) clustered by participant to evaluate changes in scores from baseline to follow-up, and correlates of participant WhatsApp messaging. Results: The median participant age was 18 years, and 67% (37/55) were female. Intervention acceptability was high. All participants reported that it was helpful, and 73% (38/52) sent ≥1 WhatsApp message. Messaging levels varied considerably between participants and were higher during school holidays, earlier in the intervention period, and among youth aged ≥18 years. IMB scores increased from enrollment to follow-up (66.9% to 71.3%; P<.001). Stigma scores also increased (8.3% to 16.7%; P=.001), and resilience scores decreased (75.0% to 70.0%; P<.001). We found no significant change in ART adherence, social support, or depression. We detected a positive association between the level of messaging during the study and the resilience score, but no significant association between messaging and other outcomes. Once enrolled, it was common for participants to change their phone numbers or leave the groups and request to be added back, which may present implementation challenges at a larger scale. Conclusions: Increased IMB scores following WhatsApp group participation may improve HIV outcomes. Increased stigma and decreased resilience were unintended consequences and may reflect transient effects of group sharing of challenging experiences, which should be addressed in larger randomized evaluations. WhatsApp groups present a promising and acceptable modality to deliver supportive interventions to youth living with HIV beyond the clinic, and further evaluation is warranted. Trial Registration: ClinicalTrials.gov (NCT05634265); https://clinicaltrials.gov/study/NCT05634265 %M 37955957 %R 10.2196/49174 %U https://formative.jmir.org/2023/1/e49174 %U https://doi.org/10.2196/49174 %U http://www.ncbi.nlm.nih.gov/pubmed/37955957 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46128 %T Feasibility of a Text Messaging–Integrated and Chatbot-Interfaced Self-Management Program for Symptom Control in Patients With Gastrointestinal Cancer Undergoing Chemotherapy: Pilot Mixed Methods Study %A Gomaa,Sameh %A Posey,James %A Bashir,Babar %A Basu Mallick,Atrayee %A Vanderklok,Eleanor %A Schnoll,Max %A Zhan,Tingting %A Wen,Kuang-Yi %+ Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut Street, Philadelphia, PA, 19107, United States, 1 215 503 4623, kuang-yi.wen@jefferson.edu %K chemotherapy %K gastrointestinal cancer %K digital health %K text messaging %K chatbot %K side effect management %D 2023 %7 10.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Outpatient chemotherapy often leaves patients to grapple with a range of complex side effects at home. Leveraging tailored evidence-based content to monitor and manage these symptoms remains an untapped potential among patients with gastrointestinal (GI) cancer. Objective: This study aims to bridge the gap in outpatient chemotherapy care by integrating a cutting-edge text messaging system with a chatbot interface. This approach seeks to enable real-time monitoring and proactive management of side effects in patients with GI cancer undergoing intravenous chemotherapy. Methods: Real-Time Chemotherapy-Associated Side Effects Monitoring Supportive System (RT-CAMSS) was developed iteratively, incorporating patient-centered inputs and evidence-based information. It synthesizes chemotherapy knowledge, self-care symptom management skills, emotional support, and healthy lifestyle recommendations. In a single-arm 2-month pilot study, patients with GI cancer undergoing chemotherapy received tailored intervention messages thrice a week and a weekly Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events–based symptom assessment via a chatbot interface. Baseline and postintervention patient surveys and interviews were conducted. Results: Out of 45 eligible patients, 34 were enrolled (76% consent rate). The mean age was 61 (SD 12) years, with 19 (56%) being females and 21 (62%) non-Hispanic White. The most common cancer type was pancreatic (n=18, 53%), followed by colon (n=12, 35%) and stomach (n=4, 12%). In total, 27 (79% retention rate) participants completed the postintervention follow-up. In total, 20 patients texted back at least once to seek additional information, with the keyword “chemo” or “support” texted the most. Among those who used the chatbot system checker, fatigue emerged as the most frequently reported symptom (n=15), followed by neuropathy (n=7). Adjusted for multiple comparisons, patients engaging with the platform exhibited significantly improved Patient Activation Measure (3.70, 95% CI –6.919 to –0.499; P=.02). Postintervention interviews and satisfaction surveys revealed that participants found the intervention was user-friendly and were provided with valuable information. Conclusions: Capitalizing on mobile technology communication holds tremendous scalability for enhancing health care services. This study presents initial evidence of the engagement and acceptability of RT-CAMSS, warranting further evaluation in a controlled clinical trial setting. %M 37948108 %R 10.2196/46128 %U https://formative.jmir.org/2023/1/e46128 %U https://doi.org/10.2196/46128 %U http://www.ncbi.nlm.nih.gov/pubmed/37948108 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50872 %T Automated Messaging Delivered Alongside Behavioral Treatment for Weight Loss: Qualitative Study %A Berry,Michael %A Taylor,Lauren %A Huang,Zhuoran %A Chwyl,Christina %A Kerrigan,Stephanie %A Forman,Evan %+ Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut St., Philadelphia, PA, 19103, United States, 1 (267) 961 2578, mpb334@drexel.edu %K mobile health technology %K weight loss %K tailored messaging %K lifestyle modification %K mobile health %K mHealth %K messaging %K weight loss %K intervention %K overweight %K obesity %K qualitative %K thematic analysis %D 2023 %7 6.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health interventions for weight loss frequently use automated messaging. However, this intervention modality appears to have limited weight loss efficacy. Furthermore, data on users’ subjective experiences while receiving automated messaging–based interventions for weight loss are scarce, especially for more advanced messaging systems providing users with individually tailored, data-informed feedback. Objective: The purpose of this study was to characterize the experiences of individuals with overweight or obesity who received automated messages for 6-12 months as part of a behavioral weight loss trial. Methods: Participants (n=40) provided Likert-scale ratings of messaging acceptability and completed a structured qualitative interview (n=39) focused on their experiences with the messaging system and generating suggestions for improvement. Interview data were analyzed using thematic analysis. Results: Participants found the messages most useful for summarizing goal progress and least useful for suggesting new behavioral strategies. Overall message acceptability was moderate (2.67 out of 5). From the interviews, 2 meta-themes emerged. Participants indicated that although the messages provided useful reminders of intervention goals and skills, they did not adequately capture their lived experiences while losing weight. Conclusions: Many participants found the automated messages insufficiently tailored to their personal weight loss experiences. Future studies should explore alternative methods for message tailoring (eg, allowing for a higher degree of participant input and interactivity) that may boost treatment engagement and efficacy. Trial Registration: ClinicalTrials.gov NCT05231824; https://clinicaltrials.gov/study/NCT05231824 %M 37930786 %R 10.2196/50872 %U https://formative.jmir.org/2023/1/e50872 %U https://doi.org/10.2196/50872 %U http://www.ncbi.nlm.nih.gov/pubmed/37930786 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48968 %T Effectiveness of a Theory-Based Digital Animated Video Intervention to Reduce Intention and Willingness to Sext Among Diploma Students: Cluster Randomized Controlled Trial %A Mansor,Norain %A Ahmad,Norliza %A Md Said,Salmiah %A Tan,Kit-Aun %A Sutan,Rosnah %+ Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Serdang, 43400, Malaysia, 60 192710577, lizaahmad@upm.edu.my %K sexting %K randomized controlled trial %K YouTube %K intention %K willingness %K young adult %K Malaysia, diploma students %K digital content %K digital health intervention %K attrition rate %K primary outcome %K sexual risk %K sexual health %K WhatsApp %D 2023 %7 20.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexting refers to the exchange of sexually explicit digital content in the form of texts, photos, or videos. In recent years, sexting has become a public health concern. Surveys in Malaysia show a high prevalence of young adults engaged in sexting. Given that sexting is associated with sexual risk behavior, cyberbullying, and mental health issues, this behavior needs intervention to alleviate the resulting public health burden. However, there is a scarcity of theory-based intervention programs on the prevention of intention and willingness to sext among young adults. Objective: This study aimed to develop and implement a sexting intervention module guided by the prototype willingness model (PWM), delivered using web-based animated video, and evaluate its effectiveness among diploma students from a public higher educational institution. The primary outcomes were intention and willingness to sext, while the secondary outcomes were knowledge, attitude, perceived norms, and prototype perceptions of sexting. Methods: This 2-armed, parallel, single-blinded cluster randomized controlled trial was conducted in a public higher educational institution in the state of Melaka, Malaysia. Diploma students from 12 programs were randomly allocated into intervention and control groups. Both groups answered a self-administered web-based questionnaire assessing the outcomes at the baseline. The intervention group received a newly developed intervention module based on the PWM in the form of 5 animated videos posted on a private YouTube platform, while the control group was put on the waitlist. The intervention group was encouraged to discuss any issues raised with the researchers via WhatsApp private chat after viewing the videos. All participants were observed immediately and 3 months postintervention. Data analysis was performed with SPSS (version 26; IBM Corp). A generalized linear mixed model was used to determine the effectiveness of the intervention. Results: There were a total of 300 participants with an attrition rate of 8.3% (n=25). After adjusting for age, sex, relationship status, and the amount of time spent on the web, there were significant differences in the intention to sext (β=–.12; P=.002; Cohen d=0.23), willingness to sext (β=–.16; P<.001; Cohen d=0.40), knowledge (β=.12; P<.001; Cohen d=0.39), attitude (β=–.11; P=.001; Cohen d=0.31), perceived norms (β=–.06; P=.04; Cohen d=0.18), and prototype perceptions (β=–.11; P<.001; Cohen d=0.35) between the intervention and control groups over 3 months. Conclusions: In this study, the sexting intervention module using the PWM that was delivered via web-based animated videos was effective in reducing intention and willingness to sext as well as in improving knowledge of sexting, attitudes, perceived norms, and prototype perceptions. Therefore, relevant agencies involved in the promotion of sexual and reproductive health among young adults in Malaysia can consider the implementation of this module. Trial Registration: Thai Clinical Trial Registry TCTR20201010002; https://www.thaiclinicaltrials.org/show/TCTR20201002001 %M 37862090 %R 10.2196/48968 %U https://www.jmir.org/2023/1/e48968 %U https://doi.org/10.2196/48968 %U http://www.ncbi.nlm.nih.gov/pubmed/37862090 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45977 %T Optimizing an mHealth Program to Promote Type 2 Diabetes Prevention in High-Risk Individuals: Cross-Sectional Questionnaire Study %A Ross,Edgar %A Al Ozairi,Ebaa %A Al qabandi,Naeema %A Jamison,Robert %+ Atrius Healthcare, Harvard Medical School, 20 Wall Street, Burlington, MA, 01803-4758, United States, 1 617 657 6410, edgarross245@gmail.com %K SMS %K short text message interventions: mHealth %K smartphone %K type 2 diabetes prevention %K social media %K friends and family %K percolation theory %K diabetes %K prevention %K risk %K development %K pilot study %K social network %K theory modeling %K disease control %K initiative %D 2023 %7 16.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: We evaluated the outcomes of a pilot SMS text messaging–based public health campaign that identified social networking nodes and variations of response rates to develop a list of variables that could be used to analyze and develop an outreach strategy that would maximize the impact of future public health campaigns planned for Kuwait. Computational analysis of connections has been used to analyze the spread of infectious diseases, dissemination of new thoughts and ideas, efficiency of logistics networks, and even public health care campaigns. Percolation theory network analysis provides a mathematical alternative to more established heuristic approaches that have been used to optimize network development. We report on a pilot study designed to identify and treat subjects at high risk of developing type 2 diabetes mellitus in Kuwait. Objective: The aim of this study was to identify ways to optimize efficient deployment of resources and improve response rates in a public health campaign by using variables identified in this secondary analysis of our previously published data (Alqabandi et al, 2020). This analysis identified key variables that could be used in a computational analysis to plan for future public health campaigns. Methods: SMS text message screening posts were sent inviting recipients to answer 6 questions to determine their risk of developing type 2 diabetes mellitus. If subjects agreed to participate, a link to the Centers for Disease Control and Prevention prediabetes screening test was automatically transmitted to their mobile devices. The phone numbers used in this campaign were recorded and compared to the responses received through SMS text messaging and social media forwarding. Results: A total of 180,000 SMS text messages through 5 different campaigns were sent to 6% of the adult population in Kuwait. A total of 260 individuals agreed to participate, of which 153 (58.8%) completed the screening. Remarkably, 367 additional surveys were received from individuals who were not invited by the original circulated SMS text messages. These individuals were invited through forwarded surveys from the original recipients after authentication with the study center. The original SMS text messages were found to successfully identify influencers in existing social networks to improve the efficacy of the public health campaign. Conclusions: SMS text messaging–based health care screening campaigns were found to have limited effectiveness alone; however, the increased reach through shared second-party forwarding suggests the potential of exponentially expanding the reach of the study and identifying a higher percentage of eligible candidates through the use of percolation theory. Future research should be directed toward designing SMS text messaging campaigns that support a combination of SMS text message invitations and social networks along with identification of influential nodes and key variables, which are likely unique to the environment and cultural background of the population, using percolation theory modeling and chatbots. %M 37843911 %R 10.2196/45977 %U https://formative.jmir.org/2023/1/e45977 %U https://doi.org/10.2196/45977 %U http://www.ncbi.nlm.nih.gov/pubmed/37843911 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47266 %T Effect of Short, Animated Video Storytelling on Maternal Knowledge and Satisfaction in the Perinatal Period in South Africa: Randomized Controlled Trial %A Adam,Maya %A Kwinda,Zwannda %A Dronavalli,Mithilesh %A Leonard,Elizabeth %A Nguyễn,Vān Kính %A Tshivhase,Vusani %A Bärnighausen,Till %A Pillay,Yogan %+ Department of Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, United States, 1 6508393600, madam@stanford.edu %K maternal child health %K mHealth %K mobile health %K randomized controlled trial %K short animated storytelling %K South Africa %K video health messaging %D 2023 %7 13.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Innovative mobile health (mHealth) interventions can improve maternal knowledge, thereby supporting national efforts to reduce preventable maternal and child mortality in South Africa. Studies have documented a potential role for mobile video content to support perinatal health messaging, enhance maternal satisfaction, and overcome literacy barriers. Short, animated storytelling (SAS) is an innovative, emerging approach to mHealth messaging. Objective: We aimed to measure the effect of SAS videos on maternal knowledge and user satisfaction for mothers enrolled in antenatal care programs at 2 public health facilities in the Tshwane District of South Africa. Methods: We used a randomized controlled trial with a nested evaluation of user satisfaction. Participants were randomized 1:1 into Standard-of-Care (SOC) Control, and SAS Intervention groups. The intervention videos were delivered through WhatsApp, and 1 month later, participants responded to telephone surveys assessing their knowledge. The intervention group then participated in a nested evaluation of user satisfaction. Results: We surveyed 204 participants. Of them, 49.5% (101/204) were aged between 25 and 34 years. Almost all participants self-identified as Black, with the majority (190/204, 93.2%) having completed secondary school. The mean overall knowledge score was 21.92/28. We observed a slight increase of 0.28 (95% uncertainty interval [UI] –0.58 to 1.16) in the overall knowledge score in the intervention arm. We found that those with secondary education or above scored higher than those with only primary education by 2.24 (95% UI 0.76-4.01). Participants aged 35 years or older also scored higher than the youngest age group (18-24 years) by 1.83 (95% CI 0.39-3.33). Finally, the nested user satisfaction evaluation revealed high maternal satisfaction (4.71/5) with the SAS video series. Conclusions: While the SAS videos resulted in high user satisfaction, measured knowledge gains were small within a participant population that was already receiving perinatal health messages through antenatal clinics. The higher knowledge scores observed in older participants with higher education levels suggest that boosting maternal knowledge in younger mothers with lower education levels should continue to be a public health priority in South Africa. Given the high maternal satisfaction among the SAS video-users in this study, policy makers should consider integrating similar approaches into existing, broad-reaching perinatal health programs, such as MomConnect, to boost satisfaction and potentially enhance maternal engagement. While previous studies have shown the promise of animated video health education, most of this research has been conducted in high-income countries. More research in underresourced settings is urgently needed, especially as access to mobile technology increases in the Global South. Future studies should explore the effect of SAS videos on maternal knowledge in hard-to-reach populations with limited access to antenatal care, although real-world logistical challenges persist when implementing studies in underresourced South African populations. Trial Registration: Pan African Clinical Trials Registry PACTR202203673222680; https://tinyurl.com/362cpuny %M 37831505 %R 10.2196/47266 %U https://www.jmir.org/2023/1/e47266 %U https://doi.org/10.2196/47266 %U http://www.ncbi.nlm.nih.gov/pubmed/37831505 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48583 %T Characterizing the Patterns of Electronic Health Record–Integrated Secure Messaging Use: Cross-Sectional Study %A Baratta,Laura R %A Harford,Derek %A Sinsky,Christine A %A Kannampallil,Thomas %A Lou,Sunny S %+ Department of Anesthesiology, Washington University School of Medicine, 660 South Euclid, Campus Box 8054, Saint Louis, MO, 63110, United States, 1 314 362 1196, slou@wustl.edu %K clinical care %K clinician burden %K communication %K electronic health record %K EHR %K interprofessional communication %K medical assistant %K messaging %K nurses %K observational study %K physicians %K secure messaging %K users %D 2023 %7 6.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Communication among health care professionals is essential for the delivery of safe clinical care. Secure messaging has rapidly emerged as a new mode of asynchronous communication. Despite its popularity, relatively little is known about how secure messaging is used and how such use contributes to communication burden. Objective: This study aims to characterize the use of an electronic health record–integrated secure messaging platform across 14 hospitals and 263 outpatient clinics within a large health care system. Methods: We collected metadata on the use of the Epic Systems Secure Chat platform for 6 months (July 2022 to January 2023). Information was retrieved on message volume, response times, message characteristics, messages sent and received by users, user roles, and work settings (inpatient vs outpatient). Results: A total of 32,881 users sent 9,639,149 messages during the study. Median daily message volume was 53,951 during the first 2 weeks of the study and 69,526 during the last 2 weeks, resulting in an overall increase of 29% (P=.03). Nurses were the most frequent users of secure messaging (3,884,270/9,639,149, 40% messages), followed by physicians (2,387,634/9,639,149, 25% messages), and medical assistants (1,135,577/9,639,149, 12% messages). Daily message frequency varied across users; inpatient advanced practice providers and social workers interacted with the highest number of messages per day (median 19). Conversations were predominantly between 2 users (1,258,036/1,547,879, 81% conversations), with a median of 2 conversational turns and a median response time of 2.4 minutes. The largest proportion of inpatient messages was from nurses to physicians (972,243/4,749,186, 20% messages) and physicians to nurses (606,576/4,749,186, 13% messages), while the largest proportion of outpatient messages was from physicians to nurses (344,048/2,192,488, 16% messages) and medical assistants to other medical assistants (236,694/2,192,488, 11% messages). Conclusions: Secure messaging was widely used by a diverse range of health care professionals, with ongoing growth throughout the study and many users interacting with more than 20 messages per day. The short message response times and high messaging volume observed highlight the interruptive nature of secure messaging, raising questions about its potentially harmful effects on clinician workflow, cognition, and errors. %M 37801359 %R 10.2196/48583 %U https://www.jmir.org/2023/1/e48583 %U https://doi.org/10.2196/48583 %U http://www.ncbi.nlm.nih.gov/pubmed/37801359 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49668 %T Mobile Phone Text Messages to Support People to Stop Smoking by Switching to Vaping: Codevelopment, Coproduction, and Initial Testing Study %A Sideropoulos,Vassilis %A Vangeli,Eleni %A Naughton,Felix %A Cox,Sharon %A Frings,Daniel %A Notley,Caitlin %A Brown,Jamie %A Kimber,Catherine %A Dawkins,Lynne %+ Department of Psychology & Human Development, IOE, UCL’s Faculty of Education and Society, University College London, 20 Bedford Way, London, WC1H 0AL, United Kingdom, 44 02035495417, v.sideropoulos@ucl.ac.uk %K coproduction %K SMS text messages %K e-cigarette %K smoking %K eHealth %K vaping %K mobile phone %K codevelopment %K text message %D 2023 %7 27.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: SMS text messages are affordable, scalable, and effective smoking cessation interventions. However, there is little research on SMS text message interventions specifically designed to support people who smoke to quit by switching to vaping. Objective: Over 3 phases, with vapers and smokers, we codeveloped and coproduced a mobile phone SMS text message program. The coproduction paradigm allowed us to collaborate with researchers and the community to develop a more relevant, acceptable, and equitable SMS text message program. Methods: In phase 1, we engaged people who vape via Twitter and received 167 responses to our request to write SMS text messages for people who wish to quit smoking by switching to vaping. We screened, adjusted, refined, and themed the messages, resulting in a set of 95 that were mapped against the Capability, Opportunity, and Motivation–Behavior constructs. In phase 2, we evaluated the 95 messages from phase 1 via a web survey where participants (66/202, 32.7% woman) rated up to 20 messages on 7-point Likert scales on 9 constructs: being understandable, clear, believable, helpful, interesting, inoffensive, positive, and enthusiastic and how happy they would be to receive the messages. In phase 3, we implemented the final set of SMS text messages as part of a larger randomized optimization trial, in which 603 participants (mean age 38.33, SD 12.88 years; n=369, 61.2% woman) received SMS text message support and then rated their usefulness and frequency and provided free-text comments at the 12-week follow-up. Results: For phase 2, means and SDs were calculated for each message across the 9 constructs. Those with means below the neutral anchor of 4 or with unfavorable comments were discussed with vapers and further refined or removed. This resulted in a final set of 78 that were mapped against early, mid-, or late stages of quitting to create an order for the messages. For phase 3, a total of 38.5% (232/603) of the participants provided ratings at the 12-week follow-up. In total, 69.8% (162/232) reported that the SMS text messages had been useful, and a significant association between quit rates and usefulness ratings was found (χ21=9.6; P=.002). A content analysis of free-text comments revealed that the 2 most common positive themes were helpful (13/47, 28%) and encouraging (6/47, 13%) and the 2 most common negative themes were too frequent (9/47, 19%) and annoying (4/47, 9%). Conclusions: In this paper, we describe the initial coproduction and codevelopment of a set of SMS text messages to help smokers stop smoking by transitioning to vaping. We encourage researchers to use, further develop, and evaluate the set of SMS text messages and adapt it to target populations and relevant contexts. %M 37756034 %R 10.2196/49668 %U https://formative.jmir.org/2023/1/e49668 %U https://doi.org/10.2196/49668 %U http://www.ncbi.nlm.nih.gov/pubmed/37756034 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46548 %T Factors Influencing the Acceptability, Acceptance, and Adoption of Conversational Agents in Health Care: Integrative Review %A Wutz,Maximilian %A Hermes,Marius %A Winter,Vera %A Köberlein-Neu,Juliane %+ Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal, Rainer-Gruenter-Str 21, Wuppertal, 42119, Germany, 49 202 439 1381, maximilian.wutz@uni-wuppertal.de %K conversational agent %K chatbot %K acceptability %K acceptance %K adoption %K health care %K digital health %K artificial intelligence %K AI %K natural language %K mobile phone %D 2023 %7 26.9.2023 %9 Review %J J Med Internet Res %G English %X Background: Conversational agents (CAs), also known as chatbots, are digital dialog systems that enable people to have a text-based, speech-based, or nonverbal conversation with a computer or another machine based on natural language via an interface. The use of CAs offers new opportunities and various benefits for health care. However, they are not yet ubiquitous in daily practice. Nevertheless, research regarding the implementation of CAs in health care has grown tremendously in recent years. Objective: This review aims to present a synthesis of the factors that facilitate or hinder the implementation of CAs from the perspectives of patients and health care professionals. Specifically, it focuses on the early implementation outcomes of acceptability, acceptance, and adoption as cornerstones of later implementation success. Methods: We performed an integrative review. To identify relevant literature, a broad literature search was conducted in June 2021 with no date limits and using all fields in PubMed, Cochrane Library, Web of Science, LIVIVO, and PsycINFO. To keep the review current, another search was conducted in March 2022. To identify as many eligible primary sources as possible, we used a snowballing approach by searching reference lists and conducted a hand search. Factors influencing the acceptability, acceptance, and adoption of CAs in health care were coded through parallel deductive and inductive approaches, which were informed by current technology acceptance and adoption models. Finally, the factors were synthesized in a thematic map. Results: Overall, 76 studies were included in this review. We identified influencing factors related to 4 core Unified Theory of Acceptance and Use of Technology (UTAUT) and Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) factors (performance expectancy, effort expectancy, facilitating conditions, and hedonic motivation), with most studies underlining the relevance of performance and effort expectancy. To meet the particularities of the health care context, we redefined the UTAUT2 factors social influence, habit, and price value. We identified 6 other influencing factors: perceived risk, trust, anthropomorphism, health issue, working alliance, and user characteristics. Overall, we identified 10 factors influencing acceptability, acceptance, and adoption among health care professionals (performance expectancy, effort expectancy, facilitating conditions, social influence, price value, perceived risk, trust, anthropomorphism, working alliance, and user characteristics) and 13 factors influencing acceptability, acceptance, and adoption among patients (additionally hedonic motivation, habit, and health issue). Conclusions: This review shows manifold factors influencing the acceptability, acceptance, and adoption of CAs in health care. Knowledge of these factors is fundamental for implementation planning. Therefore, the findings of this review can serve as a basis for future studies to develop appropriate implementation strategies. Furthermore, this review provides an empirical test of current technology acceptance and adoption models and identifies areas where additional research is necessary. Trial Registration: PROSPERO CRD42022343690; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=343690 %M 37751279 %R 10.2196/46548 %U https://www.jmir.org/2023/1/e46548 %U https://doi.org/10.2196/46548 %U http://www.ncbi.nlm.nih.gov/pubmed/37751279 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45484 %T User Evaluation of a Chat-Based Instant Messaging Support Health Education Program for Patients With Chronic Kidney Disease: Preliminary Findings of a Formative Study %A Chen,Nai-Jung %A Huang,Chiu-Mieh %A Fan,Ching-Chih %A Lu,Li-Ting %A Lin,Fen-He %A Liao,Jung-Yu %A Guo,Jong-Long %+ Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, No. 162, Sec. 1, Heping East Road, Taipei, 106, Taiwan, 886 2 7749 1737, jonglong@ntnu.edu.tw %K chronic kidney disease %K chatbot %K health education %K push notification %K users’ evaluation %D 2023 %7 19.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence–driven chatbots are increasingly being used in health care, but few chat-based instant messaging support health education programs are designed for patients with chronic kidney disease (CKD) to evaluate their effectiveness. In addition, limited research exists on the usage of chat-based programs among patients with CKD, particularly those that integrate a chatbot aimed at enhancing the communication ability and disease-specific knowledge of patients. Objective: The objective of this formative study is to gather the data necessary to develop an intervention program of chat-based instant messaging support health education for patients with CKD. Participants’ user experiences will form the basis for program design improvements. Methods: Data were collected from April to November 2020 using a structured questionnaire. A pre-post design was used, and a total of 60 patients consented to join the 3-month program. Among them, 55 successfully completed the study measurements. The System Usability Scale was used for participant evaluations of the usability of the chat-based program. Results: Paired t tests revealed significant differences before and after intervention for communicative literacy (t54=3.99; P<.001) and CKD-specific disease knowledge (t54=7.54; P<.001). Within disease knowledge, significant differences were observed in the aspects of CKD basic knowledge (t54=3.46; P=.001), lifestyle (t54=3.83; P=.001), dietary intake (t54=5.51; P<.001), and medication (t54=4.17; P=.001). However, no significant difference was found in the aspect of disease prevention. Subgroup analysis revealed that while the findings among male participants were similar to those of the main sample, this was not the case among female participants. Conclusions: The findings reveal that a chat-based instant messaging support health education program may be effective for middle-aged and older patients with CKD. The use of a chat-based program with multiple promoting approaches is promising, and users’ evaluation is satisfactory. Trial Registration: ClinicalTrials.gov NCT05665517; https://clinicaltrials.gov/study/NCT05665517 %M 37725429 %R 10.2196/45484 %U https://formative.jmir.org/2023/1/e45484 %U https://doi.org/10.2196/45484 %U http://www.ncbi.nlm.nih.gov/pubmed/37725429 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e52204 %T Authors’ Reply: Methodological Considerations for a Diabetes Family-Based eHealth Intervention %A Feng,Yuheng %A Li,Xiaohong %+ Department of Health Policy and Management, School of Public Health, Fudan University, PO Box 177, 130 Dong’ an Road, Shanghai, China, 86 13918213586, lixh@fudan.edu.cn %K public health %K type 2 diabetes mellitus %K intervention %K randomized controlled trial %K community health center %D 2023 %7 18.9.2023 %9 Letter to the Editor %J JMIR Mhealth Uhealth %G English %X %M 37721796 %R 10.2196/52204 %U https://mhealth.jmir.org/2023/1/e52204 %U https://doi.org/10.2196/52204 %U http://www.ncbi.nlm.nih.gov/pubmed/37721796 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e48652 %T Methodological Considerations for a Diabetes Family-Based eHealth Intervention %A Brož,Jan %A Campbell,Matthew D %A Krollová,Pavlína %A Michalec,Juraj %+ Department of Internal Medicine, Second Faculty of Medicine, Charles University, V Úvalu 84, Prague, 150 00, Czech Republic, 420 734738858, zorb@seznam.cz %K public health %K type 2 diabetes mellitus %K intervention %K randomized controlled trial %K community health center %D 2023 %7 18.9.2023 %9 Letter to the Editor %J JMIR Mhealth Uhealth %G English %X %M 37721787 %R 10.2196/48652 %U https://mhealth.jmir.org/2023/1/e48652 %U https://doi.org/10.2196/48652 %U http://www.ncbi.nlm.nih.gov/pubmed/37721787 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e33810 %T A Culturally Adapted Diet and Physical Activity Text Message Intervention to Prevent Type 2 Diabetes Mellitus for Women of Pakistani Origin Living in Scotland: Formative Study %A Krasuska,Marta %A Davidson,Emma M %A Beune,Erik %A Jenum,Anne Karen %A Gill,Jason MR %A Stronks,Karien %A van Valkengoed,Irene GM %A Diaz,Esperanza %A Sheikh,Aziz %+ Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, United Kingdom, 44 131 650 8102, emma.davidson@ed.ac.uk %K diabetes %K diet %K ethnic minority populations %K Pakistani %K physical activity %K prevention %K South Asian %K text messages %K women %K women’s health %K health intervention %K digital health %K mobile health %K minority %K exercise %K text message %K text messaging %K SMS %K development %K formative %K diabetes mellitus %D 2023 %7 15.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals of South Asian origin are at an increased risk of developing type 2 diabetes mellitus (T2DM) compared with other ethnic minority groups. Therefore, there is a need to develop interventions to address, and reduce, this heightened risk. Objective: We undertook formative work to develop a culturally adapted diet and physical activity text message intervention to prevent T2DM for women of Pakistani origin living in Scotland. Methods: We used a stepwise approach that was informed by the Six Steps in Quality Intervention Development framework, which consisted of gathering evidence through literature review and focus groups (step 1), developing a program theory for the intervention (step 2), and finally developing the content of the text messages and an accompanying delivery plan (step 3). Results: In step 1, we reviewed 12 articles and identified 3 key themes describing factors impacting on diet and physical activity in the context of T2DM prevention: knowledge on ways to prevent T2DM through diet and physical activity; cultural, social, and gender norms; and perceived level of control and sense of inevitability over developing T2DM. The key themes that emerged from the 3 focus groups with a total of 25 women were the need for interventions to provide “friendly encouragement,” “companionship,” and a “focus on the individual” and also for the text messages to “set achievable goals” and include “information on cooking healthy meals.” We combined the findings of the focus groups and literature review to create 13 guiding principles for culturally adapting the text messages. In step 2, we developed a program theory, which specified the main determinants of change that our text messages should aim to enhance: knowledge and skills, sense of control, goal setting and planning behavior, peer support, and norms and beliefs guiding behavior. In step 3, we used both the intervention program theory and guiding principles to develop a set of 73 text messages aimed at supporting a healthy diet and 65 text messages supporting increasing physical activity. Conclusions: We present a theory-based approach to develop a culturally adapted diet and physical activity text message intervention to prevent T2DM for women of Pakistani origin living in Scotland. This study outlines an approach that may also be applicable to the development of interventions for other ethnic minority populations in diverse settings. There is now a need to build on this formative work and undertake a feasibility trial of a text message–based diet and physical activity intervention to prevent T2DM for women of Pakistani origin living in Scotland. %M 37713245 %R 10.2196/33810 %U https://formative.jmir.org/2023/1/e33810 %U https://doi.org/10.2196/33810 %U http://www.ncbi.nlm.nih.gov/pubmed/37713245 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46560 %T A Text Messaging Intervention for Priming the Affective Rewards of Exercise in Adults: Protocol for a Microrandomized Trial %A Mishra,Sonali R %A Dempsey,Walter %A Klasnja,Predrag %+ Department of Internal Medicine, University of Michigan, NCRC B100, Ann Arbor, MI, 48109, United States, 1 215 266 0952, srmishra@umich.edu %K mobile health %K mHealth interventions %K physical activity %K affective attitudes %K mobile phone %D 2023 %7 1.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical activity is a critical target for health interventions, but effective interventions remain elusive. A growing body of work suggests that interventions targeting affective attitudes toward physical activity may be more effective for sustaining activity long term than those that rely on cognitive constructs alone, such as goal setting and self-monitoring. Anticipated affective response in particular is a promising target for intervention. Objective: We will evaluate the efficacy of an SMS text messaging intervention that manipulates anticipated affective response to exercise to promote physical activity. We hypothesize that reminding users of a positive postexercise affective state before their planned exercise sessions will increase their calories burned during this exercise session. We will deploy 2 forms of affective SMS text messages to explore the design space: low-reflection messages written by participants for themselves and high-reflection prompts that require users to reflect and respond. We will also explore the effect of the intervention on affective attitudes toward exercise. Methods: A total of 120 individuals will be enrolled in a 9-week microrandomized trial testing affective messages that remind users about feeling good after exercise (40% probability), control reminders (30% probability), or no message (30% probability). Two types of affective SMS text messages will be deployed: one requiring a response and the other in a read-only format. Participants will write the read-only messages themselves to ensure that the messages accurately reflect the participants’ anticipated postexercise affective state. Affective attitudes toward exercise and intrinsic motivation for exercise will be measured at the beginning and end of the study. The weighted and centered least squares method will be used to analyze the effect of delivering the intervention versus not on calories burned over 4 hours around the time of the planned activity, measured by the Apple Watch. Secondary analyses will include the effect of the intervention on step count and active minutes, as well as an investigation of the effects of the intervention on affective attitudes toward exercise and intrinsic motivation for exercise. Participants will be interviewed to gain qualitative insights into intervention impact and acceptability. Results: Enrollment began in May 2023, with 57 participants enrolled at the end of July 2023. We anticipate enrolling 120 participants. Conclusions: This study will provide early evidence about the effect of a repeated manipulation of anticipated affective response to exercise. The use of 2 different types of messages will yield insight into optimal design strategies for improving affective attitudes toward exercise. Trial Registration: ClinicalTrials.gov NCT05582369; https://classic.clinicaltrials.gov/ct2/show/NCT05582369 International Registered Report Identifier (IRRID): PRR1-10.2196/46560 %M 37656493 %R 10.2196/46560 %U https://www.researchprotocols.org/2023/1/e46560 %U https://doi.org/10.2196/46560 %U http://www.ncbi.nlm.nih.gov/pubmed/37656493 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e44612 %T Advanced Messaging Intervention for Medication Adherence and Clinical Outcomes Among Patients With Cancer: Randomized Controlled Trial %A Ni,Chen-Xu %A Lu,Wen-Jie %A Ni,Min %A Huang,Fang %A Li,Dong-Jie %A Shen,Fu-Ming %+ Department of Pharmacy, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai, 200072, China, 86 66302570, fumingshen@tongji.edu.cn %K 5G messaging %K fifth-generation %K medication adherence %K patients with cancer %K clinical pharmacists %K randomized controlled trial %D 2023 %7 31.8.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Medication adherence is crucial for improving clinical outcomes in the treatment of patients with cancer. The lack of adherence and adverse drug reactions can reduce the effectiveness of cancer therapy including the quality of life. The commonly used intervention methods for medication adherence continue to evolve, and the age of fifth-generation (5G) messaging has arrived. Objective: In this study, we conducted a prospective, pilot randomized controlled trial to evaluate the effect of 5G messaging on medication adherence and clinical outcomes among patients with cancer in China. Methods: The research population was patients with nonsmall cell lung cancer undergoing pemetrexed chemotherapy who require regular folic acid (FA) and vitamin B12 supplements. The intervention and control groups were assigned to 5G messaging and second-generation (2G) messaging, respectively. The patients’ medication adherence and quality of life were assessed at baseline and 1-month and 3-month time points. Moreover, the chemotherapy-related hematologic or nonhematologic toxicities, as well as the serum levels of FA and vitamin B12, were measured. Results: Of the 567 patients assessed for eligibility between January and May 2021, a total of 154 (27.2%) patients were included. Overall, 80 were randomized to the control group and 74 to the intervention group. The odds of adherence in the 5G messaging intervention group were significantly higher than the control group at the 1-month (62/69, 90% vs 56/74, 76%; adjusted odds ratio 2.67, 95% CI 1.02-7.71) and 3-month (50/60, 83% vs 48/64, 75%; adjusted odds ratio 2.36, 95% CI 1.00-5.23) time points. Correspondingly, the FA and vitamin B12 serum levels of patients in the 5G messaging group were higher than those of the control group. Regarding hematologic toxicities, only the incidence of leukopenia in the intervention group was lower than that in the control group (25/80, 31% in the control group vs 12/74, 16% in the intervention group; P=.04). There were no differences in nonhematologic toxicities and quality of life between the 2 groups. Conclusions: In summary, we conclude that compared with conventional 2G text-based messaging, a 5G messaging intervention can better improve medication adherence and clinical outcome among patients with cancer. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200058188; https://www.chictr.org.cn/showproj.html?proj=164489 %M 37651170 %R 10.2196/44612 %U https://cancer.jmir.org/2023/1/e44612 %U https://doi.org/10.2196/44612 %U http://www.ncbi.nlm.nih.gov/pubmed/37651170 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45198 %T Intentions of Patients With Cancer and Their Relatives to Use a Live Chat on Familial Cancer Risk: Results From a Cross-Sectional Web-Based Survey %A Memenga,Paula %A Baumann,Eva %A Luetke Lanfer,Hanna %A Reifegerste,Doreen %A Geulen,Julia %A Weber,Winja %A Hahne,Andrea %A Müller,Anne %A Weg-Remers,Susanne %+ Hanover Center for Health Communication, Department of Journalism and Communication Research, Hanover University of Music, Drama and Media, Expo Plaza 12, Hannover, 30539, Germany, 49 5113100488, paula.memenga@ijk.hmtm-hannover.de %K live chat %K technology acceptance %K familial cancer risk %K Extended Unified Theory of Acceptance and Use of Technology %K cancer information seeking %K patients and relatives with cancer %K patients with cancer %K cancer risk %K genetic testing %K diagnosis %K severity %K cross-sectional survey %D 2023 %7 28.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: An important prerequisite for actively engaging in cancer prevention and early detection measures, which is particularly recommended in cases of familial cancer risk, is the acquisition of information. Although a lot of cancer information is available, not all social groups are equally well reached because information needs and communicative accessibility differ. Previous research has shown that a live chat service provided by health professionals could be an appropriate, low-threshold format to meet individual information needs on sensitive health topics such as familial cancer risk. An established German Cancer Information Service is currently developing such a live chat service. As it is only worthwhile if accepted by the target groups, formative evaluation is essential in the course of the chat service’s development and implementation. Objective: This study aimed to explore the acceptance of a live chat on familial cancer risk by patients with cancer and their relatives (research question [RQ] 1) and examine the explanatory power of factors associated with their intentions to use such a service (RQ2). Guided by the Extended Unified Theory of Acceptance and Use of Technology (UTAUT2), we examined the explanatory power of the following UTAUT2 factors: performance expectancy, effort expectancy, social influence, facilitating conditions, and habit, supplemented by perceived information insufficiency, perceived susceptibility, perceived severity, and cancer diagnosis as additional factors related to information seeking about familial cancer. Methods: We conducted a cross-sectional survey via a German web-based access panel in March 2022 that was stratified by age, gender, and education (N=1084). The participants are or have been diagnosed with cancer themselves (n=144) or have relatives who are or have been affected (n=990). All constructs were measured with established scales. To answer RQ1, descriptive data (mean values and distribution) were used. For RQ2, a blockwise multiple linear regression analysis was conducted. Results: Overall, 32.7% of participants were (rather) willing, 28.9% were undecided, and 38.4% were (rather) not willing to use a live chat on familial cancer risk in the future. A multiple linear regression analysis explained 47% of the variance. It revealed that performance expectancy, social influence, habit, perceived susceptibility, and perceived severity were positively associated with the intention to use a live chat on familial cancer risk. Effort expectancy, facilitating conditions, information insufficiency, and cancer diagnosis were not related to usage intentions. Conclusions: A live chat seems promising for providing information on familial cancer risk. When promoting the service, the personal benefits should be addressed in particular. UTAUT2 is an effective theoretical framework for explaining live chat usage intentions and does not need to be extended in the context of familial cancer risk. %M 37639311 %R 10.2196/45198 %U https://www.jmir.org/2023/1/e45198 %U https://doi.org/10.2196/45198 %U http://www.ncbi.nlm.nih.gov/pubmed/37639311 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e41833 %T Acceptability of Personal Sensing Among People With Alcohol Use Disorder: Observational Study %A Wyant,Kendra %A Moshontz,Hannah %A Ward,Stephanie B %A Fronk,Gaylen E %A Curtin,John J %+ Department of Psychology, University of Wisconsin-Madison, 1202 W Johnson St, Madison, WI, 53706, United States, 1 (608) 262 1040, jjcurtin@wisc.edu %K personal sensing %K digital therapeutics %K mobile health %K smartphone %K alcohol use disorder %K self-report %K alcohol use %K symptom monitoring %K mental health %K acceptability %K alcohol intake %K mobile phone %D 2023 %7 28.8.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Personal sensing may improve digital therapeutics for mental health care by facilitating early screening, symptom monitoring, risk prediction, and personalized adaptive interventions. However, further development and the use of personal sensing requires a better understanding of its acceptability to people targeted for these applications. Objective: We aimed to assess the acceptability of active and passive personal sensing methods in a sample of people with moderate to severe alcohol use disorder using both behavioral and self-report measures. This sample was recruited as part of a larger grant-funded project to develop a machine learning algorithm to predict lapses. Methods: Participants (N=154; n=77, 50% female; mean age 41, SD 11.9 years; n=134, 87% White and n=150, 97% non-Hispanic) in early recovery (1-8 weeks of abstinence) were recruited to participate in a 3-month longitudinal study. Participants were modestly compensated for engaging with active (eg, ecological momentary assessment [EMA], audio check-in, and sleep quality) and passive (eg, geolocation, cellular communication logs, and SMS text message content) sensing methods that were selected to tap into constructs from the Relapse Prevention model by Marlatt. We assessed 3 behavioral indicators of acceptability: participants’ choices about their participation in the study at various stages in the procedure, their choice to opt in to provide data for each sensing method, and their adherence to a subset of the active methods (EMA and audio check-in). We also assessed 3 self-report measures of acceptability (interference, dislike, and willingness to use for 1 year) for each method. Results: Of the 192 eligible individuals screened, 191 consented to personal sensing. Most of these individuals (169/191, 88.5%) also returned 1 week later to formally enroll, and 154 participated through the first month follow-up visit. All participants in our analysis sample opted in to provide data for EMA, sleep quality, geolocation, and cellular communication logs. Out of 154 participants, 1 (0.6%) did not provide SMS text message content and 3 (1.9%) did not provide any audio check-ins. The average adherence rate for the 4 times daily EMA was .80. The adherence rate for the daily audio check-in was .54. Aggregate participant ratings indicated that all personal sensing methods were significantly more acceptable (all P<.001) compared with neutral across subjective measures of interference, dislike, and willingness to use for 1 year. Participants did not significantly differ in their dislike of active methods compared with passive methods (P=.23). However, participants reported a higher willingness to use passive (vs active) methods for 1 year (P=.04). Conclusions: These results suggest that active and passive sensing methods are acceptable for people with alcohol use disorder over a longer period than has previously been assessed. Important individual differences were observed across people and methods, indicating opportunities for future improvement. %M 37639300 %R 10.2196/41833 %U https://mhealth.jmir.org/2023/1/e41833 %U https://doi.org/10.2196/41833 %U http://www.ncbi.nlm.nih.gov/pubmed/37639300 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44707 %T Understanding Trust Determinants in a Live Chat Service on Familial Cancer: Qualitative Triangulation Study With Focus Groups and Interviews in Germany %A Luetke Lanfer,Hanna %A Reifegerste,Doreen %A Berg,Annika %A Memenga,Paula %A Baumann,Eva %A Weber,Winja %A Geulen,Julia %A Müller,Anne %A Hahne,Andrea %A Weg-Remers,Susanne %+ School of Public Health, Bielefeld University, Universitätsstraße 25, Bielefeld, 33615, Germany, 49 521 106 3834, hanna.luetkelanfer@uni-bielefeld.de %K trust %K live chat %K web-based health seeking %K qualitative research %K cancer %D 2023 %7 23.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In dealing with familial cancer risk, seeking web-based health information can be a coping strategy for different stakeholder groups (ie, patients, relatives, and those suspecting an elevated familial cancer risk). In the vast digital landscape marked by a varied quality of web-based information and evolving technologies, trust emerges as a pivotal factor, guiding the process of health information seeking and interacting with digital health services. This trust formation in health information can be conceptualized as context dependent and multidimensional, involving 3 key dimensions: information seeker (trustor), information provider (trustee), and medium or platform (application). Owing to the rapid changes in the digital context, it is critical to understand how seekers form trust in new services, given the interplay among these different dimensions. An example of such a new service is a live chat operated by physicians for the general public with personalized cancer-related information and a focus on familial cancer risk. Objective: To gain a comprehensive picture of trust formation in a cancer-related live chat service, this study investigates the 3 dimensions of trust—trustor, trustee, and application—and their respective relevant characteristics based on a model of trust in web-based health information. In addition, the study aims to compare these characteristics across the 3 different stakeholder groups, with the goal to enhance the service’s trustworthiness for each group. Methods: This qualitative study triangulated the different perspectives of medical cancer advisers, advisers from cancer support groups, and members of the public in interviews and focus group discussions to explore the 3 dimensions of trust—trustor, trustee, and application—and their determinants for a new live chat service for familial cancer risk to be implemented at the German Cancer Information Service. Results: The results indicate that experience with familial cancer risk is the key trustor characteristic to using, and trusting information provided by, the live chat service. The live chat might also be particularly valuable for people from minority groups who have unmet needs from physician-patient interactions. Participants highlighted trustee characteristics such as ability, benevolence, integrity, and humanness (ie, not a chatbot) as pivotal in a trustworthy cancer live chat service. Application-related characteristics, including the reputation of the institution, user-centric design, modern technology, and visual appeal, were also deemed essential. Despite the different backgrounds and sociodemographics of the 3 stakeholder groups, many overlaps were found among the 3 trust dimensions and their respective characteristics. Conclusions: Trust in a live chat for cancer information is formed by different dimensions and characteristics of trust. This study underscores the importance of understanding trust formation in digital health services and suggests potential enhancements for effective, trustworthy interactions in live chat services (eg, by providing biographies of the human medical experts to differentiate them from artificial intelligence chatbots). %M 37610815 %R 10.2196/44707 %U https://www.jmir.org/2023/1/e44707 %U https://doi.org/10.2196/44707 %U http://www.ncbi.nlm.nih.gov/pubmed/37610815 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44924 %T Understanding Attrition in Text-Based Health Promotion for Fathers: Survival Analysis %A Fletcher,Richard %A Regan,Casey %A Dizon,Jason %A Leigh,Lucy %+ School of Health Sciences, College of Health, Medicine, and Wellbeing, The University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 429 152 405, richard.fletcher@newcastle.edu.au %K attrition %K dropout %K text-based program %K parenting %K fathers %D 2023 %7 18.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based interventions targeting parents with health and parenting support frequently report high rates of attrition. The SMS4dads text messaging program, developed in Australia, has delivered texts to over 10,000 fathers. The brief text messages, which are sent 3 times per week from 16 weeks of gestation to 48 weeks after birth, include regular reminders that participants can leave the program by texting back “STOP” to any message. Although acceptance of the program is high, almost 1 in 5 ask it to be removed. Analyzing the factors influencing attrition from digital parenting programs such as SMS4dads may assist in developing more effective interventions. Objective: This study aimed to examine factors associated with attrition in a text-based intervention targeting fathers. Methods: Demographic characteristics, requests to complete a psychological scale, individual message content, participant feedback, and automatically collected data registering clicks on links embedded in the texts were examined to identify attrition factors among 3261 participants enrolled in SMS4dads from 4 local health districts in New South Wales, Australia, between September 2020 and December 2021. Results: Participants who were smokers, recorded risky alcohol consumption, had a lower education level, or signed up prenatally had 30% to 47% higher hazard of dropout from the program, whereas participant age, Aboriginal or Torres Strait Islander status, rurality, and psychological distress score (as Kessler Psychological Distress Scale [K10] category) were not associated with dropout. Primary reasons for dropping out reported by 202 of 605 respondents included “other reasons” (83/202, 41.1%), followed by “not helpful” (47/202, 23.3%) and “too busy” (44/202, 21.8%). Program features such as repeated requests to complete a psychological scale (K10) and the content of individual messages were not linked to increased dropout rates. Analysis of a sample (216/2612) of inactive participants who had not engaged (clicked on any embedded links) for at least 10 weeks but who had not opted out identified a further 1.5% of participants who would opt to leave the program if asked. Conclusions: Identifying which features of the participant population and of the program are linked to dropout rates can provide guidance for improving program adherence. However, with limited information from feedback surveys of those exiting early, knowing which features to target does not, by itself, suggest ways to increase engagement. Planning ahead to include robust measures of attrition, including more detailed feedback from participants, could provide more effective guidance. A novel element in this study was seeking feedback from inactive participants to estimate dropout from this group and thereby provide an overall dropout rate of 20%. The retention rate of 80%, relatively high compared with other web-based parenting programs for fathers, suggests that tailoring the content to specifically address fathers’ role may be an important consideration in reducing fathers’ disengagement. %M 37594788 %R 10.2196/44924 %U https://formative.jmir.org/2023/1/e44924 %U https://doi.org/10.2196/44924 %U http://www.ncbi.nlm.nih.gov/pubmed/37594788 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e43024 %T Tailoring a Text Messaging and Fotonovela Program to Increase Patient Engagement in Colorectal Cancer Screening in a Large Urban Community Clinic Population: Quality Improvement Project %A Guo,Monica %A Brar Prayaga,Rena %A Levitz,Carly E %A Kuo,Elena S %A Ruiz,Esmeralda %A Torres-Ozadali,Evelyn %A Escaron,Anne %+ Institute for Health Equity, AltaMed, 2035 Camfield Ave, Los Angeles, CA, 90040, United States, 1 323 914 9765, monguo@altamed.org %K colorectal cancer screening %K texting program %K fotonovela %K fecal immunochemical test %K FIT %K FIT kit %K thematic analysis %K mobile phone %D 2023 %7 10.8.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Appropriate annual screenings for colorectal cancer (CRC) are an essential preventive measure for the second-leading cause of cancer-related death in the United States. Studies have shown that CRC screening rates are influenced by various social determinants of health (SDOH) factors, including race, ethnicity, and geography. According to 2018 national data, participation in screening is lowest among Hispanic or Latinx individuals (56.1%). At an urban Federally Qualified Health Center, a quality improvement project was conducted to evaluate a texting program with a motivational fotonovela—a short narrative comic. Fotonovelas have previously been used in programs to improve knowledge of cervical cancer and human papillomavirus, vaccinations, and treatments for depression. Objective: This study aimed to encourage compliance with fecal immunochemical test (FIT) screening. Patient engagement involved a texting program with fotonovelas informed by behavior change techniques. This study sought to understand the qualitative characteristics of patient motivation, intention, and barriers to completing their screening. Methods: A total of 5241 English-speaking or Spanish-speaking Federally Qualified Health Center patients aged 50 to 75 years were randomized to either intervention (a 4-week tailored 2-way texting program with a fotonovela comic) or usual care (an SMS text message reminder and patient navigator phone call). The texting vendor used a proprietary algorithm to categorize patients in the intervention group into SDOH bands based on their home addresses (high impact=high social needs and low impact=low social needs). Over 4 weeks, patients were texted questions about receiving and returning their FIT, what barriers they may be experiencing, and their thoughts about the fotonovela. Results: The SDOH index analysis showed that most of the patient population was in the SDOH band categories of high impact (555/2597, 21.37%) and very high impact (1416/2597, 54.52%). Patients sent 1969 total responses to the texting system. Thematic analysis identified 3 major themes in these responses: messages as a reminder, where patients reported that they were motivated to return the FIT and had already done so or would do so as soon as possible; increasing patients’ understanding of screening importance, where patients expressed an increased knowledge about the purpose and importance of the FIT; and expressing barriers, where patients shared reasons for not completing the FIT. Conclusions: The texting program and fotonovela engaged a subset of patients in each SDOH band, including the high and very high impact bands. Creating culturally tailored messages can encourage patient engagement for accepting the content of the messaging, confirming intentions to complete their FIT, and sharing insights about barriers to behavior change. To better support all patients across the continuum of care with CRC screening, it is important to continue to develop and assess strategies that engage patients who did not return their home-mailed FIT. %M 37561562 %R 10.2196/43024 %U https://cancer.jmir.org/2023/1/e43024 %U https://doi.org/10.2196/43024 %U http://www.ncbi.nlm.nih.gov/pubmed/37561562 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e50231 %T Examining the Use of Text Messages Among Multidisciplinary Care Teams to Reduce Avoidable Hospitalization of Nursing Home Residents with Dementia: Protocol for a Secondary Analysis %A Powell,Kimberly R %A Popescu,Mihail %A Lee,Suhwon %A Mehr,David R %A Alexander,Gregory L %+ Sinclair School of Nursing, University of Missouri, 915 Hitt Street, Columbia, MO, 65211, United States, 1 5026407556, powellk@missouri.edu %K age-friendly health systems %K Alzheimer disease %K communication %K dementia %K nursing homes %K older adults %D 2023 %7 9.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Reducing avoidable nursing home (NH)–to-hospital transfers of residents with Alzheimer disease or a related dementia (ADRD) has become a national priority due to the physical and emotional toll it places on residents and the high costs to Medicare and Medicaid. Technologies supporting the use of clinical text messages (TMs) could improve communication among health care team members and have considerable impact on reducing avoidable NH-to-hospital transfers. Although text messaging is a widely accepted mechanism of communication, clinical models of care using TMs are sparsely reported in the literature, especially in NHs. Protocols for assessing technologies that integrate TMs into care delivery models would be beneficial for end users of these systems. Without evidence to support clinical models of care using TMs, users are left to design their own methods and protocols for their use, which can create wide variability and potentially increase disparities in resident outcomes. Objective: Our aim is to describe the protocol of a study designed to understand how members of the multidisciplinary team communicate using TMs and how salient and timely communication can be used to avert poor outcomes for NH residents with ADRD, including hospitalization. Methods: This project is a secondary analysis of data collected from a Centers for Medicare & Medicaid Services (CMS)–funded demonstration project designed to reduce avoidable hospitalizations for long-stay NH residents. We will use two data sources: (1) TMs exchanged among the multidisciplinary team across the 7-year CMS study period (August 2013-September 2020) and (2) an adapted acute care transfer tool completed by advanced practice registered nurses to document retrospective details about NH-to-hospital transfers. The study is guided by an age-friendly model of care called the 4Ms (What Matters, Medications, Mentation, and Mobility) framework. We will use natural language processing, statistical methods, and social network analysis to generate a new ontology and to compare communication patterns found in TMs occurring around the time NH-to-hospital transfer decisions were made about residents with and without ADRD. Results: After accounting for inclusion and exclusion criteria, we will analyze over 30,000 TMs pertaining to over 3600 NH-to-hospital transfers. Development of the 4M ontology is in progress, and the 3-year project is expected to run until mid-2025. Conclusions: To our knowledge, this project will be the first to explore the content of TMs exchanged among a multidisciplinary team of care providers as they make decisions about NH-to-hospital resident transfers. Understanding how the presence of evidence-based elements of high-quality care relate to avoidable hospitalizations among NH residents with ADRD will generate knowledge regarding the future scalability of behavioral interventions. Without this knowledge, NHs will continue to rely on ineffective and outdated communication methods that fail to account for evidence-based elements of age-friendly care. International Registered Report Identifier (IRRID): DERR1-10.2196/50231 %M 37556199 %R 10.2196/50231 %U https://www.researchprotocols.org/2023/1/e50231 %U https://doi.org/10.2196/50231 %U http://www.ncbi.nlm.nih.gov/pubmed/37556199 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47018 %T Testing the Impact of Phone Texting Reminders for Children's Immunization Appointments in Rural Cameroon: Protocol for a Nonrandomized Controlled Trial %A Ngah,Yayah Emerencia %A Raoufi,Ghazal %A Amirkhani,Maral %A Esmaeili,Ashkan %A Nikooifard,Rasa %A Ghaemi Mood,Shidrokh %A Rahmanian,Ava %A Boltena,Minyahil Tadesse %A Aga,Eresso %A Neogi,Ujjwal %A Ikomey Mondinde,George %A El-Khatib,Ziad %+ Department of Global Public Health, Karolinska Institutet, Norrbackagatan 4, Stockholm, 171 76, Sweden, 43 6643461861, ziad.khatib@gmail.com %K immunization %K children %K Cameroon %K digital health %K global health %K nonrandomized controlled trial %K child vaccination %D 2023 %7 9.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Globally, over 20 million children are unvaccinated and over 25 million missed their follow-up doses during the COVID-19 pandemic; thus, they face vaccine-preventable diseases and unnecessary deaths. This is especially the case for those with HIV or living in vulnerable settings. Using cell phones to send reminders to parents has been shown to improve vaccination rates. Objective: We aim to determine whether implementation of an automated SMS reminder will improve child vaccination rates in a turbulent, semiurban/semirural setting in a low-income country. Methods: This will be a nonrandomized controlled trial that will be conducted at Azire Integrated Health Centre, Bamenda, Cameroon. Results: A total of 200 parents per study group (aged over 18 years) who are registered at the clinic at least one month prior to the study will be recruited. The intervention group will receive 2 reminders: 1 week and 2 days prior to the scheduled vaccination. For those who miss their appointments, a reminder will be sent 1 week after their missed appointment. The control group will receive the regular care provided at the clinic. Baseline information, clinical visit data, and vaccination records will be collected for both groups. Descriptive statistics will be used to summarize baseline characteristics between and within clusters and groups. The Fisher exact test will be used to compare parent-child units who return for follow-up visits (as a percentage) and children vaccinated as scheduled (as a percentage) between the study groups. Finally, we will compare how many members of both study groups return for 1 follow-up visit using Kaplan-Meier survival analysis. Conclusions: Due to limited effective child vaccination interventions in unstable settings, this study will be of high importance for suggesting a holistic approach to improve child vaccination and public health. International Registered Report Identifier (IRRID): DERR1-10.2196/47018 %M 37556178 %R 10.2196/47018 %U https://www.researchprotocols.org/2023/1/e47018 %U https://doi.org/10.2196/47018 %U http://www.ncbi.nlm.nih.gov/pubmed/37556178 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46606 %T An SMS Text Message–Based Type 2 Diabetes Prevention Program for Hispanic Adolescents With Obesity: Qualitative Co-Design Process %A Soltero,Erica %A Lopez,Callie %A Mihail,Sandra %A Hernandez,Ayleen %A Musaad,Salma M %A O'Connor,Teresia M %A Thompson,Debbe %+ USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Str, Houston, TX, 77030, United States, 1 713 798 3802, soltero@bcm.edu %K Hispanic health %K adolescents %K digital health %K physical activity %K sleep %K type 2 diabetes %K mobile phone %K smartphone %D 2023 %7 2.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: SMS text message–based interventions are a promising approach for reaching and engaging high-risk youths, such as Hispanic adolescents with obesity, in health promotion and disease prevention opportunities. This is particularly relevant, given that SMS text messaging is widely accessible and available and that adolescents are frequent texters. Including youths in the development of SMS text message content can lead to more acceptable and relevant messaging; however, few studies include this group as cocollaborators. Objective: This study aimed to use a co-design process to inform the development of SMS text messages that promote healthy physical activity (PA) and sleep behaviors among Hispanic adolescents with obesity. Methods: The co-design framework uses multiple methods across several phases. Self-determination theory and a literature review of SMS text message–based interventions guided the background and research phases. In the co-design phase, Hispanic adolescents (n=20) completed in-depth interviews to identify barriers and facilitators of PA and sleep, preferences for ways to emphasize key self-determination theory constructs (autonomy, competence, and relatedness), and suggestions for making SMS text message content engaging. In the design and content phase, interview findings were used to develop initial SMS text messages, which were then evaluated in the early evaluation phase by experts (n=6) and adolescents (n=6). Feedback from these panels was integrated into the SMS text message content during refinement. Results: The background phase revealed that few SMS text message–based interventions have included Hispanic adolescents. Common barriers and facilitators of activity and sleep as well as preferences for ways in which SMS text messages could provide autonomy, competence, and relatedness support were identified in the co-design phase. The youths also wanted feedback about goal attainment. Suggestions to make SMS text messages more engaging included using emojis, GIFs, and media. This information informed an initial bank of SMS text messages (N=116). Expert review indicated that all (116/116, 100%) SMS text messages were age and culturally appropriate; however, some (21/116, 18.1%) did not adequately address youth-identified barriers and facilitators of PA and sleep, whereas others (30/116, 25.9%) were not theoretically adherent. Adolescents reported that SMS text messages were easy to understand (116/116, 100%), provided the support needed for behavior change (103/116, 88.8%), and used mostly acceptable language (84/116, 72.4%). Feedback was used to refine and develop the final bank of 125 unique text messages. Conclusions: Using a co-design process, a theoretically grounded, appealing, and relevant bank of SMS text messages promoting healthy PA and sleep behaviors to adolescents was developed. The SMS text messages will be further evaluated in a pilot study to assess feasibility, acceptability, and preliminary efficacy. The co-design process used in this study provides a framework for future studies aimed at developing SMS text message–based strategies among high-risk adolescents. International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2023.107117 %M 37531191 %R 10.2196/46606 %U https://formative.jmir.org/2023/1/e46606 %U https://doi.org/10.2196/46606 %U http://www.ncbi.nlm.nih.gov/pubmed/37531191 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 7 %N %P e45769 %T WeChat-Based Intervention for Chinese Immigrants With Hypertension: Development and Evaluation Study %A Li,Wen-Wen %A Toh,Prisca %+ School of Nursing, San Francisco State University, 1600 Holloway Ave, BH383, San Francisco, CA, 94132, United States, 1 4153382368, wenwenli@sfsu.edu %K social media %K hypertension %K medication adherence %K Chinese immigrants %K WeChat %K blood pressure %K BP %D 2023 %7 27.7.2023 %9 Original Paper %J Asian Pac Isl Nurs J %G English %X Background: Despite Chinese immigrants having a higher or comparable proportion of hypertension (HTN) compared to non-Hispanic White and Hispanic individuals, there are no effective technology-based intervention studies that target HTN management in Chinese immigrants in the United States. Objective: The aim of this study was to develop and pilot-test the efficacy of a culturally and linguistically sensitive social media–based intervention (WeChat) for Chinese immigrants to improve blood pressure (BP) control, antihypertensive medication adherence, and self-efficacy. Methods: The study was conducted in 2020 with a pre- and posttest design (N=20). A WeChat-based intervention was implemented using one 20-minute video presentation plus one 20-minute nurse counseling session via WeChat at the baseline, followed by 4 biweekly 20-minute nurse counseling sessions via WeChat calls. The primary outcome (BP control) and secondary outcomes, including medication adherence and self-efficacy in HTN management, were measured at baseline and at 6 months. Results: The participants’ mean age was 68.9 (SD 10.2; range: 51-86) years. The majority of the participants were female (n=13, 65%), had a high school degree or less (n=15, 75%), were married (n=16, 80%), not religious (n=13, 65%), and not employed (n=12, 60%). The results showed that the mean baseline systolic BP was 131.43 (SD 9.61) mmHg, and the mean diastolic BP was 79.79 (SD 9.62) mmHg. The 6-month outcome showed a reduction of systolic BP (–0.74, SD 9.18 mmHg; P=.05) and diastolic BP (–0.96, SD 6.92 mmHg; P=.001). The mean score for medication adherence at baseline was 4.50 (SD 1.70), and it significantly improved to 3.65 (SD 1.18) at 6 months (reversely scored; possible range was 1-5, with 1 being the best score; P=.001). Self-efficacy in HTN management had a trend in reduction from a baseline score of 8.28 (SD 1.25) decreasing to 7.93 (SD 1.48) at 6 months, with a mean difference of 0.34 (SD 2.02), with a score of 0 indicating the lowest self-efficacy and a score of 10 indicating the highest self-efficacy. Conclusions: Our WeChat-based HTN management program showed a significant improvement in diastolic BP and medication adherence as well as a trend of reduction for systolic BP and self-efficacy in managing HTN in Chinese immigrants. Compared to the traditional health care system, the proposed WeChat-based HTN management program has a low cost and is easy to implement. Thus, further investigation is recommended to generate further results. This intervention should be tested across different regions and clinical settings to verify the findings. The long-term goal is to implement the intervention in clinical settings to help Chinese immigrants at large achieve better HTN management. %M 37498663 %R 10.2196/45769 %U https://apinj.jmir.org/2023/1/e45769 %U https://doi.org/10.2196/45769 %U http://www.ncbi.nlm.nih.gov/pubmed/37498663 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45164 %T A National Health and Wellness SMS Text Message Program for Breast Cancer Survivors During COVID-19 (EMPOWER-SMS COVID-19): Mixed Methods Evaluation Using the RE-AIM Framework %A Singleton,Anna C %A Raeside,Rebecca %A Hyun,Karice K %A Hayes,Molly %A Sherman,Kerry A %A Elder,Elisabeth %A Redfern,Julie %A Partridge,Stephanie R %+ Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Level 6 Block K Westmead Hospital, Sydney, 2753, Australia, 61 2 9351 2222, anna.singleton@sydney.edu.au %K digital health %K telemedicine %K SMS text messaging %K breast cancer %K implementation science %K cancer survivorship %K supportive care %K public health %K COVID-19 %D 2023 %7 25.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 lockdowns caused widespread closures of supportive care services for breast cancer survivors in Australia. In a randomized controlled trial, our team’s lifestyle-focused, evidence-based SMS text message support program (EMPOWER-SMS COVID-19) was found to be acceptable and useful for breast cancer survivors, and it was ready for rapid widespread delivery. Objective: This study aims to evaluate the reach (uptake) of an adapted 3-month lifestyle-focused SMS text message program (EMPOWER-SMS COVID-19) and barriers and enablers to implementation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Methods: A mixed methods pre-post study was conducted to evaluate the EMPOWER-SMS COVID-19 program. The study evaluated the following aspects: (1) reach/representativeness, which refers to the proportion of participant enrollment (ie, number enrolled/number that visited the study website) and demographics (eg, age, sex, ethnicity, time since completing treatment, Index of Relative Socio-economic Advantage and Disadvantage [IRSAD; quintile 1, which refers to most disadvantaged areas, to quintile 5, which refers to least disadvantaged areas, and remoteness); (2) effectiveness, in which participant engagement and acceptability were evaluated using SMS text message reply data and a feedback survey (5-point Likert scale and free-text responses); (3) adoption, which corresponds to the proportion of organizations or health professionals who agreed to promote the program; (4) implementation fidelity and maintenance, which evaluated SMS text message delivery data, opt-outs, costs, and adaptations. Quantitative data were summarized using means and SDs or frequencies and percentages, while qualitative data were analyzed thematically. Results: With regard to the reach/representativeness of the program, 841/1340 (62.8%) participants enrolled and provided electronic consent. Participants had a mean age of 58.8 (SD 9.8; range 30-87) years. According to the data collected, most participants identified as female (837/840, 99.6%) and White (736/840, 87.6%) and nearly half (418/841, 49.7%) finished treatment ≤18 months ago. Most resided in major cities (574/838, 68.5%) and 30% (251/838) in IRSAD quintile 1 or 2. In terms of effectiveness, 852 replies were received from 511 unique participants (median 1; range 1-26). The most common replies were participants stating how they heard about the program (467/852, 54.8%) or “thank you” (131/852, 15.4%). None of the replies contained urgent safety concerns. Among participants who provided feedback (449/841, 53.4%), most “(strongly) agreed” the SMS text messages were easy to understand (445/448, 99.3%), useful (373/440, 84.8%), helped participants feel supported (388/448, 86.6%), and motivated participants to be physically active (312/445, 70.1%) and eat healthier (313/457, 68.5%). Free-text responses revealed 5 factors influencing engagement: (1) feeling supported and less alone, (2) motivation and reassurance for health self-management, (3) the variety of information, (4) weblinks to information and resources, and (5) the option to save the SMS text messages. Concerning adoption, 50% (18/36) of organizations/health professionals agreed to promote the program. With regard to implementation/maintenance, SMS text messages were delivered as planned (97.43% [41,257/42,344] of SMS text messages were successfully delivered) with minimal opt-outs (62/838, 7.4%) and low cost (Aus $15.40/participant; Aus $1=US $0.67). No adaptations were made during the intervention period. Postintervention adaptations included adding weblinks and participant-selected customizations. Conclusions: EMPOWER-SMS COVID-19 was implemented quickly, had a broad reach, and had high engagement and acceptability among socioeconomically diverse participants. The program had high fidelity, low cost, and required minimal staff oversight, which may facilitate future implementation. However, further research is needed to evaluate barriers and enablers to adoption and implementation for health professionals and strategies for long-term maintenance. %M 37490319 %R 10.2196/45164 %U https://www.jmir.org/2023/1/e45164 %U https://doi.org/10.2196/45164 %U http://www.ncbi.nlm.nih.gov/pubmed/37490319 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47121 %T Behavioral Economic Strategies to Improve Enrollment Rates in Clinical Research: Embedded Recruitment Pilot Trial %A Greene,Brittney %A Bernardo,Leah %A Thompson,Morgan %A Loughead,James %A Ashare,Rebecca %+ State University of New York at Buffalo, 334 Diefendorf Hall, Buffalo, NY, 14214, United States, 1 7168296273, rlashare@buffalo.edu %K behavior change %K behavioral economics %K clinical trials %K contingency management %K evidence based %K information provision %K recruitment %K retention %K SMS text messaging %K study within a trial %K SWAT %D 2023 %7 21.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Nearly 1 in 3 clinical trials end prematurely due to underenrollment. Strategies to enhance recruitment are often implemented without scientific rigor to evaluate efficacy. Evidence-based, cost-effective behavioral economic strategies designed to influence decision-making may be useful to promote clinical trial enrollment. Objective: This study evaluated 2 behavioral economic strategies to improve enrollment and retention rates across 4 clinical trials: information provision (IP) and contingency management (CM; ie, lottery). IP targets descriptive and injunctive norms about participating in research and CM provides participants incentives to reinforce a target behavior. Methods: A sample of 212 participants was enrolled across 4 clinical trials focused on tobacco use: 2 focused on HIV and 2 focused on neuroimaging. The CM condition included a lottery: for each study visit completed, participants received 5 “draws” from a bowl containing 500 “chips” valued at US $0, US $1, US $5, or US $100. In the IP condition, text messages that targeted injunctive norms about research (eg, “Many find it a rewarding way to advance science and be part of a community”) were sent through the Way to Health platform before all study visits. Participants were randomized to 1 of 4 conditions: IP, CM, IP+CM, or standard recruitment (SR). We performed logistic regression, controlling for sex and study, with condition as a between-subject predictor. Outcomes were the percentage of participants who attended a final eligibility visit (primary), met intent-to-treat (ITT) criteria (secondary), and completed the study (secondary). Recruitment was evaluated by the percentage of participants who attended a final eligibility visit, enrollment by ITT status, and retention by the percentage of participants who completed the study. Results: Rates of attending the eligibility visit and meeting ITT status were 58.9% (33/56) and 33.9% (19/56) for IP+CM; 45.5% (25/55) and 18.2% (10/55) for IP only; 41.5% (22/53) and 18.9% (10/53) for CM only; and 37.5% (18/48) and 12.5% (6/48) for SR, respectively. In the logistic regression, females were more likely to meet ITT status than males (odds ratio [OR] 2.7, 95% CI 1.2-5.7; P=.01). The IP+CM group was twice as likely to attend the final eligibility visit than the SR group (OR 2.4, 95% CI 1.1-5.2; P=.04). The IP+CM group was also significantly more likely to reach ITT status than the SR condition (OR 3.9, 95% CI 1.3-11.1; P=.01). Those who received any active intervention (IP, CM, or IP+CM) had a higher study completion rate (33/53, 63.5%) compared to those who received SR (5/12, 41.7%), but this difference was not significant (P=.26). Conclusions: Combining IP and CM strategies may motivate participants to participate in research and improve recruitment and retention rates. Evidence from this study provides preliminary support for the utility of behavioral economics strategies to improve enrollment and reduce attrition in clinical trials. %M 37477975 %R 10.2196/47121 %U https://formative.jmir.org/2023/1/e47121 %U https://doi.org/10.2196/47121 %U http://www.ncbi.nlm.nih.gov/pubmed/37477975 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e45186 %T Testing Mechanisms of Change for Text Message–Delivered Cognitive Behavioral Therapy: Randomized Clinical Trial for Young Adult Depression %A Mason,Michael J %A Coatsworth,J Douglas %A Zaharakis,Nikola %A Russell,Michael %A Brown,Aaron %A McKinstry,Sydney %+ Center for Behavioral Health Research, College of Social Work, University of Tennessee, Center for Behavioral Health Research, 202 Henson Hall, Knoxville, TN, 37996, United States, 1 18659749148, mmason29@utk.edu %K young adults %K depression %K SMS text message–delivered treatment %K cognitive behavioral therapy %K randomized clinical trial %K mobile health treatment %K mHealth treatment %K mobile phone %D 2023 %7 11.7.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Current psychiatric epidemiological evidence estimates that 17% of young adults (aged 18-25 years) experienced a major depressive episode in 2020, relative to 8.4% of all adults aged ≥26 years. Young adults with a major depressive episode in the past year are the least likely to receive treatment for depression compared with other age groups. Objective: We conducted a randomized clinical trial following our initial 4-week SMS text message–delivered cognitive behavioral therapy (CBT-txt) for depression in young adults. We sought to test mechanisms of change for CBT-txt. Methods: Based on participant feedback, outcome data, and the empirical literature, we increased the treatment dosage from 4-8 weeks and tested 3 mechanisms of change with 103 young adults in the United States. Participants were from 34 states, recruited from Facebook and Instagram and presenting with at least moderate depressive symptomatology. Web-based assessments occurred at baseline prior to randomization and at 1, 2, and 3 months after enrollment. The primary outcome, the severity of depressive symptoms, was assessed using the Beck Depression Inventory II. Behavioral activation, perseverative thinking, and cognitive distortions were measured as mechanisms of change. Participants were randomized to CBT-txt or a waitlist control condition. Those assigned to the CBT-txt intervention condition received 474 fully automated SMS text messages, delivered every other day over a 64-day period and averaging 14.8 (SD 2.4) SMS text messages per treatment day. Intervention texts are delivered via TextIt, a web-based automated SMS text messaging platform. Results: Across all 3 months of the study, participants in the CBT-txt group showed significantly larger decreases in depressive symptoms than those in the control group (P<.001 at each follow-up), producing a medium-to-large effect size (Cohen d=0.76). Over half (25/47, 53%) of the treatment group moved into the “high-end functioning” category, representing no or minimal clinically significant depressive symptoms, compared with 15% (8/53) of the control condition. Mediation analysis showed that CBT-txt appeared to lead to greater increases in behavioral activation and greater decreases in cognitive distortions and perseverative thinking across the 3-month follow-up period, which were then associated with larger baseline to 3-month decreases in depression. The size of the indirect effects was substantial: 57%, 41%, and 50% of the CBT-txt effect on changes in depression were mediated by changes in behavioral activation, cognitive distortions, and perseverative thinking, respectively. Models including all 3 mediators simultaneously showed that 63% of the CBT-txt effect was mediated by the combined indirect effects. Conclusions: Results provide evidence for the efficacy of CBT-txt to reduce young adult depressive symptoms through hypothesized mechanisms. To the best of our knowledge, CBT-txt is unique in its SMS text message–delivered modality, the strong clinical evidence supporting efficacy and mechanisms of change. Trial Registration: ClinicalTrials.gov NCT05551702; https://clinicaltrials.gov/study/NCT05551702 %M 37432723 %R 10.2196/45186 %U https://mhealth.jmir.org/2023/1/e45186 %U https://doi.org/10.2196/45186 %U http://www.ncbi.nlm.nih.gov/pubmed/37432723 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44165 %T An Automatically Adaptive Digital Health Intervention to Decrease Opioid-Related Risk While Conserving Counselor Time: Quantitative Analysis of Treatment Decisions Based on Artificial Intelligence and Patient-Reported Risk Measures %A Piette,John D %A Thomas,Laura %A Newman,Sean %A Marinec,Nicolle %A Krauss,Joel %A Chen,Jenny %A Wu,Zhenke %A Bohnert,Amy S B %+ Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, United States, 1 734 223 0127, jpiette@umich.edu %K artificial intelligence %K opioid safety %K telehealth %K reinforcement learning %K pain management %D 2023 %7 11.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Some patients prescribed opioid analgesic (OA) medications for pain experience serious side effects, including dependence, sedation, and overdose. As most patients are at low risk for OA-related harms, risk reduction interventions requiring multiple counseling sessions are impractical on a large scale. Objective: This study evaluates whether an intervention based on reinforcement learning (RL), a field of artificial intelligence, learned through experience to personalize interactions with patients with pain discharged from the emergency department (ED) and decreased self-reported OA misuse behaviors while conserving counselors’ time. Methods: We used data representing 2439 weekly interactions between a digital health intervention (“Prescription Opioid Wellness and Engagement Research in the ED” [PowerED]) and 228 patients with pain discharged from 2 EDs who reported recent opioid misuse. During each patient’s 12 weeks of intervention, PowerED used RL to select from 3 treatment options: a brief motivational message delivered via an interactive voice response (IVR) call, a longer motivational IVR call, or a live call from a counselor. The algorithm selected session types for each patient each week, with the goal of minimizing OA risk, defined in terms of a dynamic score reflecting patient reports during IVR monitoring calls. When a live counseling call was predicted to have a similar impact on future risk as an IVR message, the algorithm favored IVR to conserve counselor time. We used logit models to estimate changes in the relative frequency of each session type as PowerED gained experience. Poisson regression was used to examine the changes in self-reported OA risk scores over calendar time, controlling for the ordinal session number (1st to 12th). Results: Participants on average were 40 (SD 12.7) years of age; 66.7% (152/228) were women and 51.3% (117/228) were unemployed. Most participants (175/228, 76.8%) reported chronic pain, and 46.2% (104/225) had moderate to severe depressive symptoms. As PowerED gained experience through interactions over a period of 142 weeks, it delivered fewer live counseling sessions than brief IVR sessions (P=.006) and extended IVR sessions (P<.001). Live counseling sessions were selected 33.5% of the time in the first 5 weeks of interactions (95% CI 27.4%-39.7%) but only for 16.4% of sessions (95% CI 12.7%-20%) after 125 weeks. Controlling for each patient’s changes during the course of treatment, this adaptation of treatment-type allocation led to progressively greater improvements in self-reported OA risk scores (P<.001) over calendar time, as measured by the number of weeks since enrollment began. Improvement in risk behaviors over time was especially pronounced among patients with the highest risk at baseline (P=.02). Conclusions: The RL-supported program learned which treatment modalities worked best to improve self-reported OA risk behaviors while conserving counselors’ time. RL-supported interventions represent a scalable solution for patients with pain receiving OA prescriptions. Trial Registration: Clinicaltrials.gov NCT02990377; https://classic.clinicaltrials.gov/ct2/show/NCT02990377 %M 37432726 %R 10.2196/44165 %U https://www.jmir.org/2023/1/e44165 %U https://doi.org/10.2196/44165 %U http://www.ncbi.nlm.nih.gov/pubmed/37432726 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39576 %T Examination of Text Message Plans and Baseline Usage of Families Enrolled in a Text Message Influenza Vaccine Reminder Trial: Survey Study %A Wynn,Chelsea S %A Fiks,Alexander G %A Localio,Russell %A Shults,Justine %A Nekrasova,Ekaterina %A Shone,Laura P %A Torres,Alessandra %A Griffith,Miranda %A Unger,Rebecca %A Ware,Leigh Ann %A Kelly,Mary Kate %A Stockwell,Melissa S %+ Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 617 West 168th Street, New York, NY, 10032, United States, 1 2123425732, mss2112@columbia.edu %K influenza vaccine %K mHealth %K mobile phone %K pediatric %K primary care %K PROS %K reminders %K text message %D 2023 %7 30.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) is quickly expanding as a method of health promotion, but some interventions may not be familiar or comfortable for potential users. SMS text messaging has been investigated as a low-cost, accessible way to provide vaccine reminders. Most (97%) US adults own a cellphone and of those adults most use SMS text messaging. However, understanding patterns of SMS text message plan type and use in diverse primary care populations needs more investigation. Objective: We sought to use a survey to examine baseline SMS text messaging and data plan patterns among families willing to accept SMS text message vaccine reminders. Methods: As part of a National Institutes of Health (NIH)–funded national study (Flu2Text) conducted during the 2017-2018 and 2018-2019 influenza seasons, families of children needing a second seasonal influenza vaccine dose were recruited in pediatric primary care offices at the time of their first dose. Practices were from the American Academy of Pediatrics’ (AAP) Pediatric Research in Office Settings (PROS) research network, the Children’s Hospital of Philadelphia, and Columbia University. A survey was administered via telephone (Season 1) or electronically (Season 2) at enrollment. Standardized (adjusted) proportions for SMS text message plan type and texting frequency were calculated using logistic regression that was adjusted for child and caregiver demographics. Results: Responses were collected from 1439 participants (69% of enrolled). The mean caregiver age was 32 (SD 6) years, and most children (n=1355, 94.2%) were aged 6-23 months. Most (n=1357, 94.3%) families were English-speaking. Most (n=1331, 92.8%) but not all participants had an unlimited SMS text messaging plan and sent or received texts at least once daily (n=1313, 91.5%). SMS text messaging plan type and use at baseline was uniform across most but not all subgroups. However, there were some differences in the study population’s SMS text messaging plan type and usage. Caregivers who wanted Spanish SMS text messages were less likely than those who chose English to have an unlimited SMS text messaging plan (n=61, 86.7% vs n=1270, 94%; risk difference –7.2%, 95% CI –27.1 to –1.8). There were no significant differences in having an unlimited plan associated with child’s race, ethnicity, age, health status, insurance type, or caregiver education level. SMS text messaging use at baseline was not uniform across all subgroups. Nearly three-quarters (n=1030, 71.9%) of participants had received some form of SMS text message from their doctor’s office; most common were appointment reminders (n=1014, 98.4%), prescription (n=300, 29.1%), and laboratory notifications (n=117, 11.4%). Even the majority (n=64, 61.5%) of those who did not have unlimited plans and who texted less than daily (n=72, 59%) reported receipt of these SMS text messages. Conclusions: In this study, most participants had access to unlimited SMS text messaging plans and texted at least once daily. However, infrequent texting and lack of access to an unlimited SMS text messaging plan did not preclude enrolling to receive SMS text message reminders in pediatric primary care settings. %M 37389945 %R 10.2196/39576 %U https://formative.jmir.org/2023/1/e39576 %U https://doi.org/10.2196/39576 %U http://www.ncbi.nlm.nih.gov/pubmed/37389945 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48923 %T Ending Tobacco Use Through Interactive Tailored Messaging for Cambodian People With HIV (Project EndIT): Protocol for a Randomized Controlled Trial %A Bui,Thanh Cong %A Hoogland,Charles E %A Chhea,Chhorvann %A Sopheab,Heng %A Ouk,Vichea %A Samreth,Sovannarith %A Hor,Bunleng %A Vidrine,Jennifer I %A Businelle,Michael S %A Shih,Ya Chen Tina %A Sutton,Steven K %A Jones,Sarah R %A Shorey Fennell,Bethany %A Cottrell-Daniels,Cherell %A Frank-Pearce,Summer G %A Ngor,Chamnab %A Kulkarni,Shweta %A Vidrine,Damon J %+ TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway Suite 400, Oklahoma City, OK, 73104, United States, 1 405 271 8001 ext 50559, thanh-c-bui@ouhsc.edu %K smoking cessation %K HIV/AIDS %K cost-effectiveness %K low- and middle-income countries %K Cambodia %K Phase-Based Model %K RCT %K randomized controlled trial %K mHealth %D 2023 %7 29.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The prevalence of smoking remains high in many low- and middle-income countries (LMICs), including the Southeast Asian nation of Cambodia. Smoking is especially hazardous for people with HIV. In Cambodia, approximately 43%-65% of men with HIV and 3%-5% of women with HIV smoke cigarettes. Thus, there is a critical need for cost-effective smoking cessation interventions for Cambodian people with HIV. This paper describes the design, methods, and data analysis plans for a randomized controlled trial assessing the efficacy of a theory-based mobile health smoking cessation intervention in Cambodian people with HIV. Objective: This 2-group randomized controlled trial compares the efficacy of a mobile health–based automated messaging (AM) intervention versus standard care (SC) in facilitating smoking cessation among Cambodian people with HIV. Methods: Cambodian people with HIV who currently smoke and are receiving antiretroviral treatment (target, N=800) will be randomized to (1) SC or (2) the AM intervention. SC participants will receive brief advice to quit smoking, written self-help materials, nicotine patches, and will complete weekly app-delivered dietary assessments for 26 weeks. AM participants will receive all SC components (but will complete smoking-related weekly assessments instead of dietary assessments), in addition to a fully automated tailored messaging program driven by the weekly assessments to facilitate smoking cessation. In the Phase-Based Model of smoking cessation, the cessation process is partitioned into 4 phases: motivation, preparation (precessation), cessation (quit date to 2 weeks post quit), and maintenance (up to 6 months post quit). Our AM program targets processes within these phases, including increasing motivation to quit, enhancing self-efficacy, obtaining social support, skills to cope with nicotine withdrawal symptoms and stress, and skills to maintain abstinence. All participants will complete baseline and 3-, 6-, and 12-month in-person follow-up assessments. The primary outcome is biochemically confirmed abstinence at 12 months, with 3- and 6-month abstinence as secondary outcomes. Potential mediators and moderators underlying treatment effects will be explored, and cost-effectiveness will be assessed. Results: This study was approved by all relevant domestic and international institutional and ethical review boards. Participant recruitment commenced in January 2023. Data collection is expected to conclude by the end of 2025. Conclusions: By demonstrating the greater efficacy and cost-effectiveness of AM relative to SC, this study has the potential to transform HIV care in Cambodia and prevent tobacco-related diseases. Furthermore, it may be adapted for use in other Cambodian populations and in other low- and middle-income countries. Ultimately, the AM approach to smoking cessation could greatly improve public health in the developing world and beyond. Trial Registration: ClinicalTrials.gov NCT05746442; https://clinicaltrials.gov/ct2/show/NCT05746442 International Registered Report Identifier (IRRID): PRR1-10.2196/48923 %M 37384390 %R 10.2196/48923 %U https://www.researchprotocols.org/2023/1/e48923 %U https://doi.org/10.2196/48923 %U http://www.ncbi.nlm.nih.gov/pubmed/37384390 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46431 %T User Satisfaction With a Daily Supportive Text Message Program (Text4PTSI) for Public Safety Personnel: Longitudinal Cross-Sectional Study %A Obuobi-Donkor,Gloria %A Eboreime,Ejemai %A Shalaby,Reham %A Agyapong,Belinda %A Phung,Natalie %A Eyben,Scarlett %A Wells,Kristopher %A Dias,Raquel da Luz %A Hilario,Carla %A Jones,Chelsea %A Brémault-Phillips,Suzette %A Zhang,Yanbo %A Greenshaw,Andrew J %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor, Abbie J Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 7802157771, agyapong@ualberta.ca %K public safety personnel %K Text4PTSI %K text messaging %K satisfaction %K occupational health %K work safety %K public safety %K digital health intervention %K mental health service %K user satisfaction %D 2023 %7 23.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Public safety personnel (PSP) are exposed to traumatic events due to their work environments, which increases the risk of mental health challenges. Providing effective and evidence-based interventions, such as SMS text messaging programs, can improve PSP's overall mental well-being with high user satisfaction rates. Objective: This study aims to evaluate users’ satisfaction, receptiveness, and perceptions of a cognitive behavioral therapy (CBT)–based supportive SMS text messaging intervention (Text4PTSI). Methods: Participants self-subscribed to Text4PTSI and received unidirectional cognitive behavioral–based supportive text messages for 6 months. Participants completed a web-based survey delivered via SMS text message at enrollment, and 6 weeks, 3 months, and 6 months post enrollment. Respondents’ perception and receptivity of the program were assessed using a questionnaire measured on a 5-point Likert scale. Data were collected as categorical variables, and overall satisfaction with the Text4PTSI program was measured on a scale from 0 to 100. Results: There were 131 subscribers to the Text4PTSI program; however, only 81 subscribers responded to the survey, producing 100 survey responses across the 3 follow-up time points. The overall mean score of satisfaction was 85.12 (SD 13.35). More than half of the survey responses agreed or strongly agreed that Text4PTSI helped participants cope with anxiety (79/100 responses, 79%), depressive symptoms (72/100 responses, 72%), and loneliness (54/100 responses, 54%). Similarly, most of the survey responses agreed or strongly agreed that the Text4PTSI program made respondents feel connected to a support system, improved their overall mental well-being (84/100 responses, 84%), felt more hopeful about managing concerns about their mental health or substance use (82 out of responses, 82%), and helped enhance their overall quality of life (77/100 responses, 77%). The available survey responses suggest that the majority always read the supportive text messages (84/100 responses, 84%), took time to reflect on each message (75/100 responses, 75%), and returned to read the text messages more than once (76/100 responses, 76%). Conclusions: PSP who responded to the follow-up surveys reported high user satisfaction and appreciation for receiving the Text4PTSI intervention during the 6-month program. The reported satisfaction with the service provided could pave the way to ensuring a better uptake of the service with potential effectiveness to end users. %M 37351940 %R 10.2196/46431 %U https://formative.jmir.org/2023/1/e46431 %U https://doi.org/10.2196/46431 %U http://www.ncbi.nlm.nih.gov/pubmed/37351940 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e38275 %T Effect of Mobile Phone Text Messaging Self-Management Support for Patients With Diabetes or Coronary Heart Disease in a Chronic Disease Management Program (SupportMe) on Blood Pressure: Pragmatic Randomized Controlled Trial %A Cheung,Ngai Wah %A Redfern,Julie %A Thiagalingam,Aravinda %A Hng,Tien-Ming %A Marschner,Simone %A Haider,Rabbia %A Faruquie,Sonia %A Von Huben,Amy %A She,Shelley %A McIntyre,Daniel %A Cho,Jin-Gun %A Chow,Clara K %A , %+ Department of Diabetes & Endocrinology, Westmead Hospital, Hawkesbury Rd, Westmead, 2145, Australia, 61 288916796, wah.cheung@sydney.edu.au %K diabetes mellitus %K type 2 %K coronary disease %K chronic disease %K SMS text messaging %K delivery of health care %K integrated %K self-management %D 2023 %7 16.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Maintaining engagement and support for patients with chronic diseases is challenging. SMS text messaging programs have complemented patient care in a variety of situations. However, such programs have not been widely translated into routine care. Objective: We aimed to examine the implementation and utility of a customized SMS text message–based support program for patients with type 2 diabetes (T2D), coronary heart disease, or both within a chronic disease integrated care program. Methods: We conducted a 6-month pragmatic parallel-group, single-blind randomized controlled trial that recruited people with T2D or coronary heart disease. Intervention participants received 4 semipersonalized SMS text messages per week providing self-management support to supplement standard care. Preprogrammed algorithms customized content based on participant characteristics, and the messages were sent at random times of the day and in random order by a fully automated SMS text messaging engine. Control participants received standard care and only administrative SMS text messages. The primary outcome was systolic blood pressure. Evaluations were conducted face to face whenever possible by researchers blinded to randomization. Participants with T2D were evaluated for glycated hemoglobin level. Participant-reported experience measures were evaluated using questionnaires and focus groups and summarized using proportions and thematic analysis. Results: A total of 902 participants were randomized (n=448, 49.7% to the intervention group and n=454, 50.3% to the control group). Primary outcome data were available for 89.5% (807/902) of the participants. At 6 months, there was no difference in systolic blood pressure between the intervention and control arms (adjusted mean difference=0.9 mm Hg, 95% CI −1.1 to 2.1; P=.38). Of 642 participants with T2D, there was no difference in glycated hemoglobin (adjusted mean difference=0.1%, 95% CI −0.1% to 0.3%; P=.35). Self-reported medication adherence was better in the intervention group (relative risk=0.82, 95% CI 0.68-1.00; P=.045). Participants reported that the SMS text messages were useful (298/344, 86.6%) and easily understood (336/344, 97.7%) and motivated change (217/344, 63.1%). The lack of bidirectional messaging was identified as a barrier. Conclusions: The intervention did not improve blood pressure in this cohort, possibly because of high clinician commitment to improved routine patient care as part of the chronic disease management program as well as favorable baseline metrics. There was high program engagement, acceptability, and perceived value. Feasibility as part of an integrated care program was demonstrated. SMS text messaging programs may supplement chronic disease management and support self-care. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616001689460; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371769&isReview=true International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-025923 %M 37327024 %R 10.2196/38275 %U https://www.jmir.org/2023/1/e38275 %U https://doi.org/10.2196/38275 %U http://www.ncbi.nlm.nih.gov/pubmed/37327024 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46793 %T Delivery of WeChat-Based HIV Result e-Reports in Social Networks for Recruitment of High-Risk Population: Baseline Data From a Cluster Randomized Controlled Trial %A Li,Ju-Shuang %A Gu,Yu-Zhou %A Hou,Feng-Su %A Lu,Yong-Heng %A Fan,Xiao-Ru %A Qiu,Jia-Ling %A Yang,Qing-Ling %A Gu,Jing %A Li,Jing-Hua %A Xu,Dong Roman %A Hao,Chun %+ Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Rd Yuexiu District, Guangzhou, Guangdong 510080, China, 86 87332517, haochun@mail.sysu.edu.cn %K social network strategy %K HIV result e-report %K recruitment %K MSM %D 2023 %7 15.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Disclosure of infectious disease status to social network peers can facilitate reaching and early detection among high-risk populations. In this era of social media, globally, HIV/AIDS represents a high burden of infectious disease. Thus, delivery of an HIV result e-report via social media presents a new approach that has the potential to improve contact with and enrollment of the high-risk population in research studies and routine practice. Objective: This study explores the effectiveness and associated factors of a recruitment strategy (ie, WeChat-based HIV e-report delivery in social networks) on the enrollment of men who have sex with men (MSM) for an HIV testing intervention study. Methods: This was an enrollment result analysis of an ongoing cluster randomized controlled trial (RCT) aiming to promote HIV testing among MSM. Recruitment of potential participants was based on the unit of an egocentric social network, which includes 1 core member (an offline tested ego as the recruiter) and several network members (online alters as network associates). Alters’ enrollment and alters’ transformation to ego-recruiters (alter-ego) were measured as outcomes. Recruitment outcomes were compared between the exchangeable and regular e-report groups of the RCT. Associated factors of both outcomes were also investigated, including sociodemographic characteristics, health behaviors, social network characteristics, e-report types, and online delivery information. Binary outcomes were modeled using logistic models, with Firth correction for rare events. Qualitative interviews were conducted to understand facilitators and barriers in detail for alter-ego as the subsequent wave’s recruiter. Results: The e-report of 1157 egos who tested offline were delivered to 5165 alters in 3 recruitment waves; eventually, 1162 eligible alters enrolled in this RCT (response rate: 22.5%). In the exchangeable e-report group, 544 egos recruited 467 alters, of which 35 alters transformed to alter-egos (7.5%), whereas in the regular e-report group, 613 egos recruited 695 alters, of which 40 alters transformed to alter-egos (5.8%). Alters’ enrollment at first wave was associated with a higher number of e-reports being forwarded by the egos. Alters’ transformation to alter-egos for the subsequent wave was associated with the exchangeable e-report, higher income, being a Guangzhou resident, unprotected anal intercourse, preferring self-testing, and viewing senders’ e-reports frequently. Qualitative interviews revealed that the lack of awareness of e-reports’ function and inadequate access to e-reports at offline testing facilities were major barriers to alters’ transformation to offline ego-recruiters. Conclusions: The delivery of e-report was feasible in MSM social network, and the success and sustainability of online recruitment depended on high levels of familiarity among MSM with the digital tool. The HIV e-report exchange mechanism might promote MSM to test HIV offline to get their own e-report for exchange in the community. The e-report provides an innovative recruitment method with great potential to trace direct contacts for infectious diseases studies. %M 37318850 %R 10.2196/46793 %U https://www.jmir.org/2023/1/e46793 %U https://doi.org/10.2196/46793 %U http://www.ncbi.nlm.nih.gov/pubmed/37318850 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45102 %T Evaluating the Mental Health of Physician-Trainees Using an SMS Text Message–Based Assessment Tool: Longitudinal Pilot Study %A Goldhaber,Nicole H %A Chea,Annie %A Hekler,Eric B %A Zhou,Wenjia %A Fergerson,Byron %+ Department of Surgery, School of Medicine, University of California, San Diego Health, 9300 Campus Point Drive, #7220, La Jolla, CA, 92037, United States, 1 310 889 8678, nhgoldhaber@health.ucsd.edu %K physician burnout %K mental health %K text-message assessment %K text %K mobile text %K stress assessment %K text message %K pilot study %K physician %K burnout %K United States %K survey %K trainee %K stress %K engagement %K users %K tracking %D 2023 %7 2.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Physician burnout is a multibillion-dollar issue in the United States. Despite its prevalence, burnout is difficult to accurately measure. Institutions generally rely on periodic surveys that are subject to recall bias. SMS text message–based surveys or assessments have been used in health care and have the advantage of easy accessibility and high response rates. Objective: In this pilot project, we evaluated the utility of and participant engagement with a simple, longitudinal, and SMS text message–based mental health assessment system for physician-trainees at the study institution. The goal of the SMS text message–based assessment system was to track stress, burnout, empathy, engagement, and work satisfaction levels faced by users in their normal working conditions. Methods: Three SMS text message-based questions per week for 5 weeks were sent to each participant. All data received were deidentified. Additionally, each participant had a deidentified personal web page to follow their scores as well as the aggregated scores of all participants over time. A 13-question optional survey was sent at the conclusion of the study to evaluate the usability of the platform. Descriptive statistics were performed. Results: In all, 81 participants were recruited and answered at least six (mean 14; median 14; range 6-16) questions for a total of 1113 responses. Overall, 10 (17%) out of 59 participants responded “Yes” to having experienced a traumatic experience during the study period. Only 3 participants ever answered being “Not at all satisfied” with their job. The highest number of responses indicating that participants were stressed or burnt out came on day 25 in the 34-day study period. There were mixed levels of concern for the privacy of responses. No substantial correlations were noted between responses and having experienced a traumatic experience during the study period. Furthermore, 12 participants responded to the optional feedback survey, and all either agreed or strongly agreed that the SMS text message–based assessment system was easy to use and the number of texts received was reasonable. None of the 12 respondents indicated that using the SMS text message–based assessment system caused stress. Conclusions: Responses demonstrated that SMS text message–based mental health assessments are potentially useful for recording physician-trainee mental health levels in real time with minimal burden, but further study of SMS text message–based mental health assessments should address limitations such as improving response rates and clarifying participants’ sense of privacy when using the SMS text message–based assessment system. The findings of this pilot study can inform the development of institution-wide tools for assessing physician burnout and protecting physicians from occupational stress. %M 37266985 %R 10.2196/45102 %U https://formative.jmir.org/2023/1/e45102 %U https://doi.org/10.2196/45102 %U http://www.ncbi.nlm.nih.gov/pubmed/37266985 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e42983 %T Increasing Participation in a TelePrEP Program for Sexual and Gender Minority Adolescents and Young Adults in Louisiana: Protocol for an SMS Text Messaging–Based Chatbot %A Braddock,William Richard Traylor %A Ocasio,Manuel A %A Comulada,W Scott %A Mandani,Jan %A Fernandez,M Isabel %+ Department of Pediatrics, School of Medicine, Tulane University, Suite 965, 1440 Canal St, New Orleans, LA, 70112, United States, 1 504 988 3864, manuel.ocasio@gmail.com %K chatbot %K conversational agent %K develop %K iterative %K messaging %K text message %K HIV %K PrEP %K pre-exposure prophylaxis %K user testing %K rule-based %K prevention %K eHealth %K telehealth %K mobile phone %K sexual minority youth %K gender minority youth %K young adult %K youth %K adolescent %K sexual minority %K gender minority %K gender diverse %K gender diversity %K SMS %K artificial intelligence %K patient education %K health information %K web-based information %K user experience %D 2023 %7 31.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sexual and gender minority (SGM) adolescents and young adults (AYAs) are at increased risk of HIV infection, particularly in the Southern United States. Despite the availability of effective biomedical prevention strategies, such as pre-exposure prophylaxis (PrEP), access and uptake remain low among SGM AYAs. In response, the Louisiana Department of Health initiated the LA TelePrEP Program, which leverages the power of telemedicine to connect Louisiana residents to PrEP. A virtual TelePrEP Navigator guides users through the enrollment process, answers questions, schedules appointments, and facilitates lab testing and medication delivery. To increase the participation of SGM AYAs in the program, the TelePrEP program partnered with researchers to develop a chatbot that would facilitate access to the program and support navigator functions. Chatbots are capable of carrying out many functions that reduce employee workload, and despite their successful use in health care and public health, they are relatively new to HIV prevention. Objective: In this paper, we describe the iterative and community-engaged process that we used to develop an SMS text messaging–based chatbot tailored to SGM AYAs that would support navigator functions and disseminate PrEP-related information. Methods: Our process was comprised of 2 phases: conceptualization and development. In the conceptualization phase, aspects of navigator responsibilities, program logistics, and user interactions to prioritize in chatbot programming (eg, scheduling appointments and answering questions) were identified. We also selected a commercially available chatbot platform that could execute these functions and could be programmed with minimal coding experience. In the development phase, we engaged Department of Health staff and SGM AYAs within our professional and personal networks. Five different rounds of testing were conducted with various groups to evaluate each iteration of the chatbot. After each iteration of the testing process, the research team met to discuss feedback, guide the programmer on incorporating modifications, and re-evaluate the chatbot’s functionality. Results: Through our highly collaborative and community-engaged process, a rule-based chatbot with artificial intelligence components was successfully created. We gained important knowledge that could advance future chatbot development efforts for HIV prevention. Key to the PrEPBot’s success was resolving issues that hampered the user experience, like asking unnecessary questions, responding too quickly, and misunderstanding user input. Conclusions: HIV prevention researchers can feasibly and efficiently program a rule-based chatbot with the assistance of commercially available tools. Our iterative process of engaging researchers, program personnel, and different subgroups of SGM AYAs to obtain input was key to successful chatbot development. If the results of this pilot trial show that the chatbot is feasible and acceptable to SGM AYAs, future HIV researchers and practitioners could consider incorporating chatbots as part of their programs. International Registered Report Identifier (IRRID): PRR1-10.2196/42983 %M 37256669 %R 10.2196/42983 %U https://www.researchprotocols.org/2023/1/e42983 %U https://doi.org/10.2196/42983 %U http://www.ncbi.nlm.nih.gov/pubmed/37256669 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e43673 %T Evaluation of an mHealth Intervention (Growin’ Up Healthy Jarjums) Designed With and for Aboriginal and Torres Strait Islander Mothers: Engagement and Acceptability Study %A Perkes,Sarah Jane %A Huntriss,Belinda %A Skinner,Noelene %A Leece,Bernise %A Dobson,Rosie %A Mattes,Joerg %A Hall,Kerry %A Bonevski,Billie %+ Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Health Sciences Building, Level 2, Sturt Road, Bedford Park, South Australia, 5042, Australia, 61 8 72218410, billie.bonevski@flinders.edu.au %K mobile health %K mHealth %K co-design %K Aboriginal and Torres Strait Islander %K mother %K baby %K young children %K mobile phone %D 2023 %7 26.5.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Aboriginal and Torres Strait Islander women have access to and interest in mobile health (mHealth), although few culturally relevant, evidence-based mHealth programs are available. We codeveloped an mHealth program in New South Wales with Aboriginal and Torres Strait Islander women, focusing on women’s and children's health and well-being. Objective: This study aims to assess the engagement with and acceptability of the Growin’ Up Healthy Jarjums program among mothers caring for Aboriginal and Torres Strait Islander children aged <5 years and assess the acceptability of the program among professionals. Methods: Women were given access to Growin’ Up Healthy Jarjums—a web-based application, a Facebook (Meta Platforms, Inc) page, and SMS text messages—for 4 weeks. Short videos of health professionals presenting health information were tested within the application and on the Facebook page. Engagement with the application was examined through the number of log-ins, page views, and links used on the application. Engagement with the Facebook page was examined through likes, follows, comments, and the reach of posts. Engagement with the SMS text messages was examined through the number of mothers who opted out, and engagement with the videos was examined through the number of plays and videos watched and duration of the video watched. The acceptability of the program was examined through posttest interviews with mothers and focus groups with professionals. Results: A total of 47 participants joined the study (n=41, 87%, mothers and n=6, 13%, health professionals). Interviews were completed by 78% (32/41) of the women and 100% (6/6) health professionals. Of the 41 mothers, 31 (76%) women accessed the application, 13 (42%) scrolled the main page only, and 18 (58%) clicked on other pages. There were 48 plays and 6 completions of the 12 videos. The Facebook page received 49 page likes and 51 followers. The post with the most reach was a supportive and affirming cultural post. No participants opted out of the SMS text messages. Almost all mothers (30/32, 94%) reported that Growin’ Up Healthy Jarjums was useful, and all mothers reported that the program was culturally appropriate and easy to use. Of the 32 mothers, 6 (19%) mothers reported technical problems with accessing the application. Moreover, 44% (14/32) of mothers suggested improvements to the application. All the women reported that they would recommend the program to other families. Conclusions: This study demonstrated that the Growin’ Up Healthy Jarjums program was perceived useful and culturally appropriate. SMS text messages had the highest engagement, followed by the Facebook page and then the application. This study identified areas for technical and engagement-related improvements to the application. A trial is needed to assess the effectiveness of the Growin’ Up Healthy Jarjums program at improving health outcomes. %M 37234043 %R 10.2196/43673 %U https://pediatrics.jmir.org/2023/1/e43673 %U https://doi.org/10.2196/43673 %U http://www.ncbi.nlm.nih.gov/pubmed/37234043 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e38073 %T Codevelopment of a Text Messaging Intervention to Support Adherence to Adjuvant Endocrine Therapy in Women With Breast Cancer: Mixed Methods Approach %A Green,Sophie M C %A French,David P %A Hall,Louise H %A Bartlett,Yvonne Kiera %A Rousseau,Nikki %A Raine,Erin %A Parbutt,Catherine %A Gardner,Benjamin %A , %A Smith,Samuel G %+ Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9LU, United Kingdom, 44 1133430892, s.m.c.green@leeds.ac.uk %K breast cancer %K medication adherence %K habit formation %K behavior change techniques %K SMS text messages %K intervention development %D 2023 %7 24.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Adjuvant endocrine therapy (AET) reduces breast cancer recurrence and mortality in women with early-stage breast cancer. Unintentional nonadherence to AET is common (eg, forgetting to take medication). Forming habits surrounding medication taking could reduce reliance on memory and improve AET adherence. SMS text messaging interventions may offer a low-cost approach for promoting medication-taking habits. To optimize the likely effectiveness of such SMS text messages, the content should be developed using a transparent approach to ensure fidelity to relevant psychological theory and with user input to increase acceptability. Objective: This study aimed to develop a pool of brief SMS text messages promoting habit formation to support AET adherence, which are acceptable to women with breast cancer and show fidelity to theory-based behavior change techniques (BCTs). Methods: According to published literature, we selected 6 BCTs derived from the habit formation model: action planning, habit formation, restructuring the physical environment, adding objects to the environment, prompts/cues, and self-monitoring of behavior. In study 1, behavior change experts (n=10) created messages, each based on 1 of the 6 BCTs, in a web-based workshop and rated the fidelity of the messages to the intended BCT. In study 2, women with experience of taking AET discussed the acceptability of the messages in a focus group (n=5), and the messages were refined following this. In study 3, women with breast cancer rated the acceptability of each message in a web-based survey (n=60). In study 4, additional behavior change experts rated the fidelity of the remaining messages to the intended BCT in a web-based survey (n=12). Finally, a consultant pharmacist reviewed a selection of messages to ensure that they did not contradict general medical advice. Results: In study 1, 189 messages were created targeting the 6 BCTs. In total, 92 messages were removed because they were repetitious, unsuitable, or >160 characters, and 3 were removed because of low fidelity (scoring <5.5/10 on a fidelity rating scale). Following study 2, we removed 13 messages considered unacceptable to our target population. In study 3, all remaining messages scored above the midpoint on an acceptability scale (1-5); therefore, no messages were removed (mean 3.9/5, SD 0.9). Following study 4, we removed 13 messages owing to low fidelity (scoring <5.5/10 on a fidelity rating scale). All the remaining messages showed fidelity to the intended BCTs (mean 7.9/10, SD 1.3). Following the pharmacist review, 2 messages were removed, and 3 were amended. Conclusions: We developed a pool of 66 brief SMS text messages targeting habit formation BCTs to support AET adherence. These showed acceptability to women with breast cancer and fidelity to the intended BCTs. The delivery of the messages will be further evaluated to assess their effect on medication adherence. %M 37223964 %R 10.2196/38073 %U https://www.jmir.org/2023/1/e38073 %U https://doi.org/10.2196/38073 %U http://www.ncbi.nlm.nih.gov/pubmed/37223964 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40709 %T Preferences for Electronic Modes of Communication Among Older Primary Care Patients: Cross-sectional Survey %A Fridman,Ilona %A Smalls,Ahmaya %A Fleming,Patrice %A Elston Lafata,Jennifer %+ Cancer Care Quality Program, Lineberger Cancer Center, University of North Carolina, 450 West Dr, Chapel Hill, NC, 27599, United States, 1 6469028137, ilona_fridman@med.unc.edu %K electronic communication %K patient preferences %K digital health %K patient portals %K physician-patient communication %K communication %K text %K phone %K test %K treatment %K clinical %K vaccination %K survey %K intervention %K screening %K social media %K information %D 2023 %7 24.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Health information delivered via daily modes of communication such as email, text, or telephone reportedly supports improved health behavior and outcomes. While different modes of communication beyond clinical visits have proven successful for patient outcomes, preferences for communication modes have not been comprehensively studied among older primary care patients. We addressed this gap by assessing patient preferences for receiving cancer screening and other information from their doctors’ offices. Objective: We explored stated preferences by communication modes through the lens of social determinants of health (SDOH) to gauge acceptability and equity implications for future interventions. Methods: A cross-sectional survey was mailed to primary care patients aged 45-75 years, in 2020-2021, which assessed respondents' use of telephones, computers, or tablets in daily life and their preferred modes of communication for different types of health information, including educational materials about cancer screening, tips for taking prescription medication, and protection from respiratory diseases from their doctors’ offices. Respondents indicated their willingness to receive messages from their doctors’ offices via each of the provided modes of communication, including telephone, text, email, patient portals, websites, and social media, on a 5-point Likert scale ranging from “unwilling” to “willing.” We present the percentage of respondents who indicated that they were “willing” to receive information via specific electronic mode. Chi-square tests were used to compare participants’ willingness by social characteristics. Results: In total, 133 people completed the survey (response rate 27%). The average respondent age was 64 years, 82 (63%) respondents were female, 106 (83%) were White, 20 (16%) were Black, and 1 (1%) was Asian. In total, 75 (58%) respondents had a bachelor’s degree or higher; 26 (20%) resided in rural areas, 37 (29%) in suburban areas, 50 (39%) in a town, and 15 (12%) in a city. The majority, 73 (57%), reported being comfortable with their income. Preferences of respondents for electronic communication about cancer screening were distributed as follows: 100 (75%) respondents were willing to receive information from their doctor’s office via their patient portal, 98 (74%) via email, 75 (56%) via text, 60 (45%) via the hospital website, 50 (38%) via telephone, and 14 (11%) via social media. About 6 (5%) respondents were unwilling to receive any communication via electronic modes. Preferences were distributed similarly for other types of information. Respondents reporting lesser income and education consistently preferred receiving telephone calls relative to other communication modes. Conclusions: To optimize health communication and reach a socioeconomically diverse population, telephone calls should be added to electronic communication, especially for people with less income and education. Further research needs to identify the underlying reasons for the observed differences and how best to ensure that socioeconomically diverse groups of older adults can access reliable health information and health care services. %M 37223979 %R 10.2196/40709 %U https://formative.jmir.org/2023/1/e40709 %U https://doi.org/10.2196/40709 %U http://www.ncbi.nlm.nih.gov/pubmed/37223979 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e40561 %T Improving Knowledge About Pregnancy for Deaf South African Women of Reproductive Age Through a Text Messaging–Based Information Campaign: Mixed Methods Study %A Haricharan,Hanne Jensen %A Hacking,Damian %A Lau,Yan Kwan %A Heap,Marion %+ School of Public Health, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa, 27 829656103, hanne.haricharan@uct.ac.za %K SMS text messages %K cell phones %K mobile health %K mHealth %K health information %K health literacy %K healthy behavior %K maternal health %K antenatal care %K Deaf %K South Africa %D 2023 %7 22.5.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Signing Deaf South Africans have limited access to health information and, consequently, limited knowledge about health. Maternal and neonatal mortality rates are high. Cell phone use is high, making it a potentially effective way of communicating about maternal and child health. Objective: The primary aim of this study was to assess whether an SMS text messaging–based health information campaign could improve knowledge about pregnancy, antenatal care, and healthy living during pregnancy for signing Deaf South African women of reproductive age. The secondary aim was to evaluate the acceptability of such an intervention. Methods: This study was designed as a pretest-posttest study. A baseline questionnaire assessed participants’ knowledge about pregnancy, antenatal care, and healthy living during pregnancy before an SMS text messaging–based information campaign was conducted. After the campaign, an exit questionnaire was administered containing the same questions as the baseline questionnaire with additional questions on general acceptability and communication preferences. The results were compared between baseline and exit using the McNemar and Wilcoxon signed rank tests. A focus group aimed to obtain further information on the impact and acceptability of SMS text messages. The focus group was analyzed inductively. Results: The study showed a statistically significant improvement in overall health knowledge among participants. Despite this, some participants found the medical terminology challenging to understand. Several ways of improving SMS text messaging campaigns for the Deaf were identified, including using Multimedia Messaging Services with a person signing messages and linking information campaigns to a communication service that would enable Deaf people to pose questions. The focus group also suggested that SMS text messages might play a role in motivating healthy behaviors during pregnancy. Conclusions: The SMS text messaging campaign effectively improved Deaf women’s knowledge about pregnancy, antenatal care, and healthy living during pregnancy and has the potential to affect health behavior. This contrasts with a similar study on hearing pregnant women. This suggests that SMS text messages may be particularly effective in improving Deaf people’s health knowledge. However, attention should be paid to Deaf participants’ specific needs and communication preferences to optimize impact. The potential of using SMS text messaging campaigns to affect behavior should be studied. Trial Registration: Pan-African Clinical Trials Registry (PACTR) PACTR201512001352180; https://tinyurl.com/3rxvsrbe %M 37213174 %R 10.2196/40561 %U https://pediatrics.jmir.org/2023/1/e40561 %U https://doi.org/10.2196/40561 %U http://www.ncbi.nlm.nih.gov/pubmed/37213174 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42590 %T Impact of Multimedia Messaging Service Education and Exercise Social Support on Physical Activity Among Patients With Type 2 Diabetes: Quasi-Experimental Study %A Alyahya,Mohammad S %A Al-Sheyab,Nihaya A %A Khader,Yousef S %A Alqudah,Jumana A %+ Health Management and Policy, Faulty of Medicine, Jordan University of Science and Technology (JUST), 22110, Irbid, 3030, Jordan, 962 775582824, msalyahya@just.edu.jo %K diabetes mellitus %K educational interventions %K multimedia messaging service %K physical activity %K social support %D 2023 %7 22.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Social support is one of the interpersonal stimuli that define an individual’s predisposition to engage in health-promoting behaviors and is considered a facilitator in improving health habits. Patients with type 2 diabetes mellitus (T2DM) can benefit from educating supportive families and friends on self-care management including exercise behavior. Multimedia messaging service (MMS) could also be an effective method for delivering targeted educational interventions that focus on physical activity (PA). Objective: This study aimed to assess the effectiveness of MMS educational interventions and perceived social support for exercise on level of PA of patients with T2DM. Methods: A quasi-experimental pretest-posttest design was conducted to recruit 98 patients with T2DM. The intervention group received MMS education aiming to improve exercise social support and PA level for 2 months, and their counterparts in the control group received the usual routine care. We sent 2 to 3 messages daily for 2 weeks from Saturday to Thursday (12 days total). These messages were a combination of videos and texts, and the evidence-based content of these messages was reviewed and approved by the advisory committee. We randomly assigned eligible patients in a 1:1 ratio into the intervention or the control groups. Participants completed a survey in 3 periods. Results: There were no significant differences in friends’ support, family verbal, practical, or emotional support over time in the intervention group (P>.05). Yet, there was a small effect size (Cohen d) in friends’ social support (0.389), family practical support (0.271), and moderate activities (0.386). A medium effect size was found in family verbal (0.463) and emotional (0.468) support. Being married increased the likelihood of friends’ support by 2.3 times after intervention (P=.04), whereas rarely doing exercise decreased the likelihood of friends’ support by 28% (P=.03) and family practical support by 28% (P=.01). Being female and married increased the likelihood of doing moderate activities by 1.6 times (P=.002) and 1.5 times (P=.049) in the intervention group. Being a housewife decreased the likelihood of doing moderate activities by 20% (P=.001). Finally, being a female with a higher educational level decreased the likelihood of doing hard activities by 20% (P=.04) and 15% (P=.002), respectively. Conclusions: A theoretically based MMS health education targeting PA levels and social support of family and friends to perform PA seems promising in promoting family and friends’ social support and improving PA levels among patients with T2DM. Actively involving family and friends in educational interventions that target PA can have an impact on health-promoting behaviors in patients with diabetes. %M 37213171 %R 10.2196/42590 %U https://formative.jmir.org/2023/1/e42590 %U https://doi.org/10.2196/42590 %U http://www.ncbi.nlm.nih.gov/pubmed/37213171 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45440 %T Promoting Well-being Among Informal Caregivers of People With HIV/AIDS in Rural Malawi: Community-Based Participatory Research Approach %A Sbaffi,Laura %A Zamani,Efpraxia %A Kalua,Khumbo %+ Information School, University of Sheffield, The Wave, 2 Whitham Road, Sheffield, S10 2AH, United Kingdom, 44 1142222686, l.sbaffi@sheffield.ac.uk %K informal caregivers %K HIV/AIDS %K rural Malawi %K health advisory messages %K mobile phone %D 2023 %7 11.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: People living with HIV/AIDS and their informal caregivers (usually family members) in Malawi do not have adequate access to patient-centered care, particularly in remote rural areas of the country because of the high burden of HIV/AIDS, coupled with a fragmented and patchy health care system. Chronic conditions require self-care strategies, which are now promoted in both developed and developing contexts but are still only emerging in sub-Saharan African countries. Objective: This study aims to explore the effects of the implementation of a short-term intervention aimed at supporting informal caregivers of people living with HIV/AIDS in Malawi in their caring role and improving their well-being. The intervention includes the dissemination of 6 health advisory messages on topics related to the management of HIV/AIDS over a period of 6 months, via the WhatsApp audio function to 94 caregivers attending peer support groups in the rural area of Namwera. Methods: We adopted a community-based participatory research approach, whereby the health advisory messages were designed and formulated in collaboration with informal caregivers, local medical physicians, social care workers, and community chiefs and informed by prior discussions with informal caregivers. Feedback on the quality, relevance, and applicability of the messages was gathered via individual interviews with the caregivers. Results: The results showed that the messages were widely disseminated beyond the support groups via word of mouth and highlighted a very high level of adoption of the advice contained in the messages by caregivers, who reported immediate (short-term) and long-term self-assessed benefits for themselves, their families, and their local communities. Conclusions: This study offers a novel perspective on how to combine community-based participatory research with a cost-effective, health-oriented informational intervention that can be implemented to support effective HIV/AIDS self-care and facilitate informal caregivers’ role. %M 37166971 %R 10.2196/45440 %U https://www.jmir.org/2023/1/e45440 %U https://doi.org/10.2196/45440 %U http://www.ncbi.nlm.nih.gov/pubmed/37166971 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e44513 %T WeChat-Based HIV e-Report, a New Approach for HIV Serostatus Requests and Disclosures Among Men Who Have Sex With Men: Prospective Subgroup Analysis of a Randomized Controlled Trial %A Sun,Hai-Tong %A Fan,Xiao-Ru %A Gu,Yu-Zhou %A Lu,Yong-Heng %A Qiu,Jia-Ling %A Yang,Qing-Ling %A Li,Jing-Hua %A Gu,Jing %A Hao,Chun %+ Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Rd Yuexiu District, Guangzhou, 510080, China, 86 87332517, haochun@mail.sysu.edu.cn %K behavioral intervention %K HIV serostatus disclosure %K HIV testing %K men who have sex with men %K mHealth %D 2023 %7 8.5.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Requesting and disclosing HIV serostatus is associated with a reduction in HIV transmission among men who have sex with men (MSM). However, the reliability of common methods for HIV serostatus request and disclosure is inadequate. Validated approaches for requesting and disclosing HIV serostatus are necessary. Objective: The objective of this study was to investigate the use of the HIV e-report as authentic evidence of HIV serostatus among the MSM community in Guangzhou, China. Additionally, the study aimed to explore its correlation with HIV serostatus requesting and disclosure receiving behavior. Methods: This study is a subgroup analysis of a cluster randomized controlled trial (RCT) that enrolled 357 participants during the first year. Participants in this RCT were recruited from the WeChat-based HIV testing service miniprogram developed by Guangzhou Center for Disease Control and Prevention, China. Participants completed web-based questionnaires at baseline and at the month 3 follow-up, which covered sociodemographic characteristics, HIV-related, HIV serostatus requests, receiving HIV serostatus disclosures, and HIV e-report usage. Results: The WeChat-based HIV e-report was available in Guangzhou when the RCT project started. At the month 3 follow-up, 32.2% (115/357) of participants had their own HIV e-reports, and 37.8% (135/357) of them had received others’ HIV e-reports. In all, 13.1% (27/205) and 10.5% (16/153) of participants started to use HIV e-reports to request the HIV serostatus from regular and casual male sex partners, respectively. Moreover, 27.3% (42/154) and 16.5% (18/109) of the regular and casual male sex partners, respectively, chose HIV e-reports to disclose their HIV serostatus. Compared to MSM who did not have HIV e-reports, those who had HIV e-reports and stated, “I had had my own HIV e-report(s) but hadn’t sent to others” (multivariate odds ratio 2.71, 95% CI 1.19-6.86; P=.02) and “I had had my own HIV e-reports and had sent to others” (multivariate odds ratio 2.67, 95% CI 1.07-7.73; P=.048) were more likely to request HIV serostatus from their partners. However, no factor was associated with receiving an HIV serostatus disclosure from partners. Conclusions: The HIV e-report has been accepted by the MSM community in Guangzhou and could be applied as a new optional approach for HIV serostatus requests and disclosures. This innovative intervention could be effective in promoting infectious disease serostatus disclosure among the related high-risk population. Trial Registration: ClinicalTrials.gov NCT03984136; https://clinicaltrials.gov/show/NCT03984136 International Registered Report Identifier (IRRID): RR2-10.1186/s12879-021-06484-y %M 37155223 %R 10.2196/44513 %U https://mhealth.jmir.org/2023/1/e44513 %U https://doi.org/10.2196/44513 %U http://www.ncbi.nlm.nih.gov/pubmed/37155223 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e42952 %T Behavioral Predictors of Intention to Use a Text Messaging Reminder System Among People Living With HIV in Rural Uganda: Survey Study %A Campbell,Jeffrey I %A Aturinda,Isaac %A Mwesigwa,Evans %A Habinka,Annabella %A Kanyesigye,Michael %A Holden,Richard J %A Siedner,Mark J %A Kraemer,John D %+ Boston Medical Center, 6th floor, 670, Albany Street, Boston, MA, 02118, United States, 1 617 414 4290, jeffrey.campbell@bmc.org %K mobile health %K mHealth %K HIV %K intention %K SMS %K cellular phone %K cell phone %K Africa %K reminder %K alert %K notification %K prompt %D 2023 %7 5.5.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The expansion of cellular phones in sub-Saharan Africa spurred the development of SMS text message–based mobile health (mHealth) technology. Numerous SMS text message–based interventions have attempted to increase retention in care for people living with HIV in sub-Saharan Africa. Many of these interventions have failed to scale. Understanding theory-grounded factors leading to mHealth acceptability is needed to create scalable, contextually appropriate, and user-focused interventions to improve longitudinal HIV care for people living with HIV in sub-Saharan Africa. Objective: In this study, we aimed to understand the relationship between constructs from the Unified Theory of Acceptance and Use of Technology (UTAUT), constructs identified in previous qualitative research, and behavioral intention to use a novel SMS text message–based mHealth intervention designed to improve care retention among people living with HIV initiating treatment in rural Uganda. Methods: We conducted a survey of people living with HIV who were newly initiating HIV care in Mbarara, Uganda, and had agreed to use a novel SMS text message–based system that notified them of abnormal laboratory results and reminded them to return to the clinic. Survey items assessed behavioral intention to use the SMS text messaging system; constructs from UTAUT; and demographics, literacy, SMS text messaging experience, HIV status disclosure, and social support. We used factor analysis and logistic regression to estimate the relationships between UTAUT constructs and the behavioral intention to use the SMS text messaging system. Results: A total of 249 participants completed the surveys, of whom 115 (46.2%) expressed high behavioral intention to use the SMS text messaging intervention. In a multivariable analysis, we found that performance expectancy (adjusted odds ratio [aOR] of the scaled factor score 5.69, 95% CI 2.64-12.25; P<.001), effort expectancy (aOR of the scaled factor score 4.87, 95% CI 1.75-13.51; P=.002), and social influence (measured as a 1-unit Likert score increase in the perception that clinical staff have been helpful in the use of the SMS text messaging program; aOR 3.03, 95% CI 1.21-7.54; P=.02) were significantly associated with high behavioral intention to use the SMS text messaging program. SMS text messaging experience (aOR/1-unit increase 1.48, 95% CI 1.11-1.96; P=.008) and age (aOR/1-year increase 1.07, 95% CI 1.03-1.13; P=.003) were also significantly associated with increased odds of high intention to use the system. Conclusions: Performance expectancy, effort expectancy, and social influence, as well as age and SMS experience, were drivers of high behavioral intention to use an SMS text messaging reminder system among people living with HIV initiating treatment in rural Uganda. These findings highlight salient factors associated with SMS intervention acceptability in this population and indicate attributes that are likely to be key to the successful development and scaling of novel mHealth interventions. %M 37145834 %R 10.2196/42952 %U https://humanfactors.jmir.org/2023/1/e42952 %U https://doi.org/10.2196/42952 %U http://www.ncbi.nlm.nih.gov/pubmed/37145834 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e40917 %T Exploring the Acceptability of Text Messages to Inform and Support Shared Decision-making for Colorectal Cancer Screening: Online Panel Survey %A Hwang,Soohyun %A Lazard,Allison J %A Reffner Collins,Meredith K %A Brenner,Alison T %A Heiling,Hillary M %A Deal,Allison M %A Crockett,Seth D %A Reuland,Daniel S %A Elston Lafata,Jennifer %+ Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, United States, 1 7347076635, soohwang@live.unc.edu %K text messages %K shared decision-making %K colorectal cancer %K cancer screening %K mHealth %K cancer %K health care %K marginalized groups %D 2023 %7 5.5.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: While online portals may be helpful to engage patients in shared decision-making at the time of cancer screening, because of known disparities in patient portal use, sole reliance on portals to support cancer screening decision-making could exacerbate well-known disparities in this health care area. Innovative approaches are needed to engage patients in health care decision-making and to support equitable shared decision-making. Objective: We assessed the acceptability of text messages to engage sociodemographically diverse individuals in colorectal cancer (CRC) screening decisions and support shared decision-making in practice. Methods: We developed a brief text message program offering educational information consisting of components of shared decision-making regarding CRC screening (eg, for whom screening is recommended, screening test options, and pros/cons of options). The program and postprogram survey were offered to members of an online panel. The outcome of interest was program acceptability measured by observed program engagement, participant-reported acceptability, and willingness to use similar programs (behavioral intent). We evaluated acceptability among historically marginalized categories of people defined by income, literacy, and race. Results: Of the 289 participants, 115 reported having a low income, 146 were Black/African American, and 102 had less than extreme confidence in their health literacy. With one exception, we found equal or greater acceptability, regardless of measure, within each of the marginalized categories of people compared to their counterparts. The exception was that participants reporting an income below US $50,000 were less likely to engage with sufficient content of the program to learn that there was a choice among different CRC screening tests (difference –10.4%, 95% CI –20.1 to –0.8). Of note, Black/African American participants reported being more likely to sign up to receive text messages from their doctor’s office compared to white participants (difference 18.7%, 95% CI 7.0-30.3). Conclusions: Study findings demonstrate general acceptance of text messages to inform and support CRC screening shared decision-making. %M 37145859 %R 10.2196/40917 %U https://cancer.jmir.org/2023/1/e40917 %U https://doi.org/10.2196/40917 %U http://www.ncbi.nlm.nih.gov/pubmed/37145859 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44840 %T Utilization and Effectiveness of a Message-Based Tobacco Cessation Program (mCessation) in the Chinese General Population: Longitudinal, Real-world Study %A Su,Zheng %A Wei,Xiaowen %A Cheng,Anqi %A Zhou,Xinmei %A Li,Jinxuan %A Qin,Rui %A Liu,Yi %A Xia,Xin %A Song,Qingqing %A Liu,Zhao %A Zhao,Liang %A Xiao,Dan %A Wang,Chen %+ Department of Tobacco Control and Prevention of Respiratory Diseases, China-Japan Friendship Hospital, Center of Respiratory Medicine, District Chaoyang, Beijing, 100021, China, 86 868 420 5425, danxiao@263.net %K smoking cessation %K real-world evidence %K text message %K general population %D 2023 %7 2.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Randomized controlled trials on text message interventions for smoking cessation have shown they are effective and recommended for tobacco control. However, the effectiveness in real-world settings is largely unknown, especially in low- and middle-income countries. Objective: This study aimed to provide real-world evidence about the utilization and effectiveness of a message-based tobacco cessation program (mCessation) in China. Methods: From May 2021 to September 2022, 16,746 people from the general population participated in the mCessation program provided by the World Health Organization. All participants received text messages on smoking cessation via instant messaging for 6 months, and they were also required to report smoking status. We randomly selected 2500 participants and interviewed them by telephone to determine the 7-day point prevalence abstinence rate at 6 months. Descriptive statistics were used to analyze population characteristics and abstinence rate. Logistic regression analysis was performed to explore risk factors for the abstinence rate. Results: Among the 2500 participants, the mean age was 35 years, and most (2407/2500, 96.20%) were male. The prevalence of tobacco dependence and light degree of tobacco dependence were 85.70% (2142/2500) and 89.10% (2228/2500), respectively. For respondents (953/2500, 38.10%), the 7-day point prevalence abstinence rate at 6 months was 21.90% (209/953). Participants older than 40 years or with tobacco dependence had significantly higher abstinence rates than those who were younger than 30 years old (odds ratio [OR] 1.77, 95% CI 1.06-3.29) or without dependence (OR 1.64, 95% CI 1.08-2.51), respectively. However, married people or heavily dependent smokers tended to find it more difficult to successfully quit smoking compared with unmarried people (OR 0.57, 95% CI 0.34-0.93) or lightly dependent smokers (OR 0.16, 95% CI 0.02-0.98), respectively. Conclusions: In a real-world setting, mCessation China was generally acceptable to men and lightly dependent smokers, and it could help 1 in 5 smokers aged 18 years to 67 years quit smoking. However, strategies to increase awareness of young and married adults may improve implementation and abstinence rates. %M 37129934 %R 10.2196/44840 %U https://www.jmir.org/2023/1/e44840 %U https://doi.org/10.2196/44840 %U http://www.ncbi.nlm.nih.gov/pubmed/37129934 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e42339 %T The Impact of Secure Messaging in the Treatment of Patients With Diabetes Within a Primary Care Setting: Protocol for a Scoping Review %A Lawal,Abdul %A Menon,Devidas %A Affleck,Ewan %A Stafinski,Tania %+ School of Public Health, University of Alberta, 3032, Research Transition Facility, 8308 114 Street, Edmonton, AB, T6G 1C9, Canada, 1 780 710 8403, alawal1@ualberta.ca %K secure messaging %K secure message %K text messaging %K security %K privacy %K chronic disease %K chronic condition %K primary care %K health outcome %K diabetic %K diabetes %K virtual care %K scoping review %K review methodology %K health care system %D 2023 %7 2.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Diabetes—a high-burden chronic disease—requires lifetime active management involving the use of different tools and health care resources to improve patient health outcomes. Recent studies have demonstrated promising results regarding the impact of the use of virtual care technology on the treatment of chronic diseases, such as diabetes. However, it is unclear whether the use of technologies, such as secure messaging, improves the quality of care and reduces diabetes-related costs to the health care system. Objective: The purpose of our scoping review is to explore what is known about the use of secure messaging in the treatment of diabetes within the primary care setting and how its impact has been assessed from the patient and health system perspectives. Our review aims to understand to what extent secure messaging improves the quality of diabetes care. Methods: Our scoping review will follow the 6-step Arksey and O’Malley methodological framework, as well as the Joanna Briggs Institute methodology for scoping reviews and their recommended tools. The tools to guide the development and reporting of the review in a structured way will include the Population, Concept, and Context framework and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines and checklist. The search strategy was developed iteratively in collaboration with a professional information specialist. Furthermore, a peer review of electronic search strategies was also conducted by an independent, third-party, professional information specialist. A systematic literature search will be conducted against databases, including Ovid MEDLINE ALL, Embase, APA PsycINFO, Cochrane Library on Wiley, CINAHL on EBSCO, and PubMed. Grey literature sources will also be searched for relevant literature. Literature on the use of secure messaging in the treatment of diabetes (types 1 and 2) within a primary care setting will be included. Two reviewers will review the literature based on the inclusion criteria in the following two steps: (1) title and abstract review and (2) full-text review. Discrepancies will be discussed to reach consensus where possible; otherwise, a third reviewer will resolve the dispute. Results: The results and a final report are expected to be completed and submitted to a peer-reviewed journal in 6 months. Conclusions: The review will examine existing literature to identify the impact of secure messaging in diabetes treatment within primary care settings. Research gaps will also be identified to determine if there is a need for further studies. International Registered Report Identifier (IRRID): DERR1-10.2196/42339 %M 37129935 %R 10.2196/42339 %U https://www.researchprotocols.org/2023/1/e42339 %U https://doi.org/10.2196/42339 %U http://www.ncbi.nlm.nih.gov/pubmed/37129935 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e37359 %T The Effectiveness of Interactive Text Messaging and Structured Psychosocial Support Groups on Developmental Milestones of Children From Adolescent Pregnancies in Kenya: Quasi-Experimental Study %A Mwenda,Valerian %A Makena,Ireen %A Ogweno,Vincent %A Obonyo,James %A Were,Vincent %+ Department of Non-communicable Diseases, Ministry of Health, PO Box 30016, Nairobi, 00100, Kenya, 254 723992573, valmwenda@gmail.com %K text messages %K adolescent pregnancy %K milestones %K mHealth %K psychosocial support %K Kenya %K nurturing care %D 2023 %7 1.5.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: In sub-Saharan Africa, one-quarter of all pregnancies occur in adolescents. Children born to adolescent mothers have poorer physical and socio-cognitive development. One reason may be inadequate knowledge on childcare and psychosocial support during pregnancy and post partum, since adolescent mothers have less antenatal care attendance and overall interaction with the health care system. Mobile health technology has been used to relay health information to special groups; however, psychosocial support commonly requires physical interaction. Objective: We aimed to assess the efficacy of an interactive mobile text messaging platform and support groups in improving adolescent mothers’ knowledge and practices as well as infant growth and development. Methods: This was a quasi-experimental study, conducted among adolescent mothers with infants younger than 3 months, in Homa Bay County, Kenya. Five of the 8 subcounties in Homa Bay County were purposively selected as study clusters. Four subcounties were assigned as intervention clusters and 1 as a control cluster. Adolescent mothers from 2 intervention subcounties received interactive text messaging only (limited package), whereas those from the other 2 subcounties received text messaging and weekly support groups, moderated by a community health extension worker and a counselor (full package); the control cluster only received the end-line evaluation (posttest-only control). The follow-up period was 9 months. Key outcomes were maternal knowledge on childcare and infant development milestones assessed using the Developmental Milestones Checklist (DMC III). Knowledge and DMC III scores were compared between the intervention and control groups, as well as between the 2 intervention groups. Results: We recruited 791 mother-infant pairs into the intervention groups (full package: n=375; limited package: n=416) at baseline and 220 controls at end line. Attrition from the intervention groups was 15.8% (125/791). Compared with the control group, adolescent mothers receiving the full package had a higher knowledge score on infant care and development (9.02 vs 8.01; P<.001) and higher exclusive breastfeeding rates (238/375, 63.5% vs 112/220, 50.9%; P=.004), and their infants had higher average DMC III scores (53.09 vs 48.59; P=.01). The limited package group also had higher knowledge score than the control group (8.73 vs 8.01; P<.001); this group performed better than the full package group on exclusive breastfeeding (297/416, 71.4% vs 112/220, 50.9%; P<.001) and DMC III scores (58.29 vs 48.59; P<.001) when compared with the control group. We found a marginal difference in knowledge scores between full and limited package groups (9.02 vs 8.73; P=.048) but no difference in DMC III scores between the 2 groups (53.09 vs 58.29; P>.99). Conclusions: An interactive text messaging platform improved adolescent mothers’ knowledge on nurturing infant care and the development of their children, even without physical support groups. Such platforms offer a convenient avenue for providing reproductive health information to adolescents. Trial Registration: Pan African Clinical Trials Registry PACTR201806003369302; https://tinyurl.com/kkxvzjse %M 37126373 %R 10.2196/37359 %U https://pediatrics.jmir.org/2023/1/e37359 %U https://doi.org/10.2196/37359 %U http://www.ncbi.nlm.nih.gov/pubmed/37126373 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44108 %T Efficacy of an mHealth Behavior Change Intervention for Promoting Physical Activity in the Workplace: Randomized Controlled Trial %A Alshagrawi,Salah %A Abidi,Syed Taha %+ Saudi Electronic University, 6730 Prince Mohammed Ibn Salman Ibn Abdulaziz Rd, Riyadh, 13316, Saudi Arabia, 966 580462066, s.alshagrawi@seu.edu.sa %K text messaging %K mobile phones %K physical activity %K eHealth %K pedometer %K smartphone %K activity tracker %K accelerometer %K behavioral %K workplace %K risk factor %K noncommunicable disease %K BMI %K wellness %D 2023 %7 27.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Insufficient physical activity (PA) is a well-established risk factor for several noncommunicable diseases such as cardiovascular diseases, cancer, diabetes, depression, and dementia. The World Health Organization (WHO) advises that individuals engage in 150 minutes of moderate PA per week or 75 minutes of intense PA per week. According to the WHO’s latest report, 23% of adults fail to meet the minimum recommended level of PA. The percentage was even higher in a recent global study that showed 27% of adults were insufficiently active and reported a 5% increase in the prevalence trend of insufficient PA between 2001 and 2016. The study also showed the rate of insufficient PA among countries varied significantly. For instance, it was estimated that 40% were insufficiently active in the United States, and the percentage was even higher in Saudi Arabia (more than 50%). Governments are actively developing policies and methods to successfully establish a PA-inducing environment that encourages a healthy lifestyle in order to address the global steady decline in PA. Objective: The purpose of this study was to determine the effectiveness of mobile health (mHealth) interventions, particularly SMS text messaging interventions, to improve PA and decrease BMI in healthy adults in the workplace. Methods: In this parallel, 2-arm randomized controlled trial, healthy adults (N=327) were randomized to receive an mHealth intervention (tailored text messages combined with self-monitoring (intervention; n=166) or no intervention (control; n=161). Adults who were fully employed in an academic institution and had limited PA during working hours were recruited for the study. Outcomes, such as PA and BMI, were assessed at baseline and 3 months later. Results: Results showed significant improvement in PA levels (weekly step counts) in the intervention group (β=1097, 95% CI 922-1272, P<.001). There was also a significant reduction in BMI (β=0.60, 95% CI 0.50-0.69, P<.001). Conclusions: Combining tailored text messages and self-monitoring interventions to improve PA and lower BMI was significantly effective and has the potential to leverage current methods to improve wellness among the public. %M 37103981 %R 10.2196/44108 %U https://www.jmir.org/2023/1/e44108 %U https://doi.org/10.2196/44108 %U http://www.ncbi.nlm.nih.gov/pubmed/37103981 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41911 %T A Personalized Mobile Cessation Intervention to Promote Smokers From the Preparation Stage to the Action Stage: Double-blind Randomized Controlled Trial %A Lin,Haoxiang %A Wang,Ying %A Xing,Yanling %A Han,Yinglian %A Zhang,Chengqian %A Luo,Ting %A Chang,Chun %+ School of Public Health, Peking University, 38 Xueyuanlu, Beijing, 100191, China, 86 13641338346, changchun@bjmu.edu.cn %K smoking cessation %K mobile health %K health education %K smoking %K behavior intervention %K behavior change %K support %K text message %K personalized %K smoking abstinence %K health behavior %K health promotion %D 2023 %7 26.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Most mobile cessation studies have found that such interventions have a higher quitting rate than interventions providing minimal smoking cessation support. However, why such interventions are effective has been almost unstudied by researchers. Objective: This paper describes the principles of the personalized mobile cessation intervention-based WeChat app and used generalized estimated equations to assess why a personalized mobile cessation intervention was more likely to promote smokers from the preparation stage to the action stage than a nonpersonalized intervention. Methods: This is a 2-arm, double-blind, randomized controlled trial in five cities in China. The intervention group received a personalized mobile cessation intervention. The control group received a nonpersonalized SMS text message smoking cessation intervention. All information was sent by the WeChat app. The outcomes were the change in protection motivation theory construct scores and the change in transtheoretical model stages. Results: A total of 722 participants were randomly assigned to the intervention or control group. Compared with those who received the nonpersonalized SMS text message intervention, smokers who received the personalized intervention presented lower intrinsic rewards, extrinsic rewards, and response costs. Intrinsic rewards were determinants of stage change, thus explaining why the intervention group was more likely to promote smokers from the preparation stage to the action stage (odds ratio 2.65, 95% CI 1.41-4.98). Conclusions: This study identified the psychological determinants at different stages to facilitate smokers moving forward to the next stage of quitting behavior and provides a framework to explore why a smoking cessation intervention is effective. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100041942; https://tinyurl.com/2hhx4m7f %M 37099360 %R 10.2196/41911 %U https://www.jmir.org/2023/1/e41911 %U https://doi.org/10.2196/41911 %U http://www.ncbi.nlm.nih.gov/pubmed/37099360 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41414 %T Motivational Message Framing Effects on Physical Activity Dynamics in a Digital Messaging Intervention: Secondary Analysis %A Lee,Alexandra M %A Hojjatinia,Sahar %A Courtney,Jimikaye B %A Brunke-Reese,Deborah %A Hojjatinia,Sarah %A Lagoa,Constantino M %A Conroy,David E %+ The Pennsylvania State University, 266 Rec Hall, University Park, PA, 16802, United States, 1 814 863 3451, conroy@psu.edu %K physical activity %K exercise %K fitness %K Fitbit %K tracking %K patient-specific modeling %K dynamical model %K patient specific %K fitness tracker %K psychological theory %K messaging %K motivation %K behavior change %D 2023 %7 21.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital smartphone messaging can be used to promote physical activity to large populations with limited cost. It is not clear which psychological constructs should be targeted by digital messages to promote physical activity. This gap presents a challenge for developing optimal content for digital messaging interventions. Objective: The aim of this study is to compare affectively framed and social cognitively framed messages on subsequent changes in physical activity using dynamical modeling techniques. Methods: We conducted a secondary analysis of data collected from a digital messaging intervention in insufficiently active young adults (18-29 years) recruited between April 2019 and July 2020 who wore a Fitbit smartwatch for 6 months. Participants received 0 to 6 messages at random per day across the intervention period. Messages were drawn from 3 content libraries: affectively framed, social cognitively framed, or inspirational quotes. Person-specific dynamical models were identified, and model features of impulse response and cumulative step response were extracted for comparison. Two-way repeated-measures ANOVAs evaluated the main effects and interaction of message type and day type on model features. This early-phase work with novel dynamic features may have been underpowered to detect differences between message types so results were interpreted descriptively. Results: Messages (n=20,689) were paired with valid physical activity monitoring data from 45 participants for analysis. Received messages were distributed as 40% affective (8299/20,689 messages), 39% social-cognitive (8187/20,689 messages), and 20% inspirational quotes (4219/20,689 messages). There were no statistically significant main effects for message type when evaluating the steady state of step responses. Participants demonstrated heterogeneity in intervention response: some had their strongest responses to affectively framed messages, some had their strongest responses to social cognitively framed messages, and some had their strongest responses to the inspirational quote messages. Conclusions: No single type of digital message content universally promotes physical activity. Future work should evaluate the effects of multiple message types so that content can be continuously tuned based on person-specific responses to each message type. %M 37083710 %R 10.2196/41414 %U https://formative.jmir.org/2023/1/e41414 %U https://doi.org/10.2196/41414 %U http://www.ncbi.nlm.nih.gov/pubmed/37083710 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41021 %T Feasibility and Response to the San Diego County, California, Supplemental Nutrition Assistance Program (SNAP) Agency Sending Food and Nutrition Text Messages to All Participants: Quasi-Experimental Web-Based Survey Pilot Study %A Gosliner,Wendi %A Felix,Celeste %A Strochlic,Ron %A Wright,Shana %A Yates-Berg,Allison %A Thompson,Hannah R %A Tang,Hao %A Melendrez,Blanca %+ Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 1111 Franklin St, 11th Fl, Oakland, CA, 94607, United States, 1 510 612 1552, wgosliner@ucanr.edu %K SNAP %K CalFresh %K text %K SMS text messaging %K nutrition %K fruits %K vegetables %K mHealth %D 2023 %7 19.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The Supplemental Nutrition Assistance Program (SNAP) provides over 40 million Americans with money for food without typically providing participants with food or nutrition information. Educational SMS text messages can reach large numbers of people, and studies suggest SNAP participants appreciate nutrition education and have access to mobile phones. Objective: Using a pre-post intervention design, we assessed the feasibility of, and program satisfaction and outcomes resulting from, the San Diego County, California SNAP agency sending monthly food and nutrition education SMS text messages to all SNAP participants to increase fruit and vegetable purchasing and consumption. Methods: We developed and sent 5 behavioral science–informed SMS text messages with links to a project website in English and Spanish with information about selecting, storing, and preparing seasonal fruits and vegetables. The San Diego County SNAP agency sent monthly texts to ~170,000 SNAP households from October 2020 to February 2021. SNAP participants completed web-based surveys in response to a text invitation from the SNAP agency in September 2020 (baseline, n=12,036) and April 2021 (follow-up, n=4927). Descriptive frequencies were generated, and adjusted multiple linear mixed models were run on a matched data set of participants that completed both baseline and follow-up surveys (n=875) assessing pre- or postattitudes, behaviors, knowledge, and self-efficacy. We used adjusted logistic regression models to assess differences between the matched (n=875) and nonmatched (n=4052) participants related to experiences with the intervention (questions asked only at follow-up). Results: After the intervention, matched participants reported significant increase in knowing where to get information about selecting, storing, and preparing fruits and vegetables (3.76 vs 4.02 on a 5-point Likert scale with 5=strongly agree, P<.001); feeling good about participating in SNAP (4.35 vs 4.43, P=.03); and thinking the CalFresh program helps them eat healthy (4.38 vs 4.48, P=.006). No significant pre- or postdifferences were found in fruit or vegetable consumption, though most participants at follow-up (n=1556, 64%) reported their consumption had increased. Among the sample that completed the follow-up survey only (n=4052, not including 875 participants who completed follow-up and baseline), 1583 (65%) and 1556 (64%) reported purchasing and eating more California-grown fruits and vegetables, respectively. Nearly all respondents appreciated the intervention (n=2203, 90%) and wanted it to continue (n=2037, 83%). Conclusions: SNAP can feasibly provide food and nutrition messages via text to participants. A monthly text campaign was well received by responding participants and improved some measures of their self-reported knowledge, self-efficacy, produce consumption, and perceptions of SNAP participation. Participants expressed interest in continuing to receive texts. While educational messages will not solve the complex food and nutrition challenges confronting SNAP participants, further work should employ rigorous methods to expand and test this intervention in other SNAP programs before considering to implement it at scale. %M 37074786 %R 10.2196/41021 %U https://www.jmir.org/2023/1/e41021 %U https://doi.org/10.2196/41021 %U http://www.ncbi.nlm.nih.gov/pubmed/37074786 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44661 %T Expectant Parents’ Preferences for Teaching by Texting: Development and Usability Study of SmartMom %A Murray,Jennifer B %A Sharp,Alexander %A Munro,Sarah %A Janssen,Patricia A %+ School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada, 1 604 822 2772, jennifer.murray@ubc.ca %K pregnancy %K pregnant %K prenatal %K patient education %K text message %K SMS text messaging %K prenatal education %K mHealth %K evidence-based health care %K mobile app %K Canada %K mobile health %K preference %K focus group %K information need %K user need %D 2023 %7 18.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Prenatal education encourages healthy behavioral choices and reduces rates of adverse birth outcomes. The use of mobile health (mHealth) technologies during pregnancy is increasing and changing how pregnant people acquire prenatal education. SmartMom is an evidence-based prenatal education SMS text messaging program that overcomes barriers to prenatal class attendance, including rural or remote location, cost, stigma among participants, lack of instructors, and cessation of classes during the COVID-19 pandemic. Objective: We sought to explore perceived information needs and preferences for the content and structure of prenatal education mHealth programs among persons enrolled in or eligible to enroll in SmartMom. Methods: This was a qualitative focus group study conducted as part of a development and usability study of the SmartMom program. Participants were older than 19 years of age, Canadian residents, fluent in English, and either currently pregnant or pregnant within the last year. We asked open-ended questions about information-seeking behaviors during pregnancy, the nature of the information that participants were seeking, how they wanted to receive information, and if SmartMom was meeting these needs. Focus groups took place via videoconference technology (Zoom) between August and December 2020. We used reflexive thematic analysis to identify themes that emerged from the data and the constant comparison method to compare initial coding to emerging themes. Results: We conducted 6 semistructured focus groups with 16 participants. All participants reported living with a partner and owning a cell phone. The majority (n=13, 81%) used at least 1 app for prenatal education. Our analysis revealed that “having reliable information is the most important thing” (theme 1); pregnant people value inclusive, local, and strength-based information (theme 2); and SMS text messages are a simple, easy, and timely modality (“It was nice to have that [information] fed to you”; theme 3). Participants perceived that SmartMom SMS text messages met their needs for prenatal education and were more convenient than using apps. SmartMom’s opt-in supplemental message streams, which allowed users to tailor the program to their needs, were viewed favorably. Participants also identified that prenatal education programs were not meeting the needs of diverse populations, such as Indigenous people and LGBTQIA2S+ (lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, asexual, Two-Spirit plus) communities. Conclusions: The shift toward digital prenatal education, accelerated by the COVID-19 pandemic, has resulted in a plethora of web- or mobile technology–based programs, but few of these have been evaluated. Participants in our focus groups revealed concerns about the reliability and comprehensiveness of digital resources for prenatal education. The SmartMom SMS text messaging program was viewed as being evidence-based, providing comprehensive content without searching, and permitting tailoring to individual needs through opt-in message streams. Prenatal education must also meet the needs of diverse populations. %M 37071451 %R 10.2196/44661 %U https://formative.jmir.org/2023/1/e44661 %U https://doi.org/10.2196/44661 %U http://www.ncbi.nlm.nih.gov/pubmed/37071451 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44503 %T An Avatar-Led Web-Based and SMS Text Message Smoking Cessation Program for Socioeconomically Disadvantaged Veterans: Pilot Randomized Controlled Trial %A Heffner,Jaimee L %A Kelly,Megan M %A Reilly,Erin D %A Reece,Scott G %A Claudio,Tracy %A Serfozo,Edit %A Baker,Kelsey %A Watson,Noreen L %A Karekla,Maria %+ Fred Hutchinson Cancer Center, 1100 Fairview Ave N, M3-B232 PO Box 19024, Seattle, WA, 98109, United States, 1 2066677314, jheffner@fredhutch.org %K embodied agent %K tobacco cessation %K nicotine dependence %K mobile health %K mHealth %D 2023 %7 14.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the declining prevalence of cigarette smoking in the United States, socioeconomically disadvantaged veterans receiving care from the Veterans Health Administration have a high prevalence of smoking. Currently, available treatment options for these veterans focus on tobacco users who are ready to quit and have limited reach. Consequently, there is a great need for accessible, effective smoking cessation interventions for veterans at all levels of readiness to quit smoking. Objective: To address these needs, we developed Vet Flexiquit, a web-based Acceptance and Commitment Therapy program for veterans, and evaluated its acceptability (primary aim), efficacy, and impact on theory-based change processes relative to the National Cancer Institute’s SmokefreeVET program in a pilot randomized controlled trial. Methods: Participants (N=49) were randomized 1:1 to receive either the Vet Flexiquit (n=25) or SmokefreeVET (n=24) web program. Both groups received SMS text messages as part of the intervention for 6 weeks. Both interventions are fully automated and self-guided. Primary outcome data were collected at 3 months after the randomization. Self-reported smoking abstinence was biochemically verified using saliva cotinine. Multivariable logistic regression, negative binomial regression, and linear regression models were used to evaluate the association between the treatment arm and outcomes of interest. Results: Acceptability, as measured by overall treatment satisfaction, was high and similar across treatment arms: 100% (17/17) for Vet Flexiquit and 95% (18/19) for SmokefreeVET. Acceptability, as measured by utilization, was more modest (log-ins: M=3.7 for Vet Flexiquit and M=3.2 for SmokefreeVET). There were no statistically significant differences between treatment arms for any acceptability measures. Similarly, there were no statistically significant differences between treatment arms in the secondary outcomes of smoking cessation or change in Acceptance and Commitment Therapy’s theory-based processes. In open-ended survey responses, some veterans in both treatment arms expressed interest in having support from a professional or peer to enhance their experience, as well as an expanded SMS text messaging program. Conclusions: Both programs had high ratings of acceptability, limited utilization, and a similar impact on cessation and cessation processes. Taken together with the qualitative data suggesting that additional support may enhance participants’ experience of both programs, these preliminary findings suggest that the programs may have similar outcomes among veterans who are looking for a digital cessation treatment option and that integrating provider or peer support and enhancing the SMS text messaging program holds promise as a means of boosting engagement and outcomes for both programs. Trial Registration: ClinicalTrials.gov NCT04502524; https://clinicaltrials.gov/ct2/show/NCT04502524 %M 37058346 %R 10.2196/44503 %U https://formative.jmir.org/2023/1/e44503 %U https://doi.org/10.2196/44503 %U http://www.ncbi.nlm.nih.gov/pubmed/37058346 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 8 %N %P e40272 %T Secure Messaging for Diabetes Management: Content Analysis %A Robinson,Stephanie A %A Zocchi,Mark %A Purington,Carolyn %A Am,Linda %A DeLaughter,Kathryn %A Vimalananda,Varsha G %A Netherton,Dane %A Ash,Arlene S %A Hogan,Timothy P %A Shimada,Stephanie L %+ Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, 200 Springs Rd., Bedford, MA, 01730, United States, 1 781 687 4776, stephanie.robinson5@va.gov %K secure messaging %K patient-provider communication %K veterans %K message content %K diabetes %K patient portal %K T2D %K management %K support %K messaging %K glycemic control %K communication %K engagement %K health information %K diabetic control %K disease outcomes %D 2023 %7 23.3.2023 %9 Original Paper %J JMIR Diabetes %G English %X Background: Secure messaging use is associated with improved diabetes-related outcomes. However, it is less clear how secure messaging supports diabetes management. Objective: We examined secure message topics between patients and clinical team members in a national sample of veterans with type 2 diabetes to understand use of secure messaging for diabetes management and potential associations with glycemic control. Methods: We surveyed and analyzed the content of secure messages between 448 US Veterans Health Administration patients with type 2 diabetes and their clinical teams. We also explored the relationship between secure messaging content and glycemic control. Results: Explicit diabetes-related content was the most frequent topic (72.1% of participants), followed by blood pressure (31.7% of participants). Among diabetes-related conversations, 90.7% of patients discussed medication renewals or refills. More patients with good glycemic control engaged in 1 or more threads about blood pressure compared to those with poor control (37.5% vs 27.2%, P=.02). More patients with good glycemic control engaged in 1 more threads intended to share information with their clinical team about an aspect of their diabetes management compared to those with poor control (23.7% vs 12.4%, P=.009). Conclusions: There were few differences in secure messaging topics between patients in good versus poor glycemic control. Those in good control were more likely to engage in informational messages to their team and send messages related to blood pressure. It may be that the specific topic content of the secure messages may not be that important for glycemic control. Simply making it easier for patients to communicate with their clinical teams may be the driving influence between associations previously reported in the literature between secure messaging and positive clinical outcomes in diabetes. %M 36951903 %R 10.2196/40272 %U https://diabetes.jmir.org/2023/1/e40272 %U https://doi.org/10.2196/40272 %U http://www.ncbi.nlm.nih.gov/pubmed/36951903 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e40420 %T The Effectiveness of an eHealth Family-Based Intervention Program in Patients With Uncontrolled Type 2 Diabetes Mellitus (T2DM) in the Community Via WeChat: Randomized Controlled Trial %A Feng,Yuheng %A Zhao,Yuxi %A Mao,Linqi %A Gu,Minmin %A Yuan,Hong %A Lu,Jun %A Zhang,Qi %A Zhao,Qian %A Li,Xiaohong %+ Department of Health Policy and Management, School of Public Health, Fudan University, 220 Handan Rd, Yangpu District, Shanghai, 200433, China, 86 13918213586, lixh@fudan.edu.cn %K public health %K type 2 diabetes mellitus %K intervention %K randomized controlled trial %K community health center %D 2023 %7 20.3.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Intervention based on family support and risk perception can enhance type 2 diabetes mellitus (T2DM) patients’ self-care activities. In addition, eHealth education is considered to improve family members’ support for patients with T2DM. However, there is little evidence from rigorously designed studies on the effectiveness of an intervention combining these approaches. Objective: This randomized controlled trial (RCT) aimed to assess the effectiveness of an eHealth family-based health education intervention for patients with T2DM to improve their glucose control, risk perception, and self-care behaviors. Methods: This single-center, 2-parallel-group RCT was conducted between 2019 and 2020. Overall, 228 patients were recruited from Jiading District, Shanghai, and randomly divided into intervention and control groups. The intervention group received an eHealth family intervention based on community management via WeChat, whereas the control group received usual care. The primary outcome was the glycated hemoglobin (HbA1c) level of the patients with T2DM, and the secondary outcomes were self-management behavior (general and specific diet, exercise, blood sugar testing, foot care, and smoking), risk perception (risk knowledge, personal control, worry, optimism bias, and personal risk), and family support (supportive and nonsupportive behaviors). A 2-tailed paired-sample t test was used to compare the participants at baseline and follow-up within the control and intervention groups. An analysis of covariance was used to measure the intervention effect. Results: In total, 225 patients with T2DM were followed up for 1 year. After intervention, they had significantly lower HbA1c values (β=–.69, 95% CI –0.99 to –0.39; P<.001). They also had improved general diet (β=.60, 95% CI 0.20 to 1.00; P=.003), special diet (β=.71, 95% CI 0.34 to 1.09; P<.001), blood sugar testing (β=.50, 95% CI 0.02 to 0.98; P=.04), foot care (β=1.82, 95% CI 1.23 to 2.42; P<.001), risk knowledge (β=.89, 95% CI 0.55 to 1.24; P<.001), personal control (β=.22, 95% CI 0.12 to 0.32; P<.001), worry (β=.24, 95% CI 0.10 to 0.39; P=.001), optimism bias (β=.26, 95% CI 0.09 to 0.43; P=.003), and supportive behaviors (β=5.52, 95% CI 4.03 to 7.01; P<.001). Conclusions: The eHealth family-based intervention improved glucose control and self-care activities among patients with T2DM by aiding the implementation of interventions to improve T2DM risk perceptions among family members. The intervention is generalizable for patients with T2DM using health management systems in community health centers. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900020736; https://www.chictr.org.cn/showprojen.aspx?proj=31214 %M 36939825 %R 10.2196/40420 %U https://mhealth.jmir.org/2023/1/e40420 %U https://doi.org/10.2196/40420 %U http://www.ncbi.nlm.nih.gov/pubmed/36939825 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e37351 %T Text Messages Exchanged Between Individuals With Opioid Use Disorder and Their mHealth e-Coaches: Content Analysis Study %A Ranjit,Yerina S %A Davis,Warren M %A Fentem,Andrea %A Riordan,Raven %A Roscoe,Rikki %A Cavazos-Rehg,Patricia %+ Department of Communication, University of Missouri, 207 Switzler Hall, Columbia, MO, 65211, United States, 1 573 882 4431, ranjity@missouri.edu %K opioid use disorder %K opioid %K opium %K overdose %K drug %K substance use %K content analysis %K text message intervention %K text message %K text messaging %K mobile health %K mHealth %K social support %K e-coach %K counseling %K mental health %K depression %K recovery support %K eHealth %K digital health %D 2023 %7 10.3.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Opioid use disorder (OUD) has affected 2.2 million people in the United States. About 7.2 million people reported using illicit drugs in 2019, which contributed to over 70,000 overdose deaths. SMS text messaging interventions have been shown to be effective in OUD recovery. However, the interpersonal communication between individuals in OUD treatment and a support team on digital platforms has not been well examined. Objective: This study aims to understand the communication between participants undergoing OUD recovery and their e-coaches by examining the SMS text messages exchanged from the lens of social support and the issues related to OUD treatment. Methods: A content analysis of messages exchanged between individuals recovering from OUD and members of a support team was conducted. Participants were enrolled in a mobile health intervention titled “uMAT-R,” a primary feature of which is the ability for patients to instantly connect with a recovery support staff or an “e-coach” via in-app messaging. Our team analyzed dyadic text-based messages of over 12 months. In total, 70 participants’ messages and 1196 unique messages were analyzed using a social support framework and OUD recovery topics. Results: Out of 70 participants, 44 (63%) were between the ages of 31 and 50 years, 47 (67%) were female, 41 (59%) were Caucasian, and 42 (60%) reported living in unstable housing conditions. An average of 17 (SD 16.05) messages were exchanged between each participant and their e-coach. Out of 1196 messages, 64% (n=766) messages were sent by e-coaches and 36% (n=430) by participants. Messages of emotional support occurred the most, with 196 occurrences (n=9, 0.8%) and e-coaches (n=187, 15.6%). Messages of material support had 110 occurrences (participants: n=8, 0.7%; e-coaches: n=102, 8.5%). With OUD recovery topics, opioid use risk factors appeared in most (n=72) occurrences (patient: n=66, 5.5%; e-coach: n=6, 0.5%), followed by a message of avoidance of drug use 3.9% (n=47), which occurred mainly from participants. Depression was correlated with messages of social support (r=0.27; P=.02). Conclusions: Individuals with OUD who had mobile health needs tended to engage in instant messaging with the recovery support staff. Participants who are engaged in messaging often engage in conversations around risk factors and avoidance of drug use. Instant messaging services can be instrumental in providing the social and educational support needs of individuals recovering from OUD. %M 36897632 %R 10.2196/37351 %U https://humanfactors.jmir.org/2023/1/e37351 %U https://doi.org/10.2196/37351 %U http://www.ncbi.nlm.nih.gov/pubmed/36897632 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e39645 %T Using Text Messages and Fotonovelas to Increase Return of Home-Mailed Colorectal Cancer Screening Tests: Mixed Methods Evaluation %A Levitz,Carly E %A Kuo,Elena %A Guo,Monica %A Ruiz,Esmeralda %A Torres-Ozadali,Evelyn %A Brar Prayaga,Rena %A Escaron,Anne %+ Center for Community Health and Evaluation, Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, United States, 1 2062872488, carly.e.levitz@kp.org %K colorectal cancer screening %K texting campaign %K patient navigation %K fotonovela %K fecal immunochemical test kit %K FIT kit %K screening %K cancer %K colorectal cancer %K CRC %K bidirectional texting %K health text messaging %K health promotion %K participation %K fotonovela %K comics %D 2023 %7 7.3.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Colorectal cancer (CRC) is currently the second leading cause of cancer-related deaths in the United States; however, it is mostly preventable with appropriate screening and is often treatable when detected at early stages. Many patients enrolled in an urban Federally Qualified Health Center (FQHC) clinic were found to be past due for CRC screening. Objective: This study described a quality improvement (QI) project to improve CRC screening rates. This project used bidirectional texting with fotonovela comics and natural language understanding (NLU) to encourage patients to mail fecal immunochemical test (FIT) kits back to the FQHC. Methods: The FQHC mailed FIT kits to 11,000 unscreened patients in July 2021. Consistent with the usual care, all patients received 2 text messages and a patient navigator call within the first month of mailing. As part of a QI project, 5241 patients who did not return their FIT kit within 3 months, aged 50-75 years, and spoke either English or Spanish were randomized to either usual care (no further intervention) or intervention (4-week texting campaign with a fotonovela comic and remailing kits if requested) groups. The fotonovela was developed to address known barriers to CRC screening. The texting campaign used NLU to respond to patients’ texts. A mixed methods evaluation used data from SMS text messages and electronic medical records to understand the impact of the QI project on CRC screening rates. Open-ended text messages were analyzed for themes, and interviews were completed with a convenience sample of patients to understand barriers to screening and impact of the fotonovela. Results: Of the 2597 participants, 1026 (39.5%) in the intervention group engaged with bidirectional texting. Participating in bidirectional texting was related to language preference (χ22=11.0; P=.004) and age group (χ22=19.0; P<.001). Of the 1026 participants who engaged bidirectionally, 318 (31%) clicked on the fotonovela. Furthermore, 54% (32/59) of the patients clicked on the fotonovela and responded that they loved it, and 36% (21/59) of patients responded that they liked it. The intervention group was more likely to get screened (487/2597, 18.75%) than those in usual care (308/2644, 11.65%; P<.001), and this pattern held, regardless of demographic subgroup (sex, age, screening history, preferred language, and payer type). Interview data (n=16) indicated that the text messages, navigator calls, and fotonovelas were well received and not unduly invasive. Interviewees noted several important barriers to CRC screening and offered suggestions for reducing barriers and increasing screening. Conclusions: Texting using NLU and fotonovela is valuable in increasing CRC screening as observed by the FIT return rate for patients in the intervention group. There were patterns in which patients did not engage bidirectionally; future work should investigate how to ensure that populations are not left out of screening campaigns. %M 36881466 %R 10.2196/39645 %U https://cancer.jmir.org/2023/1/e39645 %U https://doi.org/10.2196/39645 %U http://www.ncbi.nlm.nih.gov/pubmed/36881466 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44370 %T Improving Mental Health Literacy and Reducing Psychological Problems Among Teachers in Zambia: Protocol for Implementation and Evaluation of a Wellness4Teachers Email Messaging Program %A Agyapong,Belinda %A Chishimba,Charles %A Wei,Yifeng %A da Luz Dias,Raquel %A Eboreime,Ejemai %A Msidi,Eleanor %A Abidi,Syed Sibte Raza %A Mutaka-Loongo,Maryn %A Mwansa,James %A Orji,Rita %A Zulu,John Mathias %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor Abbie J. Lane Memorial Building QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 7802157771, agyapong@ualberta.ca %K burnout %K stress %K Zambia %K Africa %K teacher %K educator %K school %K anxiety %K wellness %K depression %K e-mental health %K intervention %K health literacy %K mental health %K depressive %K psychological issue %K psychological problem %K text message %K messaging %K decision-making %D 2023 %7 6.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Primary, basic, secondary, and high school teachers are constantly faced with increased work stressors that can result in psychological health challenges such as burnout, anxiety, and depression, and in some cases, physical health problems. It is presently unknown what the mental health literacy levels are or the prevalence and correlates of psychological issues among teachers in Zambia. It is also unknown if an email mental messaging program (Wellness4Teachers) would effectively reduce burnout and associated psychological problems and improve mental health literacy among teachers. Objective: The primary objectives of this study are to determine if daily supportive email messages plus weekly mental health literacy information delivered via email can help improve mental health literacy and reduce the prevalence of moderate to high stress symptoms, burnout, moderate to high anxiety symptoms, moderate to high depression symptoms, and low resilience among school teachers in Zambia. The secondary objectives of this study are to evaluate the baseline prevalence and correlates of moderate to high stress, burnout, moderate to high anxiety, moderate to high depression, and low resilience among school teachers in Zambia. Methods: This is a quantitative longitudinal and cross-sessional study. Data will be collected at the baseline (the onset of the program), 6 weeks, 3 months, 6 months (the program midpoint), and 12 months (the end point) using web-based surveys. Individual teachers will subscribe by accepting an invitation to do so from the Lusaka Apex Medical University organizational account on the ResilienceNHope web-based application. Data will be analyzed using SPSS version 25 with descriptive and inferential statistics. Outcome measures will be evaluated using standardized rating scales. Results: The Wellness4Teachers email program is expected to improve the participating teachers’ mental health literacy and well-being. It is anticipated that the prevalence of stress, burnout, anxiety, depression, and low resilience among teachers in Zambia will be similar to those reported in other jurisdictions. In addition, it is expected that demographic, socioeconomic, and organizational factors, class size, and grade teaching will be associated with burnout and other psychological disorders among teachers, as indicated in the literature. Results are expected 2 years after the program’s launch. Conclusions: The Wellness4Teachers email program will provide essential insight into the prevalence and correlates of psychological problems among teachers in Zambia and the program’s impact on subscribers’ mental health literacy and well-being. The outcome of this study will help inform policy and decision-making regarding psychological interventions for teachers in Zambia. International Registered Report Identifier (IRRID): PRR1-10.2196/44370 %M 36877571 %R 10.2196/44370 %U https://www.researchprotocols.org/2023/1/e44370 %U https://doi.org/10.2196/44370 %U http://www.ncbi.nlm.nih.gov/pubmed/36877571 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40440 %T Effects of Text4Hope-Addiction Support Program on Cravings and Mental Health Symptoms: Results of a Longitudinal Cross-sectional Study %A Obuobi-Donkor,Gloria %A Shalaby,Reham %A Vuong,Wesley %A Agyapong,Belinda %A Hrabok,Marianne %A Gusnowski,April %A Surood,Shireen %A Greenshaw,Andrew J %A Agyapong,Vincent IO %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor, Abbie J Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 780 215 7771, vn602367@dal.ca %K addiction %K substance craving %K depression %K anxiety %K Text4Hope %K satisfaction %D 2023 %7 1.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Drug misuse is complex, and various treatment modalities are emerging. Providing supportive text messages to individuals with substance use disorder offers the prospect of managing and improving symptoms of drug misuse and associated comorbidities. Objective: This study evaluated the impact of the daily supportive text message program (Text4Hope-Addiction Support) in mitigating cravings and mental health symptoms in subscribers and quantify user satisfaction with the Text4Hope-Addiction Support program. Methods: Subscribers to the Text4Hope-Addiction Support program received daily supportive text messages for 3 months; the messages were crafted based on addiction counseling and cognitive behavioral therapy principles. Participants completed an anonymous web-based questionnaire to assess cravings, anxiety, and depressive symptoms using the Brief Substance Craving Scale (BSCS), Generalized Anxiety Disorder-7 (GAD-7) scale, and Patient Health Questionnaire-9 (PHQ-9) scale at enrollment (baseline), after 6 weeks, and after 3 months. Likert scale satisfaction responses were used to assess various aspects of the Text4Hope-Addiction program. Results: In total, 408 people subscribed to the program, and 110 of 408 (26.9%) subscribers completed the surveys at least at one time point. There were significant differences between the mean baseline and 3-month BSCS scores P=.01 (−2.17, 95% CI –0.62 to 3.72), PHQ-9 scores, P=.004 (−5.08, 95% CI −1.65 to −8.51), and GAD-7 scores, P=.02 (−3.02, 95% CI −0.48 to −5.56). Participants who received the supportive text messages reported a reduced desire to use drugs and a longer time interval between substance use, which are reflected in 41.1% and 32.5% decrease, respectively, from baseline score. Approximately 89% (23/26) of the participants agreed that Text4Hope-Addiction program helped them cope with addiction-related stress, and 81% (21/25) of the participants reported that the messages assisted them in dealing with anxiety. Overall, 69% (18/26) of the participants agreed that it helped them cope with depression related to addiction; 85% (22/26) of the participants felt connected to a support system; 77% (20/26) of the participants were hopeful of their ability to manage addiction issues; and 73% (19/26) of the participants felt that their overall mental well-being was improved. Most of the participants agreed that the interventions were always positive and affirmative (19/26, 73%), and succinct (17/26, 65%). Furthermore, 88% (21/24) of the participants always read the messages; 83% (20/24) of the participants took positive or beneficial actions after reading; and no participant took a negative action after reading the messages. In addition, most participants agreed to recommend other diverse technology-based services as an adjunctive treatment for their mental and physical health disorders. Conclusions: Subscribers of Text4Hope-Addiction Support program experienced improved mental health and addiction symptoms. Addiction care practitioners and policy makers can implement supportive text-based strategies to complement conventional treatments for addiction, given that mobile devices are widely used. %M 36857114 %R 10.2196/40440 %U https://formative.jmir.org/2023/1/e40440 %U https://doi.org/10.2196/40440 %U http://www.ncbi.nlm.nih.gov/pubmed/36857114 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40207 %T Perceptions of Using Instant Messaging Apps for Alcohol Reduction Intervention Among University Student Drinkers: Semistructured Interview Study With Chinese University Students in Hong Kong %A Chau,Siu Long %A Wong,Yiu Cheong %A Zeng,Ying Pei %A Lee,Jung Jae %A Wang,Man Ping %+ School of Nursing, The University of Hong Kong, 5/F, Academic Building, 3 Sassoon Road, Pokfulam, Hong Kong, Hong Kong, 852 3917 6636, mpwang@hku.hk %K instant messaging apps %K mobile phone %K WhatsApp %K alcohol reduction intervention %K alcohol use %K university students %K young adults %K instant messaging %K alcohol reduction %K adverse lifestyle %K intervention %K health promotion %K text messages %K health behaviours %K health behaviors %K apps %D 2023 %7 27.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile instant messaging (IM) apps (eg, WhatsApp and WeChat) have been widely used by the general population and are more interactive than text-based programs (SMS text messaging) to modify unhealthy lifestyles. Little is known about IM app use for health promotion, including alcohol reduction for university students. Objective: This study aims to explore university student drinkers' perceptions of using IM apps for alcohol reduction as they had high alcohol exposure (eg, drinking invitations from peers and alcohol promotion on campus) and the proportion of IM app use in Hong Kong. Methods: A qualitative study was conducted with 20 Hong Kong Chinese university students (current drinkers) with Alcohol Use Disorder Identification test scores of ≥8 recruited using purposive sampling. Semistructured individual interviews were conducted from September to October 2019. Interview questions focused on drinking behaviors, quitting history, opinions toward IM app use as an intervention tool, perceived usefulness of IM apps for alcohol reduction, and opinions on the content and design of IM apps for alcohol reduction. Each interview lasted approximately 1 hour. All interviews were audio-taped and transcribed verbatim. Two researchers independently analyzed the transcripts using thematic analysis with an additional investigator to verify the consistency of the coding. Results: Participants considered IM apps a feasible and acceptable platform for alcohol reduction intervention. They preferred to receive IMs based on personalized problem-solving and drinking consequences with credible sources. Other perceived important components of instant messages included providing psychosocial support in time and setting goals with participants to reduce drinking. They further provided suggestions on the designs of IM interventions, in which they preferred simple and concise messages, chat styles based on participants' preferences (eg, adding personalized emojis and stickers in the chat), and peers as counselors. Conclusions: Qualitative interviews with Chinese university student drinkers showed high acceptability, engagement, and perceived utility of IM apps for alcohol reduction intervention. IM intervention can be an alternative for alcohol reduction intervention apart from traditional text-based programs. The study has implications for developing the IM intervention for other unhealthy behaviors and highlights important topics that warrant future research, including substance use and physical inactivity. Trial Registration: ClinicalTrials.gov NCT04025151; https://clinicaltrials.gov/ct2/show/NCT04025151?term=NCT04025151 %M 36848207 %R 10.2196/40207 %U https://formative.jmir.org/2023/1/e40207 %U https://doi.org/10.2196/40207 %U http://www.ncbi.nlm.nih.gov/pubmed/36848207 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40934 %T Engagement With and Acceptability of Digital Media Platforms for Use in Improving Health Behaviors Among Vulnerable Families: Systematic Review %A Eppes,Elisabet V %A Augustyn,Marycatherine %A Gross,Susan M %A Vernon,Paris %A Caulfield,Laura E %A Paige,David M %+ Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD, 21205, United States, 1 484 467 3121, elisabet.eppes@gmail.com %K text messaging %K social media %K mobile app %K low-income %K engagement %K health promotion %K community %K nutrition and physical activity %K pregnancy %K breastfeeding %K maternal and child health %K mobile phone %D 2023 %7 3.2.2023 %9 Review %J J Med Internet Res %G English %X Background: The use of digital communication platforms to improve health behaviors has increased dramatically over the last decade. Public health practitioners have adopted digital communication technologies such as text messages, mobile apps, and social media to reach diverse populations. However, the effectiveness of digital communication platforms used by community-serving agencies remains unclear, and patterns of engagement and acceptability of different platforms have not been studied. Objective: This review aimed to identify the types of digital communication strategies used by community-serving organizations to promote healthy behaviors, assess the strength of evidence for health behavioral change, and describe the degree of consumer engagement with and acceptability of these strategies. The study population included low-income pregnant women, parents of young children, and adolescents. Methods: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, Scopus, Web of Science, CINAHL, and APA PsycInfo, covering research conducted from 2009 to 2022. Studies were included if they examined the use of digital communication (ie, texting, mobile apps, or social media) to promote healthy behaviors in the target population. Risk of bias and strength of evidence were assessed using the Effective Public Health Practice Project Risk of Bias tool and criteria from Agency for Healthcare Research and Quality, respectively. Results: Twenty-three peer-reviewed research studies published between 2012 and 2022, conducted in the United States, the United Kingdom, and Australia, were included in the review. The sample comprised studies exploring the use of texting (n=12), apps (n=6), social media (n=3), and multiple platforms (n=2; eg, texting and mobile apps). Targeted health behaviors included healthy diet, physical activity, obesity prevention, healthy pregnancy, breastfeeding, vaccine use, smoking cessation, and nutrition benefit redemption. The sample included 8 randomized controlled trials, 6 pretest-posttest design, 3 mixed methods studies, 2 pilot studies, 1 feasibility study, 1 prospective cohort study, 1 descriptive study, and 1 cross-sectional study. The median sample size was 77.5. There was no strong evidence to suggest the effectiveness of digital media campaigns in improving health behaviors; however, there were moderate to high levels of engagement and high levels of acceptability across digital platforms. Conclusions: Low-income pregnant women, parents of young children, and adolescents demonstrated moderate levels of engagement with and high levels of acceptability of digital media health campaigns conducted by community-serving agencies. The effectiveness of these strategies in improving health behaviors was inconclusive. Additional rigorous studies with larger sample sizes are required. In addition, more research is required to consistently measure and report participants’ engagement with each platform. Digital communication platforms are critical tools for public health practitioners, and future investigations of the effectiveness of these platforms in engaging clients and improving health behaviors will maximize client services. %M 36735286 %R 10.2196/40934 %U https://www.jmir.org/2023/1/e40934 %U https://doi.org/10.2196/40934 %U http://www.ncbi.nlm.nih.gov/pubmed/36735286 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41193 %T Supporting Parents of Children With Type 1 Diabetes: Experiment Comparing Message and Delivery Types %A Holtz,Bree %A Mitchell,Katharine %+ Department of Advertising and Public Relations, College of Communication Arts and Sciences, Michigan State University, 404 Wilson Road, Room 309, East Lansing, MI, 48823, United States, 1 5173030159, bholtz@msu.edu %K caregiving %K children %K development %K diabetes %K diagnosis %K effectiveness %K email %K intervention %K management %K social support %K stress %K support %K type 1 diabetes %D 2023 %7 3.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Type 1 diabetes (T1D) is a chronic condition that typically affects young age group people and is estimated to afflict approximately 154,000 people younger than 20 years in the United States. Since T1D typically impacts children, parents must play an active role in helping their child manage the condition. This creates a substantial burden and responsibility for the parents. Objective: This pilot study sought to find ways to help parents with children with T1D in coping with stresses related to managing and monitoring their child’s disease by providing informational support, either about parenting a child with T1D or general parenting messages through different channels. Methods: Parents (N=120) of children with T1D were recruited through an email listserv through local T1D Facebook groups. A total of 102 participants were included in the analysis. We conducted a 2×2 experimental study over an 8-week period to test 2 types of messages (diabetes specific vs general parenting) and the medium in which the messages were delivered (Facebook vs SMS text message). Diabetes behavior, informational support, emotional support, and quality of life were the main outcomes of interest. Results: The results suggested that the participants in the diabetes message groups showed improvement in diabetes behaviors (F1,99=3.69; P=.05) and were more satisfied with the intervention (F3,98=4.59; P=.005). There were no differences between message and medium groups on informational support, emotional support, or quality of life. Conclusions: The results of this study demonstrate that the medium—Facebook or SMS text messaging—does not matter for parents’ perceptions of social support or quality of life. The diabetes message group reported higher levels of disease management. Finally, the groups with the diabetes support messages were more satisfied than those who received general parenting messages. The findings provide starting guidance for the development of social support interventions for this population. %M 36735338 %R 10.2196/41193 %U https://formative.jmir.org/2023/1/e41193 %U https://doi.org/10.2196/41193 %U http://www.ncbi.nlm.nih.gov/pubmed/36735338 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44138 %T Outcomes of a Live Messaging, Blended Care Coaching Program Among Adults With Symptoms of Anxiety: Pragmatic Retrospective Cohort Study %A Owusu,Jocelynn T %A Wang,Pam %A Wickham,Robert E %A Smith,Sarah F %A Lee,Jennifer L %A Chen,Connie %A Lungu,Anita %+ Lyra Health, 287 Lorton Avenue, Burlingame, CA, 94010, United States, 1 877 505 7147, jowusu@lyrahealth.com %K text-based coaching %K anxiety %K blended care %D 2023 %7 1.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Anxiety disorders are common and can be debilitating. In addition, various barriers exist that can hinder access to adequate care. Coaching that is grounded in evidence-based interventions and delivered via synchronous (ie, live) text-based messaging could potentially increase the reach of mental health services among populations who select this modality instead of other services (eg, face-to-face coaching and psychotherapy). In addition, the delivery of live messaging coaching within a blended care model has the potential to combine the benefits of coaching with those of evidence-based digital mental health tools. Objective: This real-world study evaluates the anxiety and satisfaction outcomes of live messaging coaching blended with digital tools (ie, digital exercises and activities). Methods: This was a retrospective cohort study of 121 adults with moderate levels of anxiety symptoms at the beginning of coaching (Generalized Anxiety Disorder-7 [GAD-7] scores: range 8-14). Participants received an employer-offered blended messaging coaching (BMC) program, and those who opted to receive all live coaching sessions via text-based messaging were included. Anxiety symptom severity was regularly measured by using the GAD-7 scale. Using growth curve models, the change in GAD-7 scores over the course of BMC was evaluated, as were the effects of text-based coaching sessions on GAD-7 scores. The proportion of participants that had a reliable improvement in anxiety symptom severity (GAD-7 score reduction of ≥4) or subclinical symptom severity (GAD-7 score of <8) at the end of care was also estimated. Participants also self-reported their likelihood of recommending their live messaging coach to someone with similar needs. Results: At baseline, the average GAD-7 score was 9.88 (SD 1.80). Anxiety symptom severity significantly decreased with each week in the BMC program (week: b=−1.04; P<.001), and the rate of decline in anxiety symptom severity decreased over time (week2: b=0.06; P<.001). Each live messaging coaching session was associated with significantly lower anxiety symptom severity during the week of the coaching session (b=−1.56; P<.001) and the week immediately following the session (b=−1.03; P<.001). Overall, 86% (104/121) of participants had subclinical symptom severity or a reliable reduction in anxiety symptom severity by the end of care. Further, 33.1% (40/121) of participants reported coaching satisfaction levels; of the 40 participants in this subset, 37 (92.5%) were likely or extremely likely to recommend their live messaging coach. Conclusions: BMC that provides coaching sessions via live messaging can be beneficial for adults with moderate symptoms of anxiety who qualify for and self-select this care modality. Large-scale studies with longer follow-ups are needed. %M 36724014 %R 10.2196/44138 %U https://formative.jmir.org/2023/1/e44138 %U https://doi.org/10.2196/44138 %U http://www.ncbi.nlm.nih.gov/pubmed/36724014 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41170 %T A Text Messaging–Based Support Intervention to Enhance Pre-exposure Prophylaxis for HIV Prevention Adherence During Pregnancy and Breastfeeding: Protocol for a Randomized Controlled Trial %A Mogaka,Jerusha Nyabiage %A Otieno,Felix Abuna %A Akim,Eunita %A Beima-Sofie,Kristin %A Dettinger,Julia %A Gomez,Lauren %A Marwa,Mary %A Odhiambo,Ben %A Ngure,Kenneth %A Ronen,Keshet %A Sharma,Monisha %A John-Stewart,Grace %A Richardson,Barbra %A Stern,Joshua %A Unger,Jennifer %A Udren,Jenna %A Watoyi,Salphine %A Pintye,Jillian %A Kinuthia,John %+ School of Nursing, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, United States, 1 206 543 4278, jpintye@uw.edu %K pre-exposure prophylaxis %K text messaging %K text message %K mobile technology %K PrEP adherence %K adherence %K prevention %K pregnancy %K pregnant %K breastfeeding %K maternal %K randomized %K RCT %K peripartum %K patient-provider %K postpartum %K HIV prevention %K SMS %K HIV %K mHealth %K mobile health %D 2023 %7 30.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cisgender women in Kenya are at elevated risk of HIV acquisition during pregnancy and post partum. Acute HIV infection during pregnancy and breastfeeding accounts for approximately one-third of all vertical HIV transmissions. The World Health Organization recommends offering oral tenofovir-based pre-exposure prophylaxis (PrEP) to pregnant and postpartum women who are HIV negative but at substantial and ongoing risk for HIV acquisition. PrEP delivery for pregnant and postpartum women is expanding within routine maternal child health clinics in Kenya. However, approximately half of pregnant women discontinue PrEP within 30 days of initiation. Therefore, it is crucial to develop PrEP adherence strategies that enhance support for adherence when peripartum events and health issues pose challenges to sustaining PrEP adherence. Objective: We are conducting a randomized controlled trial to determine the effect of a bidirectional communication platform named Mobile Solutions for Women’s and Children’s Health (mWACh), which utilizes two-way SMS text messaging between patients and remote nurses to support PrEP adherence and address maternal health concerns in real time during the peripartum period. Methods: The mWACh-PrEP study is a randomized trial designed to support PrEP adherence during the peripartum period by comparing mWACh-PrEP to the standard of care (ie, in-clinic adherence counseling) among women who are HIV negative and initiating PrEP. Purposive sampling was used to select 5 facilities offering PrEP in antenatal clinics in Kisumu and Siaya Counties, and block randomization will be used to divide participants into groups. Participants in the intervention arm will receive a customized messaging curriculum via SMS text messages targeted toward their particular perinatal stage. The primary outcome, PrEP adherence at 6 months post partum, will be evaluated using a log-binomial regression model, adjusting for imbalanced baseline characteristics. Based on a previous study of directly observed dosing conditions, we will use a hair tenofovir concentration cutoff of 0.038 ng/mg (corresponding to 7 doses/week) as the primary adherence outcome measured at 6 months post partum (binary outcome). Qualitative interviews and cost-effective analyses will be conducted to understand the feasibility, acceptability, and economic impact of the intervention. Results: Enrollment began in March 2022 and is projected to continue until July 2023, with follow-up through March 2024. The study results are expected to be reported in 2025. Conclusions: This trial will provide insights into using mobile health to enhance PrEP adherence among pregnant and postpartum mothers. Additionally, the findings will have implications for the use of mobile health technology to improve adherence to other daily medications during the peripartum period. Trial Registration: ClinicalTrials.gov NCT04472884; https://clinicaltrials.gov/ct2/show/NCT04472884 International Registered Report Identifier (IRRID): DERR1-10.2196/41170 %M 36716092 %R 10.2196/41170 %U https://www.researchprotocols.org/2023/1/e41170 %U https://doi.org/10.2196/41170 %U http://www.ncbi.nlm.nih.gov/pubmed/36716092 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e34474 %T Automatic Depression Detection Using Smartphone-Based Text-Dependent Speech Signals: Deep Convolutional Neural Network Approach %A Kim,Ah Young %A Jang,Eun Hye %A Lee,Seung-Hwan %A Choi,Kwang-Yeon %A Park,Jeon Gue %A Shin,Hyun-Chool %+ Department of Electronics Engineering, Soongsil University, 511 Sang-do dong, Seoul, 156743, Republic of Korea, 82 28287165, shinhc@ssu.ac.kr %K depression %K major depressive disorder %K MDD %K automatic depression detection %K ADD %K mobile health %K deep learning %K speech analysis %K acoustic %K mobile phone %K smartphone %D 2023 %7 25.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Automatic diagnosis of depression based on speech can complement mental health treatment methods in the future. Previous studies have reported that acoustic properties can be used to identify depression. However, few studies have attempted a large-scale differential diagnosis of patients with depressive disorders using acoustic characteristics of non-English speakers. Objective: This study proposes a framework for automatic depression detection using large-scale acoustic characteristics based on the Korean language. Methods: We recruited 153 patients who met the criteria for major depressive disorder and 165 healthy controls without current or past mental illness. Participants' voices were recorded on a smartphone while performing the task of reading predefined text-based sentences. Three approaches were evaluated and compared to detect depression using data sets with text-dependent read speech tasks: conventional machine learning models based on acoustic features, a proposed model that trains and classifies log-Mel spectrograms by applying a deep convolutional neural network (CNN) with a relatively small number of parameters, and models that train and classify log-Mel spectrograms by applying well-known pretrained networks. Results: The acoustic characteristics of the predefined text-based sentence reading automatically detected depression using the proposed CNN model. The highest accuracy achieved with the proposed CNN on the speech data was 78.14%. Our results show that the deep-learned acoustic characteristics lead to better performance than those obtained using the conventional approach and pretrained models. Conclusions: Checking the mood of patients with major depressive disorder and detecting the consistency of objective descriptions are very important research topics. This study suggests that the analysis of speech data recorded while reading text-dependent sentences could help predict depression status automatically by capturing the characteristics of depression. Our method is smartphone based, is easily accessible, and can contribute to the automatic identification of depressive states. %M 36696160 %R 10.2196/34474 %U https://www.jmir.org/2023/1/e34474 %U https://doi.org/10.2196/34474 %U http://www.ncbi.nlm.nih.gov/pubmed/36696160 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e42799 %T Effectiveness of mHealth on Adherence to Antiretroviral Therapy in Patients Living With HIV: Meta-analysis of Randomized Controlled Trials %A Sun,Liang %A Qu,Mengbing %A Chen,Bing %A Li,Chuancang %A Fan,Haohao %A Zhao,Yang %+ College of Public Health, Zhengzhou University, New campus of Zhengzhou University, 100 Science Avenue, Zhengzhou, 450001, China, 86 13803845359, zhaomiemie@126.com %K HIV %K mHealth %K antiretroviral therapy %K meta-analysis %D 2023 %7 23.1.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The World Health Organization recommends that all adults with HIV adhere to antiretroviral therapy (ART). Good adherence to ART is beneficial to patients and the public. Furthermore, mHealth has shown promise in improving HIV medication adherence globally. Objective: The aim of this meta-analysis is to analyze the effectiveness of mHealth on adherence to antiretroviral therapy in patients living with HIV. Methods: Randomized controlled trials (RCTs) of the association between mHealth and adherence to ART published until December 2021 were searched in electronic databases. Odds ratios (ORs), weighted mean differences, and 95% CIs were calculated. This meta-analysis was performed using the Mantel-Haenszel method or the inverse variance test. We evaluated heterogeneity with the I2 statistic. If I2 was ≤50%, heterogeneity was absent, and a fixed effect model was used. If I2 was >50%, heterogeneity was present, and a random effects model was used. Results: A total of 2163 participants in 8 studies were included in this meta-analysis. All included studies were RCTs. The random effects model was used for a meta-analysis of the effects of various intervention measures compared to routine nursing; the outcome was not statistically significant (OR 1.54, 95% CI 0.99-2.38; P=.05). In the subgroups, only short messaging service (SMS)-based interventions significantly increased adherence to ART (OR 1.76, 95% CI 1.07-2.89; P=.03). Further analysis showed that only interactive or bidirectional SMS could significantly increase ART adherence (OR 1.69, 95% CI 1.22-2.34; P=.001). After combining the difference in CD4 cell count before and after the interventions, we concluded that there was no statistical heterogeneity among the studies (I2=0%; tau2=0.37; P=.95). Conclusions: Interactive or bidirectional SMS can enhance intervention effects. However, whether mHealth can improve adherence to ART in patients with HIV needs further study. Owing to a lack of the required significant staff time, training, and ongoing supervision, there is still much more to do to apply mHealth to the clinical use of ART for patients living with HIV. Trial Registration: PROSPERO CRD42022358774; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=358774 %M 36689267 %R 10.2196/42799 %U https://mhealth.jmir.org/2023/1/e42799 %U https://doi.org/10.2196/42799 %U http://www.ncbi.nlm.nih.gov/pubmed/36689267 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41011 %T Patient Perspectives on a Targeted Text Messaging Campaign to Encourage Screening for Diabetes: Qualitative Study %A Lenoir,Kristin M %A Sandberg,Joanne C %A Miller,David P %A Wells,Brian J %+ Department of Biostatistics and Data Science, Public Health Sciences, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, United States, 1 717 808 4012, klenoir@wakehealth.edu %K mobile health %K diabetes screening %K electronic health records %K text messaging %K clinical decision support %K mHealth %K diabetes %K mHealth intervention %D 2023 %7 17.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: A sizeable proportion of prediabetes and diabetes cases among adults in the United States remain undiagnosed. Patient-facing clinical decision support (CDS) tools that leverage electronic health records (EHRs) have the potential to increase diabetes screening. Given the widespread mobile phone ownership across diverse groups, text messages present a viable mode for delivering alerts directly to patients. The use of unsolicited text messages to offer hemoglobin A1c (HbA1c) screening has not yet been studied. It is imperative to gauge perceptions of “cold texts” to ensure that information and language are optimized to promote engagement with text messages that affect follow-through with health behaviors. Objective: This study aims to gauge the perceptions of and receptiveness to text messages to inform content that would facilitate engagement with text messages intended to initiate a mobile health (mHealth) intervention for targeted screening. Messages were designed to invite those not already diagnosed with diabetes to make a decision to take part in HbA1c screening and walk them through the steps required to perform the behavior based solely on an automated text exchange. Methods: In total, 6 focus groups were conducted at Wake Forest Baptist Health (WFBH) between September 2019 and February 2020. The participants were adult patients without diabetes who had completed an in-person visit at the Family and Community Medicine Clinic within the previous year. We displayed a series of text messages and asked the participants to react to the message content and suggest improvements. Content was deductively coded with respect to the Health Belief Model (HBM) and inductively coded to identify other emergent themes that could potentially impact engagement with text messages. Results: Participants (N=36) were generally receptive to the idea of receiving a text-based alert for HbA1c screening. Plain language, personalization, and content, which highlighted perceived benefits over perceived susceptibility and perceived severity, were important to participants’ understanding of and receptiveness to messages. The patient-physician relationship emerged as a recurring theme in which patients either had a desire or held an assumption that their provider would be working behind the scenes throughout each step of the process. Participants needed further clarification to understand the steps involved in following through with HbA1c screening and receiving results. Conclusions: Our findings suggest that patients may be receptive to text messages that alert them to a risk of having an elevated HbA1c in direct-to-patient alerts that use cold texting. Using plain and positive language, integrating elements of personalization, and defining new processes clearly were identified by participants as modifiable content elements that could act as facilitators that would help overcome barriers to engagement with these messages. A patient’s relationship with their provider and the financial costs associated with texts and screening may affect receptiveness and engagement in this process. %M 36649056 %R 10.2196/41011 %U https://formative.jmir.org/2023/1/e41011 %U https://doi.org/10.2196/41011 %U http://www.ncbi.nlm.nih.gov/pubmed/36649056 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e37867 %T Mailed Letter Versus Phone Call to Increase Diabetic-Related Retinopathy Screening Engagement by Patients in a Team-Based Primary Care Practice: Prospective, Single-Masked, Randomized Trial %A Stamenova,Vess %A Nguyen,Megan %A Onabajo,Nike %A Merritt,Rebecca %A Sutakovic,Olivera %A Mossman,Kathryn %A Wong,Ivy %A Ives-Baine,Lori %A Bhatia,R Sacha %A Brent,Michael H %A Bhattacharyya,Onil %+ Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 4162680985, vess.stamenova@wchospital.ca %K teleophthalmology %K diabetes %K diabetic-related retinopathy %K screening %K primary care %K patient %K vision loss %K screening %K Canada %D 2023 %7 11.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Vision loss from diabetic-related retinopathy (DR) is preventable through regular screening. Objective: The purpose of this study was to test different patient engagement approaches to expand a teleophthalmology program at a primary care clinic in the city of Toronto, Canada. Methods: A teleophthalmology program was set up in a large, urban, academic, team-based primary care practice. Patients older than 18 years with type 1 or type 2 diabetes were randomized to one of the following 4 engagement strategies: phone call, mail, mail plus phone call, or usual care. Outreach was conducted by administrative staff within the clinic. The primary outcome was booking an appointment for DR screening. Results: A total of 23 patients in the phone, 28 in the mail, 32 in the mail plus phone call, and 27 in the control (usual care) group were included in the analysis. After the intervention and after excluding patients who said they were screened, 88% (15/17) of patients in the phone, 11% (2/18) in the mail, and 100% (21/21) in the mail and phone group booked an appointment with the teleophthalmology program compared to 0% (0/12) in the control group. Phoning patients positively predicted patients booking a teleophthalmology appointment (P<.001), whereas mailing a letter had no effect. Conclusions: Patient engagement to book DR screening via teleophthalmology in an urban, academic, team-based primary care practice using telephone calls was much more effective than patient engagement using letters or usual care. Practices that have access to a local DR screening program and have resources for such engagement strategies should consider using them as a means to improve their DR screening rates. Trial Registration: ClinicalTrials.gov NCT03927859; https://clinicaltrials.gov/ct2/show/NCT03927859 %M 36630160 %R 10.2196/37867 %U https://www.jmir.org/2023/1/e37867 %U https://doi.org/10.2196/37867 %U http://www.ncbi.nlm.nih.gov/pubmed/36630160 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e38607 %T COVID-19–Associated Misinformation Across the South Asian Diaspora: Qualitative Study of WhatsApp Messages %A Sharma,Anjana E %A Khosla,Kiran %A Potharaju,Kameswari %A Mukherjea,Arnab %A Sarkar,Urmimala %+ Department of Family and Community Medicine, University of California San Francisco, 1001 Potrero Avenue, Zuckerberg San Francisco General Hospital, San Francisco, CA, 94143, United States, 1 628 206 4943, anjana.sharma@ucsf.edu %K misinformation %K COVID-19 %K South Asians %K disparities %K social media %K infodemiology %K WhatsApp %K messages %K apps %K health information %K reliability %K communication %K Asian %K English %K community %K health %K organization %K public health %K pandemic %D 2023 %7 5.1.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: South Asians, inclusive of individuals originating in India, Pakistan, Maldives, Bangladesh, Sri Lanka, Bhutan, and Nepal, comprise the largest diaspora in the world, with large South Asian communities residing in the Caribbean, Africa, Europe, and elsewhere. There is evidence that South Asian communities have disproportionately experienced COVID-19 infections and mortality. WhatsApp, a free messaging app, is widely used in transnational communication within the South Asian diaspora. Limited studies exist on COVID-19–related misinformation specific to the South Asian community on WhatsApp. Understanding communication on WhatsApp may improve public health messaging to address COVID-19 disparities among South Asian communities worldwide. Objective: We developed the COVID-19–Associated misinfoRmation On Messaging apps (CAROM) study to identify messages containing misinformation about COVID-19 shared via WhatsApp. Methods: We collected messages forwarded globally through WhatsApp from self-identified South Asian community members between March 23 and June 3, 2021. We excluded messages that were in languages other than English, did not contain misinformation, or were not relevant to COVID-19. We deidentified each message and coded them for one or more content categories, media types (eg, video, image, text, web link, or a combination of these elements), and tone (eg, fearful, well intentioned, or pleading). We then performed a qualitative content analysis to arrive at key themes of COVID-19 misinformation. Results: We received 108 messages; 55 messages met the inclusion criteria for the final analytic sample; 32 (58%) contained text, 15 (27%) contained images, and 13 (24%) contained video. Content analysis revealed the following themes: “community transmission” relating to misinformation on how COVID-19 spreads in the community; “prevention” and “treatment,” including Ayurvedic and traditional remedies for how to prevent or treat COVID-19 infection; and messaging attempting to sell “products or services” to prevent or cure COVID-19. Messages varied in audience from the general public to South Asians specifically; the latter included messages alluding to South Asian pride and solidarity. Scientific jargon and references to major organizations and leaders in health care were included to provide credibility. Messages with a pleading tone encouraged users to forward them to friends or family. Conclusions: Misinformation in the South Asian community on WhatsApp spreads erroneous ideas regarding disease transmission, prevention, and treatment. Content evoking solidarity, “trustworthy” sources, and encouragement to forward messages may increase the spread of misinformation. Public health outlets and social media companies must actively combat misinformation to address health disparities among the South Asian diaspora during the COVID-19 pandemic and in future public health emergencies. %M 37113380 %R 10.2196/38607 %U https://infodemiology.jmir.org/2023/1/e38607 %U https://doi.org/10.2196/38607 %U http://www.ncbi.nlm.nih.gov/pubmed/37113380 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 12 %P e42301 %T Leveraging Mobile Health to Manage Mental Health/Behavioral Health Disorders: Systematic Literature Review %A Kruse,Clemens Scott %A Betancourt,Jose A %A Gonzales,Matthew %A Dickerson,Kennedy %A Neer,Miah %+ School of Health Administration, Texas State University, 601 University Drive, Encino, 250, San Marcos, TX, 78666, United States, 1 512 245 4462, scottkruse@txstate.edu %K mHealth %K telemedicine %K mental health %K behavioral health %K anxiety %K mobile device %K smartphone %K SMS text messaging %K RCT %D 2022 %7 27.12.2022 %9 Review %J JMIR Ment Health %G English %X Background: Mental health is a complex condition, highly related to emotion. The COVID-19 pandemic caused a significant spike in depression (from isolation) and anxiety (event related). Mobile Health (mHealth) and telemedicine offer solutions to augment patient care, provide education, improve symptoms of depression, and assuage fears and anxiety. Objective: This review aims to assess the effectiveness of mHealth to provide mental health care by analyzing articles published in the last year in peer-reviewed, academic journals using strong methodology (randomized controlled trial). Methods: We queried 4 databases (PubMed, CINAHL [Cumulative Index to Nursing and Allied Health Literature], Web of Science, and ScienceDirect) using a standard Boolean search string. We conducted this systematic literature review in accordance with the Kruse protocol and reported it in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020 checklist (n=33). Results: A total of 4 interventions (mostly mHealth) from 14 countries identified improvements in primary outcomes of depression and anxiety as well as in several secondary outcomes, namely, quality of life, mental well-being, cognitive flexibility, distress, sleep, self-efficacy, anger, decision conflict, decision regret, digestive disturbance, pain, and medication adherence. Conclusions: mHealth interventions can provide education, treatment augmentation, and serve as the primary modality in mental health care. The mHealth modality should be carefully considered when evaluating modes of care. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022343489; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=343489 %M 36194896 %R 10.2196/42301 %U https://mental.jmir.org/2022/12/e42301 %U https://doi.org/10.2196/42301 %U http://www.ncbi.nlm.nih.gov/pubmed/36194896 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e37467 %T Web-Based Short Video Intervention and Short Message Comparison of Repeat Blood Donation Behavior Based on an Extended Theory of Planned Behavior: Prospective Randomized Controlled Trial Study %A Hu,Qiuyue %A Hu,Wei %A Han,Wenjuan %A Pan,Lingling %+ Blood Center of Zhejiang Province, 789 Jianye Road, Binjiang District, Hangzhou, 310052, China, 86 13588809060, panbbs@163.com %K extended theory of planned behavior %K repeated blood donation intervention %K randomized controlled trial %K mobile phone %D 2022 %7 23.12.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Although blood is an indispensable and important resource for clinical treatment, an imbalance between supply and demand may occur as the population ages and diversifies. Studies indicate that repeat blood donors are safe blood sources because of their voluntary blood donation education and frequent blood screening. However, the high rate of reduction in the number of first-time voluntary blood donors and low rate of repeated blood donation are common problems worldwide. Objective: This study aimed to evaluate the effect of an intervention in nonregular blood donors using web-based videos and SMS text messages, in which the former was guided by the extended theory of planned behavior, to discover effective intervention methods to improve repeat blood donation rates among nonregular blood donors. Methods: A total of 692 nonregular blood donors in Zhejiang province were randomly divided into intervention and control groups. The control group received regular, short reminder messages for a 6-month period, whereas the intervention group received web-based videos on the WeChat platform. The intervention group was guided by an extended theory of planned behavior, which included 9 factors: the respondents’ attitude, subjective behavioral norms, perceived behavioral control, the willingness to donate blood, outcome expectations, self-identity, blood donation–related anxiety, cognition of the blood donation environment, and previous blood donation experience. The intervention group was divided into 2 stages: those with an intervention at 3 months and those with a follow-up 3 months later. After 6 months, the redonation rate was evaluated for the 2 groups, and the scale in the intervention group was determined both before and after the intervention. A t test, chi-square test, logistic stepwise regression, and ANOVA were performed. Results: The intervention group’s redonation rate was 16.14%, which was significantly higher than the control group’s redonation rate of 5.16%; P<.001. Men who were aged 31 to 45 years and had donated blood twice had a higher redonation rate after the web-based video intervention than after the SMS text messages; P<.05. The repeat donors’ improved blood donation anxiety (P=.01), outcome expectations (P=.008), and cognition of the blood donation environment (P=.005) after the intervention were significantly higher than those of the nonrepeat donors. Conclusions: The web-based short video intervention based on the extended theory of planned behavior can effectively improve redonation rates. Outcome expectations, blood donation anxiety, and cognition of the blood donation environment can directly influence irregular blood donors to redonate blood. %M 36379691 %R 10.2196/37467 %U https://www.jmir.org/2022/12/e37467 %U https://doi.org/10.2196/37467 %U http://www.ncbi.nlm.nih.gov/pubmed/36379691 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e41735 %T Two-way Automated Text Messaging Support From Community Pharmacies for Medication Taking in Multiple Long-term Conditions: Human-Centered Design With Nominal Group Technique Development Study %A Donovan,Gemma %A Hall,Nicola %A Smith,Felicity %A Ling,Jonathan %A Wilkes,Scott %+ Generated Health, Mercury House, 117 Waterloo Road, London, SE1 8UL, United Kingdom, 44 345 5050120, gemma.donovan@pshealthgroup.com %K medication adherence %K text messaging %K human-centered design %K complex interventions %K community pharmacy %D 2022 %7 21.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Reviews of digital communication technologies suggest that they can be effective in supporting medication use; however, their use alongside nondigital components is unclear. We also explored the delivery of a digital communication intervention in a relatively novel setting of community pharmacies and how such an intervention might be delivered to patients with multiple long-term conditions. This meant that despite the large number of intervention examples available in the literature, design questions remained, which we wanted to explore with key stakeholders. Examples of how to involve stakeholders in the design of complex health care interventions are lacking; however, human-centered design (HCD) has been suggested as a potential approach. Objective: This study aimed to design a new community pharmacy text messaging intervention to support medication use for multiple long-term conditions, with patient and health care professional stakeholders in primary care. Methods: HCD was used to map the intervention “journey” and identify design questions to explore with patients and health care professionals. Six prototypes were developed to communicate the intervention concept, and a modified version of the Nominal Group Technique was used to gather feedback. Nominal group meetings generated qualitative data using questions about the aspects that participants liked for each prototype and any suggested changes. The discussion was analyzed using a framework approach to transform feedback into statements. These statements were then ranked using a web-based questionnaire to establish a consensus about what elements of the design were valued by stakeholders and what changes to the design were most important. Results: A total of 30 participants provided feedback on the intervention design concept over 5 nominal group meetings (21 health care professionals and 9 patients) with a 57% (17/30) response rate to the ranking questionnaire. Furthermore, 51 proposed changes in the intervention were generated from the framework analysis. Of these 51 changes, 27 (53%) were incorporated into the next design stage, focusing on changes that were ranked highest. These included suggestions for how text message content might be tailored, patient information materials, and the structure for pharmacist consultation. All aspects that the participants liked were retained in the future design and provided evidence that the proposed intervention concept had good acceptability. Conclusions: HCD incorporating the Nominal Group Technique is an appropriate and successful approach for obtaining feedback from key stakeholders as part of an iterative design process. This was particularly helpful for our intervention, which combined digital and nondigital components for delivery in the novel setting of a community pharmacy. This approach enabled the collection and prioritization of useful multiperspective feedback to inform further development and testing of our intervention. This model has the potential to minimize research waste by gathering feedback early in the complex intervention design process. %M 36542458 %R 10.2196/41735 %U https://formative.jmir.org/2022/12/e41735 %U https://doi.org/10.2196/41735 %U http://www.ncbi.nlm.nih.gov/pubmed/36542458 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40166 %T A Mobile Phone Text Messaging Intervention to Manage Fatigue for People With Multiple Sclerosis, Spinal Cord Injury, and Stroke: Development and Usability Testing %A Morgan,Kerri A %A Wong,Alex W K %A Walker,Kim %A Desai,Rachel Heeb %A Knepper,Tina M %A Newland,Pamela K %+ Program in Occupational Therapy, St. Louis School of Medicine, Washington University, 5200 Berthold Avenue Suite B, St. Louis, MO, 63110, United States, 1 314 286 1659, morgank@wustl.edu %K fatigue %K disability %K mobile health %K mHealth %K patient activation %D 2022 %7 21.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Fatigue significantly affects daily functioning in persons with disabilities. Fatigue management can be challenging, and the information provided during routine physician visits to manage fatigue can be overwhelming. One way to address fatigue is to increase knowledge, skills, and confidence for self-management (ie, patient activation). Self-management programs have shown promising effects in targeting fatigue in persons with disabilities. However, satisfaction with self-management programs is low for persons with disabilities, and tailoring interventions to personalized needs has been recommended. SMS text messaging is increasingly being used to implement health behavior change interventions in a person’s natural environment. Little has been done to link mobile health approaches with patient activation and self-management to address fatigue in persons with disabilities. Objective: This study aimed to develop and test a mobile phone–based fatigue self-management SMS text messaging intervention targeting patient activation in 3 groups of persons with disabilities: persons with multiple sclerosis, persons who had a stroke, and persons with a spinal cord injury. Methods: We used evidence-based resources and input from a consumer advisory board (CAB; composed of 2 participants from each of the 3 disability groups) and a neurologist to develop the intervention. The study was conducted using a 4-step process: development of the initial SMS text messaging library and categorization of the content into 9 content areas, review and modification of the SMS text messages by the neurologist and CAB, integration of the content library into a digital platform, and utility testing by CAB members. Results: A total of 6 CAB participants rated SMS text messages covering 9 domain areas of fatigue self-management with good clarity (mean ratings=3.5-5.0 out of 5) and relevance (mean ratings=3.2-5.0 out of 5). Overall, SMS text messaging content was reported by CAB participants as helpful, clear, and well suited for a mobile health intervention. The CAB reached consensus on the time of day that SMS text messages should be sent (morning) and their frequency (once per day). This feedback led the research team to narrow down the program to deliver 48 SMS text messages, 1 per day, Monday through Thursday only, a total of 4 SMS text messages per week, over a 12-week period. The final set of SMS text messages was programmed into a digital platform with a predefined delivery schedule. The usability of the intervention was high, with 55 (83%) out of 66 responses endorsing the highest rating. Conclusions: This study demonstrates a step-by-step process for developing a fatigue self-management SMS text messaging intervention for persons with disabilities. For this population, whose access to health services is often limited, this intervention provides an alternative delivery model to increase access to fatigue information and deliver content that aligns with the person’s needs. %M 36542466 %R 10.2196/40166 %U https://formative.jmir.org/2022/12/e40166 %U https://doi.org/10.2196/40166 %U http://www.ncbi.nlm.nih.gov/pubmed/36542466 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40139 %T End User Participation in the Development of an Ecological Momentary Intervention to Improve Coping With Cannabis Cravings: Formative Study %A Anderson,Molly A %A Budney,Alan J %A Jacobson,Nicholas C %A Nahum-Shani,Inbal %A Stanger,Catherine %+ Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 46 Centerra Parkway, EverGreen Center, Suite 315, Lebanon, NH, 03766, United States, 1 603 646 7023, catherine.stanger@dartmouth.edu %K cannabis %K formative %K distraction %K mindfulness %K coping %K youth %K public health %K mental health %K health intervention %K ecological momentary intervention %D 2022 %7 15.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Cannabis misuse in young adults is a major public health concern. An important predictor of continued use is cannabis craving. Due to the time-varying nature of cravings, brief momentary interventions delivered while cravings are elevated may improve the use of strategies to cope with cravings and reduce cannabis use. Objective: The goal of this manuscript is to describe a formative study to develop coping strategy messages for use in a subsequent intervention. Methods: Young adults (aged 19-25 years; n=20) who reported using cannabis >10 of the past 30 days recruited via social media participated in this formative study. Participants rated an initial set of 15 mindfulness and 15 distraction coping strategies on a scale from 1 to 4 (very low degree to very high degree) for clarity, usefulness, and tone. They also provided comments about the content. Results: Participants found the initial distraction messages slightly clearer than mindfulness (mean 3.5, SD 0.4 and mean 3.4, SD 0.4, respectively), both were comparable in tone (mean 3.2, SD 0.5 and mean 3.2, SD 0.4, respectively), and mindfulness messages were more useful than distraction (mean 3.0, SD 0.5 and mean 2.8, SD 0.6, respectively). Of the 30 messages, 29 received a rating of very low or low (<2) on any domain by >3 participants or received a comment suggesting a change. We revised all these messages based on this feedback, and the participants rated the revised messages approximately 2 weeks later. Participants earned US $10 for completing the first and US $20 for the second survey. The ratings improved on usefulness (especially the distraction items) with very little change in clarity and tone. The top 10 messages of each coping type (mindfulness and distraction) were identified by overall average rating (collapsed across all 3 dimensions: all rated >3.0). The final items were comparable in clarity (distraction mean 3.6, SD 0.4; mindfulness mean 3.6, SD 0.4), tone (distraction mean 3.4, SD 0.4; mindfulness mean 3.4, SD 0.4), and usefulness (distraction mean 3.1, SD 0.5; mindfulness mean 3.2, SD 0.5). Conclusions: The inclusion of end users in the formative process of developing these messages was valuable and resulted in improvements to the content of the messages. The majority of the messages were changed in some way including the removal of potentially triggering language. These messages were subsequently used in an ecological momentary intervention. %M 36520509 %R 10.2196/40139 %U https://formative.jmir.org/2022/12/e40139 %U https://doi.org/10.2196/40139 %U http://www.ncbi.nlm.nih.gov/pubmed/36520509 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e38496 %T Use of an Interactive Obesity Treatment Approach in Individuals With Severe Mental Illness: Feasibility, Acceptability, and Proposed Engagement Criteria %A Nicol,Ginger %A Jansen,Madeline %A Haddad,Rita %A Ricchio,Amanda %A Yingling,Michael D %A Schweiger,Julia A %A Keenoy,Katie %A Evanoff,Bradley A %A Newcomer,John W %+ Department of Psychiatry, Washington University School of Medicine, 600 S. Taylor Ave., Suite 121, St. Louis, MO, 63110, United States, 1 13143625939, nicolg@wustl.edu %K obesity %K mentally ill people/persons %K health services %K mobile health %D 2022 %7 13.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital and mobile health interventions are increasingly being used to support healthy lifestyle change, including in certain high-risk populations such as those with severe mental illnesses (SMIs). Life expectancy in this population lags 15 years behind counterparts in the general population, primarily due to obesity-related health conditions. Objective: We tested the feasibility and usability of a 12-week interactive obesity treatment approach (iOTA) to adults with chronic SMIs (depression, bipolar disorder and schizophrenia spectrum disorder) receiving treatment in community settings. The iOTA incorporates short message service (SMS) text messages to supplement monthly in-person health coaching. Methods: Factors hypothesized to be associated with weight change were illness severity and treatment engagement. Severe psychiatric symptoms were defined as baseline Clinical Global Impression severity score of >5. Criterion engagement was defined as a text messaging response rate >80% during the first 4 weeks of treatment. Disordered eating, assessed with the Loss of Control Over Eating Scores, was also evaluated. Participants provided qualitative data, further informing assessment of intervention feasibility, usability, and acceptability. Results: A total of 26 participants were enrolled. The mean age was 48.5 (SD 15.67) years; 40% (10/26) were Black and 60% (15/26) female. Participants with lower symptom severity and adequate engagement demonstrated significantly decreased weight (F1,16=22.54, P<.001). Conversely, high symptom severity and lower text message response rates were associated with trend-level increases in weight (F1,7=4.33, P=.08). Loss-of-control eating was not observed to impact treatment outcome. Participants voiced preference for combination of live health coaching and text messaging, expressing desire for personalized message content. Conclusions: These results demonstrate the feasibility of delivering an adapted iOTA to SMI patients receiving care in community settings and suggest testable criteria for defining sufficient treatment engagement and psychiatric symptom severity, two factors known to impact weight loss outcomes. These important findings suggest specific adaptations may be needed for optimal treatment outcomes in individuals with SMI. %M 36512399 %R 10.2196/38496 %U https://formative.jmir.org/2022/12/e38496 %U https://doi.org/10.2196/38496 %U http://www.ncbi.nlm.nih.gov/pubmed/36512399 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40837 %T Co-design and Development of EndoSMS, a Supportive Text Message Intervention for Individuals Living With Endometriosis: Mixed Methods Study %A Sherman,Kerry Anne %A Pehlivan,Melissa Jade %A Singleton,Anna %A Hawkey,Alexandra %A Redfern,Julie %A Armour,Mike %A Dear,Blake %A Duckworth,Tanya Jane %A Ciccia,Donna %A Cooper,Michael %A Parry,Kelly Ann %A Gandhi,Esther %A Imani,Sara A %+ Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Balaclava Rd, Sydney, 2109, Australia, 61 9850 6874, kerry.sherman@mq.edu.au %K text message %K intervention %K co-design %K development %K endometriosis %K SMS %K mHealth %K self-management %K mobile phone %D 2022 %7 9.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Endometriosis, which affects 1 in 10 people assigned female at birth, is a chronic systemic inflammatory disease with a high symptom burden and adverse socioemotional impacts. There is a need for an accessible, cost-effective, and low-burden intervention to support individuals in managing their endometriosis condition. Objective: This study aimed to co-design and evaluate the acceptability, readability, and quality of a bank of supportive SMS text messages (EndoSMS) for individuals with endometriosis. Methods: In phase 1 of this mixed method design, 17 consumer representatives (individuals with endometriosis) participated across three 3-hour web-based (Zoom, Zoom Video Communications, Inc) focus groups. The transcripts were encoded and analyzed thematically. In phase 2, consumer representatives (n=14) and health care professionals (n=9) quantitatively rated the acceptability, readability, and appropriateness of the developed text messages in a web-based survey. All the participants initially completed a background survey assessing sociodemographic and medical factors. Results: Consumer representatives demonstrated diverse sociodemographic characteristics (Mage=33.29), varying in location (metropolitan vs rural or regional), employment, and relationship and educational statuses. Participants reached a consensus regarding the delivery of 4 SMS text messages per week, delivered randomly throughout the week and in one direction (ie, no reply), with customization for the time of day and use of personal names. Seven main areas of unmet need for which participants required assistance were identified, which subsequently became the topic areas for the developed SMS text messages: emotional health, social support, looking after and caring for your body, patient empowerment, interpersonal issues, general endometriosis information, and physical health. Through a web-based survey, 371 co-designed SMS text messages were highly rated by consumers and health care professionals as clear, useful, and appropriate for individuals with endometriosis. Readability indices (Flesch-Kincaid scale) indicated that the SMS text messages were accessible to individuals with a minimum of 7th grade high school education. Conclusions: On the basis of the needs and preferences of a diverse consumer representative group, we co-designed EndoSMS, a supportive SMS text message program for individuals with endometriosis. The initial evaluation of the SMS text messages by consumer representatives and health professionals suggested the high acceptability and suitability of the developed SMS text messages. Future studies should further evaluate the acceptability and effectiveness of EndoSMS in a broader population of individuals with endometriosis. %M 36485029 %R 10.2196/40837 %U https://formative.jmir.org/2022/12/e40837 %U https://doi.org/10.2196/40837 %U http://www.ncbi.nlm.nih.gov/pubmed/36485029 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 12 %P e42553 %T A Text-Based Smoking Cessation Intervention for Sexual and Gender Minority Groups: Protocol for a Feasibility Trial %A Tami-Maury,Irene %A Klaff,Rebecca %A Hussin,Allison %A Smith,Nathan Grant %A Chang,Shine %A McNeill,Lorna %A Reitzel,Lorraine R %A Shete,Sanjay %A Abroms,Lorien C %+ School of Public Health, The University of Texas Health Science Center at Houston, Reuel A Stallones Building, 6th Fl, 1200 Pressler Street, Houston, TX, 77030, United States, 1 713 500 9174, irene.tami@uth.tmc.edu %K smoking cessation %K sexual and gender minorities %K LGBTQ+ %K SMS text messaging %K mobile health %K mHealth %D 2022 %7 9.12.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smoking among sexual and gender minority (SGM) groups, which include lesbian, gay, bisexual, transgender, and queer individuals, has been reported to be highly prevalent. This is attributed to several factors, including minority-specific stress and targeted tobacco marketing. Therefore, this population is at an increased risk for tobacco-related diseases. SMS text messaging programs have been found to be effective for smoking cessation and appeal to traditionally hard-to-reach populations over other interventions. It has also been suggested that targeted and tailored interventions could be more effective among SGM smokers because they can be designed to assure a safe, validating health care environment that enhances receptivity to cessation. Objective: The aim of this study is to develop SmokefreeSGM, a text-based smoking cessation program tailored to and tested among SGM smokers. Methods: The study consists of three phases, culminating in a feasibility trial. In Phase 1, our research team will collaborate with a Community Advisory Board to develop and pretest the design of SmokefreeSGM. In Phase 2, the tailored text messaging program will be beta tested among 16 SGM smokers. Our research team will use a mixed-methods approach to collect and analyze data from participants who will inform the refinement of SmokefreeSGM. In Phase 3, a feasibility trial will be conducted among 80 SGM smokers either enrolled in SmokefreeSGM or SmokefreeTXT, the original text-based program developed by the National Cancer Institute for the general population. Our research team will examine recruitment, retention, and smoking abstinence rates at 1-, 3-, and 6-month follow-up. Additionally, a qualitative interview will be conducted among 32 participants to evaluate the feasibility and acceptability of the programs (SmokefreeSGM and SmokefreeTXT). Results: This study received approval from The University of Texas Health Science Center at Houston Committee for the Protection of Human Subjects to begin research on August 21, 2020. Recruitment for the beta testing of SmokefreeSGM (Phase 2) began in January 2022. We estimate that the feasibility trial (Phase 3) will begin in September 2022 and that results will be available in December 2023. Conclusions: Findings from this research effort will help reduce tobacco-related health disparities among SGM smokers by determining the feasibility and acceptability of SmokefreeSGM, an SGM-tailored smoking cessation intervention. Trial Registration: ClinicalTrials.gov NCT05029362; https://clinicaltrials.gov/ct2/show/NCT05029362 International Registered Report Identifier (IRRID): DERR1-10.2196/42553 %M 36485022 %R 10.2196/42553 %U https://www.researchprotocols.org/2022/12/e42553 %U https://doi.org/10.2196/42553 %U http://www.ncbi.nlm.nih.gov/pubmed/36485022 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 4 %P e41140 %T Analyzing User Engagement Within a Patient-Reported Outcomes Texting Tool for Diabetes Management: Engagement Phenotype Study %A Mandal,Soumik %A Belli,Hayley M %A Cruz,Jocelyn %A Mann,Devin %A Schoenthaler,Antoinette %+ Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, United States, 1 7326891369, soumik.mandal@nyulangone.org %K user engagement %K patient-reported outcomes %K mobile health %K mHealth %K digital health %K SMS %K type 2 diabetes %K health behavior %K digital phenotyping %D 2022 %7 14.11.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: Patient-reported outcomes (PROs) capture patients’ views on their health conditions and its management, and are increasingly used in clinical trials, including those targeting type 2 diabetes (T2D). Mobile health (mHealth) tools offer novel solutions for collecting PRO data in real time. Although patients are at the center of any PRO-based intervention, few studies have examined user engagement with PRO mHealth tools. Objective: This study aimed to evaluate user engagement with a PRO mHealth tool for T2D management, identify patterns of user engagement and similarities and differences between the patients, and identify the characteristics of patients who are likely to drop out or be less engaged with a PRO mHealth tool. Methods: We extracted user engagement data from an ongoing clinical trial that tested the efficacy of a PRO mHealth tool designed to improve hemoglobin A1c levels in patients with uncontrolled T2D. To date, 61 patients have been randomized to the intervention, where they are sent 6 PRO text messages a day that are relevant to T2D self-management (healthy eating and medication adherence) over the 12-month study. To analyze user engagement, we first compared the response rate (RR) and response time between patients who completed the 12-month intervention and those who dropped out early (noncompleters). Next, we leveraged latent class trajectory modeling to classify patients from the completer group into 3 subgroups based on similarity in the longitudinal engagement data. Finally, we investigated the differences between the subgroups of completers from various cross-sections (time of the day and day of the week) and PRO types. We also explored the patient demographics and their distribution among the subgroups. Results: Overall, 19 noncompleters had a lower RR to PRO questions and took longer to respond to PRO questions than 42 completers. Among completers, the longitudinal RRs demonstrated differences in engagement patterns over time. The completers with the lowest engagement showed peak engagement during month 5, almost at the midstage of the program. The remaining subgroups showed peak engagement at the beginning of the intervention, followed by either a steady decline or sustained high engagement. Comparisons of the demographic characteristics showed significant differences between the high engaged and low engaged subgroups. The high engaged completers were predominantly older, of Hispanic descent, bilingual, and had a graduate degree. In comparison, the low engaged subgroup was composed mostly of African American patients who reported the lowest annual income, with one of every 3 patients earning less than US $20,000 annually. Conclusions: There are discernible engagement phenotypes based on individual PRO responses, and their patterns vary in the timing of peak engagement and demographics. Future studies could use these findings to predict engagement categories and tailor interventions to promote longitudinal engagement. Trial Registration: Clinicaltrials.gov NCT03652389; https://clinicaltrials.gov/ct2/show/NCT03652389 International Registered Report Identifier (IRRID): RR2-10.2196/18554 %M 36374531 %R 10.2196/41140 %U https://diabetes.jmir.org/2022/4/e41140 %U https://doi.org/10.2196/41140 %U http://www.ncbi.nlm.nih.gov/pubmed/36374531 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e40507 %T A Digital Video and Text Messaging Intervention to Support People With Chronic Pain During Opioid Tapering: Content Development Using Co-design %A Magee,Michael R %A Gholamrezaei,Ali %A McNeilage,Amy G %A Sim,Alison %A Dwyer,Leah %A Ferreira,Manuela L %A Darnall,Beth D %A Glare,Paul %A Ashton-James,Claire E %+ Pain Management Research Institute, Faculty of Medicine and Health, The University of Sydney, Douglas Building, Royal North Shore Hospital, Reserve Rd, Sydney, St Leonards 2065, Australia, 61 2 9463 1526, mmag9080@uni.sydney.edu.au %K chronic pain %K deprescribing %K tapering %K dose reduction %K opioids %K mHealth %K mobile health %K SMS %K text messaging %K digital health %K behavior change %K self-efficacy %K consumer engagement %K co-design %K coproduction %D 2022 %7 10.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: People living with chronic pain report that tapering prescribed opioids is challenging and more support is needed. In our formative research, consumers indicated that mobile health (mHealth) technology could be an acceptable form of support for opioid tapering and may improve tapering self-efficacy. Objective: We aimed to evaluate and improve the content of an mHealth intervention before pilot-testing, based on consumer and clinician feedback. Methods: Participants were 12 consumers and 12 clinicians who evaluated an initial draft of a video script and 90 SMS text messages. Consumers and clinicians rated the appropriateness and likely usefulness (consumers) or likely effectiveness (clinicians) of a video script and a random selection of 15 SMS text messages using a 5-point Likert-type scale (1=totally disagree; 5=totally agree). Each draft SMS text message was reviewed by 2 consumers and 2 clinicians. Texts were deemed acceptable for inclusion in the pilot intervention only if the summed participant ratings of text appropriateness and usefulness or effectiveness were ≥8. Participants were also invited to provide open-text feedback on the draft script and SMS text messages. Results: Consumers generally agreed that the draft video script and text content were likely to be appropriate (video: mean 4.4, SD 0.52; text: mean 4.3, SD 0.79) and useful (video: mean 4.3, SD 0.65; text: mean 4.2, SD 0.84). Similarly, clinicians generally agreed that the draft video script and text content were likely to be appropriate (video: mean 4.5, SD 0.67; text: mean 4.4, SD 0.81) and effective (video: mean 4.0, SD 0.43; text: mean 4.3, SD 0.76). Overall, 77% (69/90) of the draft texts met the threshold rating for acceptability for inclusion in the pilot test of mHealth intervention by consumers, and 82% (74/90) met the threshold for acceptability by clinicians. Consumers' and clinicians’ ratings were used to rank order the texts. The top 56 draft texts (all meeting the threshold levels of acceptability) were selected for inclusion in the pilot intervention. When consumer or clinician feedback was provided, the texts meeting the criteria for inclusion in the pilot were further revised and improved. Feedback on the video script was also used to further improve the acceptability of the video script before pilot-testing the intervention. Conclusions: This study describes the process by which a 28-day mHealth intervention to support patients with chronic pain to taper opioid medications was evaluated and improved before pilot-testing. The mHealth intervention consisted of a 10-minute psychoeducational video about pain and opioid tapering and 56 unique SMS text messages providing information and reassurance (texts delivered twice per day for 28 days). Having established that the content of the mHealth intervention is acceptable to both consumer and clinician groups, the mHealth intervention will be piloted in future research. %M 36355415 %R 10.2196/40507 %U https://formative.jmir.org/2022/11/e40507 %U https://doi.org/10.2196/40507 %U http://www.ncbi.nlm.nih.gov/pubmed/36355415 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e38911 %T Text Topics and Treatment Response in Internet-Delivered Cognitive Behavioral Therapy for Generalized Anxiety Disorder: Text Mining Study %A Mylläri,Sanna %A Saarni,Suoma Eeva %A Ritola,Ville %A Joffe,Grigori %A Stenberg,Jan-Henry %A Solbakken,Ole André %A Czajkowski,Nikolai Olavi %A Rosenström,Tom %+ Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, PO Box 21, Haartmaninkatu 3 E, H218, Helsinki, 00014, Finland, 358 407678891, sanna.myllari@helsinki.fi %K iCBT %K CBT %K psychotherapy %K internet therapy %K anxiety %K topic modeling %K natural language processing %D 2022 %7 9.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Text mining methods such as topic modeling can offer valuable information on how and to whom internet-delivered cognitive behavioral therapies (iCBT) work. Although iCBT treatments provide convenient data for topic modeling, it has rarely been used in this context. Objective: Our aims were to apply topic modeling to written assignment texts from iCBT for generalized anxiety disorder and explore the resulting topics’ associations with treatment response. As predetermining the number of topics presents a considerable challenge in topic modeling, we also aimed to explore a novel method for topic number selection. Methods: We defined 2 latent Dirichlet allocation (LDA) topic models using a novel data-driven and a more commonly used interpretability-based topic number selection approaches. We used multilevel models to associate the topics with continuous-valued treatment response, defined as the rate of per-session change in GAD-7 sum scores throughout the treatment. Results: Our analyses included 1686 patients. We observed 2 topics that were associated with better than average treatment response: “well-being of family, pets, and loved ones” from the data-driven LDA model (B=–0.10 SD/session/∆topic; 95% CI –016 to –0.03) and “children, family issues” from the interpretability-based model (B=–0.18 SD/session/∆topic; 95% CI –0.31 to –0.05). Two topics were associated with worse treatment response: “monitoring of thoughts and worries” from the data-driven model (B=0.06 SD/session/∆topic; 95% CI 0.01 to 0.11) and “internet therapy” from the interpretability-based model (B=0.27 SD/session/∆topic; 95% CI 0.07 to 0.46). Conclusions: The 2 LDA models were different in terms of their interpretability and broadness of topics but both contained topics that were associated with treatment response in an interpretable manner. Our work demonstrates that topic modeling is well suited for iCBT research and has potential to expose clinically relevant information in vast text data. %M 36350678 %R 10.2196/38911 %U https://www.jmir.org/2022/11/e38911 %U https://doi.org/10.2196/38911 %U http://www.ncbi.nlm.nih.gov/pubmed/36350678 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e37579 %T Text Message Reminders to Improve Immunization Appointment Attendance in Alberta, Canada: The Childhood Immunization Reminder Project Pilot Study %A MacDonald,Shannon E %A Marfo,Emmanuel %A Sell,Hannah %A Assi,Ali %A Frank-Wilson,Andrew %A Atkinson,Katherine %A Kellner,James D %A McNeil,Deborah %A Klein,Kristin %A Svenson,Lawrence W %+ Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405 - 87 Ave NW, Edmonton, AB, T6G 1C9, Canada, 1 780 248 1463, smacdon@ualberta.ca %K text message %K SMS %K immunization reminder %K reminder-recall %K routine immunization %K childhood %K immunization %K reminder %K children %K language barrier %K Canada %K vaccine %K vaccination %K coverage %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Vaccine coverage for 18-month-old children in Canada is often below the recommended level, which may be partially because of parental forgetfulness. SMS text message reminders have been shown to potentially improve childhood immunization uptake but have not been widely used in Alberta, Canada. In addition, it has been noted that language barriers may impede immunization service delivery but continue to remain unaddressed in many existing reminder and recall systems. Objective: This study aimed to assess the effectiveness and acceptability of using SMS text messages containing a link to web-based immunization information in different languages to remind parents of their child’s 18-month immunization appointment. Methods: The Childhood Immunization Reminder Project was a pilot intervention at 2 public health centers, one each in Lethbridge and Edmonton, Alberta, Canada. Two SMS text message reminders were sent to parents: a booking reminder 3 months before their child turned 18 months old and an appointment reminder 3 days before their scheduled appointment. Booking reminders included a link to the study website hosting immunization information in 9 languages. To evaluate intervention effectiveness, we compared the absolute attendance no-show rates before the intervention and after the intervention. The acceptability of the intervention was evaluated through web-based surveys completed by parents and public health center staff. Google Analytics was used to determine how often web-based immunization information was accessed, from where, and in which languages. Results: Following the intervention, the health center in Edmonton had a reduction of 6.4% (95% CI 3%-9.8%) in appointment no-shows, with no change at the Lethbridge Health Center (0.8%, 95% CI −1.4% to 3%). The acceptability surveys were completed by 222 parents (response rate: 23.9%) and 22 staff members. Almost all (>95%) respondents indicated that the reminders were helpful and provided useful suggestions for improvement. All surveyed parents (222/222, 100%) found it helpful to read web-based immunization information in their language of choice. Google Analytics data showed that immunization information was most often read in English (118/207, 57%), Punjabi (52/207, 25.1%), Arabic (13/207, 6.3%), Spanish (12/207, 5.8%), Italian (4/207, 1.9%), Chinese (4/207, 1.9%), French (2/207, 0.9%), Tagalog (1/207, 0.5%), and Vietnamese (1/207, 0.5%). Conclusions: The study’s findings support the use of SMS text message reminders as a convenient and acceptable method to minimize parental forgetfulness and potentially reduce appointment no-shows. The diverse languages accessed in web-based immunization information suggest the need to provide appropriate translated immunization information. Further research is needed to evaluate the impact of SMS text message reminders on childhood immunization coverage in different settings. %M 36346666 %R 10.2196/37579 %U https://mhealth.jmir.org/2022/11/e37579 %U https://doi.org/10.2196/37579 %U http://www.ncbi.nlm.nih.gov/pubmed/36346666 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e40907 %T Use of a Rapid Qualitative Method to Inform the Development of a Text Messaging Intervention for People With Serious Mental Illness Who Smoke: Formative Research Study %A Nagawa,Catherine S %A Lane,Ian A %A McKay,Colleen E %A Kamberi,Ariana %A Shenette,Lisa L %A Kelly,Megan M %A Davis,Maryann %A Sadasivam,Rajani S %+ Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 508 856 8999, cnagawa@mgh.harvard.edu %K serious mental illness %K mental disorder %K psychiatric disorder %K tobacco use %K smoking cessation %K text messaging %K intervention %K smoking %K mental health %K virtual %K COVID-19 %K pandemic %K symptom %D 2022 %7 7.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: People with serious mental illness are disproportionately affected by smoking and face barriers to accessing smoking cessation treatments in mental health treatment settings. Text-based interventions are cost-effective and represent a widely accessible approach to providing smoking cessation support. Objective: We aimed to identify key factors for adapting text-based cessation interventions for people with serious mental illness who smoke. Methods: We recruited 24 adults from mental health programs who had a serious mental illness and currently smoked cigarettes or had quit smoking within the past 5 years. We then conducted virtual qualitative interviews between November 2020 and August 2021. Data were analyzed using the rapid thematic analytic approach. Results: We identified the following 3 major themes: (1) interplay between smoking and having a serious mental illness, (2) social contextual factors of smoking in adults with serious mental illness, and (3) smoking and quitting behaviors similar to the general population. Participants reported barriers and facilitators to quitting across the 3 themes. Within the “interplay between smoking and having a serious mental illness” theme, barriers included smoking to manage stress and mental health symptoms, and facilitators to quitting included the awareness of the harm of smoking on mental health and patient-provider discussions on smoking and mental health. In the “social contextual factors of smoking in adults with serious mental illness” theme, barriers included high social acceptability of smoking among peers. Positive support and the combined social stigma of smoking and having a mental health condition outside of peer groups motivated individuals to quit. Some participants indicated that low exposure to other smokers during the COVID-19 pandemic helped them to engage in cessation efforts. In the “smoking and quitting behaviors similar to the general population” theme, barriers included smoking after eating, having coffee, drinking alcohol, and experiencing negative social support, and facilitators included health concerns, improvement in the general quality of life, and use of evidence-based tobacco treatments when available. Conclusions: People with serious mental illness often smoke to cope with intense emotional states, manage mental health symptoms, or maintain social bonds. Text message content emphasizing equally effective and less harmful ways for stress reduction and mental health symptom management may improve quit rates in individuals with serious mental illness. %M 36342765 %R 10.2196/40907 %U https://formative.jmir.org/2022/11/e40907 %U https://doi.org/10.2196/40907 %U http://www.ncbi.nlm.nih.gov/pubmed/36342765 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e42216 %T Incentives and Reminders to Improve Long-term Medication Adherence (INMIND): Protocol for a Pilot Randomized Controlled Trial %A Stecher,Chad %A Ghai,Ishita %A Lunkuse,Lillian %A Wabukala,Peter %A Odiit,Mary %A Nakanwagi,Agnes %A Linnemayr,Sebastian %+ College of Health Solutions, Arizona State University, 500 N 3rd Street, Phoenix, AZ, 85004, United States, 1 6024960957, chad.stecher@asu.edu %K medication adherence %K HIV %K antiretroviral therapy %K habit formation %K routines %K behavioral economics %D 2022 %7 31.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Nonadherence to antiretroviral therapy (ART) among people living with HIV is a crucial barrier to attaining viral suppression globally. Existing behavioral interventions have successfully increased ART adherence, but typically show only short-term impact that dissipates after the interventions are withdrawn. Objective: This study aims to test the feasibility, acceptability, and preliminary efficacy of a novel intervention that uses SMS text messages and conditional incentives to support ART initiators in establishing pill-taking habits. Methods: A sample of 150 participants aged ≥18 years who have initiated ART in the preceding 3 months will be recruited from Mildmay Uganda in Kampala, Uganda. All (150/150, 100%) participants will be educated on the anchoring strategy and will choose an existing routine to pair with their daily ART adherence from a set of 3 suggested routines: getting dressed in the morning, eating breakfast, or eating dinner. Then, participants will be randomized to receive either usual care (control group: 50/150, 33.3%) or 1 of the 2 interventions delivered over 3 months: daily SMS text message reminders to follow their chosen anchoring plan (messages group; treatment group 1: 50/150, 33.3%) or daily SMS text messages and incentives conditional on taking their ART medication around the time of their chosen anchor (incentives group; treatment group 2: 50/150, 33.3%). Long-term ART adherence will be evaluated for 6 months after the intervention, and survey assessments will be conducted at baseline, 3 months, and 9 months. Outcomes include feasibility and acceptability measures and intervention efficacy outcomes defined by electronically measured mean medication adherence during the intervention and during the 6 months after the intervention, along with a measure of routine ART adherence based on taking medications around the time of participants’ anchor during the intervention and during the 6 months after intervention. Results: As of February 18, 2022, recruitment was completed. A total of 150 participants were recruited, and data collection is expected to end in December of 2022. Final results are expected to be submitted for publication by April 2023. Conclusions: This study is the first to use behavioral economics–based interventions in combination with the anchoring strategy to improve long-term ART adherence among treatment initiators. We hypothesize that the combination of SMS text message reminders and incentives will increase participants’ use of their anchoring strategy, and thus medication adherence will be better maintained after the intervention ends in our intervention groups relative to the control group that uses only the anchoring strategy. Results of this pilot study will help to refine this combined intervention approach for testing at scale and broaden our understanding of the habit formation process. Trial Registration: ClinicalTrials.gov NCT05131165; https://clinicaltrials.gov/ct2/show/NCT05131165 International Registered Report Identifier (IRRID): DERR1-10.2196/42216 %M 36315224 %R 10.2196/42216 %U https://www.researchprotocols.org/2022/10/e42216 %U https://doi.org/10.2196/42216 %U http://www.ncbi.nlm.nih.gov/pubmed/36315224 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e33276 %T Incidence of Postoperative Pain at 7 Days After Day Surgery Reported Using a Text Messaging Platform: Retrospective Observational Study %A Compère,Vincent %A Mauger,Alban %A Allard,Etienne %A Clavier,Thomas %A Selim,Jean %A Besnier,Emmanuel %+ Department of Anesthesia and Intensive Care, Rouen University Hospital, 1 Rue de Germont, Rouen, 76000, France, 33 617445203, vincent.compere@chu-rouen.fr %K day surgery %K postoperative pain %K emergency consultation %K rehospitalization %K ambulatory management %K pain management %K postsurgery %K postoperative %K ambulatory surgery %K hospitalization %K health care %K mobile health %K mobile platform %D 2022 %7 25.10.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: The most frequent complication observed after ambulatory surgery is acute postoperative pain. Objective: The purpose of this study was to evaluate the late incidence of postoperative pain at 7 days after day surgery. Methods: We retrospectively included patients who underwent day surgery under general or regional anesthesia and those who underwent local anesthesia in Rouen University Hospital from January 2018 to February 2020. Data collected were moderate-to-severe pain reports defined as numeric rating scale (NRS)>3/10 at 1 day (secondary end point) and 7 days (primary end point) after surgery. These data were collected using a semi-intelligent SMS text messaging platform to follow up with the patient at home after ambulatory surgery. Univariate and multivariate analyses were performed to analyze the risk factors for pain. Results: We analyzed 6099 patients. On the day after the surgery, 5.2% (318/6099) of the patients presented with moderate-to-severe pain: 5.9% (248/4187) in the general or regional anesthesia group and 3.7% (70/1912) in the local anesthesia group. At 7 days after the surgery, 18.6% (1135/6099) of the patients presented with moderate-to-severe pain, including 21.3% (892/4187) of the patients in the general or regional anesthesia group and 12.7% (243/1912) of the patients in the local anesthesia group. General surgery (odds ratio [OR] 1.54, 95% CI 1.23-1.92; P<.01) and orthopedic surgery (OR 1.66, 95% CI 1.42-1.94; P<.01) were associated with more late postoperative pain risk. Male gender (OR 0.66, 95% CI 0.57-0.76; P<.01), ophthalmology surgery (OR 0.51, 95% CI 0.42-0.62; P<.01), and gynecologic surgery (OR 0.67, 95% CI 0.50-0.88; P=.01) were associated with less late postoperative pain risk. The rate of emergency consultation or rehospitalization at 7 days after the surgery was 11.1% (679/6099). Late postoperative pain (OR 2.54, 95% CI 1.98-3.32; P<.001), general surgery (OR 2.15, 95% CI 1.65-2.81; P<.001), and urology surgery (OR 1.62, 95% CI 1.06-2.43; P=.02) increased the risk of emergency consultation or rehospitalization. Orthopedic surgery (OR 0.79, 95% CI 0.63-0.99; P=.04) and electroconvulsive therapy (OR 0.43, 95% CI 0.27-0.65; P<.001) were associated with less rates of emergency consultation or rehospitalization. Conclusions: Our study shows that postoperative pain at 7 days after ambulatory surgery was reported in more than 18% of the cases, which was also associated with an increase in the emergency consultation or rehospitalization rates. %M 36282551 %R 10.2196/33276 %U https://periop.jmir.org/2022/1/e33276 %U https://doi.org/10.2196/33276 %U http://www.ncbi.nlm.nih.gov/pubmed/36282551 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 14 %N 1 %P e35318 %T Text Messages to Support Caregivers in a Health Care System: Development and Pilot and National Rollout Evaluation %A Martindale-Adams,Jennifer Lynn %A Clark,Carolyn Davis %A Martin,Jessica Roxy %A Henderson,Charles Richard %A Nichols,Linda Olivia %+ Veterans Affairs Caregiver Center - Caregiver Support Program, Memphis VA Medical Center, Department of Veterans Affairs, 1030 Jefferson, Memphis, TN, 38104, United States, 1 901 523 8990 ext 5082, linda.nichols@va.gov %K mobile health %K mHealth %K self-care %K veterans %K family caregivers %K emotional stress %K burden of illness %K self-efficacy %K mobile phone %D 2022 %7 17.10.2022 %9 Original Paper %J J Particip Med %G English %X Background: Although there are many interventions to support caregivers, SMS text messaging has not been used widely. Objective: In this paper, we aimed to describe development of the Department of Veterans Affairs (VA) Annie Stress Management SMS text messaging protocol for caregivers of veterans, its pilot test, and subsequent national rollout. Methods: The stress management protocol was developed with text messages focusing on education, motivation, and stress-alleviating activities based on the Resources for Enhancing All Caregivers Health (REACH) VA caregiver intervention. This protocol was then tested in a pilot study. On the basis of the pilot study results, a national rollout of the protocol was executed and evaluated. Caregivers were referred from VA facilities nationally for the pilot and national rollout. Pilot caregivers were interviewed by telephone; national rollout caregivers were sent a web-based evaluation link at 6 months. For both evaluations, questions were scored on a Likert scale ranging from completely disagree to completely agree. For both the pilot and national rollout, quantitative data were analyzed with frequencies and means; themes were identified from open-ended qualitative responses. Results: Of the 22 caregivers in the pilot study, 18 (82%) provided follow-up data. On a 5-point scale, they reported text messages had been useful in managing stress (mean score 3.8, SD 1.1), helping them take care of themselves (mean score 3.7, SD 1.3), and making them feel cared for (mean score 4.1, SD 1.7). Texts were easy to read (mean score 4.5, SD 1.2), did not come at awkward times (mean score 2.2, SD 1.4), were not confusing (mean score 1.1, SD 0.2), and did not cause problems in responding (mean score 1.9, 1.1); however, 83% (15/18) of caregivers did not want to request an activity when stressed. Consequently, the national protocol did not require caregivers to respond. In the national rollout, 22.17% (781/3522) of the eligible caregivers answered the web-based survey and reported that the messages had been useful in managing stress (mean score 4.3, SD 0.8), helping them take care of themselves (mean score 4.3, SD 0.8) and loved ones (mean score 4.2, SD 0.8), and making them feel cared for (mean score 4.5, SD 0.8). Almost two-thirds (509/778, 65.4%) of the participants tried all or most of the strategies. A total of 5 themes were identified. The messages were appreciated, helped with self-care, and made them feel less alone, looking on Annie as a friend. The caregivers reported that the messages were on target and came when they were most needed and did not want them to stop. This success has led to four additional caregiver texting protocols: bereavement, dementia behaviors and stress management, (posttraumatic stress disorder) PTSD behaviors, and taking care of you, with 7274 caregivers enrolled as of February 2022. Conclusions: Caregivers reported the messages made them feel cared for and more confident. SMS text messaging, which is incorporated into clinical settings and health care systems, may represent a low-cost way to provide useful and meaningful support to caregivers. %M 36251368 %R 10.2196/35318 %U https://jopm.jmir.org/2022/1/e35318 %U https://doi.org/10.2196/35318 %U http://www.ncbi.nlm.nih.gov/pubmed/36251368 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e35923 %T Factors Related to Smoking and Perceptions of a Behavioral Counseling and Messenger Service–Delivered Smoking Cessation Intervention for People With HIV in China: Qualitative Study %A Yang,Shanyin %A Huang,Jiegang %A Ye,Li %A Lin,Jianyan %A Xie,Zhiman %A Guo,Baodong %A Li,Yanjun %A Liang,Bingyu %A Zheng,Zhigang %A Lunze,Karsten %A Abdullah,Abu S %A Liang,Hao %A Quintiliani,Lisa M %+ Department of Medicine, Boston Univeristy School of Medicine, 72 E Concord St, Boston, MA, 02118, United States, 1 617 638 2777, lisa.quintiliani@bmc.org %K mobile health %K mHealth %K China %K smoking %K smoking cessation %K HIV %K qualitative research %K SMS text messages %K WeChat %D 2022 %7 12.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: China, where half of the adult male population smoke tobacco, has one of the highest global burdens of smoking. Smoking rates are even higher among people with HIV. People with HIV can be affected by smoking in multiple ways, including more severe HIV-related symptoms and worse antiretroviral therapy treatment outcomes. However, smoking cessation services targeted for people with HIV are not routinely integrated into HIV care in China. Given the widespread mobile phone ownership, an exploration of factors related to smoking among people with HIV in China who smoke could inform the design and implementation of mobile smoking cessation interventions that target the needs of this vulnerable population. Objective: This study aims to explore the perspectives of smoking, barriers and facilitators to quitting, and perceptions related to a smoking cessation intervention delivered through behavioral counseling sessions and brief daily messenger service (WeChat)–delivered messages. Methods: We recruited people with HIV from the People’s 4th Hospital of Nanning, Guangxi, China, and conducted semistructured face-to-face interviews. All interviews were audio-recorded, transcribed verbatim in Chinese, and translated into English for data analysis. We conducted a thematic analysis using a codebook, which was guided by a team-based consensus approach to identify 5 main themes. We also explored themes according to the demographic groups. Results: A total of 24 participants were enrolled in the study. The mean age was 37.2 (SD=13.5) years. The participants had lived with HIV for a mean of 2.4 years. The majority were male (18/24, 75%) and lived in urban or metropolitan settings (19/24, 79%). We identified five main themes: variable knowledge of the harms of smoking, both related and unrelated to HIV; willpower perceived as the primary quitting strategy; a duality of the effect of social factors on quitting; perceptions about optimal features of the smoking cessation intervention (eg, messages should be brief and most frequent during the first few weeks); and the largely negative impact of their HIV diagnosis on smoking behaviors. In addition, some themes differed according to participant demographic characteristics such as age, sex, and education level. Conclusions: We identified barriers to and facilitators of smoking cessation among people with HIV in China by conducting semistructured qualitative interviews. Owing to the adverse impact of smoking on HIV outcomes, targeting cessation interventions to the unique needs and preferences of people with HIV in China may be needed to increase the effectiveness of future interventions. A pilot clinical trial will be conducted in the future to evaluate this behavioral counseling and brief daily messenger service (WeChat)–delivered messages approach among people with HIV who smoke in China. %M 36222795 %R 10.2196/35923 %U https://formative.jmir.org/2022/10/e35923 %U https://doi.org/10.2196/35923 %U http://www.ncbi.nlm.nih.gov/pubmed/36222795 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e37316 %T A Tailored SMS Text Message–Based Intervention to Facilitate Patient Access to Referred Community-Based Social Needs Resources: Protocol for a Pilot Feasibility and Acceptability Study %A Lian,Tyler %A Reid,Hadley %A Rader,Abigail %A Dewitt-Feldman,Sarah %A Hezarkhani,Elmira %A Gu,Elizabeth %A Scott,Malik %A Kutzer,Kate %A Sandhu,Sahil %A Crowder,Carolyn %A Ito,Kristin %A Eisenson,Howard %A Bettger,Janet Prvu %A Shaw,Ryan J %A Lewinski,Allison A %A Ming,David Y %A Bosworth,Hayden B %A Zullig,Leah L %A Batch,Bryan C %A Drake,Connor %+ Department of Population Health Science, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, United States, 1 (919) 681 6801, connor.drake@duke.edu %K text messaging %K primary health care %K social determinants of health %K needs assessment %K community health centers %K vulnerable populations %D 2022 %7 11.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health care providers are increasingly screening patients for unmet social needs (eg, food, housing, transportation, and social isolation) and referring patients to relevant community-based resources and social services. Patients’ connection to referred services is often low, however, suggesting the need for additional support to facilitate engagement with resources. SMS text messaging presents an opportunity to address barriers related to contacting resources in an accessible, scalable, and low-cost manner. Objective: In this multi-methods pilot study, we aim to develop an automated SMS text message–based intervention to promote patient connection to referred social needs resources within 2 weeks of the initial referral and to evaluate its feasibility and patient acceptability. This protocol describes the intervention, conceptual underpinnings, study design, and evaluation plan to provide a detailed illustration of how SMS technology can complement current social needs screening and referral practice patterns without disrupting care. Methods: For this pilot prospective cohort study, this SMS text message–based intervention augments an existing social needs screening, referral, and navigation program at a federally qualified health center. Patients who received at least one referral for any identified unmet social need are sent 2 rounds of SMS messages over 2 weeks. The first round consists of 5-10 messages that deliver descriptions of and contact information for the referred resources. The second round consists of 2 messages that offer a brief reminder to contact the resources. Participants will evaluate the intervention via a survey and a semistructured interview, informed by an adapted technology acceptance model. Rapid qualitative and thematic analysis will be used to extract themes from the responses. Primary outcomes are implementation feasibility and patient acceptability. Secondary outcomes relate to intervention effectiveness: self-reported attempt to connect and successful connection to referred resources 2 weeks after the initial referral encounter. Results: The study received regulatory approval in May 2021, and we anticipate enrolling 15-20 participants for this initial pilot. Conclusions: This protocol presents detailed implementation methods about a novel automated SMS intervention for social care integration within primary care. By sharing the study protocol early, we intend to facilitate the development and adoption of similar tools across different clinical settings, as more health care providers seek to address the unmet social needs of patients. Study findings will provide practical insights into the design and implementation of SMS text message–based interventions to improve social and medical care coordination. International Registered Report Identifier (IRRID): DERR1-10.2196/37316 %M 36222790 %R 10.2196/37316 %U https://www.researchprotocols.org/2022/10/e37316 %U https://doi.org/10.2196/37316 %U http://www.ncbi.nlm.nih.gov/pubmed/36222790 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e35643 %T Emergency Visits and Hospitalization After Chat Message, Voice Call, or Video Call for Telehealth in Obstetrics and Gynecology Using Telehealth Service User Data in Japan: Cross-sectional Study %A Sakakibara,Koichi %A Shigemi,Daisuke %A Toriumi,Rena %A Ota,Ai %A Michihata,Nobuaki %A Yasunaga,Hideo %+ Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, United States, 1 03 4405 9862, ksakaki1@jhmi.edu %K eHealth %K gynecology %K chat message %K mobile health %K mHealth %K obstetrics %K safety %K telehealth %K telemedicine %K video call %K voice call %D 2022 %7 23.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: In obstetric and gynecologic practices, synchronous telehealth services via chat message, voice calls, and video calls have been increasingly equipped to improve patients’ health care accessibility and clinical outcomes. Nevertheless, differences in clinical outcomes between communication tools remain unknown, especially in terms of safety. Objective: This study compared the occurrence of emergency visits and hospitalization after telehealth services through different communication tools, including chat messages, voice calls, and video calls. Methods: We collected data on obstetric and gynecologic concerns of women who consulted specialized doctors and midwives through a telehealth consulting service in Japan (Sanfujin-ka Online) between January 1, 2019, and December 31, 2020. The outcomes were emergency visits or hospitalizations at night after the consultation. Chi-square test and multivariate logistic regression analysis were performed to compare the clinical outcomes between the groups who received telehealth services via chat message, voice calls, and video calls. Results: This study included 3635 participants. The mean age of the participants was 31.4 (SD 5.7) years, and the largest age group (n=2154, 59.3%) was 30-39 years. The numbers (or proportions) of those who received telehealth services via chat message, voice calls, and video calls were 1584 (43.5%), 1947 (53.6%), and 104 (2.9%), respectively. The overall incidence of the outcome was 0.7% (26/3635), including 10 (0.3%) cases of chat message, 16 (0.5%) cases of voice calls, and no video calls. There were no emergency visits that happened due to inappropriate advice. No significant difference in the proportions of the outcomes was observed between the communication tools (P=.55). The multivariate logistic regression analysis showed no significant differences in the outcome between those who used chat message and those who used voice calls (odds ratio 1.63, 95% CI 0.73-3.65). Conclusions: The communication tools of telehealth services in obstetrics and gynecology did not show a significant difference in terms of emergency visits or hospitalizations after using the service. %M 36149744 %R 10.2196/35643 %U https://www.jmir.org/2022/9/e35643 %U https://doi.org/10.2196/35643 %U http://www.ncbi.nlm.nih.gov/pubmed/36149744 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e39617 %T The Impact of a Text Messaging Service (Tonsil-Text-To-Me) on Pediatric Perioperative Tonsillectomy Outcomes: Cohort Study With a Historical Control Group %A Wozney,Lori %A Vakili,Negar %A Chorney,Jill %A Clark,Alexander %A Hong,Paul %+ Mental Health and Addictions, Policy and Planning, Nova Scotia Health, 300 Pleasant St, Dartmouth, NS, B2Y 3S3, Canada, 1 9024490603, loriwozney@gmail.com %K tonsillectomy %K otorhinolaryngology %K text messaging %K caregivers %K surgery %K perioperative %K patient discharge %K aftercare %K short messaging service %K pain management %K mobile phone %D 2022 %7 20.9.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Tonsillectomy is a common pediatric surgical procedure performed in North America. Caregivers experience complex challenges in preparing for their child’s surgery and coordinating care at home and, consequently, could benefit from access to educational resources. A previous feasibility study of Tonsil-Text-To-Me, an automated SMS text messaging service that sends 15 time-sensitive activity reminders, links to nutrition and hydration tips, pain management strategies, and guidance on monitoring for complications, showed promising results, with high levels of caregiver satisfaction and engagement. Objective: This study aimed to pilot-test Tonsil-Text-To-Me in a real-world context to determine whether and how it might improve perioperative experiences and outcomes for caregivers and patients. Methods: Caregivers of children aged 3 to 14 years undergoing tonsillectomy were included. Data from a historical control group and an intervention group with the same study parameters (eg, eligibility criteria and surgery team) were compared. Measures included the Parenting Self-Agency Measure, General Health Questionnaire-12, Parents’ Postoperative Pain Measure, Client Satisfaction Questionnaire-8, and engagement analytics, as well as analgesic consumption, pain, child activity level, and health service use. Data were collected on the day before surgery, 3 days after surgery, and 14 days after surgery. Participants in the intervention group received texts starting 2 weeks before surgery up to the eighth day after surgery. Descriptive and inferential statistics were used. Results: In total, 51 caregivers (n=32, 63% control; n=19, 37% intervention) who were predominately women (49/51, 96%), White (48/51, 94%), and employed (42/51, 82%) participated. Intervention group caregivers had a statistically significant positive difference in Parenting Self-Agency Measure scores (P=.001). The mean postoperative pain scores were higher for the control group (mean 10.0, SD 3.1) than for the intervention group (mean 8.5, SD 3.7), both of which were still above the 6/15 threshold for clinically significant pain; however, the difference was not statistically significant (t39=1.446; P=.16). Other positive but nonsignificant trends for the intervention group compared with the control group were observed for the highest level of pain (t39=0.882; P=.38), emergency department visits (χ22=1.3; P=.52; Cramer V=0.19), and other measures. Engagement with resources linked in the texts was moderate, with all but 1 being clicked on for viewing at least once by 79% (15/19) of the participants. Participants rated the intervention as highly satisfactory across all 8 dimensions of the Client Satisfaction Questionnaire (mean 29.4, SD 3.2; out of a possible value of 32.0). Conclusions: This cohort study with a historical control group found that Tonsil-Text-To-Me had a positive impact on caregivers’ perioperative care experience. The small sample size and unclear impacts of COVID-19 on the study design should be considered when interpreting the results. Controlled trials with larger sample sizes for evaluating SMS text messaging interventions aimed to support caregivers of children undergoing tonsillectomy surgery are warranted. %M 36125849 %R 10.2196/39617 %U https://periop.jmir.org/2022/1/e39617 %U https://doi.org/10.2196/39617 %U http://www.ncbi.nlm.nih.gov/pubmed/36125849 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 9 %P e31996 %T Effect of Face-to-Face and WhatsApp Communication of a Theory-Based Health Education Intervention on Breastfeeding Self-Efficacy (SeBF Intervention): Cluster Randomized Controlled Field Trial %A Mohamad Pilus,Farahana %A Ahmad,Norliza %A Mohd Zulkefli,Nor Afiah %A Mohd Shukri,Nurul Husna %+ Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Jalan Hospital Serdang, Serdang, 43400, Malaysia, 60 97692424, lizaahmad@upm.edu.my %K self-efficacy %K breastfeeding %K intervention %K social cognitive theory %D 2022 %7 14.9.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The exclusive breastfeeding rate in Malaysia is still not satisfactory. Previous studies have shown that breastfeeding self-efficacy is one of the determinants of exclusive breastfeeding, and it can be improved using social cognitive theory. WhatsApp, which is widely used among Malaysians, could be leveraged as a platform to deliver health education interventions. Objective: This study aimed to develop, implement, and evaluate the effect of using a face-to-face and WhatsApp-based health education intervention based on social cognitive theory, namely the Self-Efficacy in Breastfeeding (SeBF) module, on mothers' self-efficacy, knowledge, and attitudes in a district in Selangor state. Methods: This study was a 2-arm, parallel, single-blind, cluster randomized controlled field trial with an intervention and a control group involving primigravida or multigravida mothers who reside in a district in Selangor state and did not exclusively breastfeed during their previous pregnancy. All 12 maternity and pediatric clinics in this district were randomly divided into 6 intervention and 6 control groups. A total of 172 pregnant mothers were randomly assigned to the intervention group (n=86) or the control group (n=86). The control group received usual routine care. The primary outcome was breastfeeding self-efficacy, while secondary outcomes were knowledge and attitude toward breastfeeding. Each subject was assessed at 4 time points: at baseline, immediately after the intervention, 4 weeks post partum, and 8 weeks post partum. Generalized mixed model analysis was applied to measure the effect of health education on breastfeeding self-efficacy, knowledge, and attitude after the intervention. Results: The response rate was 81% (139/172), with the dropout rate being 7% (6/86) in the intervention group and 31% (27/86) in the control group. In the intent-to-treat analysis, the intervention group showed a significant increase in the mean total breastfeeding self-efficacy score 8 weeks after delivery compared with the control group (F21,601=111.73, P<.001). In addition, the mean total score for breastfeeding knowledge increased significantly in the intervention group after the intervention compared to the control group (F21,601=8.33, P<.001). However, no significant difference was found in the mean total score for breastfeeding attitude after the intervention (F21,602=5.50, P=.47). Conclusions: Face-to-face and WhatsApp-based participation in the SeBF program, designed on the basis of social cognitive theory, contributed to improved self-efficacy and knowledge about breastfeeding. Further studies need to be conducted with a longer duration (until 6 months post partum) to evaluate its effectiveness in increasing exclusive breastfeeding. Furthermore, new strategies in health education need to be developed to improve breastfeeding attitudes. Trial Registration: Thaiclinicaltrials.org TCTR20200213004; https://www.thaiclinicaltrials.org/show/TCTR20200213004 %M 36103244 %R 10.2196/31996 %U https://mhealth.jmir.org/2022/9/e31996 %U https://doi.org/10.2196/31996 %U http://www.ncbi.nlm.nih.gov/pubmed/36103244 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 9 %P e34488 %T Use of a Semiautomatic Text Message System to Improve Satisfaction With Wait Time in the Adult Emergency Department: Cross-sectional Survey Study %A Ehrler,Frederic %A Rochat,Jessica %A Siebert,Johan N %A Guessous,Idris %A Lovis,Christian %A Spechbach,Hervé %+ Division of Medical Information Sciences, University Hospitals of Geneva, Gabrielle Perret Gentil 4, Geneva, 1205, Switzerland, 41 79 553 16 03, frederic.ehrler@hcuge.ch %K emergency %K patient satisfaction %K service-oriented health care %K quality of care %K health service %K emergency department %D 2022 %7 6.9.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Many factors influence patient satisfaction during an emergency department (ED) visit, but the perception of wait time plays a central role. A long wait time in the waiting room increases the risk of hospital-acquired infection, as well as the risk of a patient leaving before being seen by a physician, particularly those with a lower level of urgency who may have to wait for a longer time. Objective: We aimed to improve the perception of wait time through the implementation of a semiautomatic SMS text message system that allows patients to wait outside the hospital and facilitates the recall of patients closer to the scheduled time of meeting with the physician. Methods: We performed a cross-sectional survey to evaluate the system using a tailored questionnaire to assess the patient perspective and the Unified Theory of Acceptance and Use of Technology questionnaire for the caregiver perspective. We also monitored the frequency of system use with logs. Results: A total of 110 usable responses were collected (100 patients and 10 caregivers). Findings revealed that 97 of 100 (97%) patients were satisfied, with most patients waiting outside the ED but inside the hospital. The caregiver evaluation showed that it was very easy to use, but the adoption of the system was more problematic because of the perceived additional workload associated with its use. Conclusions: Although not suitable for all patients, our system allows those who have a low-severity condition to wait outside the waiting room and to be recalled according to the dedicated time defined in the Swiss Emergency Triage Scale. It not only has the potential to reduce the risk of hospital-acquired infection but also can enhance the patient experience; additionally, it was perceived as a real improvement. Further automation of the system needs to be explored to reduce caregiver workload and increase its use. %M 36066921 %R 10.2196/34488 %U https://medinform.jmir.org/2022/9/e34488 %U https://doi.org/10.2196/34488 %U http://www.ncbi.nlm.nih.gov/pubmed/36066921 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e38262 %T A Method to Deliver Automated and Tailored Intervention Content: 24-month Clinical Trial %A Miller,Hailey N %A Voils,Corrine I %A Cronin,Kate A %A Jeanes,Elizabeth %A Hawley,Jeffrey %A Porter,Laura S %A Adler,Rachel R %A Sharp,Whitney %A Pabich,Samantha %A Gavin,Kara L %A Lewis,Megan A %A Johnson,Heather M %A Yancy Jr,William S %A Gray,Kristen E %A Shaw,Ryan J %+ School of Nursing, Duke University, 307 Trent Drive, North Carolina, NC, 27710, United States, 1 919 684 9434, ryan.shaw@duke.edu %K text message %K weight management %K automation %K clinical trial %K engagement %K digital technology %K electronic data capture %K REDCap %K automated text message %K digital health intervention %K health intervention %K health database %K digital health %D 2022 %7 6.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of digital technologies and software allows for new opportunities to communicate and engage with research participants over time. When software is coupled with automation, we can engage with research participants in a reliable and affordable manner. Research Electronic Data Capture (REDCap), a browser-based software, has the capability to send automated text messages. This feature can be used to automate delivery of tailored intervention content to research participants in interventions, offering the potential to reduce costs and improve accessibility and scalability. Objective: This study aimed to describe the development and use of 2 REDCap databases to deliver automated intervention content and communication to index participants and their partners (dyads) in a 2-arm, 24-month weight management trial, Partner2Lose. Methods: Partner2Lose randomized individuals with overweight or obesity and cohabitating with a partner to a weight management intervention alone or with their partner. Two databases were developed to correspond to 2 study phases: one for weight loss initiation and one for weight loss maintenance and reminders. The weight loss initiation database was programmed to send participants (in both arms) and their partners (partner-assisted arm) tailored text messages during months 1-6 of the intervention to reinforce class content and support goal achievement. The weight maintenance and reminder database was programmed to send maintenance-related text messages to each participant (both arms) and their partners (partner-assisted arm) during months 7-18. It was also programmed to send text messages to all participants and partners over the course of the 24-month trial to remind them of group classes, dietary recall and physical activity tracking for assessments, and measurement visits. All text messages were delivered via Twilio and were unidirectional. Results: Five cohorts, comprising 231 couples, were consented and randomized in the Partner2Lose trial. The databases will send 53,518 automated, tailored text messages during the trial, significantly reducing the need for staff to send and manage intervention content over 24 months. The cost of text messaging will be approximately US $450. Thus far, there is a 0.004% known error rate in text message delivery. Conclusions: Our trial automated the delivery of tailored intervention content and communication using REDCap. The approach described provides a framework that can be used in future behavioral health interventions to create an accessible, reliable, and affordable method for intervention delivery and engagement that requires minimal trial-specific resources and personnel time. Trial Registration: ClinicalTrials.gov NCT03801174; https://clinicaltrials.gov/ct2/show/NCT03801174?term=NCT03801174 %M 36066936 %R 10.2196/38262 %U https://formative.jmir.org/2022/9/e38262 %U https://doi.org/10.2196/38262 %U http://www.ncbi.nlm.nih.gov/pubmed/36066936 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e36919 %T Integrating Social Determinants of Health With Tobacco Treatment for Individuals With Opioid Use Disorder: Feasibility and Acceptability Study of Delivery Through Text Messaging %A Kathuria,Hasmeena %A Shankar,Divya %A Cobb,Vinson %A Newman,Julia %A Bulekova,Katia %A Werntz,Scott %A Borrelli,Belinda %+ The Pulmonary Center, Boston University School of Medicine, 72 E Concord St, R304, Boston, MA, 02118, United States, 1 6176384860, hasmeena@bu.edu %K text message %K smoking cessation %K opioid use disorder %K tobacco dependence %K tobacco treatment interventions %K mobile phone %D 2022 %7 1.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with opioid use disorder (OUD) have a high prevalence of smoking and frequently experience unmet social determinants of health (SDOH), which may be barriers to smoking cessation. Hospitalization is an opportunity to encourage smoking cessation. Unfortunately, many clinicians do not provide tobacco treatment to support the maintenance of cessation achieved during hospitalization. Interventions are required to support these high-risk individuals after hospital discharge. Objective: This study aimed to test the feasibility and acceptability of a 28-day SMS text messaging program tailored to individuals with OUD, which provides smoking cessation support and addresses unmet SDOH needs. Methods: From July to December 2019, we enrolled 25 individuals who were hospitalized with tobacco dependence and OUD at our large safety net hospital. The SMS text messaging program was initiated during hospitalization and continued for 28 days. Participants were enrolled in either the ready to quit within 30 days or the not ready to quit within 30 days program based on their readiness to quit. Automated SMS text messages were sent twice daily for 4 weeks. The topics included health and cost benefits of quitting, both general and opioid specific (16 messages); managing mood and stress (8 messages); motivation, coping strategies, and encouragement (18 messages); addressing medication misconceptions (5 messages); links to resources to address substance use (2 messages providing links to the Massachusetts Substance Use Helpline and Boston Medical Center resources), tobacco dependence (1 message providing a link to the Massachusetts Quitline), and unmet SDOH needs (6 messages assessing SDOH needs with links to resources if unmet SDOH needs were identified). Questionnaires and interviews were conducted at baseline and at 2 and 4 weeks after enrollment. Results: The participants were 56% (14/25) female, 36% (9/25) African American, 92% (23/25) unemployed, and 96% (24/25) Medicaid insured. Approximately 84% (21/25) activated the program, and none of the participants unsubscribed. Approximately 57% (12/21) completed either the 2- or 4-week questionnaires. Program satisfaction was high (overall mean 6.7, SD 0.8, range 1-7). Many perceived that the SMS text messaging program provided social support, companionship, and motivation to stop smoking. Messages about the health benefits of quitting were well received, whereas messages on how quitting cigarettes may prevent relapse from other substances had mixed views, highlighting the importance of tailoring interventions to patient preferences. Conclusions: SMS text messaging to promote smoking cessation and address SDOH needs may be an effective tool for improving quit rates and health outcomes in individuals with tobacco dependence and OUD. Our study adds to the growing body of evidence that SMS text messaging approaches are feasible and acceptable for providing tobacco treatment to all individuals who smoke, even among low-income populations who have OUD and are not ready to quit. %M 36048509 %R 10.2196/36919 %U https://formative.jmir.org/2022/9/e36919 %U https://doi.org/10.2196/36919 %U http://www.ncbi.nlm.nih.gov/pubmed/36048509 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e39772 %T Feasibility of a Novel COVID-19 Telehealth Care Management Program Among Individuals Receiving Treatment for Opioid Use Disorder: Analysis of a Pilot Program %A Williams,Kimberly D %A Jurkovitz,Claudine T %A Papas,Mia A %A Muther,Ann Kathryn %A Anderson,Sharon L %A Anderson,Tammy L %+ Institute for Research on Equity and Community Health, ChristianaCare, Avenue North, 4000 Nexus Drive, Suite CE1-300, Wilmington, DE, 19803, United States, 1 302 428 2662, kimwilliams@christianacare.org %K opioid use disorder %K substance use %K drug addiction %K opioid treatment program %K COVID-19 %K telehealth %K telemedicine %K eHealth %K Short Message Service %K SMS %K text messaging %K text message %K opioid use %K opioid %K care management %K patient care management %K health intervention %K telehealth intervention %D 2022 %7 30.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The emergence of COVID-19 exacerbated the existing epidemic of opioid use disorder (OUD) across the United States due to the disruption of in-person treatment and support services. Increased use of technology including telehealth and the development of new partnerships may facilitate coordinated treatment interventions that comprehensively address the health and well-being of individuals with OUD. Objective: The analysis of this pilot program aimed to determine the feasibility of delivering a COVID-19 telehealth care management program using SMS text messages for patients receiving OUD treatment. Methods: Eligible individuals were identified from a statewide opioid treatment program (OTP) network. Those who screened positive for COVID-19 symptoms were invited to connect to care management through a secure SMS text message that was compliant with Health Insurance Portability and Accountability Act standards. Care management monitoring for COVID-19 was provided for a period of up to 14 days. Monitoring services consisted of daily SMS text messages from the care manager inquiring about the participant’s physical health in relation to COVID-19 symptoms by confirming their temperature, if the participant was feeling worse since the prior day, and if the participant was experiencing symptoms such as coughing or shortness of breath. If COVID-19 symptoms worsened during this observation period, the care manager was instructed to refer participants to the hospital for acute care services. The feasibility of the telehealth care management intervention was assessed by the rates of adoption in terms of program enrollment, engagement as measured by the number of SMS text message responses per participant, and retention in terms of the number of days participants remained in the program. Results: Between January and April 2021, OTP staff members referred 21 patients with COVID-19 symptoms, and 18 (82%) agreed to be contacted by a care manager. Participants ranged in age from 27 to 65 years and primarily identified as female (n=12, 67%) and White (n=15, 83%). The majority of participants were Medicaid recipients (n=14, 78%). There were no statistically significant differences in the demographic characteristics between those enrolled and not enrolled in the program. A total of 12 (67%) patients were enrolled in the program, with 2 (11%) opting out of SMS text message communication and choosing instead to speak with a care manager verbally by telephone. The remaining 10 participants answered a median of 7 (IQR 4-10) SMS text messages and were enrolled in the program for a median of 9 (IQR 7.5-12) days. No participants were referred for acute care services or hospitalized during program enrollment. Conclusions: These results demonstrate the feasibility of a novel telehealth intervention to monitor COVID-19 symptoms among OTP patients in treatment for OUD. Further research is needed to determine the applicability of this intervention to monitor patients with comorbid chronic conditions in addition to the acceptability among patients and providers using the SMS text messaging modality. %M 35973033 %R 10.2196/39772 %U https://formative.jmir.org/2022/8/e39772 %U https://doi.org/10.2196/39772 %U http://www.ncbi.nlm.nih.gov/pubmed/35973033 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e36000 %T Effects of a WeChat-Based Life Review Program for Patients With Digestive System Cancer: 3-Arm Parallel Randomized Controlled Trial %A Zheng,Meihua %A Zhang,Xiaoling %A Xiao,Huimin %+ School of Nursing, Fujian Medical University, No 1 Xuefu North Road, University Town, Shangjie Town, Minhou County, Fuzhou City, Fujian Province, 350122, China, 86 13860692061, huimin_xiao@126.com %K digestive system cancer %K life review %K digital technology %K anxiety %K depression %K hope %K self-transcendence %K cancer %K randomized controlled trial %K distress %K psychological %K digestive system %D 2022 %7 25.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients with digestive system cancer often experience psychospiritual distress. Life review is an evidence-based psychological intervention for patients with cancer, but the effects of digital life review programs are unclear, especially for patients with digestive system cancer. Objective: We examined the effects of a WeChat-based life review program on the psychospiritual well-being of patients with digestive system cancer. Methods: This study was a 3-arm parallel randomized controlled trial. Eligible patients with digestive system cancer were recruited from a university hospital in Fujian, China. They were randomized to a life review group and 2 control groups. All participants received routine care, and the life review group also received the 4-week WeChat-based life review program. Control group 1 also received a 4-week program of friendly visiting. Anxiety, depression, hope, and self-transcendence were measured at baseline and 2 days, 1 month, and 6 months after the intervention. Results: A total of 150 participants were randomly allocated to the WeChat-based life review group (n=50), control group 1 (n=50), or control group 2 (n=50). The overall dropout rate was 10% (15/150), and 92% (46/50) of participants in the the life review group completed the intervention. Significant interaction effects for time and group membership were found for anxiety (P<.001), depression (P<.001), hope (P<.001), and self-transcendence (P<.001) at all follow-up time points. For anxiety and depression, the scores did not differ significantly between the life review group and control group 1 on day 2 (P=.80 for anxiety, P=.51 for depression), but the scores were significantly lower in the life review group at month 1 and month 6 (P=.02 for anxiety at both months 1 and 6; P=.003 and P<.001 for depression at months 1 and 6, respectively). Significant increases in hope and self-transcendence were revealed in the life review group compared to control group participants at all follow-up sessions. Conclusions: The WeChat-based life review program was effective in reducing anxiety and depressive symptoms and in improving the level of hope and self-transcendence among patients with digestive system cancer. Though friendly visiting can also help to relieve anxiety, its effects are short-term. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IOR-17011998; https://tinyurl.com/5acycpd4 %M 36006665 %R 10.2196/36000 %U https://www.jmir.org/2022/8/e36000 %U https://doi.org/10.2196/36000 %U http://www.ncbi.nlm.nih.gov/pubmed/36006665 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 3 %P e37526 %T A Multimethod Evaluation of Tobacco Treatment Trial Recruitment Messages for Current Smokers Recently Diagnosed With Cancer: Pilot Factorial Randomized Controlled Trial %A Neil,Jordan M %A Senecal,Christian %A Ballini,Lauren %A Chang,Yuchiao %A Goshe,Brett %A Flores,Efren %A Ostroff,Jamie S %A Park,Elyse R %+ Tobacco Settlement Endowment Trust Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Oklahoma City, OK, 73102, United States, 1 (405) 271 4000, jordan-neil@ouhsc.edu %K teachable moment %K cancer %K tobacco treatment trial %K smoking %K message framing %K recruitment %D 2022 %7 24.8.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: A cancer diagnosis can catalyze motivation to quit smoking. Tobacco treatment trials offer cessation resources but have low accrual rates. Digital outreach may improve accrual, but knowledge of how best to recruit smokers with recent diagnoses is limited. Objective: This study aims to identify the message frames that were most effective in promoting intent to talk to a physician about participating in a tobacco treatment trial for smokers recently diagnosed with cancer. Methods: From February to April 2019, current smokers diagnosed within the past 24 months were recruited from a national web-based panel for a multimethod pilot randomized trial (N=99). Participants were randomized to a 2×3 plus control factorial design that tested 3 unique message frames: proximal versus distal threats of smoking, costs of continued smoking versus benefits of quitting, and gains of participating versus losses of not participating in a tobacco treatment trial. The primary outcome was intent to talk to a physician about participating in a tobacco treatment trial. In phase 1, the main effect within each message factor level was examined using ANOVA and compared with the control condition. Other message evaluation and effectiveness measures were collected and explored in a multivariable model predicting intent to talk to a physician. In phase 2, open-text evaluations of the messages were analyzed using natural language processing software (Leximancer) to generate a thematic concept map and Linguistic Inquiry Word Count to identify and compare the prevalence of linguistic markers among message factors. Results: Of the 99 participants, 76 (77%) completed the intervention. Participants who received the cost of continued smoking frame were significantly more likely to intend to talk to their physician about participating in a tobacco treatment trial than those who received the benefits of the quitting frame (mean costs 5.13, SD 1.70 vs mean benefits 4.23, SD 1.86; P=.04). Participants who received the proximal risks of continued smoking frame were significantly more likely to seek more information about participating (mean distal 4.83, SD 1.61 vs mean proximal 5.55, SD 1.15; P=.04), and those who received the losses of not participating frame reported significantly improved perceptions of smoking cessation research (mean gain 3.98, SD 0.83 vs mean loss 4.38, SD 0.78; P=.01). Male participants (P=.006) and those with greater message relevancy (P=.001) were significantly more likely to intend to talk to their physician. Participants’ perceptions of their smoking habits, as well as their motivation to quit smoking, were prevalent themes in the open-text data. Differences in the percentages of affective words across message frames were identified. Conclusions: Multimethod approaches are needed to develop evidence-based recruitment messages for patients recently diagnosed with cancer. Future tobacco treatment trials should evaluate the effectiveness of different message frames on smoker enrollment rates. Trial Registration: Clinicaltrials.gov NCT05471284; https://clinicaltrials.gov/ct2/show/NCT05471284 %M 36001378 %R 10.2196/37526 %U https://cancer.jmir.org/2022/3/e37526 %U https://doi.org/10.2196/37526 %U http://www.ncbi.nlm.nih.gov/pubmed/36001378 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e37309 %T Evaluation of a Text Messaging Intervention to Promote Preconception Micronutrient Supplement Use: Feasibility Study Nested in the Healthy Life Trajectories Initiative Study in South Africa %A Soepnel,Larske M %A McKinley,Michelle C %A Klingberg,Sonja %A Draper,Catherine E %A Prioreschi,Alessandra %A Norris,Shane A %A Ware,Lisa J %+ SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Private Bag X3, Wits, Johannesburg, 2050, South Africa, 27 010 447 3721, larske.soepnel@gmail.com %K preconception health %K micronutrient supplements %K adherence %K behavioral %K SMS text messaging intervention %K mobile health %K mHealth %K radio serial %K mobile phone %D 2022 %7 18.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Social messaging strategies such as SMS text messaging and radio are promising avenues for health promotion and behavior change in low- to middle-income settings. However, evidence of their acceptability, feasibility, and impact in the context of young women’s health and micronutrient deficiencies is lacking. Objective: This study aimed to evaluate the feasibility of an automated 2-way text messaging intervention nested in an ongoing preconception health trial, the Healthy Life Trajectories Initiative (HeLTI; HeLTI Bukhali) in Soweto, South Africa. Second, we aimed to evaluate the acceptability of a health promotion radio serial, which aired concurrently in the region. Methods: In this feasibility study, 120 participants enrolled in HeLTI Bukhali between November 2020 and February 2021 received the 6-month 2-way text messaging intervention. Quantitative and qualitative data on intervention acceptability, usability, interaction, perceived benefit, and fidelity were collected during 5 focus group discussions (FGDs) and from study data logs. During the FGDs, data were collected on the acceptability of the radio serial. Following the text messaging intervention, capillary hemoglobin levels were assessed, and a participant questionnaire provided information on adherence and attitudes toward supplements. The text messaging control group comprised the first 120 women recruited from November 2019 to February 2020, who received the Bukhali intervention but not the text messages. Statistical significance testing and a linear mixed model were used for indicative effect comparisons between the text message–receiving and control groups. Results: The text messaging intervention was found to be acceptable and to have perceived benefits, including being reminded to take supplements, gaining knowledge, and feeling supported by the study team. The use of the 2-way text messaging reply function was limited, with only a 10.8% (13/120) response rate by week 24. Barriers to replying included a lack of interest or phone credit and technical issues. Regarding the indicative effect, participants receiving the text messages had higher self-reported adherence at follow-up than the text messaging control group (42/63, 67% vs 33/85, 39% taking supplements every time; P=.02), and altitude-adjusted hemoglobin increased more between baseline and follow-up in the SMS text message–receiving group than in the text messaging control group (1.03, 95% CI 0.49-1.57; P<.001). The radio serial content was acceptable, although few participants reported exposure before the FGD. Conclusions: Women reported that the text messaging intervention was useful and described the benefits of receiving the messages. Examination of hemoglobin status indicated a promising beneficial effect of text messaging support on adherence to micronutrient supplementation, requiring further exploration through randomized controlled studies. Health promotion through radio and text messages were both found to be acceptable, although more research into the radio serial reach among young women is needed. Trial Registration: Pan African Clinical Trials Registry (PACTR) PACTR201903750173871; https://tinyurl.com/4x6n32ff %M 35980731 %R 10.2196/37309 %U https://formative.jmir.org/2022/8/e37309 %U https://doi.org/10.2196/37309 %U http://www.ncbi.nlm.nih.gov/pubmed/35980731 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e35685 %T Feasibility of Text Messages for Enhancing Therapeutic Engagement Among Youth and Caregivers Initiating Outpatient Mental Health Treatment: Mixed Methods Study %A Jerrott,Susan %A Clark,Sharon %A Chorney,Jill %A Coulombe,Aimee %A Wozney,Lori %+ Mental Health and Addictions Program, Nova Scotia Health, 300 Pleasant Street, EC Purdy Building, Dartmouth, NS, B2Y 3S3, Canada, 1 902 449 0603, lori.wozney@nshealth.ca %K text messaging %K youth %K mental health %K waiting list %K informatics %K health behavior %K self-care %K mental health literacy %K caregivers %K transdiagnostic %D 2022 %7 2.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Pathways to mental health services for youth are generally complex and often involve numerous contact points and lengthy delays. When starting treatment, there are a host of barriers that contribute to low rates of therapeutic engagement. Automated text messages offer a convenient, low-cost option for information sharing and skill building, and they can potentially activate positive behaviors in youth and caregivers prior to beginning formal therapy. To date, there is little evidence for the feasibility of initiating transdiagnostic text messages during the early stages of youth and caregiver contact with community outpatient mental health services. Objective: To develop and test the feasibility of implementing 2 novel text messaging campaigns aimed at youth clients and their caregivers during the early stages of engaging with outpatient mental health services. Methods: A multidisciplinary panel of experts developed two 12-message interventions with youth and caregivers prior to deployment. Each message included a link to an external interactive or multimedia resource to extend skill development. Enrollment of youth aged 13 to 18 years, their caregivers, or both occurred at 2 early treatment timepoints. At both time points, text messages were delivered automatically 2 times a week for 6 weeks. Analytics and survey data were collected in 2 phases, between January and March 2020 and between January and May 2021. Enrollment, willingness to persist in using the intervention, engagement, satisfaction, perceived value, and impact were measured. Descriptive statistics were used to summarize youth and caregiver outcomes. Results: A total of 41 caregivers and 36 youth consented to participate. Follow-up survey response rates were 54% (22/41) and 44%, (16/36) respectively. Over 1500 text messages were sent throughout the study. More than three-quarters (14/16, 88%) of youth reported that they learned something new and noticed a change in themselves due to receiving the texts; the same proportion (14/16, 88%) of youth said they would recommend the text messages to others. Youth ranked the first text message, related to coping with difficult emotions, as the most helpful of the series. Caregivers reported acting differently due to receiving the texts. Over two-thirds of caregivers were satisfied with the texts (16/22, 73%) and would recommend them to others (16/22, 73%). Caregivers perceived diverse levels of value in the text topics, with 9 of the 12 caregiver texts rated by at least one caregiver as the most helpful. Conclusions: Results are preliminary but show that brief, core skill–focused text messages for youth clients and caregivers in community outpatient mental health services are feasible. Both youth and caregivers reported promising knowledge and behavior change with exposure to only 12 messages over 6 weeks. A larger study with statistical power to detect changes in both perceived helpfulness and engagement is required to confirm the effectiveness of this type of transdiagnostic intervention. %M 35738559 %R 10.2196/35685 %U https://formative.jmir.org/2022/8/e35685 %U https://doi.org/10.2196/35685 %U http://www.ncbi.nlm.nih.gov/pubmed/35738559 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e35688 %T Mindfulness-Based Smoking Cessation Delivered Through Telehealth and Text Messaging for Low-Income Smokers: Protocol for a Randomized Controlled Trial %A Spears,Claire A %A Mhende,Josephine %A Hawkins,China %A Do,Vuong Van %A Hayat,Matthew J %A Eriksen,Michael P %A Hedeker,Donald %A Abroms,Lorien C %A Wetter,David W %+ Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, 140 Decatur Street SE, Atlanta, GA, 30303, United States, 1 404 413 9335, cspears@gsu.edu %K mobile health %K mHealth %K telehealth %K SMS text messaging %K mindfulness %K smoking cessation %K tobacco %K health disparities %K mobile phone %D 2022 %7 1.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Tobacco use is the leading cause of preventable morbidity and mortality. Adults with low income and members of certain racial and ethnic minority groups are less likely to quit, and therefore, they experience profound tobacco-related health disparities. Mindfulness training can increase the rates of smoking cessation and lapse recovery, and telehealth and SMS text messaging have the potential to provide more accessible treatment. Objective: This study aims to test the efficacy of delivering mindfulness-based smoking cessation treatment through text messaging (iQuit Mindfully) and telehealth (group videoconferencing), both as stand-alone interventions and in combination. In addition, it aims to examine the underlying mechanisms of mindfulness treatment. Methods: In this 2×2 randomized controlled trial, participants are randomized into 1 of 4 groups based on assignment to iQuit Mindfully text messages (yes or no) and mindfulness videoconference groups (yes or no). The primary outcomes are biochemically verified smoking abstinence at 8, 12, and 24 weeks after the start of treatment. Secondary outcomes include the frequency of home mindfulness practice and self-reported levels of mindfulness, emotions, craving, withdrawal, dependence, self-efficacy, and social support. Results: Recruitment, treatment, and assessment began in spring and summer 2021, and data collection is expected to continue through spring 2024. Conclusions: This project aims to improve smoking cessation outcomes for low-income, racially and ethnically diverse smokers through mindfulness-based telehealth group counseling and text messaging support. We also aim to advance the scientific study of the mechanisms of action of mindfulness treatment, which could inform the development of more efficacious and efficient treatments to reduce tobacco disparities. Trial Registration: Clinicaltrials.gov NCT04965181; https://clinicaltrials.gov/ct2/show/NCT04965181 International Registered Report Identifier (IRRID): PRR1-10.2196/35688 %M 35916707 %R 10.2196/35688 %U https://www.researchprotocols.org/2022/8/e35688 %U https://doi.org/10.2196/35688 %U http://www.ncbi.nlm.nih.gov/pubmed/35916707 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e33260 %T Evaluation of a Text Message–Based COVID-19 Vaccine Outreach Program Among Older Patients: Cross-sectional Study %A Ahmed,Naheed %A Boxley,Christian %A Dixit,Ram %A Krevat,Seth %A Fong,Allan %A Ratwani,Raj M %A Wesley,Deliya B %+ NYU Grossman School of Medicine, 180 Madison Avenue, 9th Floor, New York, NY, 10016, United States, Naheed.Ahmed@nyulangone.org %K vaccine outreach %K text messaging %K elderly patients %K evaluation %K smartphone %K text message %K SMS %K appointment %K elderly %K older adults %K vaccine %K effectiveness %K engagement %K cross-sectional %D 2022 %7 18.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 vaccines are vital tools in the defense against infection and serious disease due to SARS-CoV-2. There are many challenges to implementing mass vaccination campaigns for large, diverse populations from crafting vaccine promotion messages to reaching individuals in a timely and effective manner. During this unprecedented period, with COVID-19 mass vaccination campaigns essential for protecting vulnerable patient populations and attaining herd immunity, health care systems were faced with the dual challenges of vaccine outreach and distribution. Objective: The aim of this cross-sectional study was to assess the effectiveness of a COVID-19 vaccine text outreach approach for patients aged 65 years and older. Our goal was to determine whether this approach was successful in scheduling patients for COVID-19 vaccine appointments. Methods: We developed SMS text messages using the Tavoca platform. These messages informed patients of their vaccine eligibility and allowed them to indicate their interest in scheduling an appointment via a specific method (email or phone) or indicate their lack of interest in the vaccine. We tracked the status of these messages and how patients responded. Messages were sent to patients aged 65 years and older (N=30,826) at a nonprofit health care system in Washington, DC. Data were collected and examined from January 14 to May 10, 2021. Data were analyzed using multivariate multinomial and binary logistic regression models in SAS (version 9.4; SAS Institute Inc). Results: Approximately 57% of text messages were delivered to patients, but many messages received no response from patients (40%). Additionally, 42.1% (12,978/30,826) of messages were not delivered. Of the patients who expressed interest in the vaccine (2938/30,826, 9.5%), Black or African American patients preferred a phone call rather than an email for scheduling their appointment (odds ratio [OR] 1.69, 95% CI 1.29-2.21) compared to White patients. Patients aged 70-74 years were more likely to schedule an appointment (OR 1.38, 95% CI 1.01-1.89) than those aged 65-69 years, and Black or African American patients were more likely to schedule an appointment (OR 2.90, 95% CI 1.72-4.91) than White patients. Conclusions: This study provides insights into some advantages and challenges of using a text messaging vaccine outreach for patients aged 65 years and older. Lessons learned from this vaccine campaign underscore the importance of using multiple outreach methods and sharing of patient vaccination status between health systems, along with a patient-centered approach to address vaccine hesitancy and access issues. %M 35724339 %R 10.2196/33260 %U https://formative.jmir.org/2022/7/e33260 %U https://doi.org/10.2196/33260 %U http://www.ncbi.nlm.nih.gov/pubmed/35724339 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e37934 %T Burnout and Associated Psychological Problems Among Teachers and the Impact of the Wellness4Teachers Supportive Text Messaging Program: Protocol for a Cross-sectional and Program Evaluation Study %A Agyapong,Belinda %A Wei,Yifeng %A da Luz Dias,Raquel %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor Abbie J Lane Memorial Building QEII Health Sciences Centre, Halifax, NS, B3H 4R2, Canada, 1 7807144315, vincent.agyapong@nshealth.ca %K burnout %K stress %K Wellness4Teachers %K anxiety %K depression %K e-mental health %K teachers %K support %K text message %K mental health %K SMS %K high school %K elementary school %K prevalence %K psychological intervention %K school %D 2022 %7 14.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Stress, burnout, anxiety, and depression continue to be a problem among teachers worldwide. It is not presently known what the prevalence and correlates for these psychological problems are among teachers in Alberta and Nova Scotia. It is also not known if a supportive text message program (Wellness4Teachers) would be effective in reducing stress, burnout, anxiety, or depression symptoms among teachers. Objective: The goal of this study is to evaluate the prevalence and correlates of stress, burnout, symptoms of anxiety, depression, and low resilience among elementary and high school teachers in Alberta and Nova Scotia, Canada. It also aims to determine if daily supportive text messages can help reduce the prevalence of these psychological problems in teachers. Methods: This is a cross-sessional mixed methods study with data to be collected from subscribers of Wellness4Teachers using a web-based survey at baseline (onset of text messaging), 6 weeks, the program’s midpoint (3 months), and end point (6 months). Teachers can subscribe to the Wellness4Teachers program by texting the keyword “TeachWell” to the program phone number. Outcome measures will be assessed using standardized rating scales and key informant interviews. Data will be analyzed with descriptive and inferential statistics using SPSS and thematic analysis using NVivo. Results: The results of this study are expected 24 months after program launch. It is expected that the prevalence of stress, burnout, anxiety, depression, and low resilience among teachers in Alberta and Nova Scotia would be comparable to those reported in other jurisdictions. It is also expected that factors such as gender, number of years teaching, grade of teaching, and school type (elementary vs high school) will have an association with burnout and other psychological disorders among teachers. Furthermore, it is expected that Wellness4Teachers will reduce the prevalence and severity of psychological problems in teachers, and subscriber satisfaction will be high. Conclusions: The Wellness4Teachers project will provide key information regarding prevalence and correlates of common mental health conditions in teachers in Alberta and Nova Scotia, as well as the impact of daily supportive text messages on these mental health parameters. Information from this study will be useful for informing policy and decision-making concerning psychological interventions for schoolteachers. %M 35834305 %R 10.2196/37934 %U https://www.researchprotocols.org/2022/7/e37934 %U https://doi.org/10.2196/37934 %U http://www.ncbi.nlm.nih.gov/pubmed/35834305 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 7 %P e34102 %T Awareness, Acceptability, and Perceived Effectiveness of Text-Based Therapy Among Graduate Students: Cross-sectional Study %A Blair,Samari A %A Brockmann,Andrea N %A Arroyo,Kelsey M %A Carpenter,Chelsea A %A Ross,Kathryn M %+ Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, PO Box 100165, Gainesville, FL, 32610, United States, 1 352 294 8433, kmross@phhp.ufl.edu %K mental health %K text-based therapy %K graduate students %D 2022 %7 7.7.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Research has suggested that there is a mental health crisis occurring among graduate students in the United States. Moreover, many students go without effective treatment owing to the limited availability of mental and behavioral health resources on college campuses. Text-based therapy may represent a viable method for increasing access to mental health support for graduate students, but little is known regarding its acceptability in this population. Objective: The purpose of this study was to assess how graduate students perceive text-based therapy and their likelihood of seeking out this form of therapy. Methods: In total, 265 graduate students completed a cross-sectional web-based survey that included multiple-choice and open-ended questions assessing their perceptions of text-based therapy and the likelihood of seeking out this form of therapy. Chi-square tests, ANOVAs, and nonparametric Wilcoxon signed-rank tests were used to examine differences in multiple-choice questions. The constant comparative method was used for qualitative analyses of the open-ended question responses. Results: Participants (n=265) were predominately non-Hispanic White (166/265, 62.6%) and female (167/265, 63%) with a mean age of 28.3 (SD 5.1) years. Over half of the participants (139/265, 52.5%) were not aware that text-based therapy existed; however, 65.3% (173/265) reported that they would consider using text-based services, if available. In comparison to face-to-face therapy, participants reported being less likely to seek out text-based therapy and perceived it as less effective (P<.001). Qualitative results indicated that participants were concerned about the ability to effectively communicate and build rapport through text-based therapy and thought that this modality may be more effective for some mental and behavioral health concerns than others. Moreover, participants noted that text-based therapy would be best implemented as a way to supplement, rather than replace, face-to-face services. Conclusions: Altogether, the results of this study suggest that text-based therapy holds the potential to increase access to and use of mental and behavioral health services; however, graduate students remain concerned about its effectiveness and the optimal methods of implementation. Future research should investigate how therapeutic processes (eg, effective communication and rapport-building) can be facilitated in digital environments and how text-based therapy could be best implemented to supplement and extend, rather than replace, face-to-face services. %M 35797098 %R 10.2196/34102 %U https://mhealth.jmir.org/2022/7/e34102 %U https://doi.org/10.2196/34102 %U http://www.ncbi.nlm.nih.gov/pubmed/35797098 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e36091 %T Development of a WeChat-based Mobile Messaging Smoking Cessation Intervention for Chinese Immigrant Smokers: Qualitative Interview Study %A Jiang,Nan %A Rogers,Erin S %A Cupertino,Paula %A Zhao,Xiaoquan %A Cartujano-Barrera,Francisco %A Lyu,Joanne Chen %A Hu,Lu %A Sherman,Scott E %+ Department of Population Health, Grossman School of Medicine, New York University, 180 Madison Ave, Rm #17-54, New York, NY, 10016, United States, 1 646 501 3553, Nan.Jiang@nyulangone.org %K smoking cessation %K text messaging %K mobile health %K Chinese American %D 2022 %7 30.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking remains a major public health issue among Chinese immigrants. Smoking cessation programs that focus on this population are scarce and have a limited population-level impact due to their low reach. Mobile messaging interventions have the potential to reach large audiences and expand smokers’ access to smoking cessation treatment. Objective: This study describes the development of a culturally and linguistically appropriate mobile messaging smoking cessation intervention for Chinese immigrant smokers delivered via WeChat, the most frequently used social media platform among Chinese people globally. Methods: This study had 2 phases. In phase 1, we developed a mobile message library based on social cognitive theory and the US Clinical Practice Guidelines for Treating Tobacco Use and Dependence. We culturally adapted messages from 2 social cognitive theory-based text messaging smoking cessation programs (SmokefreeTXT and Decídetexto). We also developed new messages targeting smokers who were not ready to quit smoking and novel content addressing Chinese immigrant smokers’ barriers to quitting and common misconceptions related to willpower and nicotine replacement therapy. In phase 2, we conducted in-depth interviews with 20 Chinese immigrant smokers (including 7 women) in New York City between July and August 2021. The interviews explored the participants’ smoking and quitting experiences followed by assessment of the text messages. Participants reviewed 17 text messages (6 educational messages, 3 self-efficacy messages, and 8 skill messages) via WeChat and rated to what extent the messages enhanced their motivation to quit, promoted confidence in quitting, and increased awareness about quitting strategies. The interviews sought feedback on poorly rated messages, explored participant preferences for content, length, and format, discussed their concerns with WeChat cessation intervention, and solicited recommendations for frequency and timing of messages. Results: Overall, participants reported that the messages enhanced their motivation to quit, offered encouragement, and made them more informed about how to quit. Participants particularly liked the messages about the harms of smoking and strategies for quitting. They reported barriers to applying some of the quitting strategies, including coping with stress and staying abstinent at work. Participants expressed strong interest in the WeChat mobile messaging cessation intervention and commented on its potential to expand their access to smoking cessation treatment. Conclusions: Mobile messages are well accepted by Chinese immigrant smokers. Research is needed to assess the feasibility, acceptability, and efficacy of WeChat mobile messaging smoking cessation interventions for promoting abstinence among Chinese immigrant smokers. %M 35771603 %R 10.2196/36091 %U https://formative.jmir.org/2022/6/e36091 %U https://doi.org/10.2196/36091 %U http://www.ncbi.nlm.nih.gov/pubmed/35771603 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e36151 %T Identifying Medication-Related Intents From a Bidirectional Text Messaging Platform for Hypertension Management Using an Unsupervised Learning Approach: Retrospective Observational Pilot Study %A Davoudi,Anahita %A Lee,Natalie S %A Luong,ThaiBinh %A Delaney,Timothy %A Asch,Elizabeth %A Chaiyachati,Krisda %A Mowery,Danielle %+ Department of Biostatistics, Epidemiology, and Informatics, Institute for Biomedical Informatics, University of Pennsylvania, 3700 Hamilton Walk, Philadelphia, PA, 19104-6021, United States, 1 2157466677, dlmowery@pennmedicine.upenn.edu %K chatbots %K secure messaging systems %K unsupervised learning %K latent Dirichlet allocation %K natural language processing %D 2022 %7 29.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Free-text communication between patients and providers plays an increasing role in chronic disease management, through platforms varying from traditional health care portals to novel mobile messaging apps. These text data are rich resources for clinical purposes, but their sheer volume render them difficult to manage. Even automated approaches, such as natural language processing, require labor-intensive manual classification for developing training data sets. Automated approaches to organizing free-text data are necessary to facilitate use of free-text communication for clinical care. Objective: The aim of this study was to apply unsupervised learning approaches to (1) understand the types of topics discussed and (2) learn medication-related intents from messages sent between patients and providers through a bidirectional text messaging system for managing participant blood pressure (BP). Methods: This study was a secondary analysis of deidentified messages from a remote, mobile, text-based employee hypertension management program at an academic institution. We trained a latent Dirichlet allocation (LDA) model for each message type (ie, inbound patient messages and outbound provider messages) and identified the distribution of major topics and significant topics (probability >.20) across message types. Next, we annotated all medication-related messages with a single medication intent. Then, we trained a second medication-specific LDA (medLDA) model to assess how well the unsupervised method could identify more fine-grained medication intents. We encoded each medication message with n-grams (n=1-3 words) using spaCy, clinical named entities using Stanza, and medication categories using MedEx; we then applied chi-square feature selection to learn the most informative features associated with each medication intent. Results: In total, 253 participants and 5 providers engaged in the program, generating 12,131 total messages: 46.90% (n=5689) patient messages and 53.10% (n=6442) provider messages. Most patient messages corresponded to BP reporting, BP encouragement, and appointment scheduling; most provider messages corresponded to BP reporting, medication adherence, and confirmatory statements. Most patient and provider messages contained 1 topic and few contained more than 3 topics identified using LDA. In total, 534 medication messages were annotated with a single medication intent. Of these, 282 (52.8%) were patient medication messages: most referred to the medication request intent (n=134, 47.5%). Most of the 252 (47.2%) provider medication messages referred to the medication question intent (n=173, 68.7%). Although the medLDA model could identify a majority intent within each topic, it could not distinguish medication intents with low prevalence within patient or provider messages. Richer feature engineering identified informative lexical-semantic patterns associated with each medication intent class. Conclusions: LDA can be an effective method for generating subgroups of messages with similar term usage and facilitating the review of topics to inform annotations. However, few training cases and shared vocabulary between intents precludes the use of LDA for fully automated, deep, medication intent classification. International Registered Report Identifier (IRRID): RR2-10.1101/2021.12.23.21268061 %M 35767327 %R 10.2196/36151 %U https://www.jmir.org/2022/6/e36151 %U https://doi.org/10.2196/36151 %U http://www.ncbi.nlm.nih.gov/pubmed/35767327 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e32089 %T The Effects of Theory-Based Educational Intervention and WhatsApp Follow-up on Papanicolaou Smear Uptake Among Postnatal Women in Malaysia: Randomized Controlled Trial %A Mohammad,Zaahirah %A Ahmad,Norliza %A Baharom,Anisah %+ Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Jalan Universiti 1, Seri Kembangan, Serdang, 43400, Malaysia, 60 192710577, lizaahmad@upm.edu.my %K uterine cervical neoplasms %K Papanicolaou test %K psychological theory %K self-efficacy %K social media %K health knowledge %K attitude %K practice %K Malaysia %D 2022 %7 27.6.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the availability and accessibility of free Papanicolaou (Pap) smear as a screening tool for cervical cancer, the uptake of Pap smear in Malaysia has not changed in the last 15 years. Previous studies have shown that the high uptake of Pap smear reduces the mortality rate of patients with cervical cancer. The low uptake of Pap smear is multifactorial, and the problem could be minimized through the use of mobile technologies. Nevertheless, most intervention studies focused on individual factors, while other important aspects such as mobile technologies, especially WhatsApp, have not been investigated yet. Objective: This study aims to determine the effects of a theory-based educational intervention and WhatsApp follow-up (Pap smear uptake [PSU] intervention) in improving PSU among postnatal women in Seremban, Negeri Sembilan, Malaysia. Methods: A 2-arm, parallel single-blind cluster randomized controlled trial was conducted among postpartum women from the Seremban district. Twelve health clinics were randomly assigned to the intervention and control groups. At baseline, both groups received a self-administered questionnaire. The intervention group received standard care and PSU intervention delivered by a researcher. This 2-stage intervention module was developed based on Social Cognitive Theory, where the first stage was conducted face-to-face and the second stage included a WhatsApp follow-up. The control group received standard care. Participants were observed immediately and at 4, 8, and 12 weeks after the intervention. The primary endpoint was PSU, whereas the secondary endpoints were knowledge, attitude, and self-efficacy scores for Pap smear screening self-assessed using a Google Forms questionnaire. A generalized mixed model was used to determine the effectiveness of the intervention. All data were analyzed using IBM SPSS (version 25), and P value of .05 was considered statistically significant. Results: We analyzed 401 women, of whom 76 (response rate: 325/401, 81%) had withdrawn because of the COVID-19 pandemic, with a total of 162 respondents in the intervention group and 163 respondents in the control group. The proportion of Pap smears at the 12-week follow-up was 67.9% (110/162) in the intervention group versus 39.8% (65/163) in the control group (P<.001). Significant differences between the intervention and control groups were found for Pap smear use (F4,1178; P<.001), knowledge scores (F4,1172=14.946; P<.001), attitude scores (F4,1172=24.417; P<.001), and self-efficacy scores (F1,1172=10.432; P<.001). Conclusions: This study demonstrated that the PSU intervention is effective in increasing the uptake of Pap smear among postnatal women in Seremban district, Malaysia. This intervention module can be tested in other populations of women. Trial Registration: Thai Clinical Trials Registry TCTR20200205001; https://www.thaiclinicaltrials.org/show/TCTR20200205001 %M 35759319 %R 10.2196/32089 %U https://mhealth.jmir.org/2022/6/e32089 %U https://doi.org/10.2196/32089 %U http://www.ncbi.nlm.nih.gov/pubmed/35759319 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33036 %T Predicting Mental Health Status in Remote and Rural Farming Communities: Computational Analysis of Text-Based Counseling %A Antoniou,Mark %A Estival,Dominique %A Lam-Cassettari,Christa %A Li,Weicong %A Dwyer,Anne %A Neto,Abìlio de Almeida %+ The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Locked Bag 1797, Penrith, 2751, Australia, 61 2 9772 6673, m.antoniou@westernsydney.edu.au %K e-mental health %K text-based %K counseling %K Linguistic Inquiry and Word Count %K LIWC %K depression %K anxiety %K stress %D 2022 %7 21.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Australians living in rural and remote areas are at elevated risk of mental health problems and must overcome barriers to help seeking, such as poor access, stigma, and entrenched stoicism. e-Mental health services circumvent such barriers using technology, and text-based services are particularly well suited to clients concerned with privacy and self-presentation. They allow the client to reflect on the therapy session after it has ended as the chat log is stored on their device. The text also offers researchers an opportunity to analyze language use patterns and explore how these relate to mental health status. Objective: In this project, we investigated whether computational linguistic techniques can be applied to text-based communications with the goal of identifying a client’s mental health status. Methods: Client-therapist text messages were analyzed using the Linguistic Inquiry and Word Count tool. We examined whether the resulting word counts related to the participants’ presenting problems or their self-ratings of mental health at the completion of counseling. Results: The results confirmed that word use patterns could be used to differentiate whether a client had one of the top 3 presenting problems (depression, anxiety, or stress) and, prospectively, to predict their self-rated mental health after counseling had been completed. Conclusions: These findings suggest that language use patterns are useful for both researchers and clinicians trying to identify individuals at risk of mental health problems, with potential applications in screening and targeted intervention. %M 35727623 %R 10.2196/33036 %U https://formative.jmir.org/2022/6/e33036 %U https://doi.org/10.2196/33036 %U http://www.ncbi.nlm.nih.gov/pubmed/35727623 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e37777 %T Experiences With a Postpartum mHealth Intervention During the COVID-19 Pandemic: Key Informant Interviews Among Patients, Health Care Providers, and Stakeholders %A Sadural,Ernani %A Riley,Kristen E %A Zha,Peijia %A Pacquiao,Dula %A Faust,Amanda %+ Department of Obstetrics and Gynecology, Cooperman Barnabas Medical Center, RWJBarnabas Health, 94 Old Short Hills Road, Suite 3148, Livingston, NJ, 07039, United States, 1 973 885 9190, ernani.sadural@rwjbh.org %K maternal mortality %K health disparity %K mHealth %K patient engagement %K postbirth warning signs %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Maternal morbidity and mortality in the United States continue to be a worsening public health crisis, with persistent racial disparities among Black women during the COVID-19 pandemic. Innovations in mobile health (mHealth) technology are being developed as a strategy to connect birthing women to their health care providers during the first 6 weeks of the postpartum period. Objective: This study aimed to inform a process to evaluate the barriers to mHealth implementation in the context of the COVID-19 pandemic by exploring the experiences of mothers and stakeholders who were directly involved in the pilot program. Methods: The qualitative design used GoToMeeting (GoTo) individual interviews of 13 mothers and 7 stakeholders at a suburban teaching hospital in New Jersey. Mothers were aged ≥18 years, able to read and write in English or Spanish, had a vaginal or cesarean birth at >20 weeks of estimated gestational age, and were admitted for delivery at the hospital with at least a 24-hour postpartum stay. Stakeholders were part of the hospital network’s obstetrics collaborative subcommittee comprising administrators, physicians, registered nurses, and informatics. Responses were transcribed verbatim and analyzed for emerging themes. The socioecological framework provided a holistic lens for analyzing the multilevel influences on individual experiences. Results: A total of 3 major themes were identified: mothers experienced barriers from personal situations at home and with services in the hospital and community, which were intensified by the COVID-19 pandemic; the COVID-19 pandemic negatively impacted hospital services, priorities, and individual staff; and mothers and stakeholders had positive experiences and perceptions of the mHealth intervention. Conclusions: The use and reach of the mHealth intervention were negatively influenced by interrelated factors operating at multiple levels. The system-wide and multilevel impact of the pandemic was reflected in participants’ responses, providing evidence for the need to re-evaluate mHealth implementation with more adaptable systems and structures in place using a socioecological framework. %M 35699998 %R 10.2196/37777 %U https://formative.jmir.org/2022/6/e37777 %U https://doi.org/10.2196/37777 %U http://www.ncbi.nlm.nih.gov/pubmed/35699998 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e32416 %T Acceptability and Feasibility of Peer-to-Peer Text Messaging Among Adolescents to Increase Clinic Visits and Sexually Transmitted Infection Testing: Interrupted Times-Series Analysis %A Lightfoot,Marguerita %A Jackson-Morgan,Joi %A Pollack,Lance %A Bennett,Ayanna %+ Division of Prevention Science, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94143, United States, 1 415 502 4320, lightfom@ohsu.edu %K HIV prevention %K STI prevention %K adolescents %K youth %K text messaging %K SMS %K peer-to-peer intervention %K HIV %K STI %K HIV testing %D 2022 %7 9.6.2022 %9 Short Paper %J JMIR Form Res %G English %X Background: Adolescents are disproportionately affected by sexually transmitted infections (STIs), including HIV. Many youths with asymptomatic STI or related symptoms do not seek treatment and may not be screened if accessing the health care system for other reasons. Objective: We examined intervention completion and changes in the number of new patients, the number of STI or HIV tests, and the sexual risk profile of patients over time to determine the feasibility and acceptability of a peer-driven text messaging strategy to connect youth to STI and HIV services. Methods: The intervention enlisted consecutive patients at an adolescent medicine clinic to send a text message to 5 peers they believed were sexually active and lived in the clinic’s service area. The intervention was evaluated using an interrupted time-series design in which baseline clinic service levels were documented during a 35-week lead-in period, followed by a 20-week intervention implementation period, and a 16-week period of continued clinic observation. Clinic and patient data were obtained through chart abstraction from intake forms that occurred during the entire study period. Analyses conducted in 2015 used a generalized linear mixed model. Results: Of the 153 patients approached to participate, 100 agreed to send SMS text messages. Most (n=55, 55%) reported no concerns with sending the text message. No adverse events or negative outcomes were reported. Adolescent STI testing, positive test results, and reported risk behavior increased post intervention, although this was not statistically significant, likely because of the small sample size. Conclusions: Given low youth uptake of health care services, and STI/HIV screening, in particular, new strategies are needed to address access barriers. Common approaches for reaching youth are resource-intensive and often miss those not connected to school or community programs. The peer-based text messaging strategy showed promise for both increasing the number of youths accessing health services and finding youths engaging in sexual risk behaviors and most in need of sexual health screening and services. %M 35686737 %R 10.2196/32416 %U https://formative.jmir.org/2022/6/e32416 %U https://doi.org/10.2196/32416 %U http://www.ncbi.nlm.nih.gov/pubmed/35686737 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e30630 %T Evaluation of Dietary Management Using Artificial Intelligence and Human Interventions: Nonrandomized Controlled Trial %A Okaniwa,Fusae %A Yoshida,Hiroshi %+ Department of Theoretical Social Security Research, National Institute of Population and Social Security Research, 2-2-3 Uchisaiwaicho, Chiyoda-ku, Tokyo, 100-0011, Japan, 81 3 3595 2984, okaniwa-fusae@ipss.go.jp %K health promotion %K dietary management %K intervention %K artificial intelligence %K body fat percentage %K body mass index %K behavioral economics %K nonprofessional %K Japan %D 2022 %7 8.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There has been an increase in personal health records with the increased use of wearable devices and smartphone apps to improve health. Traditional health promotion programs by human professionals have limitations in terms of cost and reach. Due to labor shortages and to save costs, there has been a growing emphasis in the medical field on building health guidance systems using artificial intelligence (AI). AI will replace advanced human tasks to some extent in the future. However, it is difficult to sustain behavioral change through technology alone at present. Objective: This study investigates whether AI alone can effectively encourage healthy behaviors or whether human interventions are needed to achieve and sustain health-related behavioral change. We examined the effectiveness of AI and human interventions to encourage dietary management behaviors. In addition, we elucidated the conditions for maximizing the effect of AI on health improvement. We hypothesized that the combination of AI and human interventions will maximize their effectiveness. Methods: We conducted a 3-month experiment by recruiting participants who were users of a smartphone diet management app. We recruited 102 participants and divided them into 3 groups. Treatment group I received text messages using the standard features of the app (AI-based text message intervention). Treatment group II received video messages from a companion, in addition to the text messages (combined text message and human video message intervention by AI). The control group used the app to keep a dietary record, but no feedback was provided (no intervention). We examine the participants’ continuity and the effects on physical indicators. Results: Combined AI and video messaging (treatment group II) led to a lower dropout rate from the program compared to the control group, and the Cox proportional-hazards model estimate showed a hazard ratio (HR) of 0.078, which was statistically significant at the 5% level. Further, human intervention with AI and video messaging significantly reduced the body fat percentage (BFP) of participants after 3 months compared to the control group, and the rate of reduction was greater in the group with more individualized intervention. The AI-based text messages affected the BMI but had no significant effect on the BFP. Conclusions: This experiment shows that it is challenging to sustain participants' healthy behavior with AI intervention alone. The results also suggest that even if the health information conveyed is the same, the information conveyed by humans and AI is more effective in improving health than the information sent by AI alone. The support received from the companion in the form of video messages may have promoted voluntary health behaviors. It is noteworthy that companions were competent, even though they were nonexperts. This means that person-to-person communication is crucial for health interventions. %M 35675107 %R 10.2196/30630 %U https://formative.jmir.org/2022/6/e30630 %U https://doi.org/10.2196/30630 %U http://www.ncbi.nlm.nih.gov/pubmed/35675107 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e28885 %T Mobile Phone Ownership and Use Among Women Screening for Cervical Cancer in a Community-Based Setting in Western Kenya: Observational Study %A Stocks,Jacob %A Ibrahim,Saduma %A Park,Lawrence %A Huchko,Megan %+ Center for Global Reproductive Health, Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, United States, 1 919 681 7760, jacob_stocks@med.unc.edu %K cell phone %K mobile health %K mHealth %K cervical cancer screening %K Kenya %K human papillomavirus %K HPV testing %D 2022 %7 7.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Mobile phone ownership among women of reproductive age in western Kenya is not well described, and our understanding of its link with care-seeking behaviors is nascent. Understanding access to and use of mobile phones among this population as well as willingness to participate in mobile health interventions are important in improving and more effectively implementing mobile health strategies. Objective: This study aims to describe patterns of mobile phone ownership and use among women attending cervical cancer screening and to identify key considerations for the use of SMS text message–guided linkage to treatment strategies and other programmatic implications for cervical cancer screening in Kenya. Methods: This analysis was nested within a cluster randomized trial evaluating various strategies for human papillomavirus (HPV)–based cervical cancer screening and prevention in a rural area in western Kenya between February and November 2018. A total of 3299 women were surveyed at the time of screening and treatment. Questionnaires included items detailing demographics, health history, prior care-seeking behaviors, and patterns of mobile phone ownership and use. We used bivariate and multivariable log-binomial regression to analyze associations between independent variables and treatment uptake among women testing positive for high-risk HPV. Results: Rates of mobile phone ownership (2351/3299, 71.26%) and reported daily use (2441/3299, 73.99%) were high among women. Most women (1953/3277, 59.59%) were comfortable receiving their screening results via SMS text messages, although the most commonly preferred method of notification was via phone calls. Higher levels of education (risk ratio 1.23, 95% CI 1.02-1.50), missing work to attend screening (risk ratio 1.29, 95% CI 1.10-1.52), and previous cervical cancer screening (risk ratio 1.27, 95% CI 1.05-1.55) were significantly associated with a higher risk of attending treatment after testing high-risk HPV–positive, although the rates of overall treatment uptake remained low (278/551, 50.5%) among this population. Those who shared a mobile phone with their partner or spouse were less likely to attend treatment than those who owned a phone (adjusted risk ratio 0.69, 95% CI 0.46-1.05). Treatment uptake did not vary significantly according to the type of notification method, which were SMS text message, phone call, or home visit. Conclusions: Although the rates of mobile phone ownership and use among women in western Kenya are high, we found that individual preferences for communication of messages about HPV results and treatment varied and that treatment rates were low across the entire cohort, with no difference by modality (SMS text message, phone call, or home visit). Therefore, although text-based results performed as well as phone calls and home visits, our findings highlight the need for more work to tailor communication about HPV results and support women as they navigate the follow-up process. %M 35671089 %R 10.2196/28885 %U https://publichealth.jmir.org/2022/6/e28885 %U https://doi.org/10.2196/28885 %U http://www.ncbi.nlm.nih.gov/pubmed/35671089 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 2 %P e23641 %T Technological Proficiencies, Engagement, and Practical Considerations for mHealth Programs at an Urban Safety-Net Hospital Emergency Departments: Data Analysis %A Treacy-Abarca,Sean %A Mercado,Janisse %A Serrano,Jorge %A Gonzalez,Jennifer %A Menchine,Michael %A Arora,Sanjay %A Wu,Shinyi %A Burner,Elizabeth %+ David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, United States, 1 3108256373, sean.e.treacy@gmail.com %K mHealth %K engagement %K practical considerations %K safety-net hospital %K emergency department %K minority health %K low income %D 2022 %7 6.6.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: Safety-net emergency departments often serve as the primary entry point for medical care for low income predominantly minority patient populations. Herein, we sought to provide insight into the feasibility, technological proficiencies, engagement characteristics, and practical considerations for a mHealth intervention at a safety-net emergency department. Objective: We aimed to analyze patient technological proficiency to understand the feasibility of and draw practical considerations for mobile phone technology (mHealth) solutions for patients with chronic disease served by safety-net emergency departments. Methods: We analyzed data from a previous diabetes randomized clinical mHealth trial for a diabetes social support intervention. Patients from a safety-net emergency department with preexisting diabetes who used SMS text messages, owned a mobile phone, and with hemoglobin A1c levels >8.5% were enrolled. A text message–based mHealth program to improve disease self-management was provided to all patients. Supporters of patients were randomized to receive a mailed copy or mHealth-based curriculum designed to improve diabetes support. Among enrolled patients, we surveyed mobile technological capacity and frequency of use. We performed latent class analysis to identify classes of patients by level of technological proficiency and compared demographic characteristics between the latent classes to identify demographic subgroups that may require more training or tailoring of the mHealth approach. Study engagement between classes was assessed by comparing the mean number of text messages exchanged, loss to follow-up, and early termination. Results: Of 1876 patients who were approached, 44.2% (n=829) of patients had a stable mobile phone and were able to use text messages. Among them 166 met the trial inclusion and enrolled, 90% (149/166) of the cohort were ethnically diverse. Significant variance was found in technology capacity and frequency of use. Our latent class analysis classified 75% (124/166) of patients as highly technologically proficient and 25% (42/166) patients as minimally technologically proficient. Age (P<.001) and level of education (P<.001) were associated with class membership. Highly technologically proficient patients were younger and had higher levels of education (45.74 years old; high school or more: 90%) than minimally technologically proficient patients (53.64 years old; high school or more: 18%). Highly technologically proficient participants exchanged a mean of 40 text messages with the system coordinators compared to a mean of 10 text messages by minimally technologically proficient patients (P<.001). Conclusions: This study found that nearly half of the patients screened at the safety-net emergency department were equipped for an SMS text message–based mHealth intervention. In the small sample of patients who were enrolled, the majority were classified as highly technologically proficient. These highly proficient patients had greater study engagement. mHealth use in emergency departments may be an opportunity to improve health of ethnically diverse populations by pairing sophisticated chronic disease self-management program with SMS text message–based and traditional in-person interventions to reach patients through the method that is most familiar and comfortable. International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2019.03.003 %M 35666555 %R 10.2196/23641 %U https://diabetes.jmir.org/2022/2/e23641 %U https://doi.org/10.2196/23641 %U http://www.ncbi.nlm.nih.gov/pubmed/35666555 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e38543 %T A Parent-Based Intervention for Reducing High-risk Social Media Cognitions, Alcohol Use, and Negative Consequences Among Adolescents: Protocol for a Randomized Controlled Pilot Study %A Litt,Dana M %A Geusens,Femke %A Seamster,Abby %A Lewis,Melissa A %+ School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, EAD 709E, Fort Worth, TX, 76107, United States, 1 817 735 5453, dana.litt@unthsc.edu %K parent-based interventions %K alcohol %K pilot study %K social media %K mobile phone %D 2022 %7 17.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The prevalence of adolescent alcohol use continues to be a public health concern. Although adolescents spend an increasing amount of time with their friends, parents remain an important source of support and continue to play a key role in the lives of their adolescents. Extensive research in this area has resulted in parent-based intervention (PBI) efforts to prevent or reduce adolescent alcohol use. However, one major limitation of PBIs is that they do not currently consider the large role that social media plays in adolescents’ lives and in relation to their alcohol use. We will add to the literature by developing and refining a web-based PBI designed to reduce both high-risk social media cognitions and alcohol use among adolescents. Objective: The central goal of the proposed study is to develop, refine, and pilot a web-based PBI to reduce both high-risk social media cognitions and alcohol use among adolescents. Methods: A total of 100 parent-teen dyads will be randomly assigned to one of the following 2 conditions: intervention or control. Parents in the intervention group will be given access to the web-based PBI and suggestions for working through the PBI modules with their teens. The parent-teen dyads will fill out 3 questionnaires: a baseline questionnaire, 1-month questionnaire, and 6-month questionnaire. Results: Recruitment and enrollment will begin in August 2022. Upon completion of the intervention trial, we will examine the feasibility, acceptability, and preliminary effect sizes of the newly developed web-based PBI. Conclusions: This study has the potential to open doors for future studies examining the clinical implications of an efficacious web-based PBI to reduce alcohol use and high-risk cognitions about alcohol displays on social media. Trial Registration: ClinicalTrials.gov NCT04333966; https://clinicaltrials.gov/ct2/show/NCT04333966 International Registered Report Identifier (IRRID): PRR1-10.2196/38543 %M 35579931 %R 10.2196/38543 %U https://www.researchprotocols.org/2022/5/e38543 %U https://doi.org/10.2196/38543 %U http://www.ncbi.nlm.nih.gov/pubmed/35579931 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e36821 %T Participants’ Perceptions of Essential Coaching for Every Mother—a Canadian Text Message–Based Postpartum Program: Process Evaluation of a Randomized Controlled Trial %A Dol,Justine %A Aston,Megan %A McMillan,Douglas %A Tomblin Murphy,Gail %A Campbell-Yeo,Marsha %+ Faculty of Health, Dalhousie University, 6299 South St, Halifax, NS, B3H 4J1, Canada, 1 902 470 8895, Justine.dol@dal.ca %K mHealth %K text messaging %K postpartum %K process evaluation %K mobile health %K SMS %K text message %K digital health %K randomized control trial %K postnatal %D 2022 %7 13.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: “Essential Coaching for Every Mother” is a Canadian text message–based program that sends daily messages to mothers for 6 weeks after they give birth. There is a need to explore the program’s effectiveness in terms of the participants’ experience to guide refinement and modification. Objective: This study aimed to describe the process evaluation of the Essential Coaching for Every Mother randomized controlled trial through an evaluation of the research implementation extent and quality. Methods: Participants were recruited from Nova Scotia, Canada, between January 5 and August 1, 2021. Enrolled participants were randomized into the intervention or control group. Participants randomized to the intervention group received standard care along with the Essential Coaching for Every Mother program’s text messages related to newborn and maternal care for the first 6 weeks after giving birth, while the control group received standard care. Usage data were collected from the SMS text message program used, and participants completed web-based questionnaires at 6 weeks after birth. Quantitative data and qualitative responses to open-ended questions were used to triangulate findings. Quantitative data were summarized using means, SDs, and percentages, as appropriate, while qualitative data were analyzed using thematic analysis. Results: Of the 295 unique initial contacts, 150 mothers were eligible and completed the baseline survey to be enrolled in the study (intervention, n=78; control, n=72). Of those randomized into the intervention group, 75 (96%) completed the 6-week follow-up survey to provide feedback on the program. In total, 48 (62%) intervention participants received all messages as designed in the Essential Coaching for Every Mother program, with participants who enrolled late missing on average 4.7 (range 1-12) messages. Intervention participants reported an 89% satisfaction rate with the program, and 100% of participants would recommend the program to other new mothers. Participants liked how the program made them feel, the format, appropriate timing of messages, and content while disliking the frequency of messages and gaps in content. Participants also provided suggestions for future improvement. Conclusions: Our process evaluation has provided a comprehensive understanding of interest in the program as well as identified preference for program components. The findings of this study will be used to update future iterations of the Essential Coaching for Every Mother program. Trial Registration: ClincalTrials.gov NCT04730570; https://clinicaltrials.gov/ct2/show/NCT04730570 %M 35559855 %R 10.2196/36821 %U https://formative.jmir.org/2022/5/e36821 %U https://doi.org/10.2196/36821 %U http://www.ncbi.nlm.nih.gov/pubmed/35559855 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e36208 %T Automated Intraoperative Short Messaging Service Updates: Quality Improvement Initiative to Relieve Caregivers’ Worries %A Mignault,Alexandre %A Tchouaket Nguemeleu,Éric %A Robins,Stephanie %A Maillet,Éric %A Matetsa,Edwige %A Dupuis,Stéphane %+ Département des sciences infirmières, Université du Québec en Outaouais, 5 Rue St Joseph, St-Jérome, QC, J7Z 0B7, Canada, 1 450 530 7616 ext 4039, Eric.Tchouaket@uqo.ca %K COVID-19 %K surgery %K intraoperative %K OR nurse %K communication %K technology %K short messaging service %K SMS %K text message %K caregiver %K anxiety %K perioperative %K surgical %K surgical procedure %K mHealth %K mental health %K digital health %K digital health care %D 2022 %7 6.5.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Undergoing a surgical procedure is anxiety provoking for patients and their caregivers. During the intraoperative period, caregivers seek out informational updates from health care professionals, a situation complicated by COVID-19 health measures that require caregivers to wait outside the hospital. Short messaging service (SMS)-based communication that allows caregivers to follow their loved ones through surgery has shown promise in relieving anxiety and improving satisfaction with overall care. This form of communication is also well accepted by health care professionals and may be effective at relieving staff burden. Objective: Here, we describe a quality improvement initiative of a standardized and integrated intraoperative SMS-based system to improve communication between surgical teams and caregivers. The main goal was to improve satisfaction with care, while the secondary goal was to reduce caregiver anxiety. Methods: The initiative followed the framework of the Model for Improvement. A large tertiary care hospital offered the SMS to caregivers who were waiting for loved ones undergoing surgery. SMS messages were integrated into the clinical information system software and sent at key points during the surgical journey to phone numbers provided by caregivers. A satisfaction survey was sent to caregivers 1 business day after surgery. Data were collected between February 16 and July 14, 2021. Results: Of the 8129 surgeries scheduled, caregivers waiting for 6149 (75.6%) surgeries agreed to receive SMS messages. A total of 34,129 messages were sent. The satisfaction survey was completed by 2088 (34%) of the 6149 caregivers. Satisfaction with messages was high, with the majority of respondents reporting that the messages received were adequate (1476/2085, 70.8%), clear (1545/2077, 74.4%), informative (1488/2078, 71.6%), and met their needs (1234/2077, 59.4%). The overall satisfaction score was high (4.5 out of 5), and caregivers reported that receiving text messages resulted in a reduction in anxiety (score=8.2 out of 10). Technical errors were reported by 69 (3.3%) caregivers. Suggestions for improvements included having messages sent more often; providing greater patient details, including the patient’s health status; and the service being offered in other languages. Conclusions: This digital health initiative provided SMS messages that were systematically sent to caregivers waiting for their loved ones undergoing surgery, just as COVID-19 restrictions began preventing waiting onsite. The messages were used across 15 surgical specialties and have since been implemented hospital-wide. Digital health care innovations have the capacity to improve family-centered communication; what patients and their families find useful and appreciate will ultimately determine their success. %M 35436760 %R 10.2196/36208 %U https://periop.jmir.org/2022/1/e36208 %U https://doi.org/10.2196/36208 %U http://www.ncbi.nlm.nih.gov/pubmed/35436760 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34960 %T A Self-management SMS Text Messaging Intervention for People With Inflammatory Bowel Disease: Feasibility and Acceptability Study %A Rohde,Jacob A %A Fisher,Edwin B %A Boynton,Marcella H %A Freelon,Deen %A Frohlich,Dennis O %A Barnes,Edward L %A Noar,Seth M %+ Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, CB 3365, Carroll Hall, Chapel Hill, NC, 27514, United States, 1 919 962 4075, jarohde1@gmail.com %K inflammatory bowel disease %K mHealth %K self-management %K SMS text messaging %K mobile phone %D 2022 %7 6.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health technologies can be useful for providing disease self-management information and support to people with inflammatory bowel disease (IBD). Objective: The aim of this study was to test a self-management SMS text messaging intervention for people with IBD. Our goal was to examine intervention feasibility, acceptability, and engagement and to preliminarily evaluate improvements in certain self-reported health outcomes among participants. Methods: We developed an SMS text messaging program called Text4IBD. The program sent daily support messages and resources about disease self-management over the course of a 2-week, single-group, pretest-posttest intervention to participants (N=114) diagnosed with IBD. We examined intervention feasibility, acceptability, and engagement through Text4IBD message topic recall and use of resources (ie, visiting supplemental websites recommended by the Text4IBD program). We also assessed pretest-posttest measures of IBD-related distress, self-efficacy, perceived support, use of coping strategies, and medication adherence. Analyses examined participants’ evaluations of the intervention and compared pretest-posttest changes in secondary outcomes using paired-samples statistics. Results: Approximately all participants who completed the intervention (n=105) were receptive to Text4IBD and viewed the program as feasible and acceptable. In addition, most participants (103/105, 98.1%) recalled at least one of the message topics sent by the program, and 79% (83/105) of them self-reported engaging with at least one of the external self-management resources recommended by the Text4IBD program. Pretest-posttest results showed reduced IBD-related distress (mean 3.33, SD 0.68 vs mean 2.86, SD 0.73; P<.001) and improvements in most other secondary outcomes. Conclusions: Findings from this study highlight the value of SMS text messaging as a useful digital medium for providing support to people with IBD, particularly to those who may struggle with disease-related distress. Text4IBD was highly feasible and acceptable and may help people self-manage their IBD. Future studies should aim to evaluate this program in a randomized controlled trial in clinical settings. %M 35522471 %R 10.2196/34960 %U https://formative.jmir.org/2022/5/e34960 %U https://doi.org/10.2196/34960 %U http://www.ncbi.nlm.nih.gov/pubmed/35522471 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e35699 %T Characterizing User Experiences With an SMS Text Messaging–Based mHealth Intervention: Mixed Methods Study %A King,Sayde Leya %A Lebert,Jana %A Karpisek,Lacey Anne %A Phillips,Amelia %A Neal,Tempestt %A Kosyluk,Kristin %+ Department of Computer Science and Engineering, College of Engineering, University of South Florida, 4202 East Fowler Avenue, Tampa, FL, 33620, United States, 1 813 396 9353, saydeking@usf.edu %K text messaging %K SMS %K mobile health %K mHealth %K stigma %K user perceptions %K ubiquitous sensing %K low-intensity intervention %K coping %K mental health %K cognitive restructuring %K mobile phone %D 2022 %7 3.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Limited access to mental health care services due to provider shortages, geographic limitations, and cost has driven the area of mobile health (mHealth) care to address these access gaps. Reports from the Cohen Veterans Network and National Council for Behavioral Health show that in states where mental health care is more accessible, 38% of people still do not receive the care they need. mHealth strategies help to provide care to individuals experiencing these barriers at lower cost and greater convenience, making mHealth a great resource to bridge the gaps. Objective: We present a mixed methods study to evaluate user experiences with the mental mHealth service, Cope Notes. Specifically, we aimed to investigate the following research questions: How do users perceive the service in relation to stigma, impact of the intervention, and perceived usefulness? How do users rate the Cope Notes service and SMS text messaging along various dimensions of acceptability? What is the relationship between Cope Notes SMS text message ratings, user personality, and coping strategies? What are user perspectives of leveraging ubiquitous sensing technologies to improve delivery and provide tailored content? Methods: We performed qualitative interviews with Cope Notes users (N=14) who have used the service for at least 30 days to evaluate their experiences and usefulness of the service. These interviews were coded by 2 raters (SLK and JL), and the interrater reliability was calculated with SPSS (IBM Corp) at 61.8%. In addition, participants completed quantitative measures, including a user experiences survey, personality inventory (Big Five Inventory-10), and coping assessment (Brief Coping Orientation to Problems Experienced). Results: We derived 7 themes from our qualitative interviews: Likes or Perceived Benefits, Dislikes or Limitations, Suggested Changes, Stigma or Help Seeking, Perceptions of Ubiquitous Sensing, Cultural Sensitivity, and Alternative mHealth Resources. Exploratory analyses between acceptability ratings of Cope Notes and personality factors showed statistically significant positive relationships between seeing oneself as someone who is generally trusting and acceptability items, the most significant being item 7 (I fully understood the sentiment behind Cope Notes Messages) with (rs(10)=0.82, P=.001). We also found statistically significant relationships between acceptability and Brief Coping Orientation to Problems Experienced items, with the strongest positive correlation between participants strongly endorsing coping by accepting the reality that an event has happened and acceptability item 7 (rs(8)=0.86, P=.001). Conclusions: Our study found that Cope Notes subscribers appreciate the service for reframing their mental wellness with statistically significant correlations between personality and acceptability of the service. We found that some users prefer a more personalized experience with neutral to positive reactions to a potential companion app that continuously monitors user behavior via smartphone sensors to provide just-in-time interventions when users need it most. %M 35503524 %R 10.2196/35699 %U https://formative.jmir.org/2022/5/e35699 %U https://doi.org/10.2196/35699 %U http://www.ncbi.nlm.nih.gov/pubmed/35503524 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e30058 %T Effects of Using a Text Message Intervention on Psychological Constructs and the Association Between Changes to Psychological Constructs and Medication Adherence in People With Type 2 Diabetes: Results From a Randomized Controlled Feasibility Study %A Bartlett,Yvonne Kiera %A Farmer,Andrew %A Newhouse,Nikki %A Miles,Lisa %A Kenning,Cassandra %A French,David P %+ Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Coupland 1 Building, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 161 3065436, kiera.bartlett.uom@gmail.com %K medication adherence %K type 2 diabetes mellitus %K behavior change techniques %K text messaging %K feasibility studies %K diabetes %K medication %K digital health %D 2022 %7 29.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor adherence to oral medications is common in people with type 2 diabetes and can lead to an increased chance of health complications. Text messages may provide an effective delivery method for an intervention; however, thus far, the majority of these interventions do not specify either a theoretical basis or propose specific mechanisms of action. This makes it hard to determine how and whether an intervention is having an effect. The text messages included in the current intervention have been developed to deliver specific behavior change techniques. These techniques are the “active ingredients” of the intervention and were selected to target psychological constructs identified as predictors of medication adherence. Objective: There are 2 aims of this study: (1) to assess whether a text message intervention with specified behavior change techniques can change the constructs that predict medication adherence behaviors in people with type 2 diabetes and (2) to assess whether changes to psychological constructs are associated with changes in self-reported medication adherence. Methods: We conducted a randomized controlled, 6-month feasibility trial. Adults prescribed oral medication for type 2 diabetes (N=209) were recruited from general practice and randomized to either receive a text message–based intervention or care as usual. Data were analyzed with repeated measures analysis of covariance and Spearman rho correlation coefficients. Results: For 8 of the 14 constructs that were measured, a significant time-by-condition interaction was found: necessity beliefs, intention, maintenance self-efficacy, recovery self-efficacy, action control, prompts and cues, social support, and satisfaction with experienced consequences all increased in the intervention group compared to the control group. Changes in action self-efficacy, intention, automaticity, maintenance self-efficacy, and satisfaction with experienced consequences were positively associated with changes in self-reported medication adherence. Conclusions: A relatively low-cost, scalable, text message–only intervention targeting medication adherence using behavior change techniques can influence psychological constructs that predict adherence. Not only do these constructs predict self-reported medication adherence, but changes in these constructs are correlated with changes in self-reported medication adherence. These findings support the promise of text message–based interventions for medication adherence in this population and suggest likely mechanisms of action. Trial Registration: ISRCTN Registry ISRCTN13404264; https://www.isrctn.com/ISRCTN13404264 %M 35486430 %R 10.2196/30058 %U https://formative.jmir.org/2022/4/e30058 %U https://doi.org/10.2196/30058 %U http://www.ncbi.nlm.nih.gov/pubmed/35486430 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e35625 %T A Text Messaging Intervention to Support Latinx Family Caregivers of Individuals With Dementia (CuidaTEXT): Development and Usability Study %A Perales-Puchalt,Jaime %A Acosta-Rullán,Mariola %A Ramírez-Mantilla,Mariana %A Espinoza-Kissell,Paul %A Vidoni,Eric %A Niedens,Michelle %A Ellerbeck,Edward %A Hinton,Ladson %A Loera,Linda %A Ramírez,A Susana %A Lara,Esther %A Watts,Amber %A Williams,Kristine %A Resendez,Jason %A Burns,Jeffrey %+ Alzheimer’s Disease Research Center, School of Medicine, University of Kansas Medical Center, 4350 Shawnee Mission Parkway, Fairway, KS, 66205, United States, 1 913 588 3716, jperales@kumc.edu %K Latinx individuals %K mHealth %K dementia %K caregiving %D 2022 %7 28.4.2022 %9 Original Paper %J JMIR Aging %G English %X 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. %M 35482366 %R 10.2196/35625 %U https://aging.jmir.org/2022/2/e35625 %U https://doi.org/10.2196/35625 %U http://www.ncbi.nlm.nih.gov/pubmed/35482366 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e30680 %T An E–Mental Health Solution to Prevent and Manage Posttraumatic Stress Injuries Among First Responders in Alberta: Protocol for the Implementation and Evaluation of Text Messaging Services (Text4PTSI and Text4Wellbeing) %A Obuobi-Donkor,Gloria %A Eboreime,Ejemai %A Bond,Jennifer %A Phung,Natalie %A Eyben,Scarlett %A Hayward,Jake %A Zhang,Yanbo %A MacMaster,Frank %A Clelland,Steven %A Greiner,Russell %A Jones,Chelsea %A Cao,Bo %A Brémault-Phillips,Suzette %A Wells,Kristopher %A Li,Xin-Min %A Hilario,Carla %A Greenshaw,Andrew J %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor Abbie J Lane Memorial Building QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 7802157771, vn602367@dal.ca %K posttraumatic stress injury %K first responders %K messaging %K mobile phone %K text-based intervention %K Text4PTSI %K Text4Wellbeing %D 2022 %7 25.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: First responders are confronted with traumatic events in their work that has a substantial toll on their psychological health and may contribute to or result in posttraumatic stress injuries (PTSIs) for many responders. Persons with a PTSI usually seek management therapies. Evidence indicates that digital delivery of these therapies is an innovative, efficient, and effective way to improve PTSI symptoms as an adjunct to in-person delivery. Objective: This project aims to implement and provide accessible, convenient, and economical SMS text messaging services, known as Text4PTSI and Text4Wellbeing, to first responders in Alberta, Canada; to prevent and improve the symptoms of PTSI among first responders; and to improve their overall quality of life. We will evaluate posttraumatic symptoms and the impact of Text4PTSI and Text4Wellbeing on stress, anxiety, and depression in relation to the correspondents’ demographic backgrounds. Methods: First responders who subscribe to Text4PTSI or Text4Wellbeing receive daily supportive and psychoeducational SMS text messages for 6 months. The SMS text messages are preprogrammed into an online software program that delivers messages to subscribers. Baseline and follow-up data are collected through online questionnaires using validated scales at enrollment, 6 weeks, 12 weeks, and 24 weeks (end point). In-depth interviews will be conducted to assess satisfaction with the text-based intervention. Results: We hypothesize that participants who enroll in this program will have improved PTSI symptoms; increased or improved quality of life; and significant reduction in associated stress, depression, and anxiety symptoms, among other psychological concerns. Improvement will be determined in comparison to established baseline parameters. Conclusions: This research will be beneficial for practitioners and will inform policy-making and decision-making regarding psychological interventions for PTSI. Lessons from this study will inform the scale-up of the intervention, a cost-effective, zero contact therapeutic option to manage PTSI. International Registered Report Identifier (IRRID): PRR1-10.2196/30680 %M 35468094 %R 10.2196/30680 %U https://www.researchprotocols.org/2022/4/e30680 %U https://doi.org/10.2196/30680 %U http://www.ncbi.nlm.nih.gov/pubmed/35468094 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 4 %P e33628 %T Residual Effect of Texting to Promote Medication Adherence for Villagers with Schizophrenia in China: 18-Month Follow-up Survey After the Randomized Controlled Trial Discontinuation %A Cai,Yiyuan %A Gong,Wenjie %A He,Wenjun %A He,Hua %A Hughes,James P %A Simoni,Jane %A Xiao,Shuiyuan %A Gloyd,Stephen %A Lin,Meijuan %A Deng,Xinlei %A Liang,Zichao %A Dai,Bofeng %A Liao,Jing %A Hao,Yuantao %A Xu,Dong Roman %+ Center for World Health Organization (WHO) Studies and Department of Health Management, School of Health Management of Southern Medical University, 1023 South Shatai Road, Guangzhou, 510515, China, 86 02061647194, romanxu@i.smu.edu.cn %K medication adherence %K mobile texting %K lay health worker %K resource-poor community %K primary health care %K quality of care %K mHealth %K schizophrenia %K maintenance %K residual effect %K mental health %K patient outcomes %D 2022 %7 19.4.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Reducing the treatment gap for mental health in low- and middle-income countries is a high priority. Even with treatment, adherence to antipsychotics is rather low. Our integrated intervention package significantly improved medication adherence within 6 months for villagers with schizophrenia in resource-poor communities in rural China. However, considering the resource constraint, we need to test whether the effect of those behavior-shaping interventions may be maintained even after the suspension of the intervention. Objective: The aim of this study is to explore the primary outcome of adherence and other outcomes at an 18-month follow-up after the intervention had been suspended. Methods: In a 6-month randomized trial, 277 villagers with schizophrenia were randomized to receive either a government community mental health program (686 Program) or the 686 Program plus Lay health supporters, e-platform, award, and integration (LEAN), which included health supporters for medication or care supervision, e-platform access for sending mobile SMS text messaging reminders and education message, a token gift for positive behavior changes (eg, continuing taking medicine), and integrating the e-platform with the existing 686 Program. After the 6-month intervention, both groups received only the 686 Program for 18 months (phase 2). Outcomes at both phases included antipsychotic medication adherence, functioning, symptoms, number of rehospitalization, suicide, and violent behaviors. The adherence and functioning were assessed at the home visit by trained assessors. We calculated the adherence in the past 30 days by counting the percentage of dosages taken from November to December 2018 by unannounced home-based pill counts. The functioning was assessed using the World Health Organization Disability Assessment Schedule 2.0. The symptoms were evaluated using the Clinical Global Impression–Schizophrenia during their visits to the 686 Program psychiatrists. Other outcomes were routinely collected in the 686 Program system. We used intention-to-treat analysis, and missing data were dealt with using multiple imputation. The generalized estimating equation model was used to assess program effects on adherence, functioning, and symptoms. Results: In phase 1, antipsychotic adherence and rehospitalization incidence improved significantly. However, in phase 2, the difference of the mean of antipsychotic adherence (adjusted mean difference 0.05, 95% CI −0.06 to 0.16; P=.41; Cohen d effect size=0.11) and rehospitalization incidence (relative risk 0.65, 95% CI 0.32-1.33; P=.24; number needed to treat 21.83, 95% CI 8.30-34.69) was no longer statistically significant, and there was no improvement in other outcomes in either phase (P≥.05). Conclusions: The simple community-based LEAN intervention could not continually improve adherence and reduce the rehospitalization of people with schizophrenia. Our study inclined to suggest that prompts for medication may be necessary to maintain medication adherence for people with schizophrenia, although we cannot definitively exclude other alternative interpretations. %M 35438649 %R 10.2196/33628 %U https://mhealth.jmir.org/2022/4/e33628 %U https://doi.org/10.2196/33628 %U http://www.ncbi.nlm.nih.gov/pubmed/35438649 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e37106 %T Investigating Why and How Young Adults Use Protective Behavioral Strategies for Alcohol and Marijuana Use: Protocol for Developing a Randomized Controlled Trial %A Lewis,Melissa A %A Litt,Dana M %A Fairlie,Anne M %A Kilmer,Jason R %A Kannard,Emma %A Resendiz,Raul %A Walker,Travis %+ Health Behavior and Health Systems, University of North Texas Health Science Center, 3500 Camp Bowie BLVD, Fort Worth, TX, 76107, United States, 1 817 735 5136, melissa.lewis@unthsc.edu %K alcohol use %K marijuana use %K protective behavioral strategies %K intervention development %K young adults %D 2022 %7 19.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Young adulthood is associated with increased alcohol and marijuana use compared with other developmental periods. Alcohol and marijuana use place individuals at high risk for acute and long-term negative consequences. Despite the relatively large cross-sectional and longitudinal literature on protective behavioral strategies (PBS; behaviors that individuals can use to limit consequences and reduce substance use), little is known about why young adults choose to use PBS on specific occasions or why they might use PBS differently across occasions (ie, quality and consistency). There is significant room for improvement in the conceptualization, application, and understanding of PBS. Objective: This study aims to develop a novel, brief web-based and SMS text messaging intervention, with input from young adults who use alcohol and marijuana, which addresses the extent to which motivations for PBS use and nonuse (marijuana or alcohol) and the quality of PBS use (the degree of effectiveness or degree of implementation) differ when using alcohol alone versus concurrently or simultaneously with marijuana. Methods: This research will be conducted in 2 phases. Phase 1 will involve web-based focus groups (N=100) and cognitive interviews (N=10) to determine why young adults (aged 18-24 years) use or do not use specific PBS related to alcohol and marijuana use and elicit feedback on how motivations and the quality of PBS could be incorporated into a web-based and SMS text messaging PBS intervention as well as elicit feedback on developed intervention material. In phase 2, young adults (N=200; aged 18-24 years), who typically use alcohol and marijuana for at least 2 days per week, will be randomized to either the intervention or waitlist control group. The intervention will be brief, web-based, focusing on self-selected alcohol and marijuana PBS messages and motives for using alcohol- and marijuana-related PBS, and including intervention content delivered via SMS text messages 3 days a week (random day, Friday, and Saturday) over 8 consecutive weeks. All participants will report on PBS use, motivations for PBS use (and nonuse), quality of PBS use, and alcohol and marijuana use in morning surveys timed to occur the day after the intervention SMS text messages for those in the intervention group. Results: Recruitment and enrollment for phase 1 began in January 2022. Recruitment for phase 2 is anticipated to begin in January 2023. Upon completion of the phase 2 pilot, we will examine the feasibility, acceptability, and preliminary effect sizes of the newly developed brief web-based and SMS text messaging intervention. Conclusions: This study will provide an in-depth understanding of young adults’ PBS use and has the potential to develop a more efficacious intervention for co-occurring or simultaneous alcohol and marijuana behaviors. Trial Registration: ClinicalTrials.gov NCT04978129; https://clinicaltrials.gov/ct2/show/NCT04978129 International Registered Report Identifier (IRRID): DERR1-10.2196/37106 %M 35438642 %R 10.2196/37106 %U https://www.researchprotocols.org/2022/4/e37106 %U https://doi.org/10.2196/37106 %U http://www.ncbi.nlm.nih.gov/pubmed/35438642 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e27387 %T Impact of SMS Text Messaging Reminders on Helmet Use Among Motorcycle Drivers in Dar es Salaam, Tanzania: Randomized Controlled Trial %A Campbell,Benjamin %A Heitner,Jesse %A Amos Mwelelo,Peter %A Fogel,Alexis %A Mujumdar,Vaidehi %A Adams,Lisa V %A Boniface,Respicious %A Su,Yanfang %+ International Clinical Research Center, Department of Global Health, University of Washington, 908 Jefferson St, Seattle, WA, 98104, United States, 1 510 220 4266, jah495@mail.harvard.edu %K road traffic injury %K behavior change %K SMS reminders %K mobile health %K vehicle safety %K mHealth %K SMS %K traffic injuries %K transportation %K public transportation %K safety %K automotive %K automotive safety %D 2022 %7 7.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Road traffic injury is a pressing public health issue in Tanzania. Increasing helmet use among motorcycle drivers can help reduce the burden due to road traffic injuries in the country. Helmet adherence can be supported through mobile health interventions. Objective: The aim of this study is to evaluate the comparative impact of two different types of SMS text messaging reminders on motorcycle helmet use. Methods: Participants were 391 commercial motorcycle taxi drivers in Dar es Salaam, Tanzania. Participants were randomized into three groups, each receiving a different set of messages: (1) social norming messages aimed at emphasizing society’s positive stance on helmet wearing, (2) fear appeal messages that emphasized the dangers of riding without a helmet, and (3) control group messages, which included basic road safety messages unrelated to helmet use. Every participant received the control messages. Adherence to helmet use was evaluated by self-report through surveys conducted at baseline, 3 weeks, and 6 weeks. Results: At 6 weeks, the odds of self-reporting consistent helmet use were estimated to be 1.58 times higher in the social norming group than in the control group (P=.04), though this difference was not significant after accounting for multiple testing. There was little difference between fear appeal and control group recipients (odds ratio 1.03, P=.47). Subgroup analysis suggests that both fear appeal and social norming message types might have been associated with increased helmet use among participants who did not consistently wear helmets at baseline (odds ratio 1.66 and odds ratio 1.84, respectively), but this was not significant (P=.11 and P=.07, respectively). Among those who were consistent wearers at baseline, the social norming messages performed better than the fear appeal messages, and this difference reached traditional significance (P=.03), but was not significant after accounting for multiple testing. Conclusions: The use of SMS text messaging reminders may improve helmet use among motorcycle drivers when framed as social norming messages. Given that nearly half of the drivers in our sample did not consistently wear their helmets on every trip, strategies to increase consistent usage could greatly benefit public safety. Trial Registration: ClinicalTrials.gov NCT02120742; https://clinicaltrials.gov/ct2/show/NCT02120742 %M 35389364 %R 10.2196/27387 %U https://www.jmir.org/2022/4/e27387 %U https://doi.org/10.2196/27387 %U http://www.ncbi.nlm.nih.gov/pubmed/35389364 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 4 %P e27792 %T Support for Texting-Based Condom Negotiation Among Forcibly Displaced Adolescents in the Slums of Kampala, Uganda: Cross-sectional Validation of the Condom Use Negotiated Experiences Through Technology Scale %A Okumu,Moses %A Logie,Carmen H %A Ansong,David %A Mwima,Simon %A Hakiza,Robert %A Newman,Peter A %+ School of Social Work, University of Illinois, Urbana-Champaign, 1010 W Nevada St, Urbana, IL, 61801, United States, 1 217 333 2213, okumu@illinois.edu %K condom negotiation %K sexting %K refugee and displaced adolescents %K digital sexual communication %K HIV prevention %K gender %D 2022 %7 6.4.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Promoting sexual health among forcibly displaced adolescents is a global public health priority. Digital sexual communication strategies (eg, sexting) may increase adolescents’ confidence in discussing sexual health issues and negotiating condom use. However, limited evidence exists describing validated measures for text-based condom negotiation in the literature. Objective: This study helps fill this gap by adapting and examining the psychometric properties of a condom use experience through technology (condom use negotiated experiences through technology [CuNET]) scale. Methods: Using peer network sampling, 242 forcibly displaced adolescents (aged 16-19 years) living in Kampala’s slums were recruited for participation between January and March 2018. A subscale (embarrassment to negotiate condom use) of the Multidimensional Condom Attitudes Scale was adapted to incorporate sexting, yielding CuNET. Participants were randomly assigned to calibration and validation subsamples to conduct exploratory and confirmatory factor analyses to establish and validate the scale. CuNET measured participants’ support levels for texting-based condom negotiation via sexting based on gender, and multivariable logistic regression was used to explore its associations with sexual health outcomes (recent consistent condom use, access to sexual and reproductive health services, and lifetime sexually transmitted infection testing). Results: The one-factor CuNET with the validation sample was valid (χ24=5.3; P=.26; root mean square error of approximation=0.05, 90% CI 0.00-0.16; comparative fit index=0.99; Tucker-Lewis index=0.99; standardized root mean square residual=0.006), and reliability (Cronbach α=.98). Adolescent girls showed significantly lower levels of support for using sexting to negotiate condom use (mean 13.60, SE 0.70 vs mean 21.48, SE 1.23; P=.001). In multivariable analyses, a 1-point increase in the CuNET score was associated with increased odds of recent consistent condom use (adjusted odds ratio [aOR] 1.73, 95% CI 1.24-2.41) but not with access to sexual and reproductive health services (aOR 1.51, 95% CI 0.99-2.30) or lifetime sexually transmitted infection testing (aOR 0.90, 95% CI 0.64-1.26). Conclusions: The unidimensional CuNET scale is valid and reliable for forcibly displaced adolescents living in slums in Kampala, gender-sensitive, and relevant for predicting consistent condom use among urban displaced and refugee adolescents. Further development of this scale will enable a better understanding of how adolescents use digital tools for condom negotiation. %M 35384852 %R 10.2196/27792 %U https://publichealth.jmir.org/2022/4/e27792 %U https://doi.org/10.2196/27792 %U http://www.ncbi.nlm.nih.gov/pubmed/35384852 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 2 %P e33082 %T Text Messages and Financial Incentives to Increase Physical Activity in Adolescents With Prediabetes and Type 2 Diabetes: Web-Based Group Interviews to Inform Intervention Design %A Vajravelu,Mary Ellen %A Hitt,Talia Alyssa %A Mak,NaDea %A Edwards,Aliya %A Mitchell,Jonathan %A Schwartz,Lisa %A Kelly,Andrea %A Amaral,Sandra %+ Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, University of Pittsburgh School of Medicine, 4401 Penn Ave, Faculty Pavilion 6th Floor, Pittsburgh, PA, 15224, United States, 1 412 692 6533, MaryEllen.Vajravelu@pitt.edu %K diabetes mellitus type 2 %K adolescent %K young adult %K text messaging %K physical activity %K motivation %K mobile phone %D 2022 %7 6.4.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: Physical activity is a major component of treatment for adolescents with obesity and prediabetes or type 2 diabetes; however, sedentary behavior remains pervasive. An SMS text message–based intervention paired with financial incentives may be an effective way to promote physical activity in this population. Objective: This study aims to obtain end-user feedback on SMS text message content and assess the acceptability of a planned SMS text messaging intervention with financial incentives to motivate youth with prediabetes or type 2 diabetes to increase physical activity. Methods: Adolescents with overweight or obesity and prediabetes or type 2 diabetes who attended a large academic pediatric endocrinology clinic were recruited to participate in group interviews (2-4/group) via videoconferencing. Participants were asked to share their thoughts on the use of SMS text messages and financial incentives to remind and motivate them to be more physically active. They rated and provided feedback on specific messages to be used in clinical trials. Participants were also asked about their personal experience with rewards to motivate behavior change and their anticipated reactions to rewards provided for goal attainment (gain-framing) versus those provided and then taken away if a goal was not met (loss-framing). The interviews were conducted by 2 trained interviewers and a note-taker. Content analysis was used to explore themes. Results: Group interviews were completed with 20 participants (11/20, 55% women; 15/20, 75% with type 2 diabetes; 5/20, 25% with prediabetes) with a mean age of 15 (SD 1; range 12-18) years and a mean BMI of 41 (SD 5) kg/m2 (all >95th percentile for age and sex). Most participants were non-Hispanic Black (14/20, 70%) and 10% (2/20) were Hispanics. Participants frequently cited near-continuous smartphone use and agreed that SMS text messages would serve as good reminders to be physically active, but the consensus about the need for short messages was strong. Favorable content included references to what they were likely to be doing when messages were sent (eg, homework or watching television) and messages that were upbeat or informative. Specific physical activity suggestions were rated favorably. Attitudes toward financial incentives varied, with differing opinions about whether loss-framed incentives would be motivating or discouraging. Many participants highlighted the role of intrinsic, rather than extrinsic, motivation in achieving and sustaining behavior change. Conclusions: The engagement of adolescents with obesity and diabetes or prediabetes allowed for the refinement of SMS text messages for our planned intervention, with an emphasis on short, upbeat, relatable, and informative messages. Although an SMS text messaging intervention using financial incentives to motivate youth with prediabetes or type 2 diabetes to be more physically active is theoretically acceptable, the impact on actual activity levels in this population requires prospective evaluation in a clinical trial. %M 35384850 %R 10.2196/33082 %U https://diabetes.jmir.org/2022/2/e33082 %U https://doi.org/10.2196/33082 %U http://www.ncbi.nlm.nih.gov/pubmed/35384850 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e36849 %T Adaptive Text Messaging for Postpartum Risky Drinking: Conceptual Model and Protocol for an Ecological Momentary Assessment Study %A Dauber,Sarah %A Beacham,Alexa %A Hammond,Cori %A West,Allison %A Thrul,Johannes %+ Partnership to End Addiction, 711 Third Avenue, New York, NY, 10017, United States, 1 212 841 5270, sdauber@toendaddiction.org %K postpartum %K alcohol use %K risky drinking %K mobile health %K ecologic momentary assessment %K mobile phone %D 2022 %7 4.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Risky drinking is prevalent among women of childbearing age. Although many women reduce their drinking during pregnancy, more than half return to prepregnancy levels during the early postpartum period. Risky drinking in new mothers may be associated with negative child and maternal health outcomes; however, new mothers are unlikely to seek treatment for risky drinking because of stigma and fear of child protective service involvement. SMS text messaging is a promising approach for reaching non–treatment-seeking new mothers at risk because of risky drinking. SMS text messaging interventions (TMIs) are empirically supported for alcohol use, but a tailored intervention for new mothers does not exist. This study aims to fill this gap by developing a just-in-time adaptive TMI for postpartum risky drinking. Objective: The objectives of this paper are to present a preliminary conceptual model of postpartum risky drinking and describe the protocol for conducting an ecological momentary assessment (EMA) study with new mothers to inform the refinement of the conceptual model and development of the TMI. Methods: This paper presents a preliminary conceptual model of postpartum risky drinking based on the motivational model of alcohol use, social cognitive theory, and temporal self-regulation theory. The model proposes three primary intervention targets: motivation, self-efficacy, and self-regulation. Theoretical and empirical literature in support of the conceptual model is described. The paper also describes procedures for a study that will collect EMA data from 30 participants recruited via social media and the perinatal Central Intake system of New Jersey. Following the baseline assessment, EMA surveys will be sent 5 times per day for 14 days. The assessment instruments and data analysis procedures are described. Results: Recruitment is scheduled to begin in January 2022 and is anticipated to conclude in March 2022. Study results are estimated to be published in July 2022. Conclusions: The study findings will enhance our understanding of daily and momentary fluctuations in risk and protective factors for risky drinking during the early postpartum period. The findings will be used to refine the conceptual model and inform the development of the TMI. The next steps for this work include the development of intervention components via an iterative participatory design process and testing of the resulting intervention in a pilot microrandomized trial. International Registered Report Identifier (IRRID): PRR1-10.2196/36849 %M 35373778 %R 10.2196/36849 %U https://www.researchprotocols.org/2022/4/e36849 %U https://doi.org/10.2196/36849 %U http://www.ncbi.nlm.nih.gov/pubmed/35373778 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e30571 %T Web-Based TangPlan and WeChat Combination to Support Self-management for Patients With Type 2 Diabetes: Randomized Controlled Trial %A Xia,Shu-Fang %A Maitiniyazi,Gusonghan %A Chen,Yue %A Wu,Xiao-Ya %A Zhang,Yu %A Zhang,Xiao-Yan %A Li,Zi-Yuan %A Liu,Yuan %A Qiu,Yu-Yu %A Wang,Jun %+ Department of Rehabilitation, Wuxi 9th Affiliated Hospital of Soochow University, NO. 999, Liangxi Road, Wuxi, 214063, China, 86 51085867999, wangjun2115@suda.edu.cn %K type 2 diabetes %K glucose control %K TangPlan %K WeChat %K self-management %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: China has the largest number of patients with type 2 diabetes mellitus (T2DM) in the world. However, owing to insufficient knowledge of self-management in patients with diabetes, blood glucose (BG) control is poor. Most diabetes-related self-management applications fail to bring significant benefits to patients with T2DM because of the low use rate and difficult operation. Objective: This study aims to examine the effectiveness of the combination of the self-designed web-based T2DM management software TangPlan and WeChat on fasting BG (FBG), glycated hemoglobin (HbA1c), body weight, blood pressure (BP), and lipid profiles in patients with T2DM over a 6-month period. Methods: Participants were recruited and randomized into the TangPlan and WeChat or control groups. Participants in the control group received usual care, whereas the TangPlan and WeChat participants received self-management guidance with the help of TangPlan and WeChat from health care professionals, including BG self-monitoring; healthy eating; active physical exercise; increasing medication compliance; and health education during follow-ups, lectures, or web-based communication. They were also asked to record and send self-management data to the health care professionals via WeChat to obtain timely and effective guidance on diabetes self-management. Results: In this study, 76.9% (120/156) of participants completed the 6-month follow-up visit. After the intervention, FBG (mean 6.51, SD 1.66 mmol/L; P=.048), HbA1c (mean 6.87%, SD 1.11%; P<.001), body weight (mean 66.50, SD 9.51 kg; P=.006), systolic BP (mean 127.03, SD 8.00 mm Hg; P=.005), diastolic BP (mean 75.25, SD 5.88 mm Hg; P=.03), serum low-density lipoprotein cholesterol (mean 2.50, SD 0.61 mmol/L; P=.006), and total cholesterol (mean 4.01, SD 0.83 mmol/L; P=.02) in the TangPlan and WeChat group were all significantly lower, whereas serum high-density lipoprotein cholesterol (mean 1.20, SD 0.25 mmol/L; P=.01) was remarkably higher than in those in the control group. Compared with the baseline data, significance was found in the mean change in FBG (95% CI −0.83 to −0.20; P=.002), HbA1c (95% CI −1.92 to −1.28; P<.001), body weight (95% CI −3.13 to −1.68; P<.001), BMI (95% CI −1.10 to −0.60; P<.001), systolic BP (95% CI −7.37 to −3.94; P<.001), diastolic BP (95% CI −4.52 to −2.33; P<.001), triglycerides (95% CI −0.16 to −0.03; P=.004), serum low-density lipoprotein cholesterol (95% CI −0.54 to −0.30; P<.001), and total cholesterol (95% CI −0.60 to −0.34; P<.001) in the TangPlan and WeChat group but not in the control group (P=.08-.88). Conclusions: Compared with usual care for patients with T2DM, the combination of TangPlan and WeChat was effective in improving glycemic control (decrease in HbA1c and BG levels) and serum lipid profiles as well as reducing body weight in patients with T2DM after 6 months. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000028843; https://tinyurl.com/559kuve6 %M 35353055 %R 10.2196/30571 %U https://mhealth.jmir.org/2022/3/e30571 %U https://doi.org/10.2196/30571 %U http://www.ncbi.nlm.nih.gov/pubmed/35353055 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e31040 %T Comparing Reminders Sent via SMS Text Messaging and Email for Improving Adherence to an Electronic Health Program: Randomized Controlled Trial %A Kulhánek,Adam %A Lukavska,Katerina %A Gabrhelík,Roman %A Novák,Daniel %A Burda,Václav %A Prokop,Jindřich %A Holter,Marianne T S %A Brendryen,Håvar %+ Department of Addictology, General University Hospital in Prague, Apolinářská 4, Prague, 12000, Czech Republic, 420 224 968 273, katerina.lukavska@lf1.cuni.cz %K eHealth %K randomized controlled trial %K adherence %K reminders %K SMS text messaging %K email %K smoking cessation %K text message %D 2022 %7 18.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: eHealth interventions can help people change behavior (eg, quit smoking). Reminders sent via SMS text messaging or email may improve the adherence to web-based programs and increase the probability of successful behavior change; however, it is unclear whether their efficiency is affected by the modality of the communication channel. Objective: A 2-armed randomized control trial was conducted to compare the effect of providing reminders via SMS text messaging versus email on the adherence to an eHealth program for smoking cessation and on the probability to initiate a quit attempt. Methods: Smokers were recruited via an internet-based advertisement. A total of 591 participants who diverted from intended use of the program (ie, failed to log on to a session) were automatically randomized to the experimental (SMS text messaging reminder, n=304) or the active comparator (email reminder, n=287) group. Results: Unexpectedly, we found that the mode of reminder delivery did not significantly affect either the adherence, namely the number of completed program sessions, with the SMS text messaging reminder group showing a mean of 4.30 (SD 3.24) and the email reminder group showing a mean of 4.36 (SD 3.27) (t586=0.197, P=.84, and Cohen d=0.016), or the outcome, namely the quit smoking attempt rate (34.2% in the SMS text messaging group vs 31.7% in the email group; χ21=0.4, P=.52). Secondary analyses showed that age, gender, and education had significant effects on program adherence and education on the outcome. Moreover, we found a significant interaction effect between the mode of reminder delivery and gender on program adherence, suggesting that the effectiveness of SMS text message reminders might be different for females and males. However, this particular finding should be treated with care as it was based on post hoc subgroup analysis. Conclusions: This study indicates that the modality of user reminders to log on increased neither the program adherence nor the probability of quitting smoking. This suggests that program developers may save costs using emails instead of SMS text messaging reminders. Trial Registration: ClinicalTrials.gov NCT03276767; https://clinicaltrials.gov/ct2/show/ NCT03276767 %M 35302945 %R 10.2196/31040 %U https://mhealth.jmir.org/2022/3/e31040 %U https://doi.org/10.2196/31040 %U http://www.ncbi.nlm.nih.gov/pubmed/35302945 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32342 %T User Experiences With an SMS Text Messaging Program for Smoking Cessation: Qualitative Study %A Budenz,Alexandra %A Coa,Kisha %A Grenen,Emily %A Keefe,Brian %A Sanders,Amy %A Wiseman,Kara P %A Roditis,Maria %+ ICF, 9300 Lee Hwy, Fairfax, VA, 22031, United States, 1 301 572 0369, Emily.Grenen@icfnext.com %K smoking cessation %K text messaging interventions %K qualitative research %K mobile phone %D 2022 %7 18.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health strategies for smoking cessation (eg, SMS text messaging–based interventions) have been shown to be effective in helping smokers quit. However, further research is needed to better understand user experiences with these platforms. Objective: This qualitative study aims to explore the experiences of real-world users of a publicly available smoking cessation program (SmokefreeTXT). Methods: Semistructured phone interviews were conducted with 36 SmokefreeTXT users between March and July 2014. Of these 36 participants, 50% (18/36) of participants completed the SmokefreeTXT program (ie, did not opt out of the program before the 6- to 8-week completion period), and 50% (18/36) did not complete the program (ie, requested to opt out of the program before the completion period). Interview questions focused on smoking behaviors, quitting history, opinions on the program’s content and structure, answering assessment questions, using keywords, reasons for opting out, and perceived usefulness of the program for quitting smoking. A thematic content analysis was conducted, with a focus on themes to increase program engagement and optimization. Results: The findings highlighted features of the program that participants found beneficial, as well as some elements that showed opportunities for improvement to boost program retention and successful cessation. Specifically, most participants found the SmokefreeTXT program to be convenient and supportive of cessation; however, some found the messages to be repetitive and reported a desire for more flexibility based on their readiness to quit and cessation progress. We also found that program completion did not necessarily indicate successful smoking cessation and that program opt out, which might be interpreted as a less positive outcome, may occur because of successful cessation. Finally, several participants reported using SmokefreeTXT together with other evidence-based cessation methods or non–evidence-based strategies. Conclusions: Qualitative interviews with real-world SmokefreeTXT users showed high program acceptability, engagement with program features, and perceived utility for smoking cessation. Our findings directly informed several program updates, such as adding an adaptive quit date feature and offering supplemental information on live support services for users who prefer human interaction during the cessation process. The study has implications for other digital tobacco cessation interventions and highlights important topics that warrant future research, such as the relationship between program engagement (eg, opt out and retention) and successful cessation. %M 35302505 %R 10.2196/32342 %U https://formative.jmir.org/2022/3/e32342 %U https://doi.org/10.2196/32342 %U http://www.ncbi.nlm.nih.gov/pubmed/35302505 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e29407 %T Reaching Patients With Noncommunicable Diseases in Rural Tanzania Using Mobile Devices and Community Trust: Qualitative Study %A Miyashita,Ayano %A Nakamura,Keiko %A Ohnishi,Mayumi %A Bintabara,Deogratius %A Shayo,Festo K %A Maro,Isaac I %A Sato,Hideko %A Seino,Kaoruko %A Kibusi,Stephen %+ Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8519, Japan, 81 3 5803 4048, nakamura.ith@tmd.ac.jp %K noncommunicable disease %K community health workers %K Tanzania %K communication %K rural %K community %K trust %K disease %K acceptability %K usability %K text message %K SMS %K mobile phone %K implementation %D 2022 %7 17.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A health service using mobile devices, mobile health (mHealth), has been widely applied to programs focusing on maternal and child health and communicable diseases in sub-Saharan African countries. However, mHealth apps for noncommunicable disease (NCD) services remain limited. Objective: This study aimed to explore the acceptability and potential usability of SMS text messaging for patients and health care providers for the management of NCDs as part of an implementation research in rural Tanzania. Methods: Nine focus group discussions were conducted with 56 participants (21 community health workers [CHWs], 17 patients, and 18 health care professionals [HPs]) in 3 districts in the Dodoma region, Tanzania. The interview guides were prepared in Swahili, and each session was recorded, transcribed, and translated into English. The focus group discussions consisted of the following topics: (1) perceptions of the participants about the possible use of mobile devices and SMS text messages as an mHealth platform in community health services; and (2) experiences of mobile device use in health activities or receiving health services via a mobile phone in the past. Results: CHWs and HPs reported having familiarity using mobile devices to provide health services, especially for reaching or tracing patients in remote settings; however, patients with NCDs were less familiar with the use of mobile devices compared with the other groups. Hesitation to receive health services via SMS text messaging was seen in the patient group, as they wondered who would send health advice to them. Some patients expected services beyond what mHealth could do, such as aiding in recovery from a disease or sending notifications about the availability of prescription medications. CHWs showed interest in using text messaging to provide health services in the community; however, the concerns raised by CHWs included the cost of using their own mobile devices. Moreover, they demanded training about NCD management before engaging in such an activity. Conclusions: This study explored views and experiences regarding the possible installation of an mHealth intervention for managing NCDs in rural Tanzania. Although HPs and CHWs had experience using mobile devices to provide health services in non-NCD projects, only a few patients (3/17, 17%) had heard about the use of mobile devices to receive health services. To improve the suitability and acceptability of the intervention design for patients with NCDs, their trust must be earned. Involving CHWs in the intervention is recommended because they have already been appointed in the community and already know how to communicate effectively with patients in the area. %M 35297772 %R 10.2196/29407 %U https://mhealth.jmir.org/2022/3/e29407 %U https://doi.org/10.2196/29407 %U http://www.ncbi.nlm.nih.gov/pubmed/35297772 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e31894 %T Testing Digital Methods of Patient-Reported Outcomes Data Collection: Prospective Cluster Randomized Trial to Test SMS Text Messaging and Mobile Surveys %A Agarwal,Anish K %A Ali,Zarina S %A Shofer,Frances %A Xiong,Ruiying %A Hemmons,Jessica %A Spencer,Evan %A Abdel-Rahman,Dina %A Sennett,Brian %A Delgado,Mucio K %+ Department of Emergency Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, United States, 1 6103042318, anish.agarwal@pennmedicine.upenn.edu %K patient-reported outcomes %K mobile surveys %K research methods %K text messaging %K mobile survey %K data collection %K patient engagement %K response rate %D 2022 %7 17.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Health care delivery continues to evolve, with an effort being made to create patient-centered care models using patient-reported outcomes (PROs) data. Collecting PROs has remained challenging and an expanding landscape of digital health offers a variety of methods to engage patients. Objective: The aim of this study is to prospectively investigate two common methods of remote PRO data collection. The study sought to compare response and engagement rates for bidirectional SMS text messaging and mobile surveys following orthopedic surgery. Methods: The study was a prospective, block randomized trial of adults undergoing elective orthopedic procedures over 6 weeks. The primary objective was to determine if the method of digital patient engagement would impact response and completion rates. The primary outcome was response rate and total completion of PRO questionnaires. Results: A total of 127 participants were block randomized into receiving a mobile survey (n=63) delivered as a hyperlink or responding to the same questions through an automated bidirectional SMS text messaging system (n=64). Gender, age, number of comorbidities, and opioid prescriptions were similar across messaging arms. Patients receiving the mobile survey were more likely to have had a knee-related surgery (n=50, 83.3% vs n=40, 62.5%; P=.02) but less likely to have had an invasive procedure (n=26, 41.3% vs n=39, 60.9%; P=.03). Overall engagement over the immediate postoperative period was similar. Prolonged engagement for patients taking opioids past postoperative day 4 was higher in the mobile survey arm at day 7 (18/19, 94.7% vs 9/16, 56.3%). Patients with more invasive procedures showed a trend toward being responsive at day 4 as compared to not responding (n=41, 59.4% vs n=24, 41.4%; P=.05). Conclusions: As mobile patient engagement becomes more common in health care, testing the various options to engage patients to gather data is crucial to inform future care and research. We found that bidirectional SMS text messaging and mobile surveys were comparable in response and engagement rates; however, mobile surveys may trend toward higher response rates over longer periods of time. Trial Registration: ClinicalTrials.gov NCT03532256; https://clinicaltrials.gov/ct2/show/NCT03532256 %M 35298394 %R 10.2196/31894 %U https://formative.jmir.org/2022/3/e31894 %U https://doi.org/10.2196/31894 %U http://www.ncbi.nlm.nih.gov/pubmed/35298394 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32138 %T Text Messaging Intervention for Mental Wellness in American Indian and Alaska Native Teens and Young Adults (BRAVE Study): Analysis of User Engagement Patterns %A Wrobel,Julia %A Silvasstar,Joshva %A Peterson,Roger %A Sumbundu,Kanku %A Kelley,Allyson %A Stephens,David %A Craig Rushing,Stephanie %A Bull,Sheana %+ Colorado School of Public Health, University of Colorado, 13001 East 17th Place, Mail Stop B119, Aurora, CO, 80045, United States, 1 307 724 4585, JULIA.WROBEL@cuanschutz.edu %K American Indian %K Alaska Native %K adolescent %K mental health %K help-seeking skills, text messaging %K mHealth, behavioral intervention %K user engagement %K feasibility %K engagement %K low-touch %K intervention %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Many American Indian and Alaska Native (AI/AN or Native) communities express concern about high rates of suicide and poor mental health. Technology-based health interventions that nurture resilience, coping skills, connectedness, and help-seeking skills may be an effective strategy for promoting health and wellbeing among AI/AN youth. The Northwest Portland Area Indian Health Board designed the BRAVE intervention for AI/AN youth. BRAVE is delivered via SMS text messaging and includes role model videos, mental wellness strategies, links to culturally relevant resources, and social support from family and friends. Objective: The aim of this study is to explore system data from the BRAVE intervention to determine patterns of user engagement and differences in psychosocial outcomes based on the number of clicks on BRAVE content. Methods: The BRAVE study included 1030 AI/AN teens and young adults nationwide (15 to 24 years old). The message series in the BRAVE and STEM study arms included 3 to 5 SMS text messages per week, featuring 1 role model video and 1 image per week. Messages were sent out via Mobile Commons (Upland Software Inc), a mobile messaging provider that supports text, picture, and video SMS. Results: Of the 509 participants in the original BRAVE analysis, 270 had sufficient data to analyze user engagement, with at least 1 trackable click on a study SMS text message. Of the 270, 184 (68.1%) were female, 50 (18.5%) were male, and 36 (13.3%) selected another gender category. The average participant was 20.6 years old, with a minimum and maximum age of 15 and 26 years. Most participants had relatively low engagement measured by the number of clicks (median 2; mean 3.4), although others clicked message content as many as 49 times. Users engaged most frequently with the YouTube-based content (viewing 1 of 7 role model videos), with 64.8% (175/270) of total clicks coming from the role model videos, and earlier episodes receiving the highest number of clicks. Most baseline psychosocial measures were not significantly associated with the number of links clicked. However, help-seeking behavior was highly significant (P<.001), with a rate ratio of 0.82 (0.73, 0.92), indicating that each 1-unit increase in help-seeking score at baseline was associated with an 18% decrease in the expected number of study content clicks. Conclusions: This is the first study to set initial standards for assessing user engagement in an mHealth intervention. Our work underscores the feasibility of exploring the impact of engagement on intended outcomes, allowing for more precise exploration of the dose-response relationship that may be realized through these low-touch interventions that offer promising potential for reaching high numbers of program participants. Trial Registration: ClinicalTrials.gov NCT04979481; https://clinicaltrials.gov/ct2/show/NCT04979481 %M 35212633 %R 10.2196/32138 %U https://formative.jmir.org/2022/2/e32138 %U https://doi.org/10.2196/32138 %U http://www.ncbi.nlm.nih.gov/pubmed/35212633 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e31909 %T Crowdsourced Community Support Resources Among Patients Discharged From the Emergency Department During the COVID-19 Pandemic: Pilot Feasibility Study %A Agarwal,Anish K %A Southwick,Lauren %A Schneider,Rachelle %A Pelullo,Arthur %A Ortiz,Robin %A Klinger,Elissa V %A Gonzales,Rachel E %A Rosin,Roy %A Merchant,Raina M %+ Department of Emergency Medicine, University of Pennsylvania, 3600 Civic Center Boulevard, Philadelphia, PA, 19104, United States, 1 2674280125, Anish.Agarwal@pennmedicine.upenn.edu %K COVID-19 %K mHealth %K CHW %K digital health %K platform %K crowdsource %K support %K community %K health system %K monitoring %K virtual care %K text message %K model %K community health worker %K pilot study %K feasibility %D 2022 %7 23.2.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has placed strains on communities. During this public health crisis, health systems have created remote methods of monitoring symptom progression and delivering care virtually. Objective: Using an SMS text message-based system, we sought to build and test a remote model to explore community needs, connect individuals to curated resources, and facilitate community health worker intervention when needed during the pandemic. The primary aims of this pilot study were to establish the feasibility (ie, engagement with the text line) and acceptability (ie, participant ratings of resources and service) of delivering automated well-being resources via smartphone technology. Methods: Eligible patients (aged 18 years or older, having a cell phone with SMS text messaging capability, and recently visited the emergency department) were identified using the electronic health record. The patients were consented to enroll and begin receiving COVID-19–related information and links to community resources. We collected open-ended and close-ended resource and mood ratings. We calculated the frequencies and conducted a thematic review of the open-ended responses. Results: In 7 weeks, 356 participants were enrolled; 13,917 messages were exchanged including 333 resource ratings (mean 4) and 673 well-being scores (mean 6.8). We received and coded 386 open-ended responses, most of which elaborated upon their self-reported mood score (29%). Overall, 77% (n=274) of our participants rated the platform as a service they would highly recommend to a family member or friend. Conclusions: This approach is designed to broaden the reach of health systems, tailor to community needs in real time, and connect at-risk individuals with robust community health support. %M 35037886 %R 10.2196/31909 %U https://mental.jmir.org/2022/2/e31909 %U https://doi.org/10.2196/31909 %U http://www.ncbi.nlm.nih.gov/pubmed/35037886 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 1 %P e34465 %T An Innovative, Paradigm-Shifting Lifestyle Intervention to Reduce Glucose Excursions With the Use of Continuous Glucose Monitoring to Educate, Motivate, and Activate Adults With Newly Diagnosed Type 2 Diabetes: Pilot Feasibility Study %A Oser,Tamara K %A Cucuzzella,Mark %A Stasinopoulos,Marilyn %A Moncrief,Matthew %A McCall,Anthony %A Cox,Daniel J %+ Department of Family Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue F496, Academic Office One, Aurora, CO, 80045, United States, 1 303 724 2060, tamara.oser@cuanschutz.edu %K type 2 diabetes %K continuous glucose monitoring %K glycemic excursion minimization %K initial treatment %K diabetes distress %K diabetes %K monitoring %K treatment %K distress %K pilot study %K lifestyle %K intervention %K motivation. %D 2022 %7 23.2.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: Type 2 diabetes (T2D) is a growing epidemic in the United States, and metabolic control has not been improved over the last 10 years. Glycemic excursion minimization (GEM) is an alternative lifestyle treatment option focused on reducing postnutrient glucose excursions rather than reducing weight. GEM has been proven to be superior to routine care when delivered face to face, and equivalent or superior to conventional weight loss therapy, but it has not been evaluated among patients newly diagnosed with T2D or in a self-administered format. Objective: This pilot study evaluated the feasibility of a self-administered version of GEM, augmented with continuous glucose monitoring (CGM), to improve metabolic control (hemoglobin A1c [HbA1c]) while diminishing or delaying the need for diabetes medications in adults recently diagnosed with T2D. These primary objectives were hypothesized to be achieved by reducing carbohydrate intake and increasing physical activity to diminish CGM glucose excursions, leading to the secondary benefits of an increase in diabetes empowerment and reduced diabetes distress, depressive symptoms, and BMI. Methods: GEM was self-administered by 17 adults recently diagnosed with T2D (mean age 52 years, SD 11.6 years; mean T2D duration 3.9 months, SD 2.5 months; mean HbA1c levels 8.0%, SD 1.6%; 40% female; 33.3% non-White), with the aid of a 4-chapter pocket guide and diary, automated motivational text messaging, and feedback from an activity monitor, along with CGM and supplies for the 6-week intervention and the 3-month follow-up. Treatment was initiated with one telephone call reviewing the use of the technology and 3 days later with a second call reviewing the use of the GEM pocket guide and intervention. Results: At 3-month follow-up, 67% of the participants’ diabetes was in remission (HbA1c levels <6.5%), and only one participant started taking diabetes medication. Participants demonstrated a significant reduction in HbA1c levels (–1.8%; P<.001). Participants also experienced significant reductions in high-glycemic-load carbohydrates routinely consumed, CGM readings that were >140 mg/dL, diabetes distress, depressive symptoms, and BMI. Participants felt that use of the CGM was the most significant single element of the intervention. Conclusions: GEM augmented with CGM feedback may be an effective initial intervention for adults newly diagnosed with T2D. A self-administered version of GEM may provide primary care physicians and patients with a new tool to help people recently diagnosed with T2D achieve remission independent of medication and without weight loss as the primary focus. Future research is needed with a larger and more diverse sample. %M 35050857 %R 10.2196/34465 %U https://diabetes.jmir.org/2022/1/e34465 %U https://doi.org/10.2196/34465 %U http://www.ncbi.nlm.nih.gov/pubmed/35050857 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e32815 %T Development and Usability of a Text Messaging Program for Women With Gestational Diabetes: Mixed Methods Study %A Blair,Rachel A %A Horn,Christine E %A Dias,Jennifer M %A McDonnell,Marie E %A Seely,Ellen W %+ Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, United States, 1 6177329479, rblair4@bwh.harvard.edu %K gestational diabetes mellitus %K SMS text messaging %K mobile phone %K mobile health %K pregnancy %K blood glucose self-monitoring %D 2022 %7 22.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Gestational diabetes mellitus (GDM) affects 5%-10% of pregnancies and can lead to serious fetal and maternal complications. SMS text messaging is an effective way to improve diabetes management outside of pregnancy, but has not been well studied in GDM. Objective: This study aimed to perform user experience testing and assess usability and acceptability of an SMS text messaging program (Text 4 Success) for women with GDM. Methods: An automated 2-way texting program was developed. It included (1) reminders to check blood glucose levels, (2) positive feedback to user-reported glucose levels, (3) weekly educational messages, and (4) weekly motivational messages. For the user experience testing, women received simulated messages. For the usability study, women were enrolled in the program and received messages for 2 weeks. All women participated in semistructured interviews. For women in the usability study, data from glucose measuring devices were downloaded to assess adherence to self-monitoring of blood glucose (SMBG), measured as the percentage of recommended SMBG checks performed (a secondary outcome). Results: Ten women participated in user experience testing. Suggestions for optimization included further customization of message timing and minimization of jargon, which were incorporated. Ten women participated in the usability study. All 10 would recommend the program to other women with GDM. Participants liked the immediate feedback to glucose values. Suggestions included further flexibility of messages related to mealtimes and the ability to aggregate blood glucose data into a table or graph. Overall, adherence to SMBG testing was high at baseline (222/238 recommended checks, 93%). In comparing the week prior to the trial with the 2 weeks during the trial, there was a small but statistically insignificant difference (P=.48) in the percentage of recommended SMBG performed (median 93% [25th-75th IQR 89%-100%] vs median 97% [25th-75th IQR 92%-100%]). Conclusions: Overall, women with GDM would recommend the Text 4 Success in GDM program and think it is helpful for GDM self-management. The program was usable and acceptable. The program may be better suited to those who have low levels of adherence to SMBG at baseline or to women at time of their diagnosis of GDM. Adaptations to the program will be made based on user suggestions. Further study of SMS text messaging to improve SMBG in GDM is needed. %M 35191851 %R 10.2196/32815 %U https://humanfactors.jmir.org/2022/1/e32815 %U https://doi.org/10.2196/32815 %U http://www.ncbi.nlm.nih.gov/pubmed/35191851 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e32918 %T Supporting People With Type 2 Diabetes in the Effective Use of Their Medicine Through Mobile Health Technology Integrated With Clinical Care to Reduce Cardiovascular Risk: Protocol for an Effectiveness and Cost-effectiveness Randomized Controlled Trial %A Farmer,Andrew %A Jones,Louise %A Newhouse,Nikki %A Kenning,Cassandra %A Williams,Nicola %A Chi,Yuan %A Bartlett,Y Kiera %A Plumpton,Catrin %A McSharry,Jenny %A Cholerton,Rachel %A Holmes,Emily %A Robinson,Stephanie %A Allen,Julie %A Gudgin,Bernard %A Velardo,Carmelo %A Rutter,Heather %A Horne,Rob %A Tarassenko,Lionel %A Williams,Veronika %A Locock,Louise %A Rea,Rustam %A Yu,Ly-Mee %A Hughes,Dyfrig %A Bower,Peter %A French,David %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Gibson Building, Radcliffe Observatory Quarter, Oxford, OX2 6GG, United Kingdom, 44 1865 617942, andrew.farmer@phc.ox.ac.uk %K diabetes %K SMS text messages %K cardiovascular risk prevention %K medication adherence %K digital health %K randomized controlled trial %D 2022 %7 21.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Type 2 diabetes is a common lifelong condition that affects over 400 million people worldwide. The use of effective medications and active self-management can reduce the risk of serious complications. However, people often have concerns when starting new medications and face difficulties in taking their medications regularly. Support provided by brief messages delivered through mobile phone–based SMS text messages can be effective in some long-term conditions. We have identified promising behavior change techniques (BCTs) to promote medication adherence in this population via a systematic review and developed SMS text messages that target these BCTs. Feasibility work has shown that these messages have fidelity to intended BCTs, are acceptable to patients, and are successful in changing the intended determinants of medication adherence. We now plan to test this intervention on a larger scale in a clinical trial. Objective: The aim of this trial is to determine the effectiveness and cost-effectiveness of this intervention for reducing cardiovascular risk in people with type 2 diabetes by comparing it with usual care. Methods: The trial will be a 12-month, multicenter, individually randomized controlled trial in primary care and will recruit adults (aged ≥35 years) with type 2 diabetes in England. Consenting participants will be randomized to receive short SMS text messages intended to affect a change in medication adherence 3 to 4 times per week in addition to usual care. The aim is to test the effectiveness and cost-effectiveness of the intervention when it is added to usual care. The primary clinical outcome will be a composite cardiovascular risk measure. Data including patient-reported measures will be collected at baseline, at 13 and 26 weeks, and at the end of the 12-month follow-up period. With 958 participants (479 in each group), the trial is powered at 92.5% to detect a 4–percentage point difference in cardiovascular risk. The analysis will follow a prespecified plan. A nested quantitative and qualitative process analysis will be used to examine the putative mechanisms of behavior change and wider contextual influences. A health economic analysis will be used to assess the cost-effectiveness of the intervention. Results: The trial has completed the recruitment phase and is in the follow-up phase. The publication of results is anticipated in 2024. Conclusions: This trial will provide evidence regarding the effectiveness and cost-effectiveness of this intervention for people with type 2 diabetes. Trial Registration: ISRCTN Registry ISRCTN15952379; https://www.isrctn.com/ISRCTN15952379 International Registered Report Identifier (IRRID): DERR1-10.2196/32918 %M 35188478 %R 10.2196/32918 %U https://www.researchprotocols.org/2022/2/e32918 %U https://doi.org/10.2196/32918 %U http://www.ncbi.nlm.nih.gov/pubmed/35188478 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 2 %P e32680 %T An Evaluation of the Text Illness Monitoring (TIM) Platform for COVID-19: Cross-sectional Online Survey of Public Health Users %A Joseph,Heather A %A Ingber,Susan Z %A Austin,Chelsea %A Westnedge,Caroline %A Strona,F V %A Lee,Leslie %A Shah,Ami B %A Roper,Lauren %A Patel,Anita %+ Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Mailstop 106, 4770 Buford Hwy, Chamblee, GA, 30341, United States, 1 4046392636, hbj7@cdc.gov %K COVID-19 %K contact tracing %K SMS text system %K symptom monitoring %D 2022 %7 7.2.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The US public health response to the COVID-19 pandemic has required contact tracing and symptom monitoring at an unprecedented scale. The US Centers for Disease Control and Prevention and several partners created the Text Illness Monitoring (TIM) platform in 2015 to assist US public health jurisdictions with symptom monitoring for potential novel influenza virus outbreaks. Since May 2020, 142 federal, state, and local public health agencies have deployed TIM for COVID-19 symptom monitoring. Objective: The aim of this study was to evaluate the utility, benefits, and challenges of TIM to help guide decision-making for improvements and expansion to support future public health emergency response efforts. Methods: We conducted a brief online survey of previous and current TIM administrative users (admin users) from November 28 through December 21, 2020. Closed- and open-ended questions inquired about the onboarding process, decision to use TIM, groups monitored with TIM, comparison of TIM to other symptom monitoring systems, technical challenges and satisfaction with TIM, and user support. A total of 1479 admin users were invited to participate. Results: A total of 97 admin users from 43 agencies responded to the survey. Most admin users represented the Indian Health Service (35/97, 36%), state health departments (26/97, 27%), and local or county health departments (18/97, 19%), and almost all were current users of TIM (85/94, 90%). Among the 43 agencies represented, 11 (26%) used TIM for monitoring staff exclusively, 13 (30%) monitored community members exclusively, and 19 (44%) monitored both staff and community members. Agencies most frequently used TIM to monitor symptom development in contacts of cases among community members (28/43, 65%), followed by symptom development among staff (27/43, 63%) and among staff contacts of cases (24/43, 56%). Agencies also reported using TIM to monitor patients with COVID-19 for the worsening of symptoms among staff (21/43, 49%) and community members (18/43, 42%). When asked to compare TIM to previous monitoring systems, 78% (40/51) of respondents rated TIM more favorably than their previous monitoring system, 20% (10/51) said there was no difference, and 2% (1/51) rated the previous monitoring system more favorably than TIM. Most respondents found TIM favorable in terms of time burden, staff burden, timeliness of the data, and the ability to monitor large population sizes. TIM compared negatively to other systems in terms of effort to enroll participants (ie, persons TIM monitors) and accuracy of the data. Most respondents (76/85, 89%) reported that they would highly or somewhat recommend TIM to others for symptom monitoring. Conclusions: This evaluation of TIM showed that agencies used TIM for a variety of purposes and rated TIM favorably compared to previously used monitoring systems. We also identified opportunities to improve TIM; for example, enhancing the flexibility of alert deliveries would better meet admin users’ varying needs. We also suggest continuous program evaluation practices to assess and respond to implementation gaps. %M 34882572 %R 10.2196/32680 %U https://publichealth.jmir.org/2022/2/e32680 %U https://doi.org/10.2196/32680 %U http://www.ncbi.nlm.nih.gov/pubmed/34882572 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e34309 %T Design and Evaluation of a Just-in-Time Adaptive Intervention (JITAI) to Reduce Sedentary Behavior at Work: Experimental Study %A Ismail,Tasnim %A Al Thani,Dena %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar, 974 44546374, tasnim.ismail95@gmail.com %K sedentary behavior %K persuasive technology %K behavior change %K physical activity %K adaptive intervention %D 2022 %7 26.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Employees in sedentary occupations tend to spend prolonged hours physically inactive. Physical inactivity is a main factor in the increase in the risks of a wide range of chronic diseases, including obesity, diabetes, hypertension, and heart disease. This has drawn researchers’ attention to investigate methods of increasing the level of activity of employees during working hours and in their daily lifestyle. Objective: The objective of this paper is to investigate the effectiveness of using personalized messages that include user information, user goals, daily routine, and the surrounding environment to increase the level of activity among employees. In this study, we hypothesize that sending context-aware motivational messages to workers in sedentary occupations after sitting for 40 minutes can break sedentary behavior and increase daily active time compared to static reminder messages. Methods: A 66-day between-group study using a mixed methods design approach was conducted with employees who are located in Qatar and spend most of their working day sedentary. The 58 participants used 2 different interventions: The control group (n=29, 50%) used a mobile app that only sends a static message after prolonged sitting (MotiFit Lite), and the intervention group (n=29, 50%) used a mobile app that sends context-aware personalized messages to promote physical activity (PA; MotiFit). Both apps log the received messages, the step count before and after the messages are sent, and the user response to the messages to obtain an idea of the impact of the messages. The study received approval from the Qatar Biomedical Research Institute’s institutional review board (IRB application #2019-10-037). Results: The questionnaires showed satisfaction of the designed apps’ subjective quality and perceived impact. The quantitative analysis showed a high level of engagement in the intervention group compared to the control group (P<.001). The results support the original hypothesis that using context-aware motivational messages can increase PA at work compared to static messages (P<.001). However, the analysis showed no significant impact of the message type on the overall activity level during the day (P=.06). Conclusions: Context-aware motivational messages motivate employees to increase their PA in the workplace. However, future research will further develop the analysis to investigate the impact on increasing the overall activity level during the day. %M 35080498 %R 10.2196/34309 %U https://formative.jmir.org/2022/1/e34309 %U https://doi.org/10.2196/34309 %U http://www.ncbi.nlm.nih.gov/pubmed/35080498 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e33188 %T Predictors of Smartphone and Tablet Use Among Patients With Hypertension: Secondary Analysis of Health Information National Trends Survey Data %A Eze,Chinwe E %A West,Brady T %A Dorsch,Michael P %A Coe,Antoinette B %A Lester,Corey A %A Buis,Lorraine R %A Farris,Karen %+ College of Pharmacy, University of Michigan, 428 Church Street, Ann Arbor, MI, 48109-1065, United States, 1 7346806587, ceeze@umich.edu %K hypertension %K mHealth %K remote monitoring %K telemonitoring %K smartphones %K tablets %K text messaging %K Health Information National Trends Survey %K mobile health %K digital health %K mobile phone %D 2022 %7 24.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Uncontrolled hypertension leads to significant morbidity and mortality. The use of mobile health technology, such as smartphones, for remote blood pressure (BP) monitoring has improved BP control. An increase in BP control is more significant when patients can remotely communicate with their health care providers through technologies and receive feedback. Little is known about the predictors of remote BP monitoring among hypertensive populations. Objective: The objective of this study is to quantify the predictors of smartphone and tablet use in achieving health goals and communicating with health care providers via SMS text messaging among hypertensive patients in the United States. Methods: This study was a cross-sectional, secondary analysis of the 2017 and 2018 Health Information National Trends Survey 5, cycles 1 and 2 data. A total of 3045 respondents answered “Yes” to the question “Has a doctor or other healthcare provider ever told you that you had high blood pressure or hypertension?”, which defined the subpopulation used in this study. We applied the Health Information National Trends Survey full sample weight to calculate the population estimates and 50 replicate weights to calculate the SEs of the estimates. We used design-adjusted descriptive statistics to describe the characteristics of respondents who are hypertensive based on relevant survey items. Design-adjusted multivariable logistic regression models were fitted to estimate predictors of achieving health goals with the help of smartphone or tablet and sending or receiving an SMS text message to or from a health care provider in the last 12 months. Results: An estimated 36.9%, SE 0.9% (183,285,150/497,278,883) of the weighted adult population in the United States had hypertension. The mean age of the hypertensive population was 58.3 (SE 0.48) years. Electronic communication with the doctor or doctor’s office through email or internet (odds ratio 2.93, 95% CI 1.85-4.63; P<.001) and having a wellness app (odds ratio 1.82, 95% CI 1.16-2.86; P=.02) were significant predictors of using SMS text message communication with a health care professional, adjusting for other demographic and technology-related variables. The odds of achieving health-related goals with the help of a tablet or smartphone declined significantly with older age (P<.001) and ownership of basic cellphones (P=.04). However, they increased significantly with being a woman (P=.045) or with being married (P=.03), having a wellness app (P<.001), using devices other than smartphones or tablets to monitor health (P=.008), making health treatment decisions (P=.048), and discussing with a provider (P=.02) with the help of a tablet or smartphone. Conclusions: Intervention measures accounting for age, gender, marital status, and the patient’s technology-related health behaviors are required to increase smartphone and tablet use in self-care and SMS text message communication with health care providers. %M 35072647 %R 10.2196/33188 %U https://www.jmir.org/2022/1/e33188 %U https://doi.org/10.2196/33188 %U http://www.ncbi.nlm.nih.gov/pubmed/35072647 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e32211 %T A Virtual Coach (Motibot) for Supporting Healthy Coping Strategies Among Adults With Diabetes: Proof-of-Concept Study %A Bassi,Giulia %A Giuliano,Claudio %A Perinelli,Alessio %A Forti,Stefano %A Gabrielli,Silvia %A Salcuni,Silvia %+ Department of Developmental and Socialization Psychology, University of Padova, Via Venezia 8, Padova, 35131, Italy, 39 3477334405, giulia.bassi@phd.unipd.it %K virtual coach %K diabetes mellitus %K adults %K psychosocial factors %K mindfulness %K proof-of-concept study %K mobile phone %D 2022 %7 21.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Motivation is a core component of diabetes self-management because it allows adults with diabetes mellitus (DM) to adhere to clinical recommendations. In this context, virtual coaches (VCs) have assumed a central role in supporting and treating common barriers related to adherence. However, most of them are mainly focused on medical and physical purposes, such as the monitoring of blood glucose levels or following a healthy diet. Objective: This proof-of-concept study aims to evaluate the preliminary efficacy of a VC intervention for psychosocial support before and after the intervention and at follow-up. The intent of this VC is to motivate adults with type 1 DM and type 2 DM to adopt and cultivate healthy coping strategies to reduce symptoms of depression, anxiety, perceived stress, and diabetes-related emotional distress, while also improving their well-being. Methods: A total of 13 Italian adults with DM (18-51 years) interacted with a VC, called Motibot (motivational bot) using the Telegram messaging app. The interaction covered 12 sessions, each lasting 10 to 20 minutes, during which the user could dialogue with the VC by inputting text or tapping an option on their smartphone screen. Motibot is developed within the transtheoretical model of change to deliver the most appropriate psychoeducational intervention based on the user’s motivation to change. Results: Results showed that over the 12 sessions, there were no significant changes before and after the intervention and at follow-up regarding psychosocial factors. However, most users showed a downward trend over the 3 time periods in depression and anxiety symptoms, thereby presenting good psychological well-being and no diabetes-related emotional distress. In addition, users felt motivated, involved, encouraged, emotionally understood, and stimulated by Motibot during the interaction. Indeed, the analyses of semistructured interviews, using a text mining approach, showed that most users reported a perceived reduction in anxiety, depression, and/or stress symptoms. Moreover, users indicated the usefulness of Motibot in supporting and motivating them to find a mindful moment for themselves and to reflect on their own emotions. Conclusions: Motibot was well accepted by users, particularly because of the inclusion of mindfulness practices, which motivated them to adopt healthy coping skills. To this extent, Motibot provided psychosocial support for adults with DM, particularly for those with mild and moderate symptoms, whereas those with severe symptoms may benefit more from face-to-face psychotherapy. %M 35060918 %R 10.2196/32211 %U https://humanfactors.jmir.org/2022/1/e32211 %U https://doi.org/10.2196/32211 %U http://www.ncbi.nlm.nih.gov/pubmed/35060918 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e28638 %T Engagement With a Mobile Phone–Based Life Skills Intervention for Adolescents and Its Association With Participant Characteristics and Outcomes: Tree-Based Analysis %A Paz Castro,Raquel %A Haug,Severin %A Debelak,Rudolf %A Jakob,Robert %A Kowatsch,Tobias %A Schaub,Michael P %+ Swiss Research Institute for Public Health and Addiction, University of Zurich, Konradstrasse 32, Zurich, 8051, Switzerland, 41 444481180, raquel.paz@isgf.uzh.ch %K engagement %K life skills %K adolescents %K mobile phone %K machine learning %K decision tree %K mobile phone %D 2022 %7 19.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile phone–delivered life skills programs are an emerging and promising way to promote mental health and prevent substance use among adolescents, but little is known about how adolescents actually use them. Objective: The aim of this study is to determine engagement with a mobile phone–based life skills program and its different components, as well as the associations of engagement with adolescent characteristics and intended substance use and mental health outcomes. Methods: We performed secondary data analysis on data from the intervention group (n=750) from a study that compared a mobile phone–based life skills intervention for adolescents recruited in secondary and upper secondary school classes with an assessment-only control group. Throughout the 6-month intervention, participants received 1 SMS text message prompt per week that introduced a life skills topic or encouraged participation in a quiz or individual life skills training or stimulated sharing messages with other program participants through a friendly contest. Decision trees were used to identify predictors of engagement (use and subjective experience). The stability of these decision trees was assessed using a resampling method and by graphical representation. Finally, associations between engagement and intended substance use and mental health outcomes were examined using logistic and linear regression analyses. Results: The adolescents took part in half of the 50 interactions (mean 23.6, SD 15.9) prompted by the program, with SMS text messages being the most used and contests being the least used components. Adolescents who did not drink in a problematic manner and attended an upper secondary school were the ones to use the program the most. Regarding associations between engagement and intended outcomes, adolescents who used the contests more frequently were more likely to be nonsmokers at follow-up than those who did not (odds ratio 0.86, 95% CI 0.76-0.98; P=.02). In addition, adolescents who read the SMS text messages more attentively were less likely to drink in a problematic manner at follow-up (odds ratio 0.43, 95% CI 1.29-3.41; P=.003). Finally, participants who used the program the most and least were more likely to increase their well-being from baseline to 6-month follow-up compared with those with average engagement (βs=.39; t586=2.66; P=.008; R2=0.24). Conclusions: Most of the adolescents participating in a digital life skills program that aimed to prevent substance use and promote mental health engaged with the intervention. However, measures to increase engagement in problem drinkers should be considered. Furthermore, efforts must be made to ensure that interventions are engaging and powerful across different educational levels. First results indicate that higher engagement with digital life skills programs could be associated with intended outcomes. Future studies should apply further measures to improve the reach of lower-engaged participants at follow-up to establish such associations with certainty. %M 35044309 %R 10.2196/28638 %U https://www.jmir.org/2022/1/e28638 %U https://doi.org/10.2196/28638 %U http://www.ncbi.nlm.nih.gov/pubmed/35044309 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e31989 %T A Remote Health Coaching, Text-Based Walking Program in Ethnic Minority Primary Care Patients With Overweight and Obesity: Feasibility and Acceptability Pilot Study %A Smart,Mary H %A Nabulsi,Nadia A %A Gerber,Ben S %A Gupta,Itika %A Di Eugenio,Barbara %A Ziebart,Brian %A Sharp,Lisa K %+ Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, 833 South Wood St, Chicago, IL, 60612, United States, 1 312 355 3569, sharpl@uic.edu %K mHealth %K Fitbit %K SMART goals %K texting %K health coach %K mobile phone %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Over half of US adults have at least one chronic disease, including obesity. Although physical activity is an important component of chronic disease self-management, few reach the recommended physical activity goals. Individuals who identify as racial and ethnic minorities are disproportionally affected by chronic diseases and physical inactivity. Interventions using consumer-based wearable devices have shown promise for increasing physical activity among patients with chronic diseases; however, populations with the most to gain, such as minorities, have been poorly represented to date. Objective: This study aims to assess the feasibility, acceptability, and preliminary outcomes of an 8-week text-based coaching and Fitbit program aimed at increasing the number of steps in a predominantly overweight ethnic minority population. Methods: Overweight patients (BMI >25 kg/m2) were recruited from an internal medicine clinic located in an inner-city academic medical center. Fitbit devices were provided. Using 2-way SMS text messaging, health coaches (HCs) guided patients to establish weekly step goals that were specific, measurable, attainable, realistic, and time-bound. SMS text messaging and Fitbit activities were managed using a custom-designed app. Program feasibility was assessed via the recruitment rate, retention rate (the proportion of eligible participants completing the 8-week program), and patient engagement (based on the number of weekly text message goals set with the HC across the 8-week period). Acceptability was assessed using a qualitative, summative evaluation. Exploratory statistical analysis included evaluating the average weekly steps in week 1 compared with week 8 using a paired t test (2-tailed) and modeling daily steps over time using a linear mixed model. Results: Of the 33 patients initially screened; 30 (91%) patients were enrolled in the study. At baseline, the average BMI was 39.3 (SD 9.3) kg/m2, with 70% (23/33) of participants presenting as obese. A total of 30% (9/30) of participants self-rated their health as either fair or poor, and 73% (22/30) of participants set up ≥6 weekly goals across the 8-week program. In total, 93% (28/30) of participants completed a qualitative summative evaluation, and 10 themes emerged from the evaluation: patient motivation, convenient SMS text messaging experience, social support, supportive accountability, technology support, self-determined goals, achievable goals, feedback from Fitbit, challenges, and habit formation. There was no significant group change in the average weekly steps for week 1 compared with week 8 (mean difference 7.26, SD 6209.3; P=.99). However, 17% (5/30) of participants showed a significant increase in their daily steps. Conclusions: Overall, the results demonstrate the feasibility and acceptability of a remotely delivered walking study that included an HC; SMS text messaging; a wearable device (Fitbit); and specific, measurable, attainable, realistic, and time-bound goals within an ethnic minority patient population. Results support further development and testing in larger samples to explore efficacy. %M 35044308 %R 10.2196/31989 %U https://formative.jmir.org/2022/1/e31989 %U https://doi.org/10.2196/31989 %U http://www.ncbi.nlm.nih.gov/pubmed/35044308 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e31576 %T Feasibility and Acceptability of a Physical Activity Tracker and Text Messages to Promote Physical Activity During Chemotherapy for Colorectal Cancer: Pilot Randomized Controlled Trial (Smart Pace II) %A Van Blarigan,Erin L %A Dhruva,Anand %A Atreya,Chloe E %A Kenfield,Stacey A %A Chan,June M %A Milloy,Alexandra %A Kim,Iris %A Steiding,Paige %A Laffan,Angela %A Zhang,Li %A Piawah,Sorbarikor %A Fukuoka,Yoshimi %A Miaskowski,Christine %A Hecht,Frederick M %A Kim,Mi-Ok %A Venook,Alan P %A Van Loon,Katherine %+ Department of Epidemiology and Biostatistics, University of California, San Francisco, UCSF Box 0560, 550 16th St. 2nd Floor, San Francisco, CA, 94158, United States, 1 415 476 1111 ext 13608, erin.vanblarigan@ucsf.edu %K exercise %K treatment %K colon cancer %K rectal cancer %K digital health %K wearables %K SMS %D 2022 %7 11.1.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: We conducted a pilot 2-arm randomized controlled trial to assess the feasibility of a digital health intervention to increase moderate-to-vigorous physical activity in patients with colorectal cancer (CRC) during chemotherapy. Objective: This study aimed to determine whether a digital health physical activity intervention is feasible and acceptable during chemotherapy for CRC. Methods: Potentially eligible patients with CRC expected to receive at least 12 weeks of chemotherapy were identified in person at the University of California, San Francisco, and on the web through advertising. Eligible patients were randomized 1:1 to a 12-week intervention (Fitbit Flex, automated SMS text messages) versus usual care. At 0 and 12 weeks, patients wore an Actigraph GT3X+ accelerometer for 7 days and completed surveys, body size measurements, and an optional 6-minute walk test. Participants could not be masked to their intervention arm, but people assessing the body size and 6-minute walk test outcomes were masked. The primary outcomes were adherence (eg, Fitbit wear and text response rate) and self-assessed acceptability of the intervention. The intervention would be considered feasible if we observed at least 80% complete follow-up and 70% adherence and satisfaction, a priori. Results: From 2018 to 2020, we screened 240 patients; 53.3% (128/240) of patients were ineligible and 26.7% (64/240) declined to participate. A total of 44 patients (44/240, 18%) were randomized to the intervention (n=22) or control (n=22) groups. Of these, 57% (25/44) were women; 68% (30/44) identified as White and 25% (11/44) identified as Asian American or Pacific Islander; and 77% (34/44) had a 4-year college degree. The median age at enrollment was 54 years (IQR 45-62 years). Follow-up at 12 weeks was 91% (40/44) complete. In the intervention arm, patients wore Fitbit devices on a median of 67 out of 84 (80%) study days and responded to a median of 17 out of 27 (63%) questions sent via SMS text message. Among 19 out of 22 (86%) intervention patients who completed the feedback survey, 89% (17/19) were satisfied with the Fitbit device; 63% (12/19) were satisfied with the SMS text messages; 68% (13/19) said the SMS text messages motivated them to exercise; 74% (14/19) said the frequency of SMS text messages (1-3 days) was ideal; and 79% (15/19) said that receiving SMS text messages in the morning and evening was ideal. Conclusions: This pilot study demonstrated that many people receiving chemotherapy for CRC are interested in participating in digital health physical activity interventions. Fitbit adherence was high; however, participants indicated a desire for more tailored SMS text message content. Studies with more socioeconomically diverse patients with CRC are required. Trial Registration: ClinicalTrials.gov NCT03524716; https://clinicaltrials.gov/ct2/show/NCT03524716 %M 35014958 %R 10.2196/31576 %U https://cancer.jmir.org/2022/1/e31576 %U https://doi.org/10.2196/31576 %U http://www.ncbi.nlm.nih.gov/pubmed/35014958 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33438 %T Patients’ Expectations and Experiences With a Mental Health–Focused Supportive Text Messaging Program: Mixed Methods Evaluation %A Shalaby,Reham %A Vuong,Wesley %A Eboreime,Ejemai %A Surood,Shireen %A Greenshaw,Andrew J %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 17807144315, vincent.agyapong@nshealth.ca %K supportive text messages %K patients’ experience %K mental health %K mixed methods %D 2022 %7 11.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based services are an economical and easily scalable means of support that uses existing technology. Text4Support is a supportive, complementary text messaging service that supports people with different mental health conditions after they are discharged from inpatient psychiatric care. Objective: In this study, we aim to assess user satisfaction with the Text4Support service to gain a better understanding of subscribers’ experiences. Methods: This was a mixed methods study using secondary data from a pilot observational controlled trial. The trial included 181 patients discharged from acute psychiatric care and distributed into 4 randomized groups. Out of the 4 study groups in the initial study, 2 groups who received supportive text messages (89/181, 49.2% of patients), either alone or alongside a peer support worker, were included. Thematic and descriptive analyses were also performed. Differences in feedback based on sex at birth and primary diagnosis were determined using univariate analysis. The study was registered with ClinicalTrials.gov (trial registration number: NCT03404882). Results: Out of 89 participants, 36 (40%) completed the follow-up survey. The principal findings were that Text4Support was well perceived with a high satisfaction rate either regarding the feedback of the messages or their perceived impact. Meanwhile, there was no statistically significant difference between satisfactory items based on the subscriber’s sex at birth or primary diagnosis. The patients’ initial expectations were either neutral or positive in relation to the expected nature or the impact of the text messages received on their mental well-being. In addition, the subscribers were satisfied with the frequency of the messages, which were received once daily for 6 consecutive months. The participants recommended more personalized messages or mutual interaction with health care personnel. Conclusions: Text4Support was generally well perceived by patients after hospital discharge, regardless of their sex at birth or mental health diagnosis. Further personalization and interactive platforms were recommended by participants that may need to be considered when designing similar future services. %M 35014972 %R 10.2196/33438 %U https://formative.jmir.org/2022/1/e33438 %U https://doi.org/10.2196/33438 %U http://www.ncbi.nlm.nih.gov/pubmed/35014972 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e32550 %T A Text Messaging–Enhanced Intervention for African American Patients With Heart Failure, Depression, and Anxiety (TXT COPE-HF): Protocol for a Pilot Feasibility Study %A Cornelius,Judith %A Whitaker-Brown,Charlene %A Smoot,Jaleesa %A Hart,Sonia %A Lewis,Zandria %A Smith,Olivia %+ School of Nursing, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, United States, 1 7046877978, jbcornel@uncc.edu %K African American %K heart failure %K depression %K anxiety %K assessment %K decision %K administration %K production %K topical expert %K integration %K training and testing model %K text messaging %K SMS %K minorities %K behavior therapy %D 2022 %7 7.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: African Americans have a higher incidence rate of heart failure (HF) and an earlier age of HF onset compared to those of other racial and ethnic groups. Scientific literature suggests that by 2030, African Americans will have a 30% increased prevalence rate of HF coupled with depression. In addition to depression, anxiety is a predictor of worsening functional capacity, decreased quality of life, and increased hospital readmission rates. There is no consensus on the best way to treat patients with HF, depression, and anxiety. One promising type of treatment—cognitive behavioral therapy (CBT)—has been shown to significantly improve patients’ quality of life and treatment compliance, but CBT has not been used with SMS text messaging reminders to enhance the effect of reducing symptoms of depression and anxiety in racial and ethnic minority patients with HF. Objective: The objectives of our study are to (1) adapt and modify the Creating Opportunities for Personal Empowerment (COPE) curriculum for delivery to patients with HF by using an SMS text messaging component to improve depression and anxiety symptoms, (2) administer the adapted intervention to 10 patients to examine the feasibility and acceptability of the approach and modify it as needed, and (3) examine trends in depression and anxiety symptoms postintervention. We hypothesize that patients will show an improvement in depression scores and anxiety symptoms postintervention. Methods: The study will comprise a mixed methods approach. We will use the eight steps of the ADAPT-ITT (assessment, decision, administration, production, topical expert, integration, training, and testing) model to adapt the intervention. The first step in this feasibility study will involve assembling individuals from the target population (n=10) to discuss questions on a specific topic. In phase 2, we will examine the feasibility and acceptability of the enhanced SMS text messaging intervention (TXT COPE-HF [Texting With COPE for Patients With HF]) and its preliminary effects with 10 participants. The Beck Depression Inventory will be used to assess depression, the State-Trait Anxiety Inventory will be used to assess anxiety, and the Healthy Beliefs and Lifestyle Behavior surveys will be used to assess participants’ lifestyle beliefs and behavior changes. Changes will be compared from baseline to end point by using paired 2-tailed t tests. An exit focus group (n=10) will be held to examine facilitators and barriers to the SMS text messaging protocol. Results: The pilot feasibility study was funded by the Academy for Clinical Research and Scholarship. Institutional review board approval was obtained in April 2021. Data collection and analysis are expected to conclude by November 2021 and April 2022, respectively. Conclusions: The study results will add to the literature on the effectiveness of an SMS text messaging CBT-enhanced intervention in reducing depression and anxiety among African American patients with HF. International Registered Report Identifier (IRRID): PRR1-10.2196/32550 %M 34994709 %R 10.2196/32550 %U https://www.researchprotocols.org/2022/1/e32550 %U https://doi.org/10.2196/32550 %U http://www.ncbi.nlm.nih.gov/pubmed/34994709 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e26356 %T Personalized Reminders for Immunization Using Short Messaging Systems to Improve Human Papillomavirus Vaccination Series Completion: Parallel-Group Randomized Trial %A Wynn,Chelsea S %A Catallozzi,Marina %A Kolff,Chelsea A %A Holleran,Stephen %A Meyer,Dodi %A Ramakrishnan,Rajasekhar %A Stockwell,Melissa S %+ Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, 622 W 168th St, VC 417, New York, NY, 10032, United States, 1 212 342 5732, mss2112@cumc.columbia.edu %K text messaging %K mobile reminders %K human papillomavirus %K adolescent %K text reminders %K vaccine completion %K vaccine decision-making %K vaccine education %K transtheoretical model %K mobile phone %K smartphone %K mHealth %K mobile health %K minority health %D 2021 %7 27.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Completion rates among adolescents who initiate the human papillomavirus (HPV) vaccine 3-dose series are low. SMS text message vaccine reminders are effective, but less is known about the best types for HPV series completion or the ability to assess and target vaccine decision-making stage. Objective: The aim of this study is to compare the effectiveness of HPV vaccine series completion in minority adolescents who received precision and educational versus conventional SMS text message reminders. Methods: Enrolled parents of adolescents aged 9-17 years who received the first HPV vaccine dose at 1 of the 4 academic-affiliated community health clinics in New York City were randomized 1:1 to 1 of the 2 parallel, unblinded arms: precision SMS text messages (which included stage-targeted educational information, next dose due date, and site-specific walk-in hours) or conventional SMS text messages without educational information. Randomization was stratified according to gender, age, and language. The primary outcome was series completion within 12 months. In post hoc analysis, enrollees were compared with concurrent nonenrollees and historical controls. Results: Overall, 956 parents were enrolled in the study. The precision (475 families) and conventional (481 families) SMS text message arms had similarly high series completion rates (344/475, 72.4% vs 364/481, 75.7%). A total of 42 days after the first dose, two-thirds of families, not initially in the preparation stage, moved to preparation or vaccinated stage. Those in either SMS text message arm had significantly higher completion rates than nonenrollees (708/1503, 47.1% vs 679/1503, 45.17%; P<.001). Even after removing those needing only 2 HPV doses, adolescents receiving any SMS text messages had higher completion rates than historical controls (337/2823, 11.93% vs 981/2823, 34.75%; P<.001). A population-wide effect was seen from 2014 to 2016, above historical trends. Conclusions: SMS text message reminders led to timely HPV vaccine series completion in a low-income, urban, minority study population and also led to population-wide effects. Educational information did not provide an added benefit to this population. Trial Registration: ClinicalTrials.gov NCT02236273; https://clinicaltrials.gov/ct2/show/NCT02236273 %M 34958306 %R 10.2196/26356 %U https://mhealth.jmir.org/2021/12/e26356 %U https://doi.org/10.2196/26356 %U http://www.ncbi.nlm.nih.gov/pubmed/34958306 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e32660 %T Investigating the Implementation of SMS and Mobile Messaging in Population Screening (the SIPS Study): Protocol for a Delphi Study %A Acharya,Amish %A Judah,Gaby %A Ashrafian,Hutan %A Sounderajah,Viknesh %A Johnstone-Waddell,Nick %A Stevenson,Anne %A Darzi,Ara %+ Institute of Global Health Innovation, Imperial College London, 10th Floor QEQM Building St Mary's Hospital, London, W2 1NY, United Kingdom, 44 2033126666, aa2107@ic.ac.uk %K mobile messaging %K digital communication %K population screening %K SMS %K implementation %D 2021 %7 22.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The use of mobile messaging, including SMS, and web-based messaging in health care has grown significantly. Using messaging to facilitate patient communication has been advocated in several circumstances, including population screening. These programs, however, pose unique challenges to mobile communication, as messaging is often sent from a central hub to a diverse population with differing needs. Despite this, there is a paucity of robust frameworks to guide implementation. Objective: The aim of this protocol is to describe the methods that will be used to develop a guide for the principles of use of mobile messaging for population screening programs in England. Methods: This modified Delphi study will be conducted in two parts: evidence synthesis and consensus generation. The former will include a review of literature published from January 1, 2000, to October 1, 2021. This will elicit key themes to inform an online scoping questionnaire posed to a group of experts from academia, clinical medicine, industry, and public health. Thematic analysis of free-text responses by two independent authors will elicit items to be used during consensus generation. Patient and Public Involvement and Engagement groups will be convened to ensure that a comprehensive item list is generated that represents the public’s perspective. Each item will then be anonymously voted on by experts as to its importance and feasibility of implementation in screening during three rounds of a Delphi process. Consensus will be defined a priori at 70%, with items considered important and feasible being eligible for inclusion in the final recommendation. A list of desirable items (ie, important but not currently feasible) will be developed to guide future work. Results: The Institutional Review Board at Imperial College London has granted ethical approval for this study (reference 20IC6088). Results are expected to involve a list of recommendations to screening services, with findings being made available to screening services through Public Health England. This study will, thus, provide a formal guideline for the use of mobile messaging in screening services and will provide future directions in this field. Conclusions: The use of mobile messaging has grown significantly across health care services, especially given the COVID-19 pandemic, but its implementation in screening programs remains challenging. This modified Delphi approach with leading experts will provide invaluable insights into facilitating the incorporation of messaging into these programs and will create awareness of future developments in this area. International Registered Report Identifier (IRRID): PRR1-10.2196/32660 %M 34941542 %R 10.2196/32660 %U https://www.researchprotocols.org/2021/12/e32660 %U https://doi.org/10.2196/32660 %U http://www.ncbi.nlm.nih.gov/pubmed/34941542 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e17723 %T Recruitment and Retention of Parents of Adolescents in a Text Messaging Trial (MyTeen): Secondary Analysis From a Randomized Controlled Trial %A Chu,Joanna Ting Wai %A Wadham,Angela %A Jiang,Yannan %A Stasiak,Karolina %A Shepherd,Matthew %A Bullen,Christopher %+ The National Institute for Health Innovation, School of Population Health, University of Auckland, Private Bag 92019 Victoria Street West, Auckland, 1142, New Zealand, 64 3737599, jt.chu@auckland.ac.nz %K parenting %K mHealth %K text messaging %K recruitment %D 2021 %7 20.12.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parenting programs are well established as an effective strategy for enhancing both parenting skills and the well-being of the child. However, recruitment for family programs in clinical and nonclinical settings remains low. Objective: This study aims to describe the recruitment and retention methods used in a text messaging program (MyTeen) trial for parents of adolescents (10-15 years) and identify key lessons learned. We aim to provide insights and direction for researchers who seek to recruit parents and build on the limited literature on recruitment and retention strategies for parenting program trials. Methods: A recruitment plan was developed, monitored, and modified as needed throughout the course of the project. Strategies to facilitate recruitment were identified (eg, program content and recruitment material, staff characteristics, and study procedures). Traditional and web-based recruitment strategies were used. Results: Over a 5-month period, 319 parents or caregivers expressed interest in our study, of which 221 agreed to participate in the study, exceeding our recruitment target of 214 participants. Attrition was low at the 1-month (4.5% overall; intervention group: n=5, 4.6%; control group: n=5, 4.5%) and 3-month follow-ups (9% overall; intervention group: n=10, 9.2%; control group: n=10, 8.9%). Conclusions: The use of web-based recruitment strategies appeared to be most effective for recruiting and retaining parents in a text-messaging program trial. However, we encountered recruitment challenges (ie, underrepresentation of ethnic minority groups and fathers) similar to those reported in the literature. Therefore, efforts to engage ethnic minorities and fathers are needed. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000117213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374307 %M 34932007 %R 10.2196/17723 %U https://pediatrics.jmir.org/2021/4/e17723 %U https://doi.org/10.2196/17723 %U http://www.ncbi.nlm.nih.gov/pubmed/34932007 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e32441 %T Using Interactive Text Messaging to Improve Diet Quality and Increase Redemption of Foods Approved by the Special Supplemental Nutrition Program for Women, Infants, and Children: Protocol for a Cohort Feasibility Study %A Kay,Melissa C %A Hammad,Nour M %A Herring,Sharon J %A Bennett,Gary G %+ Duke University, 310 Trent Dr., Durham, NC, 27708, United States, 1 7812493062, melissa.kay@duke.edu %K WIC %K diet quality %K digital health %K text messaging %K mothers %K postpartum %K child obesity %K mobile phone %D 2021 %7 15.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Children in the United States eat too few fruits, vegetables, and whole grains and too many energy-dense foods; these dietary behaviors are associated with increased risk of obesity. Maternal diet plays a key role in shaping children's diets; however, many mothers have poor diet quality, especially those living in low-income households. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal nutrition assistance program that provides mothers and children with nutrient-dense foods, and those who participate have better diet quality. However, many mothers do not redeem all their WIC-approved foods. Thus, there is a need to create effective interventions to improve diet quality, especially among low-income children and families. Objective: This paper aims to describe the development and protocol for a study to evaluate the feasibility, satisfaction, and preliminary efficacy of a fully automated text messaging intervention as a strategy to improve maternal diet quality and the redemption of WIC-approved foods. Methods: We describe the use of the framework developed for the description of nonrandomized feasibility studies. Using an observational, prospective cohort study design, we will recruit mothers enrolled in WIC with a child aged ≤2 years. Participants will receive automated SMS text messages aimed at improving the redemption of WIC-approved foods to improve the participants’ diet quality for 12 weeks. All outcome measures will be analyzed using descriptive and inferential statistics. Qualitative data will be analyzed using thematic analysis. Results: Data collection for this study began in March 2021. We expect the study results to be available within 9 months of study commencement. The results will shed light on the feasibility, acceptability, and effectiveness of using automated text messages as a behavior change strategy for mothers enrolled in WIC. Conclusions: The results of this pilot study will explore whether this digital behavioral intervention, which will deliver nutrition guidance in accordance with the Dietary Guidelines for Americans using interactive self-monitoring and feedback, is feasible and acceptable. This will lay the foundation for a larger evaluation to determine efficacy for improving diet quality in those most at risk for obesity. Trial Registration: ClinicalTrials.gov NCT04098016; https://clinicaltrials.gov/ct2/show/NCT04098016 International Registered Report Identifier (IRRID): DERR1-10.2196/32441 %M 34914616 %R 10.2196/32441 %U https://www.researchprotocols.org/2021/12/e32441 %U https://doi.org/10.2196/32441 %U http://www.ncbi.nlm.nih.gov/pubmed/34914616 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 2 %P e22681 %T Discharge Instruction Reminders Via Text Messages After Benign Gynecologic Surgery: Quasi-Experimental Feasibility Study %A Sajnani,Jocelyn %A Swan,Kimberly %A Wolff,Sharon %A Drummond,Kelsi %+ Department of Obstetrics and Gynecology, University of California, Los Angeles, 10833 Le Conte Ave, CHS 27-139, Los Angeles, CA, 90025, United States, 1 310 825 9945, jrsajnani@gmail.com %K communication %K hysterectomy %K minimally invasive %K laparoscopy %K postoperative %K patient satisfaction %D 2021 %7 14.12.2021 %9 Original Paper %J JMIR Perioper Med %G English %X Background: With the implementation of enhanced recovery after surgery protocols and same-day hospital discharge, patients are required to take on increasing responsibility for their postoperative care. Various approaches to patient information delivery have been investigated and have demonstrated improvement in patient retention of instructions and patient satisfaction. Objective:  This study aimed to evaluate the feasibility of implementing a postoperative text messaging service in the benign gynecologic population. Methods:  We used a quasi-experimental study design to evaluate patients undergoing outpatient laparoscopic surgery for benign disease with a minimally invasive gynecologist at an academic medical center between October 2017 and March 2018. In addition to routine postoperative instructions, 19 text messages were designed to provide education and support to postoperative gynecologic patients. Patients were contacted by telephone 3 weeks postoperatively and surveyed about their satisfaction and feelings of connectedness during their recovery experience. Demographic and operative information was gathered through chart review. The cost to implement text messages was US $2.85 per patient. Results:  A total of 185 patients were eligible to be included in this study. Of the 100 intended intervention participants, 20 failed to receive text messages, leaving an 80% success in text delivery. No patients opted out of messaging. A total of 28 patients did not participate in the postrecovery survey, leaving 137 patients with outcome data (control, n=75; texting, n=62). Satisfaction, determined by a score ≥9 on a 10-point scale, was 74% (46/62) in the texting group and 63% (47/75) in the control group (P=.15). Connectedness (score ≥9) was reported by 64% (40/62) in the texting group compared with 44% (33/75) in the control group (P=.02). Overall, 65% (40/62) of those in the texting group found the texts valuable (score ≥9). Conclusions:  Postoperative text messages increased patients’ perceptions of connection with their health care team and may also increase their satisfaction with their recovery process. Errors in message delivery were identified. Given the increasing emphasis on patient experience and cost effectiveness in health care, an adequately powered future study to determine statistically significant differences in patient experience and resource use would be appropriate. %M 34904957 %R 10.2196/22681 %U https://periop.jmir.org/2021/2/e22681 %U https://doi.org/10.2196/22681 %U http://www.ncbi.nlm.nih.gov/pubmed/34904957 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e33123 %T A Multimodal Messaging App (MAAN) for Adults With Autism Spectrum Disorder: Mixed Methods Evaluation Study %A Hijab,Mohamad Hassan Fadi %A Al-Thani,Dena %A Banire,Bilikis %+ Division of Information and Computer Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Education City, Doha, 34110, Qatar, 974 50677321, mhhijab@hbku.edu.qa %K autism %K assistive technology %K mobile app %K social and communication skills %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with autism spectrum disorder (ASD) often exhibit difficulties in social and communication skills. For more than 30 years, specialists, parents, and caregivers have used techniques, such as applied behavioral analysis, augmentative and alternative communication, and the picture exchange communication system to support the social and communication skills of people with ASD. Even though there are many techniques devised to enhance communication, these techniques are not considered in existing social media apps for people with ASD. Objective: This study aimed to investigate the effect of adding accessibility features, such as text-to-speech (TTS), speech-to-text (STT), and communication symbols (CS), to a messaging app (MAAN). We hypothesized that these accessibility features can enhance the social and communication skills of adults with ASD. We also hypothesized that usage of this app can reduce social loneliness in adults with ASD. Methods: Semistructured interviews were conducted with 5 experts working in fields related to ASD to help design the app. Seven adults with ASD participated in the study for a period of 10 to 16 weeks. Data logs of participants’ interactions with the app were collected. Additionally, 6 participants’ parents and 1 caregiver were asked to complete a short version of the Social and Emotional Loneliness Scale for Adults (SELSA-S) questionnaire to compare pre-post study results. The Mobile Application Rating Scale: user version questionnaire was also used to evaluate the app’s usability. Following the study, interviews were conducted with participants to discuss their experiences with the app. Results: The SELSA-S questionnaire results showed no change in the family subscale; however, the social loneliness subscale showed a difference between prestudy and poststudy. The Wilcoxon signed-rank test indicated that poststudy SELSA-S results were statistically significantly higher than prestudy results (z=−2.047; P=.04). Point-biserial correlation indicated that the SELSA-S rate of change was strongly related to usage of the TTS feature (r=0.708; P=.04) and CS feature (r=−0.917; P=.002), and moderately related to usage of the STT feature (r=0.428; P=.17). Lastly, we adopted grounded theory to analyze the interview data, and the following 5 categories emerged: app support, feature relevance, user interface design, overall feedback, and recommendations. Conclusions: This study discusses the potential for improving the communication skills of adults with ASD through special features in mobile messaging apps. The developed app aims to support the inclusion and independent life of adults with ASD. The study results showed the importance of using TTS, STT, and CS features to enhance social and communication skills, as well as reduce social loneliness in adults with ASD. %M 34878998 %R 10.2196/33123 %U https://formative.jmir.org/2021/12/e33123 %U https://doi.org/10.2196/33123 %U http://www.ncbi.nlm.nih.gov/pubmed/34878998 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e27956 %T Conversational Agent for Healthy Lifestyle Behavior Change: Web-Based Feasibility Study %A Dhinagaran,Dhakshenya Ardhithy %A Sathish,Thirunavukkarasu %A Soong,AiJia %A Theng,Yin-Leng %A Best,James %A Tudor Car,Lorainne %+ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Clinical Sciences Building, 11 Mandalay Road, Singapore, 308232, Singapore, 65 69041258, lorainne.tudor.car@ntu.edu.sg %K chatbot %K conversational agents %K behavior change %K healthy lifestyle behavior change %K pilot study %K feasibility trial %K usability %K acceptability %K preliminary efficacy %K mobile phone %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The rising incidence of chronic diseases is a growing concern, especially in Singapore, which is one of the high-income countries with the highest prevalence of diabetes. Interventions that promote healthy lifestyle behavior changes have been proven to be effective in reducing the progression of prediabetes to diabetes, but their in-person delivery may not be feasible on a large scale. Novel technologies such as conversational agents are a potential alternative for delivering behavioral interventions that promote healthy lifestyle behavior changes to the public. Objective: The aim of this study is to assess the feasibility and acceptability of using a conversational agent promoting healthy lifestyle behavior changes in the general population in Singapore. Methods: We performed a web-based, single-arm feasibility study. The participants were recruited through Facebook over 4 weeks. The Facebook Messenger conversational agent was used to deliver the intervention. The conversations focused on diet, exercise, sleep, and stress and aimed to promote healthy lifestyle behavior changes and improve the participants’ knowledge of diabetes. Messages were sent to the participants four times a week (once for each of the 4 topics of focus) for 4 weeks. We assessed the feasibility of recruitment, defined as at least 75% (150/200) of our target sample of 200 participants in 4 weeks, as well as retention, defined as 33% (66/200) of the recruited sample completing the study. We also assessed the participants’ satisfaction with, and usability of, the conversational agent. In addition, we performed baseline and follow-up assessments of quality of life, diabetes knowledge and risk perception, diet, exercise, sleep, and stress. Results: We recruited 37.5% (75/200) of the target sample size in 1 month. Of the 75 eligible participants, 60 (80%) provided digital informed consent and completed baseline assessments. Of these 60 participants, 56 (93%) followed the study through till completion. Retention was high at 93% (56/60), along with engagement, denoted by 50% (30/60) of the participants communicating with the conversational agent at each interaction. Acceptability, usability, and satisfaction were generally high. Preliminary efficacy of the intervention showed no definitive improvements in health-related behavior. Conclusions: The delivery of a conversational agent for healthy lifestyle behavior change through Facebook Messenger was feasible and acceptable. We were unable to recruit our planned sample solely using the free options in Facebook. However, participant retention and conversational agent engagement rates were high. Our findings provide important insights to inform the design of a future randomized controlled trial. %M 34870611 %R 10.2196/27956 %U https://formative.jmir.org/2021/12/e27956 %U https://doi.org/10.2196/27956 %U http://www.ncbi.nlm.nih.gov/pubmed/34870611 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e29423 %T Incorporating African American Veterans’ Success Stories for Hypertension Management: Developing a Behavioral Support Texting Protocol %A DeLaughter,Kathryn L %A Fix,Gemmae M %A McDannold,Sarah E %A Pope,Charlene %A Bokhour,Barbara G %A Shimada,Stephanie L %A Calloway,Rodney %A Gordon,Howard S %A Long,Judith A %A Miano,Danielle A %A Cutrona,Sarah L %+ Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Rd, Bedford, MA, 01730, United States, 1 781 687 2559, kathryn.delaughter@va.gov %K texting %K African American %K hypertension %K self-management %K mobile phone %D 2021 %7 1.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Peer narratives engage listeners through personally relevant content and have been shown to promote lifestyle change and effective self-management among patients with hypertension. Incorporating key quotations from these stories into follow-up text messages is a novel way to continue the conversation, providing reinforcement of health behaviors in the patients’ daily lives. Objective: In our previous work, we developed and tested videos in which African American Veterans shared stories of challenges and success strategies related to hypertension self-management. This study aims to describe our process for developing a text-messaging protocol intended for use after viewing videos that incorporate the voices of these Veterans. Methods: We used a multistep process, transforming video-recorded story excerpts from 5 Veterans into 160-character texts. We then integrated these into comprehensive 6-month texting protocols. We began with an iterative review of story transcripts to identify vernacular features and key self-management concepts emphasized by each storyteller. We worked with 2 Veteran consultants who guided our narrative text message development in substantive ways, as we sought to craft culturally sensitive content for texts. Informed by Veteran input on timing and integration, supplementary educational and 2-way interactive assessment text messages were also developed. Results: Within the Veterans Affairs texting system Annie, we programmed five 6-month text-messaging protocols that included cycles of 3 text message types: narrative messages, nonnarrative educational messages, and 2-way interactive messages assessing self-efficacy and behavior related to hypertension self-management. Each protocol corresponds to a single Veteran storyteller, allowing Veterans to choose the story that most resonates with their own life experiences. Conclusions: We crafted a culturally sensitive text-messaging protocol using narrative content referenced in Veteran stories to support effective hypertension self-management. Integrating narrative content into a mobile health texting intervention provides a low-cost way to support longitudinal behavior change. A randomized trial is underway to test its impact on the lifestyle changes and blood pressure of African American Veterans. Trial Registration: ClinicalTrials.gov NCT03970590; https://clinicaltrials.gov/ct2/show/NCT03970590 International Registered Report Identifier (IRRID): DERR1-10.2196/29423 %M 34855617 %R 10.2196/29423 %U https://www.researchprotocols.org/2021/12/e29423 %U https://doi.org/10.2196/29423 %U http://www.ncbi.nlm.nih.gov/pubmed/34855617 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e25618 %T Mobile Text Messaging for Tobacco Risk Communication Among Young Adult Community College Students: Randomized Trial of Project Debunk %A Prokhorov,Alexander V %A Calabro,Karen Sue %A Arya,Ashish %A Russell,Sophia %A Czerniak,Katarzyna W %A Botello,Gabrielle C %A Chen,Minxing %A Yuan,Ying %A Perez,Adriana %A Vidrine,Damon J %A Perry,Cheryl L %A Khalil,Georges Elias %+ Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Clinical and Translational Science Building, 2004 Mowry Road Office 2252, Gainesville, FL, 32610, United States, 1 3522948415, gkhalil@ufl.edu %K tobacco use %K risk communication %K text messaging %K message framing %K regulatory science %K young adults %K vaping %K mobile phone %D 2021 %7 24.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of new and emerging tobacco products (NETPs) and conventional tobacco products (CTPs) has been linked to several alarming medical conditions among young adults (YAs). Considering that 96% of YAs own mobile phones, SMS text messaging may be an effective strategy for tobacco risk communication. Objective: Project Debunk is a community-based randomized trial aiming to identify specific types of messages that effectively improve perceived NETP and CTP risk among YAs in community colleges. Methods: With YAs recruited offline from 3 campuses at the Houston Community College (September 2016 to July 2017), we conducted a 6-month randomized trial with 8 arms based on the combination of 3 message categories: framing (gain-framed vs loss-framed), depth (simple vs complex), and appeal (emotional vs rational). Participants received fully automated web-based SMS text messages in two 30-day campaigns (2 messages per day). We conducted repeated-measures mixed-effect models stratified by message type received, predicting perceived CTP and NETP risks. Owing to multiple testing with 7 models, an association was deemed significant for P<.007 (.05 divided by 7). Results: A total of 636 participants completed the baseline survey, were randomized to 1 of 8 conditions (between 73 and 86 participants per condition), and received messages from both campaigns. By the 2-month post campaign 2 assessment point, 70.1% (446/636) completed all outcome measures. By the end of both campaigns, participants had a significant increase in perceived NETP risk over time (P<.001); however, participants had a marginal increase in perceived CTP risk (P=.008). Separately for each group, there was a significant increase in perceived NETP risk among participants who received rational messages (P=.005), those who received emotional messages (P=.006), those who received simple messages (P=.003), and those who received gain-framed messages (P=.003). Conclusions: In this trial, YAs had an increase in perceived NETP risk. However, with stratification, we observed a significant increase in perceived NETP risk upon exposure to rational, emotional, simple, and gain-framed messages. In addition, YAs generally had an increase in perceived CTP risk and presented nonsignificant but observable improvement upon exposure to emotional, complex, and loss-framed messages. With the results of this study, researchers and practitioners implementing mobile health programs may take advantage of our tailored messages through larger technology-based programs such as smartphone apps and social media campaigns. Trial Registration: ClinicalTrials.gov NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480 International Registered Report Identifier (IRRID): RR2-10.2196/10977 %M 34822339 %R 10.2196/25618 %U https://mhealth.jmir.org/2021/11/e25618 %U https://doi.org/10.2196/25618 %U http://www.ncbi.nlm.nih.gov/pubmed/34822339 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30995 %T Integrating SMS Text Messages Into a Preventive Intervention for Postpartum Depression Delivered via In-Home Visitation Programs: Feasibility and Acceptability Study %A Barrera,Alinne Z %A Hamil,Jaime %A Tandon,Darius %+ Department of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94304, United States, 1 6504333854, abarrera@paloaltou.edu %K perinatal mental health %K postpartum depression %K public health %K SMS %K technology %D 2021 %7 18.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The Mothers and Babies (MB) Course is recognized by the US Preventive Services Task Force as an evidence-based preventive intervention for postpartum depression (PPD) that should be recommended to pregnant women at risk for PPD. Objective: This report examines the feasibility and acceptability of enhancing the MB 1-on-1 intervention by adding 36 SMS text messages that target 3 areas: reinforcement of skills, between-session homework reminders, and responding to self-monitoring texts (ie, MB Plus Text Messaging [MB-TXT]). Methods: In partnership with 9 home visiting programs, 28 ethnically and racially diverse pregnant women (mean 25.6, SD 9.0 weeks) received MB-TXT. Feasibility was defined by home visitors’ adherence to logging into the HealthySMS platform to enter session data and trigger SMS text messages within 7 days of the in-person session. The acceptability of MB-TXT was measured by participants’ usefulness and understanding ratings of the SMS text messages and responses to the self-monitoring SMS text messages. Results: On average, home visitors followed the study protocol and entered session-specific data between 5.50 and 61.17 days following the MB 1-on-1 sessions. A high proportion of participants responded to self-monitoring texts (25/28, 89%) and rated the text message content as very useful and understandable. Conclusions: This report contributes to a growing body of research focusing on digital adaptations of the MB course. SMS is a low-cost, accessible digital tool that can be integrated into existing interventions. With appropriate resources to support staff, it can be implemented in community-based organizations and health care systems that serve women at risk for PPD. Trial Registration: ClinicalTrials.gov NCT03420755; https://clinicaltrials.gov/ct2/show/NCT03420755 %M 34792478 %R 10.2196/30995 %U https://formative.jmir.org/2021/11/e30995 %U https://doi.org/10.2196/30995 %U http://www.ncbi.nlm.nih.gov/pubmed/34792478 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e31037 %T Implementing Automated Text Messaging for Patient Self-management in the Veterans Health Administration: Qualitative Study Applying the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability Framework %A Yakovchenko,Vera %A McInnes,D Keith %A Petrakis,Beth Ann %A Gillespie,Chris %A Lipschitz,Jessica M %A McCullough,Megan B %A Richardson,Lorilei %A Vetter,Brian %A Hogan,Timothy P %+ Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road, Bedford, MA, 01730, United States, 1 781 687 3374, vera.yakovchenko@va.gov %K implementation science %K implementation facilitation %K texting %K veterans %K eHealth %K self-management %K digital health %K digital medicine %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Veterans Health Administration (VHA) is deploying an automated texting system (aTS) to support patient self-management. Objective: We conducted a qualitative evaluation to examine factors influencing national rollout of the aTS, guided by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, which is intended to support the evaluation of novel technologies. Methods: Semistructured interviews were conducted with 33 staff and 38 patients who were early adopters of the aTS. Data were analyzed following deductive and inductive approaches using a priori codes and emergent coding based on the NASSS. Results: We identified themes across NASSS domains: (1) Condition: The aTS was considered relevant for a range of patient needs; however, perceptions of patient suitability were guided by texting experience and clinical complexity rather than potential benefits. (2) Technology: Onboarding of the aTS presented difficulty and the staff had different opinions on incorporating patient-generated data into care planning. (3) Value: Supply-side value relied on the flexibility of the aTS and its impact on staff workload whereas demand-side value was driven by patient perceptions of the psychological and behavioral impacts of the aTS. (4) Adopters: Limited clarity on staff roles and responsibilities presented challenges in incorporating the aTS into clinical processes. (5) Organization: Staff were willing to try the aTS; however, perceptions of leadership support and clinic readiness hindered usage. (6) Wider system: Staff focused on enhancing aTS interoperability with the electronic medical record. (7) Embedding and adaptation over time: The interplay of aTS versatility, patient and staff demands, and broader societal changes in preferences for communicating health information facilitated aTS implementation. Conclusions: VHA’s new aTS has the potential to further engage patients and expand the reach of VHA care; however, patients and staff require additional support to adopt, implement, and sustain the aTS. The NASSS highlighted how the aTS can be better embedded into current practices, which patients might benefit most from its functionality, and which aspects of aTS messages are most relevant to self-management. Trial Registration: ClinicalTrials.gov NCT03898349; https://clinicaltrials.gov/ct2/show/NCT03898349 %M 34779779 %R 10.2196/31037 %U https://mhealth.jmir.org/2021/11/e31037 %U https://doi.org/10.2196/31037 %U http://www.ncbi.nlm.nih.gov/pubmed/34779779 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e23874 %T Formative Study of Mobile Phone Use for Family Planning Among Young People in Sierra Leone: Global Systematic Survey %A Chukwu,Emeka %A Gilroy,Sonia %A Addaquay,Kojo %A Jones,Nki Nafisa %A Karimu,Victor Gbadia %A Garg,Lalit %A Dickson,Kim Eva %+ Department of Computer Information System, Faculty of Information and Communications Technology (ICT), University of Malta, Msida, MSD 2080, Malta, 356 99330888, nnaemeka_ec@hotmail.com %K young people %K short message service %K SMS %K chatbot %K text message %K interactive voice response %K IVR %K WhatsApp %K Facebook %K family planning %K contraceptives %K Sierra Leone %D 2021 %7 12.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Teenage pregnancy remains high with low contraceptive prevalence among adolescents (aged 15-19 years) in Sierra Leone. Stakeholders leverage multiple strategies to address the challenge. Mobile technology is pervasive and presents an opportunity to reach young people with critical sexual reproductive health and family planning messages. Objective: The objectives of this research study are to understand how mobile health (mHealth) is used for family planning, understand phone use habits among young people in Sierra Leone, and recommend strategies for mobile-enabled dissemination of family planning information at scale. Methods: This formative research study was conducted using a systematic literature review and focus group discussions (FGDs). The literature survey assessed similar but existing interventions through a systematic search of 6 scholarly databases. Cross-sections of young people of both sexes and their support groups were engaged in 9 FGDs in an urban and a rural district in Sierra Leone. The FGD data were qualitatively analyzed using MAXQDA software (VERBI Software GmbH) to determine appropriate technology channels, content, and format for different user segments. Results: Our systematic search results were categorized using Grading of Recommended Assessment and Evaluation (GRADE) into communication channels, audiovisual messaging format, purpose of the intervention, and message direction. The majority of reviewed articles report on SMS-based interventions. At the same time, most intervention purposes are for awareness and as helpful resources. Our survey did not find documented use of custom mHealth apps for family planning information dissemination. From the FGDs, more young people in Sierra Leone own basic mobile phones than those that have feature capablilities or are smartphone. Young people with smartphones use them mostly for WhatsApp and Facebook. Young people widely subscribe to the social media–only internet bundle, with the cost ranging from 1000 leones (US $0.11) to 1500 leones (US $0.16) daily. Pupils in both districts top-up their voice call and SMS credit every day between 1000 leones (US $0.11) and 5000 leones (US $0.52). Conclusions: mHealth has facilitated family planning information dissemination for demand creation around the world. Despite the widespread use of social and new media, SMS is the scalable channel to reach literate and semiliterate young people. We have cataloged mHealth for contraceptive research to show SMS followed by call center as widely used channels. Jingles are popular for audiovisual message formats, mostly delivered as either push or pull only message directions (not both). Interactive voice response and automated calls are best suited to reach nonliterate young people at scale. %M 34766908 %R 10.2196/23874 %U https://formative.jmir.org/2021/11/e23874 %U https://doi.org/10.2196/23874 %U http://www.ncbi.nlm.nih.gov/pubmed/34766908 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e27779 %T Text Message Analysis Using Machine Learning to Assess Predictors of Engagement With Mobile Health Chronic Disease Prevention Programs: Content Analysis %A Klimis,Harry %A Nothman,Joel %A Lu,Di %A Sun,Chao %A Cheung,N Wah %A Redfern,Julie %A Thiagalingam,Aravinda %A Chow,Clara K %+ Faculty of Medicine and Health, Westmead Applied Research Centre, The University of Sydney, Westmead, Australia, 61 88903125, harry.klimis@sydney.edu.au %K mHealth %K machine learning %K chronic disease %K cardiovascular %K text messaging %K SMS %K digital health %K mobile phone %K engagement %K prevention %D 2021 %7 10.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: SMS text messages as a form of mobile health are increasingly being used to support individuals with chronic diseases in novel ways that leverage the mobility and capabilities of mobile phones. However, there are knowledge gaps in mobile health, including how to maximize engagement. Objective: This study aims to categorize program SMS text messages and participant replies using machine learning (ML) and to examine whether message characteristics are associated with premature program stopping and engagement. Methods: We assessed communication logs from SMS text message–based chronic disease prevention studies that encouraged 1-way (SupportMe/ITM) and 2-way (TEXTMEDS [Text Messages to Improve Medication Adherence and Secondary Prevention]) communication. Outgoing messages were manually categorized into 5 message intents (informative, instructional, motivational, supportive, and notification) and replies into 7 groups (stop, thanks, questions, reporting healthy, reporting struggle, general comment, and other). Grid search with 10-fold cross-validation was implemented to identify the best-performing ML models and evaluated using nested cross-validation. Regression models with interaction terms were used to compare the association of message intent with premature program stopping and engagement (replied at least 3 times and did not prematurely stop) in SupportMe/ITM and TEXTMEDS. Results: We analyzed 1550 messages and 4071 participant replies. Approximately 5.49% (145/2642) of participants responded with stop, and 11.7% (309/2642) of participants were engaged. Our optimal ML model correctly classified program message intent with 76.6% (95% CI 63.5%-89.8%) and replies with 77.8% (95% CI 74.1%-81.4%) balanced accuracy (average area under the curve was 0.95 and 0.96, respectively). Overall, supportive (odds ratio [OR] 0.53, 95% CI 0.35-0.81) messages were associated with reduced chance of stopping, as were informative messages in SupportMe/ITM (OR 0.35, 95% CI 0.20-0.60) but not in TEXTMEDS (for interaction, P<.001). Notification messages were associated with a higher chance of stopping in SupportMe/ITM (OR 5.76, 95% CI 3.66-9.06) but not TEXTMEDS (for interaction, P=.01). Overall, informative (OR 1.76, 95% CI 1.46-2.12) and instructional (OR 1.47, 95% CI 1.21-1.80) messages were associated with higher engagement but not motivational messages (OR 1.18, 95% CI 0.82-1.70; P=.37). For supportive messages, the association with engagement was opposite with SupportMe/ITM (OR 1.77, 95% CI 1.21-2.58) compared with TEXTMEDS (OR 0.77, 95% CI 0.60-0.98; for interaction, P<.001). Notification messages were associated with reduced engagement in SupportMe/ITM (OR 0.07, 95% CI 0.05-0.10) and TEXTMEDS (OR 0.28, 95% CI 0.20-0.39); however, the strength of the association was greater in SupportMe/ITM (for interaction P<.001). Conclusions: ML models enable monitoring and detailed characterization of program messages and participant replies. Outgoing message intent may influence premature program stopping and engagement, although the strength and direction of association appear to vary by program type. Future studies will need to examine whether modifying message characteristics can optimize engagement and whether this leads to behavior change. %M 34757324 %R 10.2196/27779 %U https://mhealth.jmir.org/2021/11/e27779 %U https://doi.org/10.2196/27779 %U http://www.ncbi.nlm.nih.gov/pubmed/34757324 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28951 %T Validation of a Mobile Health Technology Platform (FeverTracker) for Malaria Surveillance in India: Development and Usability Study %A Pal Bhowmick,Ipsita %A Chutia,Dibyajyoti %A Chouhan,Avinash %A Nishant,Nilay %A Raju,P L N %A Narain,Kanwar %A Kaur,Harpreet %A Pebam,Rocky %A Debnath,Jayanta %A Tripura,Rabindra %A Gogoi,Kongkona %A Ch Nag,Suman %A Nath,Aatreyee %A Tripathy,Debabrata %A Debbarma,Jotish %A Das,Nirapada %A Sarkar,Ujjwal %A Debbarma,Rislyn %A Roy,Rajashree %A Debnath,Bishal %A Dasgupta,Dipanjan %A Debbarma,Suraj %A Joy Tripura,Kamal %A Reang,Guneram %A Sharma,Amit %A Rahi,Manju %A Chhibber-Goel,Jyoti %+ International Centre for Genetic Engineering and Biotechnology, Vasant Kunj, New Delhi, 110067, India, 91 011 26741358 ext 170, jyotichhibbergoel@gmail.com %K fever %K health system %K mHealth app %K malaria %K surveillance %K mobile phone %D 2021 %7 10.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: A surveillance system is the foundation for disease prevention and control. Malaria surveillance is crucial for tracking regional and temporal patterns in disease incidence, assisting in recorded details, timely reporting, and frequency of analysis. Objective: In this study, we aim to develop an integrated surveillance graphical app called FeverTracker, which has been designed to assist the community and health care workers in digital surveillance and thereby contribute toward malaria control and elimination. Methods: FeverTracker uses a geographic information system and is linked to a web app with automated data digitization, SMS text messaging, and advisory instructions, thereby allowing immediate notification of individual cases to district and state health authorities in real time. Results: The use of FeverTracker for malaria surveillance is evident, given the archaic paper-based surveillance tools used currently. The use of the app in 19 tribal villages of the Dhalai district in Tripura, India, assisted in the surveillance of 1880 suspected malaria patients and confirmed malaria infection in 93.4% (114/122; Plasmodium falciparum), 4.9% (6/122; P vivax), and 1.6% (2/122; P falciparum/P vivax mixed infection) of cases. Digital tools such as FeverTracker will be critical in integrating disease surveillance, and they offer instant data digitization for downstream processing. Conclusions: The use of this technology in health care and research will strengthen the ongoing efforts to eliminate malaria. Moreover, FeverTracker provides a modifiable template for deployment in other disease systems. %M 34757321 %R 10.2196/28951 %U https://formative.jmir.org/2021/11/e28951 %U https://doi.org/10.2196/28951 %U http://www.ncbi.nlm.nih.gov/pubmed/34757321 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30580 %T A Text Message Intervention for Adolescents With Depression and Their Parents or Caregivers to Overcome Cognitive Barriers to Mental Health Treatment Initiation: Focus Groups and Pilot Trial %A Suffoletto,Brian %A Goldstein,Tina %A Brent,David %+ Department of Emergency Medicine, Stanford University, 900 Welch Road, Suite 350, Palo Alto, CA, 94304, United States, 1 4129016892, suffbp@stanford.edu %K adolescent %K depression %K help seeking %K text message %K intervention %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Many adolescents with depression do not pursue mental health treatment following a health care provider referral. We developed a theory-based automated SMS text message intervention (Text to Connect [T2C]) that attempts to reduce cognitive barriers to the initiation of mental health care. Objective: In this two-phase study, we seek to first understand the potential of T2C and then test its engagement, usability, and potential efficacy among adolescents with depression and their parents or caregivers. Methods: In phase 1, we conducted focus groups with adolescents with depression (n=9) and their parents or caregivers (n=9) separately, and transcripts were examined to determine themes. In phase 2, we conducted an open trial of T2C comprising adolescents with depression referred to mental health care (n=43) and their parents or caregivers (n=28). We assessed usability by examining program engagement, usability ratings, and qualitative feedback at the 4-week follow-up. We also assessed potential effectiveness by examining changes in perceived barriers to treatment and mental health care initiation from baseline to 4 weeks. Results: In phase 1, we found that the themes supported the T2C approach. In phase 2, we observed high engagement with daily negative affect check-ins, high usability ratings, and decreased self-reported barriers to mental health treatment over time among adolescents. Overall, 52% (22/42) of the adolescents who completed follow-up reported that they had attended an appointment with a mental health care specialist. Of the 20 adolescents who had not attended a mental health care appointment, 5% (1/20) reported that it was scheduled for a future date, 10% (2/20) reported that the primary care site did not have the ability to help them schedule a mental health care appointment, and 15% (3/20) reported that they were no longer interested in receiving mental health care. Conclusions: The findings from this study suggest that T2C is acceptable to adolescents with depression and most parents or caregivers; it is used at high rates; and it may be helpful to reduce cognitive barriers to mental health care initiation. %M 34751665 %R 10.2196/30580 %U https://formative.jmir.org/2021/11/e30580 %U https://doi.org/10.2196/30580 %U http://www.ncbi.nlm.nih.gov/pubmed/34751665 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e29896 %T Psychosocial and Behavioral Effects of the COVID-19 Pandemic in the Indian Population: Protocol for a Cross-sectional Study %A Joshi,Megha %A Shah,Aangi %A Trivedi,Bhavi %A Trivedi,Jaahnavee %A Patel,Viral %A Parghi,Devam %A Thakkar,Manini %A Barot,Kanan %A Jadawala,Vivek %+ Department of Psychiatry, Shrimati Nathiba Hargovandas Lakhamichand Municipal Medical College, Gujarat University, Pritamrai cross road,, Ellisbridge, Paldi, Ahmedabad, 380006, India, 91 9909896196, joshimegha1@gmail.com %K COVID-19 %K mental health %K India %K lockdown %K isolation %K social isolation %K behavior %K psychology %K psychosocial effects %D 2021 %7 5.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: During the year 2020, the COVID-19 pandemic spread from China to the rest of the world, which prompted the world to implement a widespread mandated quarantine or social isolation. The impending uncertainty of the pandemic must have resulted in a variety of widespread mental health maladies. There has been documentation in the literature about a lot of these in small populations of the world but limited studies have been conducted in India, leading to limited evidence in the literature. Objective: The main objective of our study is to investigate the mental health effects that the COVID-19 pandemic has had on the general population in India both quantitatively and qualitatively. These results will help contribute to reducing the knowledge gap that is recognized in the literature, which is the result of the unprecedented and novel nature of the pandemic. Methods: We designed and validated our own questionnaire and used the method of circulating the questionnaire via WhatsApp (Facebook Inc). WhatsApp is a social media app that is very popularly used in India; hence, it turned out to be an effective medium for gathering pilot data. We analyzed the pilot data and used them to validate the questionnaire. This was done with the expertise of our mentor, Nilima Shah, MD (psychiatry). We gathered pilot data on 545 subjects and used the results to determine the changes that were needed for the questionnaire while simultaneously validating the questionnaire. Results: The study protocol was approved in September 2020 by the institutional review board at Vadilal Sarabhai General Hospital, Ahmedabad, Gujarat, India. Conclusions: The following preliminary assumptions can be made about the study based on the pilot data: the majority of the survey respondents were male (289/545, 53%), most of them were educated and employed as health care workers (199/545, 36.5%). The majority of the responders were self-employed (185/545, 33.9%), single (297/545, 54.5%), and stayed with their families (427/541, 79%) for the lockdown, which helped them psychologically. Findings that are specific to mental health have been elaborated upon in the manuscript. It is evident from the data collected in previous literature that the pandemic has had significant detrimental effects on the mental health of a vast proportion of the Indian population. International Registered Report Identifier (IRRID): DERR1-10.2196/29896 %M 34519652 %R 10.2196/29896 %U https://www.researchprotocols.org/2021/11/e29896 %U https://doi.org/10.2196/29896 %U http://www.ncbi.nlm.nih.gov/pubmed/34519652 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e25209 %T Comparing Email, SMS, and Concurrent Mixed Modes Approaches to Capture Quality of Recovery in the Perioperative Period: Retrospective Longitudinal Cohort Study %A Romeiser,Jamie L %A Cavalcante,James %A Richman,Deborah C %A Singh,Sunitha M %A Liang,Xiaohui %A Pei,Allison %A Sharma,Samanvaya %A Lazarus,Zoe %A Gan,Tong J %A Bennett-Guerrero,Elliott %+ Department of Anesthesiology, Stony Brook University Medical Center, 101 Nicolls Rd, Stony Brook, NY, 11794, United States, 1 631 444 2975, jamie.romeiser@stonybrookmedicine.edu %K concurrent mixed modes %K recovery after surgery %K text messages %K SMS %K email %K perioperative recovery %K mobile phone %D 2021 %7 4.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As patients are discharged from the hospital more quickly, the ability to monitor patient recovery between hospital discharge and the first follow-up clinic visit is becoming increasingly important. Despite substantial increase in both internet use and smartphone ownership over the past 5 years, clinicians have been slow to embrace the use of these devices to capture patient recovery information in the period between hospital discharge and the first clinical follow-up appointment. Objective: This study aims to investigate the generalizability of using a web-based platform to capture patient recovery in a broad surgical patient population and compare response rates for 3 different web-based strategies for delivering recovery surveys over the perioperative period: email, SMS text messaging, and a concurrent mixed approach of using both email and SMS text messaging. Methods: Patients undergoing surgeries managed with an enhanced recovery after surgery pathway were asked to participate in a web-based quality assurance monitoring program at the time of their preoperative surgery appointment. Different follow-up methods were implemented over 3 sequential phases. Patients received Health Insurance Portability and Accountability Act–compliant web-based survey links via email (phase 1), SMS text messaging (phase 2), or concurrently using both email and SMS text messaging (phase 3) using REDCap and Twilio software. Recovery assessments using the established Quality of Recovery-9 instrument were performed 4 days before surgery and at 7 and 30 days postoperatively. Generalizability of the web-based system was examined by comparing characteristics of those who participated versus those who did not. Differences in response rates by the web-based collection method were analyzed using adjusted models. Results: A total of 615 patients were asked to participate, with 526 (85.5%) opting for the follow-up program. Those who opted in were younger, slightly healthier, and more likely to be in a partnership. The concurrent mixed modes method was the most successful for obtaining responses at each time point compared with text or email alone (pre: 119/160, 74.4% vs 116/173, 67.1% vs 56/130, 43.1%, P<.001; 7 days: 115/172, 66.9% vs 82/164, 50.0% vs 59/126, 46.8%, P=.001; 30 days: 152/234, 65.0% vs 52/105, 49.5% vs 53/123, 43.1%, P=.001, respectively). In the adjusted model, the concurrent mixed modes method significantly predicted response compared with using email alone (odds ratio 3.4; P<.001) and SMS text messaging alone (odds ratio 1.9; P<.001). Additional significant predictors of response were race, partnership, and time. Conclusions: For internet users and smartphone owners, electronic capture of recovery surveys appear to be possible through this mechanism. Discrepancies in both inclusion and response rates still exist among certain subgroups of patients, but the concurrent approach of using both email and text messages was the most effective approach to reach the largest number of patients across all subgroups. %M 34734827 %R 10.2196/25209 %U https://formative.jmir.org/2021/11/e25209 %U https://doi.org/10.2196/25209 %U http://www.ncbi.nlm.nih.gov/pubmed/34734827 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28929 %T A Case Study of an SMS Text Message Community Panel Survey and Its Potential for Use During the COVID-19 Pandemic %A Chan,Lilian %A El-Haddad,Nouhad %A Freeman,Becky %A O'Hara,Blythe J %A Woodland,Lisa %A Harris-Roxas,Ben %+ Prevention Research Collaboration, Sydney School of Public Health and Charles Perkins Centre, The University of Sydney, John Hopkins Drive, Camperdown, 2006, Australia, 61 286277554, lilian.chan@sydney.edu.au %K data collection %K mobile phone %K short message service %K tobacco %K COVID-19 %K survey %D 2021 %7 3.11.2021 %9 Viewpoint %J JMIR Form Res %G English %X During the COVID-19 pandemic many traditional methods of data collection, such as intercept surveys or focus groups, are not feasible. This paper proposes that establishing community panels through SMS text messages may be a useful method during the pandemic, by describing a case study of how an innovative SMS text message community panel was used for the “Shisha No Thanks” project to collect data from young adults of Arabic-speaking background about their attitudes on the harms of waterpipe smoking. Participants were asked to complete an initial recruitment survey, and then subsequently sent 1 survey question per week. The study recruited 133 participants to the SMS text message community panel and the mean response rate for each question was 73.0% (97.1/133) (range 76/133 [57.1%] to 112/133 [84.2%]). The SMS text message community panel approach is not suited for all populations, nor for all types of inquiry, particularly due to limitations of the type of responses that it allows and the required access to mobile devices. However, it is a rapid method for data collection, and therefore during the COVID-19 pandemic, it can provide service providers and policymakers with timely information to inform public health responses. In addition, this method negates the need for in-person interactions and allows for longitudinal data collection. It may be useful in supplementing other community needs assessment activities, and may be particularly relevant for people who are considered to be more difficult to reach, particularly young people, culturally and linguistically diverse communities, and other groups that might otherwise be missed by traditional methods. %M 34612824 %R 10.2196/28929 %U https://formative.jmir.org/2021/11/e28929 %U https://doi.org/10.2196/28929 %U http://www.ncbi.nlm.nih.gov/pubmed/34612824 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e25298 %T A Text Messaging Intervention (StayWell at Home) to Counteract Depression and Anxiety During COVID-19 Social Distancing: Pre-Post Study %A Aguilera,Adrian %A Hernandez-Ramos,Rosa %A Haro-Ramos,Alein Y %A Boone,Claire Elizabeth %A Luo,Tiffany Christina %A Xu,Jing %A Chakraborty,Bibhas %A Karr,Chris %A Darrow,Sabrina %A Figueroa,Caroline Astrid %+ School of Social Welfare, University of California, Berkeley, 120 Haviland Hall, MC7400, School of Social Welfare, Berkeley, CA, 94720, United States, 1 (510) 642 8564, aguila@berkeley.edu %K mobile health %K COVID-19 %K text messaging %K cognitive behavioral therapy %K anxiety %K depression %K microrandomized trials %K mHealth %K intervention %K mental health %K SMS %D 2021 %7 1.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Social distancing and stay-at-home orders are critical interventions to slow down person-to-person transmission of COVID-19. While these societal changes help contain the pandemic, they also have unintended negative consequences, including anxiety and depression. We developed StayWell, a daily skills-based SMS text messaging program, to mitigate COVID-19–related depression and anxiety symptoms among people who speak English and Spanish in the United States. Objective: This paper describes the changes in StayWell participants’ anxiety and depression levels after 60 days of exposure to skills-based SMS text messages. Methods: We used self-administered, empirically supported web-based questionnaires to assess the demographic and clinical characteristics of StayWell participants. Anxiety and depression were measured using the 2-item Generalized Anxiety Disorder (GAD-2) scale and the 8-item Patient Health Questionnaire-8 (PHQ-8) scale at baseline and 60-day timepoints. We used 2-tailed paired t tests to detect changes in PHQ-8 and GAD-2 scores from baseline to follow-up measured 60 days later. Results: The analytic sample includes 193 participants who completed both the baseline and 60-day exit questionnaires. At the 60-day time point, there were significant reductions in both PHQ-8 and GAD-2 scores from baseline. We found an average reduction of –1.72 (95% CI –2.35 to –1.09) in PHQ-8 scores and –0.48 (95% CI –0.71 to –0.25) in GAD-2 scores. These improvements translated to an 18.5% and 17.2% reduction in mean PHQ-8 and GAD-2 scores, respectively. Conclusions: StayWell is an accessible, low-intensity population-level mental health intervention. Participation in StayWell focused on COVID-19 mental health coping skills and was related to improved depression and anxiety symptoms. In addition to improvements in outcomes, we found high levels of engagement during the 60-day intervention period. Text messaging interventions could serve as an important public health tool for disseminating strategies to manage mental health. Trial Registration: ClinicalTrials.gov NCT04473599; https://clinicaltrials.gov/ct2/show/NCT04473599 International Registered Report Identifier (IRRID): RR2-10.2196/23592 %M 34543230 %R 10.2196/25298 %U https://mental.jmir.org/2021/11/e25298 %U https://doi.org/10.2196/25298 %U http://www.ncbi.nlm.nih.gov/pubmed/34543230 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e20970 %T WhatsApp-Based Focus Groups Among Mexican-Origin Women in Zika Risk Area: Feasibility, Acceptability, and Data Quality %A Anderson,Elizabeth %A Koss,Mary %A Castro Luque,Ana Lucía %A Garcia,David %A Lopez,Elise %A Ernst,Kacey %+ Department of Health Promotion Sciences, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85721, United States, 1 5205050040, andersone@email.arizona.edu %K WhatsApp %K synchronous text-based focus groups %K Zika %K Mexican-origin Latinas %K social media %K mHealth %K focus groups %K smartphones %K mobile phone %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite unprecedented advances in worldwide access to the internet via smartphones, barriers to engaging hard-to-reach populations remain in many methods of health research. A potential avenue for conducting qualitative research is via participatory web-based media, including the free, popular social platform WhatsApp. However, despite the clear advantages of engaging with participants over a well-established web-based platform, logistical challenges remain. Objective: This study aims to report evidence on the feasibility and acceptability of WhatsApp as a method to conduct focus groups. Methods: A pilot focus group was conducted with Spanish-speaking women near the US–Mexico border. The content focus was knowledge and perceived risks for exposure to the Zika virus during pregnancy. Results: Evidence was obtained regarding WhatsApp as a low-cost, logistically feasible methodology that resulted in rich qualitative data from a population that is often reticent to engage in traditional research. A total of 5 participants participated in a focus group, of whom all 5 consistently contributed to the focus group chat in WhatsApp, which was conducted over 3 consecutive days. Conclusions: The findings are noteworthy at a time when face-to-face focus groups, the gold standard, are risky or precluded by safe COVID-19 guidelines. Other implications include more applications and evaluations of WhatsApp for delivering one-on-one or group health education interventions on sensitive topics. This paper outlines the key steps and considerations for the replication or adaptation of methods. %M 34709185 %R 10.2196/20970 %U https://formative.jmir.org/2021/10/e20970 %U https://doi.org/10.2196/20970 %U http://www.ncbi.nlm.nih.gov/pubmed/34709185 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e28508 %T Feasibility of Indirect Secondary Distribution of HIV Self-test Kits via WeChat Among Men Who Have Sex With Men: National Cross-sectional Study in China %A Li,Shangcao %A Zhang,Jing %A Mao,Xiang %A Lu,Tianyi %A Gao,Yangyang %A Zhang,Wenran %A Wang,Hongyi %A Chu,Zhenxing %A Hu,Qinghai %A Jiang,Yongjun %A Geng,Wenqing %A Shang,Hong %A Xu,Junjie %+ NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, 110001, China, 86 8328 2634, xjjcmu@163.com %K secondary distribution %K HIV %K men who have sex with men %K WeChat %K HIV self-testing %D 2021 %7 26.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: HIV self-testing (HIVST) kits are common in key sexually active populations. Direct secondary distribution of HIVST kits (DSDHK) is effective in improving the uptake of HIVST. However, there are concerns about the various limitations of DSDHK, including limited geographic reach, payment problems, and need for face-to-face interactions. Objective: In this study, we aim to evaluate the feasibility and characteristics of indirect secondary distribution of HIVST kits (ISDHK) via WeChat (distributing HIVST application links and follow-up HIVST kits to partners) among men who have sex with men (MSM). Methods: From October 2017 to September 2019, an HIVST recruitment advertisement was disseminated on the WeChat social media platform to invite MSM to apply for the HIVST kits (referred to as index participants [IPs]). All MSM participants were encouraged to distribute the HIVST application link to their friends and sexual partners (referred to as alters) through their social networks. All the alters were further encouraged to continue distributing the HIVST application link. All participants paid a deposit (US $7), which was refundable upon completion of the questionnaire, and uploaded the test results via a web-based survey system. Results: A total of 2263 MSM met the criteria and successfully applied for HIVST. Of these, 1816 participants returned their HIVST results, including 1422 (88.3%) IPs and 394 (21.7%) alters. More alters had condomless anal intercourse, a higher proportion of them had never previously tested for HIV, and they showed a greater willingness to distribute HIVST kits to their sexual partners (P=.002) than the IPs. After controlling for age, education, and income, the alters had a greater proportion of MSM who had never tested for HIV before (adjusted odds ratio [aOR] 1.29, 95% CI 1.00-1.68), were more willing to distribute the HIVST application link (aOR 1.71, 95% CI 1.21-2.40), had a lower number of sexual partners (aOR 0.71, 95% CI 0.57-0.90), and were less likely to search for sexual partners on the web (aOR 0.78, 95% CI 0.60-1.02) than IPs. In comparison, the rates of reactive HIVST results, conducting HIV confirmatory tests, HIV seropositivity, and initiation of HIV antiretroviral therapy were similar for IPs and alters. Conclusions: The ISDHK model of distributing HIVST application links among the MSM population via social media is feasible. The ISDHK model should be used to supplement the DSDHK model to enable a greater proportion of the MSM population to know their HIV infection status. %M 34698651 %R 10.2196/28508 %U https://www.jmir.org/2021/10/e28508 %U https://doi.org/10.2196/28508 %U http://www.ncbi.nlm.nih.gov/pubmed/34698651 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e27263 %T An Enhanced SMS Text Message–Based Support and Reminder Program for Young Adults With Type 2 Diabetes (TEXT2U): Randomized Controlled Trial %A Middleton,Timothy %A Constantino,Maria %A McGill,Margaret %A D'Souza,Mario %A Twigg,Stephen M %A Wu,Ted %A Thiagalingam,Aravinda %A Chow,Clara %A Wong,Jencia %+ Diabetes Centre, Royal Prince Alfred Hospital, Missenden Road, Camperdown, 2050, Australia, 61 295155888, timothy.middleton@health.nsw.gov.au %K young-onset type 2 diabetes %K SMS %K clinic attendance %K engagement %K diabetes %K digital health %K mobile health %K adolescents %D 2021 %7 21.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Clinic attendance, metabolic control, engagement in self-management, and psychological health are suboptimal in young-onset (age of onset <40 years) type 2 diabetes. Objective: We examined the effectiveness of an enhanced SMS text message–based support and reminder program in improving clinic attendance, metabolic control, engagement in self-management, and psychological health in young-onset type 2 diabetes. Methods: A 12-month, parallel-arm, randomized controlled trial comparing an enhanced, semipersonalized SMS text message–based intervention (incorporating 1-8 supportive and/or informative text messages per month) against standard care was conducted in a specialized clinic for young adult type 2 diabetes. The primary outcome was maintenance of 100% attendance at scheduled quarterly clinical appointments. Secondary outcomes included (1) metabolic indices, (2) pathology and self-monitored blood glucose (SMBG) data availability, and (3) psychosocial well-being. Results: A total of 40 participants were randomized, and 32 completed their 12-month study visit. The average participant age was 32.7 (SD 5.1) years, 50% (20/40) were male, and baseline glycated hemoglobin A1c (HbA1c) was 7.3% (SD 1.9%) (56 mmol/mol, SD 20). A higher proportion of the intervention group achieved 100% attendance (12/21, 57%, vs 5/19, 26%, for the control group); Kaplan-Meier analysis demonstrated significantly greater cumulative attendance in the intervention group (P=.04). There were no between-group differences in HbA1c, BMI, lipids, or availability of pathology and SMBG data. Odds of recording an improvement in the Diabetes Empowerment Scale–Short Form score were higher in the intervention group at 6 months (odds ratio [OR] 4.3, 95% CI 1.1-17), with attenuation of this effect at study end (OR 3.1, 95% CI 0.9-11). Program acceptability was high; >90% of participants would recommend the program to new patients. Conclusions: An enhanced SMS text message–based support and reminder program doubled scheduled clinic attendance rates for patients with young-onset type 2 diabetes. The program was highly acceptable and provided early support for patient empowerment but had no significant effect on measures of metabolic control or self-management. Trial Registration: Australian and New Zealand Clinical Trials Registry (ACTRN12618000479202); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373579 %M 34524102 %R 10.2196/27263 %U https://www.jmir.org/2021/10/e27263 %U https://doi.org/10.2196/27263 %U http://www.ncbi.nlm.nih.gov/pubmed/34524102 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e29913 %T Six-Month Outcomes from the NEXit Junior Trial of a Text Messaging Smoking Cessation Intervention for High School Students: Randomized Controlled Trial With Bayesian Analysis %A Bendtsen,Marcus %A Bendtsen,Preben %A Müssener,Ulrika %+ Department of Health, Medicine and Caring Sciences, Linköping University, Building 511, Linköping, 58183, Sweden, 46 13286975, marcus.bendtsen@liu.se %K smoking %K cessation %K text messaging %K high school %K randomized controlled trial %K intervention %K student %K young adult %K teenager %K outcome %K Bayesian %K Sweden %K prevalence %K lifestyle %K behavior %D 2021 %7 21.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The prevalence of daily or occasional smoking among high school students in Sweden was approximately 20% in 2019, which is problematic since lifestyle behaviors are established in adolescence and track into adulthood. The Nicotine Exit (NEXit) Junior trial was conducted in response to a lack of evidence for the effects of text message smoking cessation interventions among high school students in Sweden. Objective: The aim of this study was to estimate the 3- and 6-month effects of a text messaging intervention among high school students in Sweden on smoking cessation outcomes. Methods: A 2-arm, single-blind randomized controlled trial was employed to estimate the effects of the intervention on smoking cessation in comparison to treatment as usual. Participants were recruited from high schools in Sweden using advertising and promotion by school staff from January 10, 2018, to January 10, 2019. Weekly or daily smokers who were willing to make a quit attempt were eligible for inclusion. Prolonged abstinence and point prevalence of smoking cessation were measured at 3 and 6 months after randomization. Results: Complete case analysis was possible on 57.9% (310/535) of the participants at 6 months, with no observed statistically significant effect on 5-month prolonged abstinence (odds ratio [OR] 1.27, 95% CI 0.73-2.20; P=.39) or 4-week smoking cessation (OR 1.42; 95% CI 0.83-2.46; P=.20). Sensitivity analyses using imputation yielded similar findings. Unplanned Bayesian analyses showed that the effects of the intervention were in the anticipated direction. The findings were limited by the risk of bias induced by high attrition (42.1%). The trial recruited high school students in a pragmatic setting and included both weekly and daily smokers; thus, generalization to the target population is more direct compared with findings obtained under more strict study procedures. Conclusions: Higher than expected attrition rates to follow-up 6 months after randomization led to null hypothesis tests being underpowered; however, unplanned Bayesian analyses found that the effects of the intervention were in the anticipated direction. Future trials of smoking cessation interventions targeting high school students should aim to prepare strategies for increasing retention to mid- and long-term follow-up. Trial Registration: IRCTN Registry ISRCTN15396225; https://www.isrctn.com/ISRCTN15396225 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-3028-2 %M 34673532 %R 10.2196/29913 %U https://mhealth.jmir.org/2021/10/e29913 %U https://doi.org/10.2196/29913 %U http://www.ncbi.nlm.nih.gov/pubmed/34673532 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e32271 %T Acceptability, Engagement, and Effects of a Mobile Digital Intervention to Support Mental Health for Young Adults Transitioning to College: Pilot Randomized Controlled Trial %A Suffoletto,Brian %A Goldstein,Tina %A Gotkiewicz,Dawn %A Gotkiewicz,Emily %A George,Brandie %A Brent,David %+ Department of Emergency Medicine, Stanford University, 900 Welch Road, Suite 350, Palo Alto, CA, 94304, United States, 1 412 901 6892, suffbp@stanford.edu %K college %K mental health %K self-management %K digital intervention %K mHealth %D 2021 %7 14.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The transition from high school to college can exacerbate mental health problems in young adults yet barriers prevent seamless mental health care. Existing digital support tools show promise but are not yet designed to optimize engagement or implementation. Objective: The goal of the research was to test acceptability and effects of an automated digital Mobile Support Tool for Mental Health (MoST-MH) for young adults transitioning to college. Methods: Youths aged 18 years and older with a current mental health diagnosis preparing to transition to college (n=52; 85% female [45/52], 91% White [48/52]) were recruited from a primary care (n=31) and a mental health clinic (n=21). Participants were randomized 2:1 to either receive MoST-MH (n=34) or enhanced Usual Care (eUC; n=18). MoST-MH included periodic text message and web-based check-ins of emotional health, stressors, negative impacts, and self-efficacy that informed tailored self-care support messages. Both eUC and MoST-MH participants received links to a library of psychoeducational videos and were asked to complete web-based versions of the Mental Health Self-Efficacy Scale (MHSES), College Counseling Center Assessment of Psychological Symptoms (CCAPS), and Client Service Receipt Inventory for Mental Health (C-SRI) monthly for 3 months and the Post-Study System Usability Scale (PSSUQ) at 3-months. Results: MoST-MH participants were sent a median of 5 (range 3 to 10) text message check-in prompts over the 3-month study period and 100% were completed; participants were sent a median of 2 (range 1 to 8) web-based check-in prompts among which 78% (43/55) were completed. PSSUQ scores indicate high usability (mean score 2.0). Results from the completer analysis demonstrated reductions in mental health symptoms over time and significant between-group effects of MoST-MH compared to eUC on depressive symptom severity (d=0.36, 95% CI 0.08 to 0.64). No significant differences in mental health self-efficacy or mental health health care use were observed. Conclusions: In this pilot trial, we found preliminary evidence that MoST-MH was engaged with at high rates and found to be highly usable and reduced depression symptoms relative to eUC among youth with mental health disorders transitioning to college. Findings were measured during the COVID-19 pandemic, and the study was not powered to detect differences in outcomes between groups; therefore, further testing is needed. Trial Registration: ClinicalTrials.gov NCT04560075; https://clinicaltrials.gov/ct2/show/NCT04560075 %M 34647893 %R 10.2196/32271 %U https://formative.jmir.org/2021/10/e32271 %U https://doi.org/10.2196/32271 %U http://www.ncbi.nlm.nih.gov/pubmed/34647893 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e29495 %T Text Messaging Versus Email Messaging to Support Patients With Major Depressive Disorder: Protocol for a Randomized Hybrid Type II Effectiveness-Implementation Trial %A Adu,Medard Kofi %A Shalaby,Reham %A Eboreime,Ejemai %A Sapara,Adegboyega %A Nkire,Nnamdi %A Chawla,Rajan %A Chima,Chidi %A Achor,Michael %A Osiogo,Felix %A Chue,Pierre %A Greenshaw,Andrew J %A Agyapong,Vincent Israel %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor Abbie J. Lane Memorial Building QEII Health Sciences Centre, Halifax, NS, T6G 2B7, Canada, 1 7807144315, vincent.agyapong@nshealth.ca %K email messaging %K text messaging %K supportive %K major depressive disorder %K randomized trial %K mental health %K digital health %K mobile health %K mHealth %K patient care %K health policy %K decision-making %K health care resources %D 2021 %7 13.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 34643541 %R 10.2196/29495 %U https://www.researchprotocols.org/2021/10/e29495 %U https://doi.org/10.2196/29495 %U http://www.ncbi.nlm.nih.gov/pubmed/34643541 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e27478 %T Adaptation and Assessment of a Text Messaging Smoking Cessation Intervention in Vietnam: Pilot Randomized Controlled Trial %A Jiang,Nan %A Nguyen,Nam %A Siman,Nina %A Cleland,Charles M %A Nguyen,Trang %A Doan,Hue Thi %A Abroms,Lorien C %A Shelley,Donna R %+ Department of Population Health, Grossman School of Medicine, New York University, 180 Madison Ave, Room #17-54, New York, NY, 10016, United States, 1 646 501 3553, Nan.Jiang@nyulangone.org %K smoking cessation %K text messaging %K mHealth %K mobile health %K low- and middle-income country %K smoking %K developing countries %K SMS %K Vietnam %D 2021 %7 8.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Text message (ie, short message service, SMS) smoking cessation interventions have demonstrated efficacy in high-income countries but are less well studied in low- and middle-income countries, including Vietnam. Objective: The goal of the research is to assess the feasibility, acceptability, and preliminary efficacy of a fully automated bidirectional SMS cessation intervention adapted for Vietnamese smokers. Methods: The study was conducted in 3 phases. In phase 1, we adapted the SMS library from US-based SMS cessation programs (ie, SmokefreeTXT and Text2Quit). The adaptation process consisted of 7 focus groups with 58 smokers to provide data on culturally relevant patterns of tobacco use and assess message preferences. In phase 2, we conducted a single-arm pilot test of the SMS intervention with 40 smokers followed by in-depth interviews with 10 participants to inform additional changes to the SMS library. In phase 3, we conducted a 2-arm pilot randomized controlled trial (RCT) with 100 smokers. Participants received either the SMS program (intervention; n=50) or weekly text assessment on smoking status (control; n=50). The 6-week SMS program consisted of a 2-week prequit period and a 4-week postquit period. Participants received 2 to 4 automated messages per day. The main outcomes were engagement and acceptability which were assessed at 6 weeks (end of intervention). We assessed biochemically confirmed smoking abstinence at 6 weeks and 12 weeks. Postintervention in-depth interviews explored user experiences among a random sample of 16 participants in the intervention arm. Results: Participants in both arms reported high levels of engagement and acceptability. Participants reported using the program for an average of 36.4 (SD 3.4) days for the intervention arm and 36.0 (SD 3.9) days for the control arm. Four of the 50 participants in the intervention arm (8%) reset the quit date and 19 (38%) texted the keyword TIPS. The majority of participants in both arms reported that they always or usually read the text messages. Compared to the control arm, a higher proportion of participants in the intervention arm reported being satisfied with the program (98% [49/50] vs 82% [41/50]). Biochemically verified abstinence was higher in the intervention arm at 6 weeks (20% [10/50] vs 2% [1/50]; P=.01), but the effect was not significant at 12 weeks (12% [6/50] vs 6% [3/50]; P=.49). In-depth interviews conducted after the RCT suggested additional modifications to enhance the program including tailoring the timing of messages, adding more opportunities to interact with the program, and placing a greater emphasis on messages that described the harms of smoking. Conclusions: The study supported the feasibility and acceptability of an SMS program adapted for Vietnamese smokers. Future studies need to assess whether, with additional modifications, the program is associated with prolonged abstinence. Trial Registration: ClinicalTrials.gov NCT03219541; https://clinicaltrials.gov/ct2/show/NCT03219541 %M 34623318 %R 10.2196/27478 %U https://mhealth.jmir.org/2021/10/e27478 %U https://doi.org/10.2196/27478 %U http://www.ncbi.nlm.nih.gov/pubmed/34623318 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e31578 %T Improving the Follow-up Rate for Pediatric Patients (0-16 years) of an Eye Hospital in Nepal: Protocol for a Public Health Intervention Study %A Shrestha,Manisha %A Bhandari,Gopal %A Rathi,Suresh Kumar %A Gudlavalleti,Anirudh Gaurang %A Pandey,Binod %A Ghimire,Ramesh %A Ale,Daman %A Kayastha,Sajani %A Chaudhary,Daya Shankar %A Byanju,Raghunandan %A , %+ Bharatpur Eye Hospital, Bypass Rd-10, Bharatpur Metropolitan City, Chitwan, 42201, Nepal, 977 984 502 3273, maneeshasht9845@gmail.com %K counseling %K follow-up %K intervention study %K pediatric patients %K ophthalmology %K public health %K Nepal %D 2021 %7 8.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The follow-up of pediatric patients ensures regular ocular morbidity monitoring and better treatment outcome. Hiralal Santudevi Pradhan Institute of Ophthalmic Science (Bharatpur Eye Hospital [BEH]) noticed that the follow-up rate was only 22% among its pediatric patients. Several factors like lack of awareness and forgetfulness among patients may contribute to a lower number of follow-up visits. Therefore, BEH decided to find if counseling and reminders through SMS text messaging and phone calls would improve the follow-up rates. Objective: This study aims to evaluate the impact of interventions like counseling and reminder SMS text messaging and phone calls in improving the follow-up rate of pediatric patients. Methods: This is a public health intervention study being conducted using quantitative analysis. All children (0-16 years) with ocular conditions requiring at least 3 follow-up visits in the study period will be included. In all, 264 participants will be allocated to 3 groups: routine standard care, counseling, and reminders with SMS text messaging and phone calls. In counseling, patients will take part in 20-minute counseling sessions with trained counselors at each visit, and information leaflets will be provided to them. In the reminder SMS text messaging and phone call group, patients will receive an SMS text message 3 days prior and a phone call 1 day prior to their scheduled visits. Patients attending within 2 days of the scheduled date will be considered compliant to follow-up. The proportion of patients completing all the follow-up visits in each group will be assessed. Informed consent will be taken from parents and children. Univariate and multivariate analyses will be conducted. Results: The ethical approval for this study has been obtained from the Ethical Review Board (ERB) of Nepal Health Research Council (ERB protocol registration #761/2020 P). The data collection was initiated on January, 24, 2021, but due to the COVID-19 pandemic, as of September 2021, we have only been able to enroll 154 of the planned 264 participants (58.3% of the sample size). Conclusions: This study will reliably document not only the factors associated with follow-up rate through an intervention package (counseling and reminders through SMS text messaging and phone calls) but also the cost effectiveness of the intervention package, which can be applied in all the departments of the hospital. Trial Registration: ClinicalTrials.gov NCT04837534; https://clinicaltrials.gov/ct2/show/NCT04837534 International Registered Report Identifier (IRRID): DERR1-10.2196/31578 %M 34521615 %R 10.2196/31578 %U https://www.researchprotocols.org/2021/10/e31578 %U https://doi.org/10.2196/31578 %U http://www.ncbi.nlm.nih.gov/pubmed/34521615 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e30947 %T mHealth Messaging to Motivate Quitline Use and Quitting: Protocol for a Community-Based Randomized Controlled Trial in Rural Vietnam %A Larkin,Celine %A Wijesundara,Jessica %A Nguyen,Hoa L %A Ha,Duc Anh %A Vuong,Anh %A Nguyen,Cuong Kieu %A Amante,Daniel %A Ngo,Chau Quy %A Phan,Phuong Thu %A Pham,Quyen Thi Le %A Nguyen,Binh Ngoc %A Nguyen,Anh Thi Phuong %A Nguyen,Phuong Thi Thu %A Person,Sharina %A Allison,Jeroan J %A Houston,Thomas K %A Sadasivam,Rajani %+ Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 5084211436, celine.larkin@umassmed.edu %K tobacco cessation %K smoking cessation %K mHealth %K global health %K Vietnam %K randomized controlled trial %D 2021 %7 7.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Tobacco kills more than 8 million people each year, mostly in low- and middle-income countries. In Vietnam, 1 in every 2 male adults smokes tobacco. Vietnam has set up telephone Quitline counseling that is available to all smokers, but it is underused. We previously developed an automated and effective motivational text messaging system to support smoking cessation among US smokers. Objective: The aim of this study is to adapt the aforementioned system for rural Vietnamese smokers to promote cessation of tobacco use, both directly and by increasing the use of telephone Quitline counseling services and nicotine replacement therapy. Moreover, we seek to enhance research and health service capacity in Vietnam. Methods: We are testing the effectiveness of our culturally adapted motivational text messaging system by using a community-based randomized controlled trial design (N=600). Participants were randomly allocated to the intervention (regular motivational and assessment text messages) or control condition (assessment text messages only) for a period of 6 months. Trial recruitment took place in four communes in the Hung Yen province in the Red River Delta region of Vietnam. Recruitment events were advertised to the local community, facilitated by community health workers, and occurred in the commune health center. We are assessing the impact of the texting system on 6-month self-reported and biochemically verified smoking cessation, as well as smoking self-efficacy, uptake of the Quitline, and use of nicotine replacement therapy. In addition to conducting the trial, the research team also provided ongoing training and consultation with the Quitline during the study period. Results: Site preparation, staff training, intervention adaptation, participant recruitment, and baseline data collection were completed. The study was funded in August 2017; it was reviewed and approved by the University of Massachusetts Medical School Institutional Review Board in 2017. Recruitment began in November 2018. A total of 750 participants were recruited from four communes, and 700 (93.3%) participants completed follow-up by March 2021. An analysis of the trial results is in progress; results are expected to be published in late 2022. Conclusions: This study examines the effectiveness of mobile health interventions for smoking in rural areas in low- and middle-income countries, which can be implemented nationwide if proven effective. In addition, it also facilitates significant collaboration and capacity building among a variety of international partners, including researchers, policy makers, Quitline counselors, and community health workers. Trial Registration: ClinicalTrials.gov NCT03567993; https://clinicaltrials.gov/ct2/show/NCT03567993. International Registered Report Identifier (IRRID): DERR1-10.2196/30947 %M 34617915 %R 10.2196/30947 %U https://www.researchprotocols.org/2021/10/e30947 %U https://doi.org/10.2196/30947 %U http://www.ncbi.nlm.nih.gov/pubmed/34617915 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26418 %T Psychoeducational Messaging to Reduce Alcohol Use for College Students With Type 1 Diabetes: Internet-Delivered Pilot Trial %A Wisk,Lauren E %A Magane,Kara M %A Nelson,Eliza B %A Tsevat,Rebecca K %A Levy,Sharon %A Weitzman,Elissa R %+ Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, United States, 1 3102675308, lwisk@mednet.ucla.edu %K adolescent %K young adult %K diabetes mellitus %K type 1 %K binge drinking %K alcohol drinking %K self care %K risk-taking %K universities %K students %K attitude %K mobile phone %D 2021 %7 30.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: College environments promote high-volume or binge alcohol consumption among youth, which may be especially harmful to those with type 1 diabetes (T1D). Little is known about the acceptability and effectiveness of interventions targeting reduced alcohol use by college students with T1D, and it is unclear whether intervention framing (specifically, the narrator of intervention messages) matters with respect to affecting behavior change. Interventions promoted by peer educators may be highly relatable and socially persuasive, whereas those delivered by clinical providers may be highly credible and motivating. Objective: The aim of this study is to determine the acceptability and impacts of an alcohol use psychoeducational intervention delivered asynchronously through web-based channels to college students with T1D. The secondary aim is to compare the impacts of two competing versions of the intervention that differed by narrator (peer vs clinician). Methods: We recruited 138 college students (aged 17-25 years) with T1D through web-based channels and delivered a brief intervention to participants randomly assigned to 1 of 2 versions that differed only with respect to the audiovisually recorded narrator. We assessed the impacts of the exposure to the intervention overall and by group, comparing the levels of alcohol- and diabetes-related knowledge, perceptions, and use among baseline, immediately after the intervention, and 2 weeks after intervention delivery. Results: Of the 138 enrolled participants, 122 (88.4%) completed all follow-up assessments; the participants were predominantly women (98/122, 80.3%), were White non-Hispanic (102/122, 83.6%), and had consumed alcohol in the past year (101/122, 82.8%). Both arms saw significant postintervention gains in the knowledge of alcohol’s impacts on diabetes-related factors, health-protecting attitudes toward drinking, and concerns about drinking. All participants reported significant decreases in binge drinking 2 weeks after the intervention (21.3%; odds ratio 0.48, 95% CI 0.31-0.75) compared with the 2 weeks before the intervention (43/122, 35.2%). Changes in binge drinking after the intervention were affected by changes in concerns about alcohol use and T1D. Those who viewed the provider narrator were significantly more likely to rate their narrator as knowledgeable and trustworthy; there were no other significant differences in intervention effects by the narrator. Conclusions: The intervention model was highly acceptable and effective at reducing self-reported binge drinking at follow-up, offering the potential for broad dissemination and reach given the web-based format and contactless, on-demand content. Both intervention narrators increased knowledge, improved health-protecting attitudes, and increased concerns regarding alcohol use. The participants’ perceptions of expertise and credibility differed by narrator. Trial Registration: ClinicalTrials.gov NCT02883829; https://clinicaltrials.gov/ct2/show/NCT02883829 International Registered Report Identifier (IRRID): RR2-10.1177/1932296819839503 %M 34591022 %R 10.2196/26418 %U https://www.jmir.org/2021/9/e26418 %U https://doi.org/10.2196/26418 %U http://www.ncbi.nlm.nih.gov/pubmed/34591022 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e29928 %T mHealth Interventions for Lifestyle and Risk Factor Modification in Coronary Heart Disease: Randomized Controlled Trial %A Bae,Jang-Whan %A Woo,Seoung-Il %A Lee,Joongyub %A Park,Sang-Don %A Kwon,Sung Woo %A Choi,Seong Huan %A Yoon,Gwang-Seok %A Kim,Mi-Sook %A Hwang,Seung-Sik %A Lee,Won Kyung %+ Department of Prevention and Management, School of Medicine, Inha University Hospital, Inha University, 27 Inhang-Ro, Jung-Gu, Incheon, Republic of Korea, 82 10 6360 7965, bluewhale65@gmail.com %K coronary heart disease %K prevention %K lifestyle modification %K mobile health %K text message %K mHealth %D 2021 %7 24.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Self-management of lifestyle and cardiovascular disease risk factors is challenging in older patients with coronary heart disease (CHD). SMS text messaging could be a potential support tool for self-management and the most affordable and accessible method through a mobile phone. High-quality evidence had been lacking, and previous studies evaluated the effects of SMS text messaging on the subjective measures of short-term outcomes. Recently, a large-sized randomized controlled trial in Australia reported promising findings on the objective measures upon 6-month follow-up. However, an examination of the effectiveness of such interventions in an Asian population with unique demographic characteristics would be worthwhile. Objective: This study examined the effectiveness of a 1-way SMS text messaging program to modify the lifestyle and cardiovascular disease risk factors of patients who underwent the first percutaneous coronary intervention (PCI). Methods: A parallel, single-blinded, 1:1 random allocation clinical trial was conducted with 879 patients treated through PCI. They were recruited during hospital admission from April 2017 to May 2020 at 2 university hospitals in the Republic of Korea. In addition to standard care, the intervention group received access to a supporting website and 4 SMS text messages per week for 6 months regarding a healthy diet, physical activity, smoking cessation, and cardiovascular health. Random allocation upon study enrollment and SMS text messaging after hospital discharge were performed automatically using a computer program. The coprimary outcomes were low-density-lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), and BMI. The secondary outcomes were change in lifestyle and adherence to the recommended health behaviors. Results: Of the eligible population, 440 and 439 patients who underwent PCI were assigned to the intervention and control groups, respectively. The 1-way SMS text messaging program significantly enhanced physical activity (P=.02), healthy diet (P<.01), and medication adherence (P<.04) among patients with CHD. Hence, more people were likely to control their cardiovascular disease risk factors per the recommendations. The intervention group was more likely to control all 5 risk factors by 62% (relative risk 1.62, 95% CI 1.05-2.50) per the recommendations. On the other hand, physiological measures of the primary outcomes, including LDL-C levels, SBP, and BMI, were not significant. Most participants found the SMS text messaging program useful and helpful in motivating lifestyle changes. Conclusions: Lifestyle-focused SMS text messages were effective in the self-management of a healthy diet, exercise, and medication adherence, but their influence on the physiological measures was not significant. One-way SMS text messages can be used as an affordable adjuvant method for lifestyle modification to help prevent the recurrence of cardiovascular disease. Trial Registration: Clinical Research Information Service (CRiS) KCT0005087; https://cris.nih.go.kr/cris/search/detailSearch.do/19282 %M 34559058 %R 10.2196/29928 %U https://mhealth.jmir.org/2021/9/e29928 %U https://doi.org/10.2196/29928 %U http://www.ncbi.nlm.nih.gov/pubmed/34559058 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e25558 %T Development of Digital Health Messages for Rural Populations in Tanzania: Multi- and Interdisciplinary Approach %A Holst,Christine %A Isabwe,Ghislain Maurice Norbert %A Sukums,Felix %A Ngowi,Helena %A Kajuna,Flora %A Radovanović,Danica %A Mansour,Wisam %A Mwakapeje,Elibariki %A Cardellichio,Peter %A Ngowi,Bernard %A Noll,Josef %A Winkler,Andrea Sylvia %+ Centre for Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postbox 1130, Blindern, Oslo, 0318, Norway, 47 48234044, christine.holst@medisin.uio.no %K digital health %K eHealth %K mHealth %K Tanzania %K health education %K HIV/AIDS %K tuberculosis %K cysticercosis %K tapeworm %K anthrax %K mobile phone %D 2021 %7 22.9.2021 %9 Tutorial %J JMIR Mhealth Uhealth %G English %X Background: Health workers have traditionally delivered health promotion and education to rural communities in the Global South in paper leaflet formats or orally. With the rise of digital technologies, health promotion and education can be provided in innovative and more effective formats, which are believed to have a higher impact on disease prevention and treatment. Objective: The aim of this tutorial is to illustrate how a multi- and interdisciplinary approach can be applied in the design process of digital health messages for use in the Global South. Methods: The multi- and interdisciplinary team of the Non-discriminating access for Digital Inclusion (DigI) project digitalized and customized available government-approved paper-based health promotion messages into a screen-suitable format. The team worked closely together and used its diverse expertise to develop digital health messages with disease-specific content in Tanzania’s national language (Swahili) as well as English. The development process included the following phases: a local needs assessment; identification of government-approved health promotion materials in a nondigital format; identification of key health messages; creation of a practical and engaging story, easy to understand for the general public; drafting of a storyboard for an animated video with review, feedback, and revisions; forward and backward translation; audio recording of the story in both languages; finalization and presentation of the animations; development of relevant questions related to the health messages in each domain; and development of web and mobile apps to access the digital health messages. Results: Between 2017 and 2019, we developed key health messages, quizzes, and animated health videos to address HIV/AIDS, tuberculosis, Taenia solium cysticercosis and taeniasis, and anthrax, all of which are of public health importance in Tanzania. Feedback from local stakeholders and test users was included in various phases of the process. The 4 videos and other content are available in local information spots on a digital health platform (DigI platform), established by the DigI project, in both Tanzanian Swahili and English. Conclusions: Our methodological multi- and interdisciplinary approach ensures that the digital health messages for the public are clear, high quality, and align with the government’s objectives for health promotion. It also demonstrates the diversity of scientific disciplines required when collaborating on a digital health project. We recommend this approach to be applied to the development of other digital health messages for a wide range of diseases. International Registered Report Identifier (IRRID): RR2-10.2196/25128 %M 34550081 %R 10.2196/25558 %U https://mhealth.jmir.org/2021/9/e25558 %U https://doi.org/10.2196/25558 %U http://www.ncbi.nlm.nih.gov/pubmed/34550081 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e24527 %T Effectiveness of Text Messaging Interventions on Blood Pressure Control Among Patients With Hypertension: Systematic Review of Randomized Controlled Trials %A Tam,Hon Lon %A Wong,Eliza Mi Ling %A Cheung,Kin %A Chung,Siu Fung %+ School of Nursing, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China (Hong Kong), 852 34003804, hon-lon.tam@connect.polyu.hk %K text messaging %K hypertension %K blood pressure %K mHealth %K meta-analysis %D 2021 %7 22.9.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Controlling blood pressure (BP) is an international health concern, and high BP is a major contributor to cardiovascular disease mortality. Evidence has shown that educational interventions directed at patients potentially improve BP control and adherence to medications and lifestyle modifications. In addition, a text messaging intervention has a potential effect on BP control; however, the dosage of a text messaging intervention has not been determined in previous reviews, resulting in difficult application in practice. Objective: This review aimed to identify the effectiveness of a text messaging intervention on hypertension management with a specific focus on the dosage of text messaging and the type of additional interventions with text messaging. Methods: A systematic review was conducted and reported on in accordance with PRISMA guideline. Participants were aged 18 years and older and diagnosed with primary hypertension. The included studies used text messaging as a component of the intervention. We searched for randomized controlled trials published until June 30, 2020, from the following health-related electronic databases: Embase, Medline, CINAHL Complete, PsycINFO, and Scopus. Data were extracted for qualitative synthesis and meta-analysis. The Physiotherapy Evidence Database Scale was used to assess the methodological quality of each study, and the quality of the included studies was assessed independently by two authors. Results: Twelve studies met the inclusion criteria. The overall methodological quality was fair (mean score 5.75). The frequency of text message delivery varied from daily to biweekly. Health education was identified in 4 studies as an additional intervention with text messaging. The overall results showed that the text messaging intervention significantly reduced systolic BP (SBP) but not diastolic BP (DBP). There was no significant difference in BP reduction between studies that lasted 6 months or less and those that lasted more than 7 months. Seven studies that lasted 6 months or less involving 1428 patients with hypertension were pooled for further meta-analysis. Text messages delivered at a lower frequency (once per week or less) had a small effect on SBP reduction (effect size 0.35, P<.01) and DBP reduction (effect size 0.28, P=.01). In addition, the use of a text messaging intervention halved the odds of uncontrolled BP among patients with hypertension in 6 months (odds ratio 0.46, P=.02). Conclusions: This review found that a text messaging intervention was effective in BP control. One-way text messaging delivered in a weekly manner was suggested to be effective and required fewer resources. Future studies should use different forms of text message and be integrated into other interventions to improve adherence behaviors and BP control among patients with hypertension. %M 34550078 %R 10.2196/24527 %U https://mhealth.jmir.org/2021/9/e24527 %U https://doi.org/10.2196/24527 %U http://www.ncbi.nlm.nih.gov/pubmed/34550078 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26224 %T Understanding Preferences for Lifestyle-Focused Visual Text Messages in Patients With Cardiovascular and Chronic Respiratory Disease: Discrete Choice Experiment %A Choi,Michael %A Raeside,Rebecca %A Hyun,Karice %A Partridge,Stephanie R %A Thiagalingam,Aravinda %A Redfern,Julie %+ Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Level 6, Block K, Westmead Hospital, Westmead, Sydney, 2154, Australia, 61 88909214, julie.redfern@sydney.edu.au %K mHealth %K cardiovascular disease %K respiratory disease %K visual communication %K lifestyle change %K consumer preferences %K secondary prevention %K rehabilitation %K persuasive health technology %D 2021 %7 20.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Supporting healthy lifestyle changes is a key aim of cardiovascular and pulmonary rehabilitation programs. SMS text messaging programs have demonstrated effectiveness in cardiovascular disease risk reduction, weight loss, increasing physical activity, and smoking cessation. The optimization of SMS text messaging programs may deliver greater population benefits as mobile phone use becomes ubiquitous. Visual messaging (ie, image-based messages) has the potential to communicate health messages via digital technology and result in enhanced engagement. Objective: This study aims to determine and understand patient preferences for lifestyle-focused visual text messages that support cardiovascular and pulmonary rehabilitation. Methods: A discrete choice experiment was conducted in a 4-stage iterative process to elicit patient preferences for visual message features. Attribute and level development yielded 3 attributes (purpose, image type, and web address), and 16 choice sets were subsequently constructed according to a full factorial design. Patients participating in cardiovascular and pulmonary rehabilitation were surveyed (on the web) for their preferences regarding the visual message choice sets. Respondents were asked to choose among 16 pairs of visual messages regarding key lifestyle behaviors, namely, physical activity and nutrition. The data were analyzed using a conditional logit model. Results: There was a total of 1728 observations from 54 unique respondents. Two factors that were associated with patient preference were gain-framed purpose compared with no purpose (odds ratio [OR] 1.93, 95% CI 1.40-2.65) and real images compared with cartoon images (OR 1.26, 95% CI 1.04-1.54). A loss-framed purpose was less preferred than no purpose (OR 0.55, 95% CI 0.42-0.74). Overall, patients preferred positive images that were colorful and engaged with text that supported the image and had a preference for images of real people rather than cartoons. Conclusions: A discrete choice experiment is a scientific method for eliciting patient preferences for a visual messaging intervention that is designed to support changes in lifestyle behaviors. SMS text messaging programs that use visual aids may result in greater patient satisfaction by using a gain frame, using real images, and avoiding a loss frame. Further research is needed to explore the feasibility of implementation and the health and behavioral outcomes associated with such visual messaging programs. %M 34542413 %R 10.2196/26224 %U https://www.jmir.org/2021/9/e26224 %U https://doi.org/10.2196/26224 %U http://www.ncbi.nlm.nih.gov/pubmed/34542413 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26158 %T Efficacy of an mHealth Intervention (BRAVE) to Promote Mental Wellness for American Indian and Alaska Native Teenagers and Young Adults: Randomized Controlled Trial %A Craig Rushing,Stephanie %A Kelley,Allyson %A Bull,Sheana %A Stephens,David %A Wrobel,Julia %A Silvasstar,Joshva %A Peterson,Roger %A Begay,Corey %A Ghost Dog,Thomas %A McCray,Celena %A Love Brown,Danica %A Thomas,Morgan %A Caughlan,Colbie %A Singer,Michelle %A Smith,Paige %A Sumbundu,Kanku %+ Northwest Portland Area Indian Health Board, 2121 SW Broadway #300, Portland, OR, 97201, United States, 1 503 228 4185, SCraig@npaihb.org %K American Indian %K Alaska Native %K adolescent %K mental health %K help-seeking skills, text messaging %K mHealth, behavioral intervention %K Indian health %K mobile phone %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Culturally relevant interventions are needed to help American Indian and Alaska Native (AI/AN) teenagers and young adults navigate common risky situations involving family and friends, including drug and alcohol misuse, dating violence, and suicidality. Leveraging We R Native, a multimedia health resource for Native teenagers and young adults, staff of the Northwest Portland Area Indian Health Board designed the BRAVE intervention for Native youth. The program is delivered via SMS text messaging and includes role model videos, mental wellness strategies, links to culturally relevant resources, and social support from family and friends. Objective: We aim to conduct a randomized controlled trial of the BRAVE intervention among AI/AN teenagers and young adults (aged 15-24 years) to assess its impact on their physical, mental, and spiritual health; their resilience and self-esteem; and their coping and help-seeking skills. Methods: From October to December 2019, we recruited 2334 AI/AN teenagers and young adults nationwide via social media channels and SMS text messages and enrolled 1044 participants. AI/AN teenagers and young adults enrolled in the study received either BRAVE SMS text messages, designed to improve mental health, help-seeking skills, and cultural resilience, or 8 weeks of science, technology, engineering, and math (STEM) SMS text messages, designed to elevate and reaffirm Native voices in STEM and medicine and then received the BRAVE SMS text messages. The impacts of the BRAVE intervention were tested using linear mixed-effect models and linear regressions. Results: A total of 833 AI/AN teenagers and young adults were included in the analysis. Individuals in the BRAVE and STEM arms showed significant positive trends over the course of the study for all outcomes, except cultural identity and help-seeking behavior. Mean scores were significantly different for health (P<.001), resilience (P<.001), negative coping (P=.03), positive coping (P<.001), self-efficacy (P=.02), and self-esteem (P<.001). Changes in help-seeking self-efficacy were significant in those exhibiting risky behaviors at baseline to exit (P=.01). Those who reported positive coping scores at baseline also reported better health on average; however, no difference was found in risky drug and alcohol use (P<.001). The number of participants who used SMS text messages to help themselves increased from 69.1% (427/618) at 3 months to 76% (381/501; P<.001) at 8 months. Similarly, the number of participants who used SMS text messages to help friends or family members increased from 22.4% (138/616) at 3 months to 54.6% (272/498) at 8 months. Conclusions: This is the first national randomized controlled trial of a mobile health intervention among AI/AN teenagers and young adults to test the efficacy of a mental wellness intervention in relation to STEM career messages. This study provides new insights for supporting the next generation of AI/AN changemakers. Trial Registration: ClinicalTrials.gov NCT04979481; https://clinicaltrials.gov/ct2/show/NCT04979481 %M 34524092 %R 10.2196/26158 %U https://mental.jmir.org/2021/9/e26158 %U https://doi.org/10.2196/26158 %U http://www.ncbi.nlm.nih.gov/pubmed/34524092 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27137 %T Recovery Following Peer and Text Messaging Support After Discharge From Acute Psychiatric Care in Edmonton, Alberta: Controlled Observational Study %A Shalaby,Reham %A Hrabok,Marianne %A Spurvey,Pamela %A Abou El-Magd,Rabab M %A Knox,Michelle %A Rude,Rebecca %A Vuong,Wesley %A Surood,Shireen %A Urichuk,Liana %A Snaterse,Mark %A Greenshaw,Andrew J %A Li,Xin-Min %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 7807144315, agyapong@ualberta.ca %K peer support %K recovery %K controlled observational study %K inpatients %K mental health %K supportive text messages %D 2021 %7 3.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Peer support is an emotional, social, and practical help provided by nonprofessionals to assist others in sustaining health behaviors. Peer support is valued in recovery-oriented models of mental health and is becoming increasingly implemented at the organizational level. Text messaging is a relatively low-cost, high-impact, and easily scalable program that uses existing technology, is devoid of geographic barriers, and is easily accessible to end users. Objective: This study aims to evaluate the effectiveness of an innovative peer support system plus a supportive text messaging program on the recovery of discharged patients from acute psychiatric care. Methods: This prospective, rater blinded, controlled observational study included 181 patients who were discharged from acute psychiatric care. Patients were randomized to one of four conditions: treatment as usual (follow-up care), daily supportive text messages only, peer support only, or peer support plus daily supportive text messages. A standardized self-report measure of recovery (Recovery Assessment Scale [RAS]) was completed at baseline, 6 weeks, 3 months, and 6 months. Descriptive analysis, one-way analysis of variance, and repeated measures multivariate analysis of covariance were used to examine the changes in the RAS among the study groups and over the follow-up time points. Results: A total of 65 patients completed the assessments at each time point. For the overall sample, higher scores were found for the peer support plus text message condition compared with the text message only and treatment as usual condition on several scales (ie, willingness to ask for help and personal confidence and hope) and total score on the RAS, after 6 months of intervention. Conclusions: Peer support plus supportive text messaging seems to result in improved recovery compared with other interventions. It may be advisable to incorporate the two interventions as part of routine practice for patients with psychiatric disorders upon hospital discharge. %M 34477565 %R 10.2196/27137 %U https://formative.jmir.org/2021/9/e27137 %U https://doi.org/10.2196/27137 %U http://www.ncbi.nlm.nih.gov/pubmed/34477565 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e28163 %T Evaluation and Refinement of a Bank of SMS Text Messages to Promote Behavior Change Adherence Following a Diabetes Prevention Program: Survey Study %A MacPherson,Megan %A Cranston,Kaela %A Johnston,Cara %A Locke,Sean %A Jung,Mary E %+ School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada, 1 250 807 9670, mary.jung@ubc.ca %K text messaging %K prediabetic state %K telemedicine %K telecommunications %K exercise %K diet %K preventive medicine %K mHealth %K intervention development %K behavior change %K mobile phone %D 2021 %7 27.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: SMS text messaging is a low-cost and far-reaching modality that can be used to augment existing diabetes prevention programs and improve long-term diet and exercise behavior change adherence. To date, little research has been published regarding the process of SMS text message content development. Understanding how interventions are developed is necessary to evaluate their evidence base and to guide the implementation of effective and scalable mobile health interventions in public health initiatives and in future research. Objective: This study aims to describe the development and refinement of a bank of SMS text messages targeting diet and exercise behavior change to be implemented following a diabetes prevention program. Methods: A bank of 124 theory-based SMS text messages was developed using the Behaviour Change Wheel and linked to active intervention components (behavior change techniques [BCTs]). The Behaviour Change Wheel is a theory-based framework that provides structure to intervention development and can guide the use of evidence-based practices in behavior change interventions. Once the messages were written, 18 individuals who either participated in a diabetes prevention program or were a diabetes prevention coach evaluated the messages on their clarity, utility, and relevance via survey using a 5-point Likert scale. Messages were refined according to participant feedback and recoded to obtain an accurate representation of BCTs in the final bank. Results: 76/124 (61.3%) messages were edited, 4/124 (3.2%) were added, and 8/124 (6.5%) were removed based on participant scores and feedback. Of the edited messages, 43/76 (57%) received minor word choice and grammar alterations while retaining their original BCT code; the remaining 43% (33/76, plus the 4 newly written messages) were recoded by a reviewer trained in BCT identification. Conclusions: This study outlines the process used to develop and refine a bank of SMS text messages to be implemented following a diabetes prevention program. This resulted in a bank of 120 theory-based, user-informed SMS text messages that were overall deemed clear, useful, and relevant by both individuals who will be receiving and delivering them. This formative development process can be used as a blueprint in future SMS text messaging development to ensure that message content is representative of the evidence base and is also grounded in theory and evaluated by key knowledge users. %M 34448713 %R 10.2196/28163 %U https://formative.jmir.org/2021/8/e28163 %U https://doi.org/10.2196/28163 %U http://www.ncbi.nlm.nih.gov/pubmed/34448713 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e25900 %T Cyberbullying Prevention for Adolescents: Iterative Qualitative Methods for Mobile Intervention Design %A Ranney,Megan L %A Pittman,Sarah K %A Moseley,Isabelle %A Morgan,Kristen E %A Riese,Alison %A Ybarra,Michele %A Cunningham,Rebecca %A Rosen,Rochelle %+ Center for Digital Health, Brown University, 139 Point St, Providence, RI, 02903, United States, 1 4014445159, megan_ranney@brown.edu %K adolescent %K mobile health %K digital health %K cyberbullying %K user-centered design %K qualitative %K mobile phone %D 2021 %7 27.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Cybervictimization among adolescents is associated with multiple negative mental health consequences. Although pediatricians often screen for cyberbullying, validated and acceptable programs to reduce the frequency and impact of adolescent cybervictimization are lacking. Objective: This study uses agile qualitative methods to refine and evaluate the acceptability of a mixed-modality intervention, initiated within the context of usual pediatric care, for adolescents with a history of cyberharassment and cyberbullying victimization. Methods: Three groups of adolescents were successively recruited from an urban primary care clinic to participate in three consecutive iterations (1, 2, and 3) of the program, which consisted of a brief in-clinic intervention followed by 8 weeks of daily, automated SMS text messaging. After 2 weeks of messaging, iteration 1 (I1) participants completed semistructured interviews regarding intervention experiences. Participant feedback was evaluated via framework matrix analysis to guide changes to the program for iteration 2 (I2). Feedback from 2-week interviews of I2 participants was similarly used to improve the program before initiating iteration 3 (I3). Participants in all 3 iterations completed the interviews after completing the program (8 weeks). Daily response rates assessed participant engagement, and satisfaction questionnaires assessed acceptability. Results: A total of 19 adolescents (aged 13-17 years) reporting past-year cybervictimization were enrolled: 7 in I1, 4 in I2, and 8 in I3. Demographic variables included the following: a mean age of 15 (SD 1.5) years; 58% (11/19) female, 42% (8/19) male, 63% (12/19) Hispanic, 37% (7/19) non-Hispanic, 79% (15/19) people of color, and 21% (4/19) White. A total of 73% (14/19) self-identified as having a low socioeconomic status, and 37% (7/19) self-identified as lesbian, gay, or bisexual. The average past 12-month cybervictimization score at baseline was 8.2 (SD 6.58; range 2-26). Participant feedback was used to iteratively refine intervention content and design. For example, participants in I1 recommended that the scope of the intervention be expanded to include web-based conflicts and drama, rather than narrowly focusing on cyberbullying prevention. On the basis of this feedback, the I2 content was shifted toward more general de-escalation skills and bystander empowerment. Overall, 88.34% (940/1064) of the daily queries sent to participants across all 3 iterations received a reply. Participant satisfaction improved considerably with each iteration; 0% (0/7) of I1 participants rated the overall quality of Intervention to Prevent Adolescent Cybervictimization with Text message as excellent, compared to 50% (2/4) of I2 participants and 86% (6/7) of I3 participants. Engagement also improved between the first and third iterations, with participants replying to 59.9% (235/392) of messages in I1, compared to 79.9% (358/488) of messages in I3. Conclusions: This study shows the value of structured participant feedback gathered in an agile intervention refinement methodology for the development of a technology-based intervention targeting adolescents. %M 34448702 %R 10.2196/25900 %U https://formative.jmir.org/2021/8/e25900 %U https://doi.org/10.2196/25900 %U http://www.ncbi.nlm.nih.gov/pubmed/34448702 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e24555 %T Effect of Physician-Pharmacist Participation in the Management of Ambulatory Cancer Pain Through a Digital Health Platform: Randomized Controlled Trial %A Zhang,Lu %A McLeod,Howard L %A Liu,Ke-Ke %A Liu,Wen-Hui %A Huang,Hang-Xing %A Huang,Ya-Min %A Sun,Shu-Sen %A Chen,Xiao-Ping %A Chen,Yao %A Liu,Fang-Zhou %A Xiao,Jian %+ Department of Pharmacy, Xiangya Hospital, Central South University, Room 404, No. 87 Xiangya Road, Kaifu District, Changsha, 410008, China, 86 13973168895, admanoas@163.com %K cancer pain %K self-management %K ambulatory setting %K digital health %K physician-pharmacist %D 2021 %7 16.8.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Self-management of ambulatory cancer pain is full of challenges. Motivated by the need for better pain management, we developed a WeChat-supported platform, Medication Housekeeper (MediHK), to enhance communication, optimize outcomes, and promote self-management in the home setting. Objective: We conducted a randomized controlled trial to assess whether the joint physician-pharmacist team through MediHK would provide better self-management of ambulatory patients with cancer pain. Methods: Patients were randomly assigned to either an intervention group or control group. During the 4-week study period, the pharmacist would send 24-hour pain diaries daily, adverse drug reaction (ADR) forms every 3 days, and the Brief Pain Inventory form every 15 days to patients in the intervention group via MediHK. If a patient needed a change in drug/dosage or treatment of an ADR after the comprehensive review, the pharmacist would propose pharmacological interventions to the attending physician, who was then responsible for prescribing or adjusting pain medications. If no adjustments were needed, the pharmacist provided appropriate targeted education based on knowledge deficits. Patients in the control group received conventional care and did not receive reminders to fill out the forms. However, if the control group patients filled out a form via MediHK, the pain management team would review and respond in the same way as for the intervention group. The primary outcomes included pain intensity and pain interference in daily life. Secondary outcomes included patient-reported outcome measures, medication adherence, ADRs, and rehospitalization rates. Results: A total of 100 patients were included, with 51 (51%) in the intervention group and 49 (49%) in the control group. The worst pain scores, least pain scores, and average pain scores in the intervention group and the control group were statistically different, with median values of 4 (IQR 3-7) vs 7 (IQR 6-8; P=.001), 1 (IQR 0-2) vs 2 (IQR 1-3; P=.02), and 2 (IQR 2-4) vs 4 (IQR 3-5; P=.001), respectively, at the end of the study. The pain interference on patients' general activity, mood, relationships with others, and interests was reduced, but the difference was not statistically significant compared with the control group (Ps=.10-.76). The medication adherence rate increased from 43% to 63% in the intervention group, compared with an increase of 33% to 51% in the control group (P<.001). The overall number of ADRs increased at 4 weeks, and more ADRs were monitored in the intervention group (P=.003). Rehospitalization rates were similar between the 2 groups. Conclusions: The joint physician-pharmacist team operating through MediHK improved pain management. This study supports the feasibility of integrating the internet into the self-management of cancer pain. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900023075; https://www.chictr.org.cn/showproj.aspx?proj=36901 %M 34398796 %R 10.2196/24555 %U https://mhealth.jmir.org/2021/8/e24555 %U https://doi.org/10.2196/24555 %U http://www.ncbi.nlm.nih.gov/pubmed/34398796 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e25548 %T Efficacy and Safety of Text Messages Targeting Adherence to Cardiovascular Medications in Secondary Prevention: TXT2HEART Colombia Randomized Controlled Trial %A Bermon,Anderson %A Uribe,Ana Fernanda %A Pérez-Rivero,Paula Fernanda %A Prieto-Merino,David %A Saaibi,Jose Federico %A Silva,Federico Arturo %A Canon,Diana Ivonne %A Castillo-Gonzalez,Karol Melissa %A Cáceres-Rivera,Diana Isabel %A Guio,Elizabeth %A Meneses-Castillo,Karen Janneth %A Castillo-Meza,Alberto %A Atkins,Louise %A Horne,Robert %A Murray,Elizabeth %A Serrano,Norma Cecilia %A Free,Caroline %A Casas,Juan Pablo %A Perel,Pablo %+ Research Center, Fundación Cardiovascular de Colombia, Calle 155A #23-58, Floridablanca, 681001, Colombia, 57 3002053041, andebermon@gmail.com %K randomized controlled trial %K Colombia %K text messaging %K cardiovascular disease %K secondary prevention %D 2021 %7 28.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality worldwide, with a prevalence of approximately 100 million patients. There is evidence that antiplatelet agents and antihypertensive medications could reduce the risk of new vascular events in this population; however, treatment adherence is very low. An SMS text messaging intervention was recently developed based on behavior change techniques to increase adherence to pharmacological treatment among patients with a history of ASCVD. Objective: This study aims to evaluate the efficacy and safety of an SMS text messaging intervention to improve adherence to cardiovascular medications in patients with ASCVD. Methods: A randomized controlled clinical trial for patients with a prior diagnosis of cardiovascular events, such as acute myocardial infarction, unstable angina, cerebrovascular disease, or peripheral artery disease, in one center in Colombia was conducted. Patients randomized to the intervention arm were assigned to receive SMS text messages daily for the first 4 weeks, 5 SMS text messages on week 5, 3 SMS text messages each in weeks 6 and 7, and 1 SMS text message weekly from week 8 until week 52. In contrast, patients in the control arm received a monthly SMS text message reminding them of the next study appointment and the importance of the study, requesting information about changes in their phone number, and thanking them for participating in the study. The primary endpoint was the change in low-density lipoprotein cholesterol (LDL-C) levels, whereas the secondary endpoints were the changes in thromboxane B2 levels, heart rate, systolic and diastolic blood pressure, medication adherence, cardiac and noncardiac mortality, and hospitalization. Linear regression analyses and bivariate tests were performed. Results: Of the 930 randomized patients, 805 (86.5%) completed follow-up and were analyzed for the primary endpoint. There was no evidence that the intervention changed the primary outcome (LDL-C levels; P=.41) or any of the secondary outcomes evaluated (all P>.05). There was also no evidence that the intervention was associated with adverse events. Conclusions: In this study, there was no evidence that a behavior modification intervention delivered by SMS text messaging improved LDL-C levels, blood pressure levels, or adherence at 12 months. More research is needed to evaluate whether different SMS text messaging strategies, including personalized messages and different timings, are effective; future studies should include mixed methods to better understand why, for whom, and in which context (eg, health system or social environment) SMS text messaging interventions work (or not) to improve adherence in patients with ASCVD. Trial Registration: ClinicalTrials.gov NCT03098186; https://clinicaltrials.gov/ct2/show/NCT03098186 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-028017 %M 34319247 %R 10.2196/25548 %U https://mhealth.jmir.org/2021/7/e25548 %U https://doi.org/10.2196/25548 %U http://www.ncbi.nlm.nih.gov/pubmed/34319247 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e25926 %T Mobile Delivery of Mindfulness-Based Smoking Cessation Treatment Among Low-Income Adults During the COVID-19 Pandemic: Pilot Randomized Controlled Trial %A Mhende,Josephine %A Bell,Sharrill A %A Cottrell-Daniels,Cherell %A Luong,Jackie %A Streiff,Micah %A Dannenfelser,Mark %A Hayat,Matthew J %A Spears,Claire Adams %+ Georgia State University, 140 Decatur Street, Suite 400, Atlanta, GA, 30303, United States, 1 404 413 9335, cspears@gsu.edu %K acceptability %K addiction %K African American %K cessation %K COVID-19 %K feasibility %K income %K low socioeconomic status %K mHealth %K mindfulness %K minority %K smoking %K SMS %K text messaging %K treatment %D 2021 %7 23.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking is the leading cause of premature death, and low-income adults experience disproportionate burden from tobacco. Mindfulness interventions show promise for improving smoking cessation. A text messaging program “iQuit Mindfully” was developed to deliver just-in-time support for quitting smoking among low-income adults. A pilot study of iQuit Mindfully was conducted in spring 2020, during the COVID-19 pandemic, among low-income and predominantly African American smokers. Objective: This pilot study examined the acceptability and feasibility of delivering Mindfulness-Based Addiction Treatment via mHealth during the COVID-19 pandemic. Methods: Participants were adult cigarette smokers (n=23), of whom 8 (34.8%) were female, 19 (82.6%) were African American, and 18 (78.3%) had an annual income of .99; diabetes status category: P=.52, medication adjustment category: P=.65; HbA1c category: P=.69; BMI: P>.99). The 21 patients who completed the study rated a mean of 9.0 out of 10 on the Likert scale for both satisfaction questions. For the Yes-No question on benefit of the program, all of the patients selected “Yes.” Mean HbA1c decreased from 7.6% to 7.0% (P=.004). There were no severe hypoglycemia events (glucose level <3.0 mmol/L) reported. Mean weight decreased from 76.8 kg to 73.9 kg (P<.001), a mean decrease of 3.5% from baseline weight. Mean BMI decreased from 27.8 kg/m2 to 26.7 kg/m2 (P<.001). Conclusions: The personalized mHealth program was feasible, acceptable, and produced significant reductions in HbA1c (P=.004) and body weight (P<.001) in individuals with type 2 diabetes. Such mHealth programs could overcome challenges posed to chronic disease management by COVID-19, including disruptions to in-person health care access. %M 34111018 %R 10.2196/25820 %U https://diabetes.jmir.org/2021/3/e25820 %U https://doi.org/10.2196/25820 %U http://www.ncbi.nlm.nih.gov/pubmed/34111018 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e24915 %T Examining the Impact of an mHealth Behavior Change Intervention With a Brief In-Person Component for Cancer Survivors With Overweight or Obesity: Randomized Controlled Trial %A Walsh,Jane C %A Richmond,Janice %A Mc Sharry,Jenny %A Groarke,AnnMarie %A Glynn,Liam %A Kelly,Mary Grace %A Harney,Owen %A Groarke,Jenny M %+ Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, David Keir Building, Belfast, BT7 1NN, United Kingdom, 44 02890974886, j.groarke@qub.ac.uk %K cancer survivors %K overweight %K obesity %K health behavior %K goals %K accelerometry %K text messaging %K technology %K Ireland %K self-management %K mobile phone %D 2021 %7 5.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cancer survivorship in Ireland is increasing in both frequency and longevity. However, a significant proportion of cancer survivors do not reach the recommended physical activity levels and have overweight. This has implications for both physical and psychological health, including an increased risk of subsequent and secondary cancers. Mobile health (mHealth) interventions demonstrate potential for positive health behavior change, but there is little evidence for the efficacy of mobile technology in improving health outcomes in cancer survivors with overweight or obesity. Objective: This study aims to investigate whether a personalized mHealth behavior change intervention improves physical and psychological health outcomes in cancer survivors with overweight or obesity. Methods: A sample of 123 cancer survivors (BMI≥25 kg/m2) was randomly assigned to the standard care control (n=61) or intervention (n=62) condition. Group allocation was unblinded. The intervention group attended a 4-hour tailored lifestyle education and information session with physiotherapists, a dietician, and a clinical psychologist to support self-management of health behavior. Over the following 12 weeks, participants engaged in personalized goal setting to incrementally increase physical activity (with feedback and review of goals through SMS text messaging contact with the research team). Direct measures of physical activity were collected using a Fitbit accelerometer. Data on anthropometric, functional exercise capacity, dietary behavior, and psychological measures were collected at face-to-face assessments in a single hospital site at baseline (T0), 12 weeks (T1; intervention end), and 24 weeks (T2; follow-up). Results: The rate of attrition was 21% (13/61) for the control condition and 14% (9/62) for the intervention condition. Using intent-to-treat analysis, significant reductions in BMI (F2,242=4.149; P=.02; ηp2=0.033) and waist circumference (F2,242=3.342; P=.04; ηp2=0.027) were observed in the intervention group. Over the 24-week study, BMI was reduced by 0.52 in the intervention condition, relative to a nonsignificant reduction of 0.11 in the control arm. Waist circumference was reduced by 3.02 cm in the intervention condition relative to 1.82 cm in the control condition. Physical activity level was significantly higher in the intervention group on 8 of the 12 weeks of the intervention phase and on 5 of the 12 weeks of the follow-up period, accounting for up to 2500 additional steps per day (mean 2032, SD 270). Conclusions: The results demonstrate that for cancer survivors with a BMI≥25 kg/m2, lifestyle education and personalized goal setting using mobile technology can yield significant changes in clinically relevant health indicators. Further research is needed to elucidate the mechanisms of behavior change and explore the capacity for mHealth interventions to improve broader health and well-being outcomes in the growing population of cancer survivors. Trial Registration: ISRCTN Registry ISRCTN18676721; https://www.isrctn.com/ISRCTN18676721 International Registered Report Identifier (IRRID): RR2-10.2196/13214 %M 36260394 %R 10.2196/24915 %U https://mhealth.jmir.org/2021/7/e24915 %U https://doi.org/10.2196/24915 %U http://www.ncbi.nlm.nih.gov/pubmed/36260394 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e20199 %T Efficacy of Short Message Service Text Messaging Interventions for Postoperative Pain Management: Systematic Review %A Buck,Christoph %A Keweloh,Christian %A Bouras,Adam %A Simoes,Eduardo J %+ School of Business and Economics, Philipps-Universität Marburg, Am Plan 1, Marburg, 35037, Germany, 49 064212823914, christoph.buck@wiwi.uni-marburg.de %K systematic literature review %K pain management %K opioid %K short message service (SMS) %K postoperative %D 2021 %7 16.6.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Addiction to opiates and synthetic opioids poses a major threat to public health worldwide, with pharmaceutical opioids prescribed to manage pain constituting the main problem. To counteract this threat, suitable pain management strategies should be implemented in health care. Monitoring pain management seems to be feasible using telemedicine with a certain degree of resource intensity and digitization. As a communication channel for this type of monitoring, SMS appears to be a valid alternative. Objective: The aim of this systematic literature review was to (1) provide information on the state of research regarding postoperative pain management via SMS, (2) establish a basic understanding of SMS-based pain management, and (3) provide insight into the feasibility of these management strategies. The research question was as follows: Is postoperative pain management feasible and effective utilizing SMS? Methods: A systematic literature review was performed mainly following the PRISMA guidelines and another guide on performing a systematic literature review for information systems–related research. A search string was developed based on the objectives and research question, and eight databases were searched. Results: The initial search resulted in 2083 records, which could be narrowed down by applying various exclusion criteria. Thereby, 11 articles were identified as relevant, which were accordingly analyzed and evaluated by full-text screening. In all articles, pain management interventions were performed using SMS communication between health care professionals and patients or their legal guardians. A prospective approach was predominantly chosen as the study design (91%) with the leading research objective of determining the intervention’s feasibility (73%). The primary reason for sending SMS messages was to monitor patients (64%). Overall, the use of SMS improved adherence, acceptance, and satisfaction regarding postoperative pain management. With an average response rate of approximately 89.5% (SD 3.8%), the reliability of SMS as a communication and monitoring tool was further emphasized. This response rate is significantly higher than that for email interventions (66.63%, P<.001). Conclusions: This study provides a comprehensive picture of the current status on postoperative pain management by SMS. Communication via SMS was beneficial in all interventions, even preoperative. Six SMS interventions could be certified by the respective institutional review board and three were Health Insurance Portability and Accountability Act–compliant. Therefore, the results of this study could be leveraged to address the opioid epidemic. Overall, the research question could be confirmed. Future research should extend this systematic literature review regarding preoperative pain management. Based on these findings, a pre- and postoperative communication model should be developed to address the opioid epidemic effectively. %M 34132646 %R 10.2196/20199 %U https://mhealth.jmir.org/2021/6/e20199 %U https://doi.org/10.2196/20199 %U http://www.ncbi.nlm.nih.gov/pubmed/34132646 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e27603 %T Effect of Mobile Phone Text Message Reminders on the Completion and Timely Receipt of Routine Childhood Vaccinations: Superiority Randomized Controlled Trial in Northwest Ethiopia %A Mekonnen,Zeleke Abebaw %A Gelaye,Kassahun Alemu %A Were,Martin %A Tilahun,Binyam %+ Department of Health Informatics, Institute of Public Health, University of Gondar, Chechela Street, Gondar, 196, Ethiopia, 251 913747092, zelekeabebaw7@gmail.com %K mHealth %K eHealth %K mobile phone %K text message %K short message service %K reminder %K immunization %K vaccination %K Ethiopia %D 2021 %7 15.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nonattendance at vaccination appointments is a big challenge for health workers as it is difficult to track routine vaccination schedules. In Ethiopia, 3 out of 10 children have incomplete vaccination and the timely receipt of the recommended vaccines is low. Thus, innovative strategies are required to reach the last mile where mobile technology can be effectively utilized to achieve better compliance. Despite this promising technology, little is known about the role of text message–based mobile health interventions in improving the complete and timely receipt of routine childhood vaccinations in Ethiopia. Objective: This trial aimed to determine the effect of mobile phone text message reminders on the completion and timely receipt of routine childhood vaccinations in northwest Ethiopia. Methods: A two-arm, parallel, superiority randomized controlled trial was conducted in 9 health facilities in northwest Ethiopia. A sample size of 434 mother-infant pairs was considered in this trial. Randomization was applied in selected health facilities during enrollment with a 1:1 allocation ratio by using sealed and opaque envelopes. Participants assigned to the intervention group received mobile phone text message reminders one day before the scheduled vaccination visits. Owing to the nature of the intervention, blinding of participants was not possible. Primary outcomes of full and timely completion of vaccinations were measured objectively at 12 months. A two-sample test of proportion and log-binomial regression analyses were used to compare the outcomes between the study groups. A modified intention-to-treat analysis approach was applied and a one-tailed test was reported, considering the superiority design of the trial. Results: A total of 426 participants were included for the analysis. We found that a higher proportion of infants in the intervention group received Penta-3 (204/213, 95.8% vs 185/213, 86.9%, respectively; P<.001), measles (195/213, 91.5% vs 169/213, 79.3%, respectively; P<.001), and full vaccination (176/213, 82.6% vs 151/213, 70.9%, respectively; P=.002; risk ratio 1.17, 95% lower CI 1.07) compared to infants in the usual care group. Similarly, a higher proportion of infants in the intervention group received Penta-3 (181/204, 88.7% vs 128/185, 69.2%, respectively; P<.001), measles (170/195, 87.1% vs 116/169, 68.6%, respectively; P<.001), and all scheduled vaccinations (135/213, 63.3% vs 85/213, 39.9%, respectively; P<.001; risk ratio 1.59, 95% lower CI 1.35) on time compared to infants in the usual care group. Of the automatically sent 852 mobile phone text messages, 764 (89.7%) were delivered successfully to the participants. Conclusions: Mobile phone text message reminders significantly improved complete and timely receipt of all recommended vaccines. Besides, they had a significant effect in improving the timely receipt of specific vaccines. Thus, text message reminders can be used to supplement the routine immunization program in resource-limited settings. Considering different contexts, studies on the implementation challenges of mobile health interventions are recommended. Trial Registration: Pan African Clinical Trial Registry PACTR201901533237287; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5839 %M 34128813 %R 10.2196/27603 %U https://mhealth.jmir.org/2021/6/e27603 %U https://doi.org/10.2196/27603 %U http://www.ncbi.nlm.nih.gov/pubmed/34128813 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27076 %T Co-designing a Lifestyle-Focused Text Message Intervention for Women After Breast Cancer Treatment: Mixed Methods Study %A Singleton,Anna %A Raeside,Rebecca %A Partridge,Stephanie R %A Hayes,Molly %A Maka,Katherine %A Hyun,Karice K %A Thiagalingam,Aravinda %A Chow,Clara K %A Sherman,Kerry A %A Elder,Elisabeth %A Redfern,Julie %+ Consumer Engagement and Codesign Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Level 6 Block K Westmead Hospital, Sydney, 2145, Australia, 61 288908181, anna.singleton@sydney.edu.au %K breast neoplasms %K cancer survivors %K text messaging %K telemedicine %K mobile health %K co-design %D 2021 %7 14.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Breast cancer is the most common cancer among women globally. Recovery from breast cancer treatment can be mentally and physically challenging. SMS text message programs offer a novel way to provide health information and support, but few programs are co-designed with consumer representatives. Objective: This study aims to report the procedures and outcomes of a co-design process of a lifestyle-focused SMS text message program to support women’s mental and physical health after breast cancer treatment. Methods: We followed an iterative mixed methods two-step process: (1) co-design workshop with consumers and health professionals and researchers to draft text messages and (2) evaluation of message content, which was scored (5-point Likert scale; 1=strongly disagree to 5=strongly agree) for ease of understanding, usefulness, and appropriateness, and readability (Flesch-Kincaid score). Additional free-text responses and semistructured interviews were coded into themes. Messages were edited or deleted based on the evaluations, with consumers’ evaluations prioritized. Results: In step 1, co-designed text messages (N=189) were semipersonalized, and the main content themes were (1) physical activity and healthy eating, (2) medications and side effects, (3) mental health, and (4) general breast cancer information. In step 2, consumers (n=14) and health professionals and researchers (n=14) provided 870 reviews of 189 messages and found that most messages were easy to understand (799/870, 91.8%), useful (746/870, 85.7%), and appropriate (732/870, 84.1%). However, consumers rated 50 messages differently from health professionals and researchers. On the basis of evaluations, 37.6% (71/189) of messages were deleted, 36.5% (69/189) were edited, and 12 new messages related to fatigue, self-care, and cognition were created. The final 130 text messages had a mean 7.12 (SD 2.8) Flesch-Kincaid grade level and 68.9 (SD 15.5) ease-of-reading score, which represents standard reading ease. Conclusions: Co-designing and evaluating a bank of evidence-based mental and physical health-themed text messages with breast cancer survivors, health professionals, and researchers was feasible and resulted in a bank of 130 text messages evaluated highly by participants. Some consumer evaluations differed from health professionals and researchers, supporting the importance of co-design. %M 34125072 %R 10.2196/27076 %U https://www.jmir.org/2021/6/e27076 %U https://doi.org/10.2196/27076 %U http://www.ncbi.nlm.nih.gov/pubmed/34125072 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e25958 %T Preferences for mHealth Technology and Text Messaging Communication in Patients With Type 2 Diabetes: Qualitative Interview Study %A Lauffenburger,Julie C %A Barlev,Renee A %A Sears,Ellen S %A Keller,Punam A %A McDonnell,Marie E %A Yom-Tov,Elad %A Fontanet,Constance P %A Hanken,Kaitlin %A Haff,Nancy %A Choudhry,Niteesh K %+ Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA, 02120, United States, 1 6175258865, jlauffenburger@bwh.harvard.edu %K diabetes %K technology %K mobile health %K medication adherence %K mobile phone %D 2021 %7 11.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Individuals with diabetes need regular support to help them manage their diabetes on their own, ideally delivered via mechanisms that they already use, such as their mobile phones. One reason for the modest effectiveness of prior technology-based interventions may be that the patient perspective has been insufficiently incorporated. Objective: This study aims to understand patients’ preferences for mobile health (mHealth) technology and how that technology can be integrated into patients’ routines, especially with regard to medication use. Methods: We conducted semistructured qualitative individual interviews with patients with type 2 diabetes from an urban health care system to elicit and explore their perspectives on diabetes medication–taking behaviors, daily patterns of using mobile technology, use of mHealth technology for diabetes care, acceptability of text messages to support medication adherence, and preferred framing of information within text messages to support diabetes care. The interviews were digitally recorded and transcribed. The data were analyzed using codes developed by the study team to generate themes, with representative quotations selected as illustrations. Results: We conducted interviews with 20 participants, of whom 12 (60%) were female and 9 (45%) were White; in addition, the participants’ mean glycated hemoglobin A1c control was 7.8 (SD 1.1). Overall, 5 key themes were identified: patients try to incorporate cues into their routines to help them with consistent medication taking; many patients leverage some form of technology as a cue to support adherence to medication taking and diabetes self-management behaviors; patients value simplicity and integration of technology solutions used for diabetes care, managing medications, and communicating with health care providers; some patients express reluctance to rely on mobile technology for these diabetes care behaviors; and patients believe they prefer positively framed communication, but communication preferences are highly individualized. Conclusions: The participants expressed some hesitation about using mobile technology in supporting diabetes self-management but have largely incorporated it or are open to incorporating it as a cue to make medication taking more automatic and less burdensome. When using technology to support diabetes self-management, participants exhibited individualized preferences, but overall, they preferred simple and positively framed communication. mHealth interventions may be improved by focusing on integrating them easily into daily routines and increasing the customization of content. %M 34114964 %R 10.2196/25958 %U https://www.jmir.org/2021/6/e25958 %U https://doi.org/10.2196/25958 %U http://www.ncbi.nlm.nih.gov/pubmed/34114964 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e20330 %T mHealth Interventions for Treatment Adherence and Outcomes of Care for Cardiometabolic Disease Among Adults Living With HIV: Systematic Review %A Odukoya,Oluwakemi Ololade %A Ohazurike,Chidumga %A Akanbi,Maxwell %A O'Dwyer,Linda C %A Isikekpei,Brenda %A Kuteyi,Ewemade %A Ameh,Idaomeh O %A Osadiaye,Olanlesi %A Adebayo,Khadijat %A Usinoma,Adewunmi %A Adewole,Ajoke %A Odunukwe,Nkiruka %A Okuyemi,Kola %A Kengne,Andre Pascal %+ Department of Community Health and Primary Care, College of Medicine, University of Lagos, #16 Ishaga Road, Idi-Araba, Lagos, PMB 12003, Nigeria, 234 8023200770, drolukemiodukoya@yahoo.com %K mHealth %K HIV %K cardiometabolic disease %K text messaging %K mobile %K systematic review %K telephone calls %K wearable devices %K smartphones %K desktop %K web-based %K mobile apps %D 2021 %7 9.6.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The success of antiretroviral therapy has led to an increase in life expectancy and an associated rise in the risk of cardiometabolic diseases (CMDs) among people living with HIV. Objective: Our aim was to conduct a systematic review to synthesize the existing literature on the patterns of use and effects of mobile health (mHealth) interventions for improving treatment adherence and outcomes of care for CMD among people living with HIV. Methods: A systematic search of multiple databases, including PubMed-MEDLINE, Embase, CINAHL, Scopus, Web of Science, African Journals online, ClinicalTrials.gov, and the World Health Organization Global Index Medicus of peer-reviewed articles, was conducted with no date or language restrictions. Unpublished reports on mHealth interventions for treatment adherence and outcomes of care for CMD among adults living with HIV were also included in this review. Studies were included if they had at least 1 component that used an mHealth intervention to address treatment adherence or 1 or more of the stated outcomes of care for CMD among people living with HIV. Results: Our search strategy yielded 1148 unique records. In total, 10 articles met the inclusion criteria and were included in this review. Of the 10 studies, only 4 had published results. The categories of mHealth interventions ranged from short messaging, telephone calls, and wearable devices to smartphone and desktop web-based mobile apps. Across the different categories of interventions, there were no clear patterns in terms of consistency in the use of a particular intervention, as most studies (9/10, 90%) assessed a combination of mHealth interventions. Short messaging and telephone calls were however the most common interventions. Half of the studies (5/10, 50%) reported on outcomes that were indirectly linked to CMD, and none of them provided reliable evidence for evaluating the effectiveness of mHealth interventions for treatment adherence and outcomes of care for CMD among people living with HIV. Conclusions: Due to the limited number of studies and the heterogeneity of interventions and outcome measures in the studies, no definitive conclusions could be drawn on the patterns of use and effects of mHealth interventions for treatment adherence and outcomes of care for CMD among people living with HIV. We therefore recommend that future trials should focus on standardized outcomes for CMD. We also suggest that future studies should consider having a longer follow-up period in order to determine the long-term effects of mHealth interventions on CMD outcomes for people living with HIV. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42018086940; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018086940 %M 34106075 %R 10.2196/20330 %U https://mhealth.jmir.org/2021/6/e20330 %U https://doi.org/10.2196/20330 %U http://www.ncbi.nlm.nih.gov/pubmed/34106075 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e24952 %T An Intervention to Improve Medication Adherence in People With Heart Disease (Text4HeartII): Randomized Controlled Trial %A Maddison,Ralph %A Jiang,Yannan %A Stewart,Ralph %A Scott,Tony %A Kerr,Andrew %A Whittaker,Robyn %A Benatar,Jocelyn %A Rolleston,Anna %A Estabrooks,Paul %A Dale,Leila %+ Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia, 61 3 924 46218, ralph.maddison@deakin.edu.au %K cardiovascular disease %K self-management %K text messaging %K risk factors %D 2021 %7 9.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health technologies have the potential to improve the reach and delivery of interventions for promoting long-term secondary prevention of coronary heart disease. Objective: This study aims to determine the effectiveness of an SMS text messaging intervention (Text4HeartII) for improving adherence to medication and lifestyle changes over and above usual care in people with coronary heart disease at 24 and 52 weeks. Methods: A two-arm, parallel, randomized controlled trial was conducted in New Zealand. Participants with a recent acute coronary syndrome were randomized to receive usual cardiac services alone (control, n=153) or a 24-week SMS text message program for supporting self-management plus usual cardiac services (n=153). The primary outcome was adherence to medication at 24 weeks, defined as a medication possession ratio of 80% or more for aspirin, statin, and antihypertensive therapy. Secondary outcomes included medication possession ratio at 52 weeks, self-reported medication adherence, adherence to healthy lifestyle behaviors, and health-related quality of life at 24 and 52 weeks. Results: Participants were predominantly male (113/306, 80.3%) and European New Zealanders (210/306, 68.6%), with a mean age of 61 years (SD 11 years). Groups were comparable at baseline. National hospitalization and pharmacy dispensing records were available for all participants; 92% (282/306, 92.1%) of participants completed a 24-week questionnaire and 95.1% (291/306) of participants completed a 52-week questionnaire. Adherence with 3 medication classes were lower in the intervention group than in the control group (87/153, 56.8% vs 105/153, 68.6%, odds ratio 0.60, 95% CI 0.38-0.96; P=.03) and 52 weeks (104/153, 67.9% vs 83/153, 54.2%; odds ratio 0.56, 95% CI 0.35-0.89; P=.01). Self-reported medication adherence scores showed the same trend at 52 weeks (mean difference 0.3; 95% CI 0.01-0.59; P=.04). Moreover, self-reported adherence to health-related behaviors was similar between groups. Conclusions: Text4HeartII did not improve dispensed medication or adherence to a favorable lifestyle over and above usual care. This finding contrasts with previous studies and highlights that the benefits of text interventions may depend on the context in which they are used. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000422426; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370398. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2468-z %M 34106081 %R 10.2196/24952 %U https://mhealth.jmir.org/2021/6/e24952 %U https://doi.org/10.2196/24952 %U http://www.ncbi.nlm.nih.gov/pubmed/34106081 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e22513 %T Patient-Provider Text Messaging and Video Calling Among Case-Managed Patients Living With HIV: Formative Acceptability and Feasibility Study %A Fonner,Virginia A %A Kennedy,Samuel %A Desai,Rohan %A Eichberg,Christie %A Martin,Lisa %A Meissner,Eric G %+ Division of Global and Community Health, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 176 Croghan Spur, Suite 104, Charleston, SC, 29407, United States, 1 8438761463, fonner@musc.edu %K HIV %K mHealth %K text messaging %K video calling %K implementation science %K mobile phone %D 2021 %7 27.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient-provider communication is critical for engaging and retaining people living with HIV in care, especially among medically case-managed patients in need of service coordination and adherence support. Expanding patient-provider communication channels to include mobile health modalities, such as text messaging and video calling, has the potential to facilitate communication and ultimately improve clinical outcomes. However, the implementation of these communication modalities in clinical settings has not been well characterized. Objective: The purpose of this study is to understand patient and provider perspectives on the acceptability of and preferences for using text messaging and video calling as a means of communication; perceived factors relevant to adoption, appropriateness, and feasibility; and organizational perspectives on implementation within an HIV clinic in South Carolina. Methods: We conducted 26 semistructured in-depth interviews among patients receiving case management services (n=12) and clinic providers (n=14) using interview guides and content analysis informed by the Proctor taxonomy of implementation outcomes and the Consolidated Framework for Implementation Research. Participants were purposefully sampled to obtain maximum variation in terms of age and gender for patients and clinic roles for providers. The data were analyzed using quantitative and qualitative content analyses. Results: Most patients (11/12, 92%) and providers (12/14, 86%) agreed that they should have the capacity to text message and/or video call each other. Although consensus was not reached, most preferred using a secure messaging app rather than standard text messaging because of the enhanced security features. Perceived benefits to adoption included the added convenience of text messaging, and potential barriers included the cost and access of smartphone-based technology for patients. From an organizational perspective, some providers were concerned that offering text messaging could lead to unreasonable expectations of instant access and increased workload. Conclusions: Patients and providers perceived text messaging and video calling as acceptable, appropriate, and feasible and felt that these expanded modes of communication could help meet patients’ needs while being safe and not excessively burdensome. Although patients and providers mostly agreed on implementation barriers and facilitators, several differences emerged. Taking both perspectives into account when using implementation frameworks is critical for expanding mobile health–based communication, especially as implementation requires active participation from providers and patients. %M 34042596 %R 10.2196/22513 %U https://formative.jmir.org/2021/5/e22513 %U https://doi.org/10.2196/22513 %U http://www.ncbi.nlm.nih.gov/pubmed/34042596 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e22881 %T Comparing the Efficacies of Telemedicine and Standard Prenatal Care on Blood Glucose Control in Women With Gestational Diabetes Mellitus: Randomized Controlled Trial %A Tian,Ying %A Zhang,Suhan %A Huang,Feiling %A Ma,Liangkun %+ Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), No 1 Shuaifuyuan, Wangfujing Dongcheng District, Beijing, 100730, China, 86 13021961166, MaLiangKun@pumch.cn %K gestational diabetes mellitus %K blood glucose %K mhealth %K health education %K lifestyle management %D 2021 %7 25.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Gestational diabetes mellitus (GDM) can usually be well controlled by health education and lifestyle management, resulting in better pregnancy outcomes. However, standard clinical prenatal care, which consists of clinic visits every 2 weeks, may not provide sufficient management for women with GDM. Telemedicine demonstrates a potential to fill this gap. Objective: The objective of this study was to investigate whether health education and lifestyle management delivered through a WeChat group chat was more effective in controlling blood glucose (BG) than standard clinical prenatal care among women with GDM. Methods: In this multicenter randomized controlled trial, women with GDM diagnosed by an oral glucose tolerance test between 23 and 30 (+6) gestational weeks were randomized to a WeChat group chat–based BG management group or a routine clinical prenatal care group. The primary outcome was the change in the glycemic qualification rate during the follow-up period in both groups. The secondary outcomes were pregnancy outcomes. Results: A total of 309 women with GDM participated in the trial, with 162 women randomized to the control group and 147 to the intervention group. No significant differences in baseline characteristics were found between the control and intervention groups. Participants were further divided into 4 groups according to gestational weeks at enrollment for further analysis. The glycemic qualification rate of the intervention group was higher than that of the control group at nearly all time points in Groups 1 to 3, among which 3 time points reached statistical significance: Group 1 at T3 (54.8% vs 83.3%) and Group 2 at T3 (62.5% vs 80.0%) and T7 (75.0% vs 100%). The glycemic qualification rate gradually increased as gestational weeks progressed in both groups, regardless of the intervention method. None of the pregnancy outcomes measured, including delivery mode, premature rupture of the membranes, preterm birth, infant's birth weight, and postpartum hemorrhage, were significantly different between the control and intervention groups. Conclusions: This multicenter randomized controlled trial that assessed women with noninsulin-dependent GDM demonstrated that additional instant messaging platforms, such as WeChat, used for health education and lifestyle intervention in China tend to be more effective for BG control than standard clinical prenatal care alone. Trial Registration: ClinicalTrials.gov NCT03748576; https://clinicaltrials.gov/ct2/show/NCT03748576 %M 33783365 %R 10.2196/22881 %U https://mhealth.jmir.org/2021/5/e22881 %U https://doi.org/10.2196/22881 %U http://www.ncbi.nlm.nih.gov/pubmed/33783365 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e21177 %T Developing Messaging Content for a Physical Activity Smartphone App Tailored to Low-Income Patients: User-Centered Design and Crowdsourcing Approach %A Pathak,Laura Elizabeth %A Aguilera,Adrian %A Williams,Joseph Jay %A Lyles,Courtney Rees %A Hernandez-Ramos,Rosa %A Miramontes,Jose %A Cemballi,Anupama Gunshekar %A Figueroa,Caroline Astrid %+ School of Social Welfare, University of California, Berkeley, 120 Haviland Hall, MC 7400, Berkeley, CA, 94720, United States, 1 510 642 8564, aguila@berkeley.edu %K user centered design %K mHealth %K text messaging %K crowdsourcing %K mobile phone %D 2021 %7 19.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Text messaging interventions can be an effective and efficient way to improve health behavioral changes. However, most texting interventions are neither tested nor designed with diverse end users, which could reduce their impact, and there is limited evidence regarding the optimal design methodology of health text messages tailored to low-income, low–health literacy populations and non-English speakers. Objective: This study aims to combine participant feedback, crowdsourced data, and researcher expertise to develop motivational text messages in English and Spanish that will be used in a smartphone app–based texting intervention that seeks to encourage physical activity in low-income minority patients with diabetes diagnoses and depression symptoms. Methods: The design process consisted of 5 phases and was iterative in nature, given that the findings from each step informed the subsequent steps. First, we designed messages to increase physical activity based on the behavior change theory and knowledge from the available evidence. Second, using user-centered design methods, we refined these messages after a card sorting task and semistructured interviews (N=10) and evaluated their likeability during a usability testing phase of the app prototype (N=8). Third, the messages were tested by English- and Spanish-speaking participants on the Amazon Mechanical Turk (MTurk) crowdsourcing platform (N=134). Participants on MTurk were asked to categorize the messages into overarching theoretical categories based on the capability, opportunity, motivation, and behavior framework. Finally, each coauthor rated the messages for their overall quality from 1 to 5. All messages were written at a sixth-grade or lower reading level and culturally adapted and translated into neutral Spanish by bilingual research staff. Results: A total of 200 messages were iteratively refined according to the feedback from target users gathered through user-centered design methods, crowdsourced results of a categorization test, and an expert review. User feedback was leveraged to discard unappealing messages and edit the thematic aspects of messages that did not resonate well with the target users. Overall, 54 messages were sorted into the correct theoretical categories at least 50% of the time in the MTurk categorization tasks and were rated 3.5 or higher by the research team members. These were included in the final text message bank, resulting in 18 messages per motivational category. Conclusions: By using an iterative process of expert opinion, feedback from participants that were reflective of our target study population, crowdsourcing, and feedback from the research team, we were able to acquire valuable inputs for the design of motivational text messages developed in English and Spanish with a low literacy level to increase physical activity. We describe the design considerations and lessons learned for the text messaging development process and provide a novel, integrative framework for future developers of health text messaging interventions. %M 34009130 %R 10.2196/21177 %U https://mhealth.jmir.org/2021/5/e21177 %U https://doi.org/10.2196/21177 %U http://www.ncbi.nlm.nih.gov/pubmed/34009130 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e25969 %T mHealth Interventions to Support Prescription Opioid Tapering in Patients With Chronic Pain: Qualitative Study of Patients’ Perspectives %A Magee,Michael Reece %A McNeilage,Amy Gray %A Avery,Nicholas %A Glare,Paul %A Ashton-James,Claire Elizabeth %+ Pain Management Research Institute, Faculty of Medicine and Health, The University of Sydney, Lvl 2 Douglas Building, Royal North Shore Hospital, St Leonards, 2065, Australia, 61 294631528, claire.ashton-james@sydney.edu.au %K prescription opioids %K chronic noncancer pain %K tapering %K digital health %K support %K mobile health technology %K SMS %K mobile phone %D 2021 %7 18.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with chronic pain who are tapering prescription opioids report a need for greater support for coping with symptoms of pain and withdrawal. Mobile health (mHealth) technologies (SMS text messaging– or app-based) have the potential to provide patients with educational, emotional, and motivational support for opioid tapering beyond what is offered by their health care provider. However, it is not known whether patients with chronic pain who are tapering opioids would be willing or able to engage with technology-based support. Objective: This study aims to examine patients’ use of mobile technologies in health care, interest in using mHealth support, preferences for the form and content of mHealth support, and potential barriers to and facilitators of engagement with mHealth support for opioid tapering. Methods: A total of 21 patients (11 women and 10 men; age range 29-83 years) with chronic noncancer pain on long-term opioid therapy who had recently initiated a voluntary opioid taper were recruited from primary and tertiary care clinics in metropolitan and regional Australia for a larger study of patients’ experiences of opioid tapering. Participants had been taking prescription opioids for a mean duration of 13 (SD 9.6; range 0.25-30) years at the time of the study. Survey items characterized participants’ typical mobile phone use and level of interest in mobile technology–based support for opioid tapering. Semistructured interviews further explored patients’ use of mobile technologies and their interest in, preferences for, and perspectives on potential barriers to and facilitators of engagement with mHealth support for opioid tapering. Two researchers collaborated to conduct a thematic analysis of the interview data. Results: All participants reported owning and using a mobile phone, and most (17/21, 81%) participants reported using mobile apps. The majority of participants expressed interest in SMS text messaging–based (17/21, 81%) and app-based (15/21, 71%) support for opioid tapering. Participants expected that messages delivering both informational and socioemotional support would be helpful. Participants expected that access to technology, mobile reception, internet connectivity, vision impairment, and low self-efficacy for using apps may be barriers to user engagement. Patients expected that continuity of care from their health care provider, flexible message dosing, responsivity, and familiarity with pain self-management strategies would increase user engagement. Conclusions: The results of this study indicate that patients with chronic noncancer pain may be willing to engage with SMS text messaging–based and app-based mHealth interventions to support opioid tapering. However, the feasibility and acceptability of these interventions may depend on how patients’ preferences for functionality, content, and design are addressed. %M 34003133 %R 10.2196/25969 %U https://formative.jmir.org/2021/5/e25969 %U https://doi.org/10.2196/25969 %U http://www.ncbi.nlm.nih.gov/pubmed/34003133 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e24530 %T The Use of SMS Text Messaging to Improve the Hospital-to-Community Transition in Patients With Acute Coronary Syndrome (Txt2Prevent): Results From a Pilot Randomized Controlled Trial %A Ross,Emily S %A Sakakibara,Brodie M %A Mackay,Martha H %A Whitehurst,David G T %A Singer,Joel %A Toma,Mustafa %A Corbett,Kitty K %A Van Spall,Harriette G C %A Rutherford,Kimberly %A Gheorghiu,Bobby %A Code,Jillianne %A Lear,Scott A %+ Division of Cardiology, Providence Health Care, Healthy Heart Program St Paul's Hospital, B180-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada, 1 604 682 2344 ext 62778, slear@providencehealth.bc.ca %K SMS text messaging %K mHealth %K acute coronary syndrome %K cardiovascular disease %D 2021 %7 14.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Acute coronary syndrome (ACS) is a leading cause of hospital admission in North America. Many patients with ACS experience challenges after discharge that impact their clinical outcomes and psychosocial well-being. SMS text messaging has the potential to provide support to patients during this postdischarge period. Objective: This study pilot tested a 60-day SMS text messaging intervention (Txt2Prevent) for patients with ACS. The primary objective was to compare self-management domains between usual care and usual care plus Txt2Prevent. The secondary objectives were to compare medication adherence, health-related quality of life, self-efficacy, and health care resource use between groups. The third objective was to assess the feasibility of the study protocol and the acceptability of the intervention. Methods: This was a randomized controlled trial with blinding of outcome assessors. We recruited 76 patients with ACS from St. Paul’s Hospital in Vancouver, Canada, and randomized them to 1 of 2 groups within 7 days of discharge. The Txt2Prevent program included automated 1-way SMS text messages about follow-up care, self-management, and healthy living. Data were collected during the index admission and at 60 days after randomization. The primary outcome was measured with the Health Education Impact Questionnaire (heiQ). Other outcomes included the EQ-5D-5L, EQ-5D-5L Visual Analog Scale, a modified Sullivan Cardiac Self-Efficacy Scale, and Morisky Medication Adherence Scale scores, and self-reported health care resource use. Analyses of covariance were used to test the effect of group assignment on follow-up scores (controlling for baseline) and were considered exploratory in nature. Feasibility was assessed with descriptive characteristics of the study protocol. Acceptability was assessed with 2 survey questions and semistructured interviews. Results: There were no statistically significant differences between the groups for the heiQ domains (adjusted mean difference [Txt2Prevent minus usual care] for each domain—Health-directed activity: –0.13, 95% CI –0.39 to 0.13, P=.31; Positive and active engagement in life: 0.03, 95% CI –0.19 to 0.25, P=.76; Emotional distress: 0.04, 95% CI –0.22 to 0.29, P=.77; Self-monitoring and insight: –0.14, 95% CI –0.33 to 0.05, P=.15; Constructive attitudes and approaches: –0.10, 95% CI –0.36 to 0.17, P=.47; Skill technique and acquisition: 0.05, 95% CI –0.18 to 0.27, P=.69; Social integration and support: –0.12, 95% CI –0.34 to 0.10, P=.27; and Health services navigation: –0.05, 95% CI –0.29 to 0.19, P=.69). For the secondary outcomes, there were no statistically significant differences in adjusted analyses except in 1 self-efficacy domain (Total plus), where the Txt2Prevent group had lower scores (mean difference –0.36, 95% CI –0.66 to –0.50, P=.03). The study protocol was feasible, but recruitment took longer than expected. Over 90% (29/31 [94%]) of participants reported they were satisfied with the program. Conclusions: The Txt2Prevent study was feasible to implement; however, although exploratory, there were no differences between the 2 groups in adjusted analyses except for 1 self-efficacy domain. As the intervention appeared acceptable, there is potential in using SMS text messages in this context. The design of the intervention may need to be reconsidered to have more impact on outcome measures. Trial Registration: ClinicalTrials.gov NCT02336919; https://clinicaltrials.gov/ct2/show/NCT02336919 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.6968 %M 33988519 %R 10.2196/24530 %U https://mhealth.jmir.org/2021/5/e24530 %U https://doi.org/10.2196/24530 %U http://www.ncbi.nlm.nih.gov/pubmed/33988519 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e18984 %T Text Messaging and Home Blood Pressure Monitoring for Patients with Uncontrolled Hypertension: Proposal for a Feasibility Pilot Randomized Controlled Trial %A Campos,Claudia L %A Jones,Deanna %A Snively,Beverly M %A Rocco,Michael %A Pedley,Carolyn %A Atwater,Sara %A Moore,Justin B %+ Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, United States, 1 336713600, ccampos@wakehealth.edu %K hypertension %K home blood pressure monitoring %K telehealth %K medication adherence %K SMS %K health disparities %D 2021 %7 14.5.2021 %9 Proposal %J JMIR Res Protoc %G English %X Background: A decrease in blood pressure, even modestly (ie, 2 mmHg), lowers cardiovascular morbidity and mortality. Low patient adherence to antihypertensive medication is the most significant modifiable patient-related barrier to achieving controlled blood pressure. Preliminary studies have shown that SMS text messaging and home blood pressure monitoring (HBPM) can be effective in promoting medication adherence and blood pressure control. The best strategy to engage with older patients of low socioeconomic status who are low adopters of technology and disproportionally affected by uncontrolled hypertension is still unknown. Objective: The objective of this study is to improve blood pressure control in the older, low socioeconomic status population. The study will test two aims: First, we aim to evaluate the feasibility of conducting a randomized controlled trial by using an SMS-based approach among nonadherent, older patients of low socioeconomic status who have uncontrolled hypertension. Feasibility will be assessed in terms of recruitment rates per month (primary outcome); patient acceptability will be evaluated by monitoring retention rates and SMS response rates and using the validated Systems Usability Scale (secondary outcomes). Second, we aim to estimate the effects of the SMS approach on lowering blood pressure and adherence to antihypertensive medications. Methods: We will recruit 24 patients of low socioeconomic status with uncontrolled hypertension (systolic BP>140 mmHg or diastolic BP>90 mmHg) showing low medication adherence and taking at least two antihypertensives, who have presented to two outpatient clinics of Wake Forest Baptist Health (Winston Salem, North Carolina, USA). Participants will be randomly assigned to either SMS and HBPM (n=12) or usual care and HBPM (n=12) intervention. Clinicians adjusting the patients’ medications will be blinded to the study assignment. Text messages will be sent from a secure platform to assess medication adherence and HBPM on a weekly basis. The content and delivery frequency of the proposed SMS intervention are based on input from three focus groups conducted in Spring 2019. Participants in both study arms will receive education on HBPM and using an HBPM device. We hypothesize that we will successfully recruit 24 participants and the intervention will be acceptable to the participants. It will also improve medication adherence (assessed by question Medication Adherence Questionnaire scores) and blood pressure control. Results: Our study was funded in July 2020. As of May 2021, we have enrolled 6 participants. Conclusions: Our findings will help design a larger efficacy trial to advance the field of eHealth delivery systems particularly for older adults of low socioeconomic status. This study addresses a highly significant topic and targets a population of high morbidity and mortality that has been traditionally underrepresented in clinical trials. Trial Registration: ClinicalTrials.gov NCT03596242; https://clinicaltrials.gov/ct2/show/NCT03596242 International Registered Report Identifier (IRRID): PRR1-10.2196/18984 %M 33988513 %R 10.2196/18984 %U https://www.researchprotocols.org/2021/5/e18984 %U https://doi.org/10.2196/18984 %U http://www.ncbi.nlm.nih.gov/pubmed/33988513 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e25895 %T Real-Time UV Measurement With a Sun Protection System for Warning Young Adults About Sunburn: Prospective Cohort Study %A Robinson,June K %A Patel,Shiv %A Heo,Seung Yun %A Gray,Elizabeth %A Lim,Jaeman %A Kwon,Kyeongha %A Christiansen,Zach %A Model,Jeffrey %A Trueb,Jacob %A Banks,Anthony %A Kwasny,Mary %A Rogers,John A %+ Northwestern University Feinberg School of Medicine, 132 East Delaware Place, #5806, Chicago, IL, 60611, United States, 1 3129433703, june-robinson@northwestern.edu %K sun protection %K UV dosimeter %K health promotion technology %K melanoma %K sunburn %K preventive medicine %K mobile phone %D 2021 %7 6.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Melanoma is attributable to predisposing phenotypical factors, such as skin that easily sunburns and unprotected exposure to carcinogenic UV radiation. Reducing the proportion of young adults who get sunburned may reduce the incidence of melanoma, a deadly form of skin cancer. Advances in technology have enabled the delivery of real-time UV light exposure and content-relevant health interventions. Objective: This study aims to examine the feasibility of young adults performing the following tasks daily: wearing a UV dosimeter, receiving text messages and real-time UV-B doses on their smartphone, and responding to daily web-based surveys about sunburn and sun protection. Methods: Young adults aged 18-39 years (n=42) were recruited in the United States in June 2020 via social media. Participants received the UV Guard sun protection system, which consisted of a UV dosimeter and a smartphone app. During 3 consecutive periods, intervention intensity increased as follows: real-time UV-B dose; UV-B dose and daily behavioral facilitation text messages; and UV-B dose, goal setting, and daily text messages to support self-efficacy and self-regulation. Data were self-reported through daily web-based surveys for 28 days, and UV-B doses were transmitted to cloud-based storage. Results: Patients’ median age was 22 years (IQR 20, 29), and all patients had sun-sensitive skin. Sunburns were experienced during the study by fewer subjects (n=18) than those in the preceding 28 days (n=30). In July and August, the face was the most commonly sunburned area among 13 body locations; 52% (22/42) of sunburns occurred before the study and 45% (19/42) occurred during the study. The mean daily UV-B dose decreased during the 3 periods; however, this was not statistically significant. Young adults were most often exercising outdoors from 2 to 6 PM, walking from 10 AM to 6 PM, and relaxing from noon to 2 PM. Sunburn was most often experienced during exercise (odds ratio [OR] 5.65, 95% CI 1.60-6.10) and relaxation (OR 3.69, 95% CI 1.03-4.67) relative to those that did not exercise or relax in each category. The self-reported exit survey indicated that participants felt that they spent less time outdoors this summer compared to the last summer because of the COVID-19 pandemic and work. In addition, 38% (16/42) of the participants changed their use of sun protection based on their app-reported UV exposure, and 48% (20/42) shifted the time they went outside to periods with less-intense UV exposure. A total of 79% (33/42) of the participants were willing to continue using the UV Guard system outside of a research setting. Conclusions: In this proof-of-concept research, young adults demonstrated that they used the UV Guard system; however, optimization was needed. Although some sun protection behaviors changed, sunburn was not prevented in all participants, especially during outdoor exercise. Trial Registration: ClinicalTrials.gov NCT03344796; http://clinicaltrials.gov/ct2/show/NCT03344796 %M 33955844 %R 10.2196/25895 %U https://mhealth.jmir.org/2021/5/e25895 %U https://doi.org/10.2196/25895 %U http://www.ncbi.nlm.nih.gov/pubmed/33955844 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e21481 %T Written Advice Given by African American Smokers to Their Peers: Qualitative Study of Motivational Messages %A Nagawa,Catherine S %A Faro,Jamie M %A Menon,Anitha J %A Ito Fukunaga,Mayuko %A Williams,Jessica H %A Mourao,Dalton %A Emidio,Oluwabunmi M %A Davis,Maryann %A Pbert,Lori %A Cutrona,Sarah L %A Houston,Thomas K %A Sadasivam,Rajani S %+ Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, United States, 1 508 856 8999, catherine.nagawa@umassmed.edu %K tobacco disparities %K peer-to-peer %K communication %K smoking %K cessation %K thematic analysis %K intervention %K African American %D 2021 %7 30.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Although African Americans have the lowest rates of smoking onset and progression to daily smoking, they are less likely to achieve long-term cessation. Interventions tailored to promote use of cessation resources in African American individuals who smoke are needed. In our past work, we demonstrated the effectiveness of a technology-assisted peer-written message intervention for increasing smoking cessation in non-Hispanic White smokers. In this formative study, we have adapted this intervention to be specific for African American smokers. Objective: We aimed to report on the qualitative analysis of messages written by African American current and former smokers for their peers in response to hypothetical scenarios of smokers facing cessation challenges. Methods: We recruited African American adult current and former smokers (n=41) via ResearchMatch between April 2017 and November 2017. We asked participants to write motivational messages for their peers in response to smoking-related hypothetical scenarios. We also collected data on sociodemographic factors and smoking characteristics. Thematic analysis was conducted to identify cessation strategies suggested by the study participants. Results: Among the study participants, 60% (25/41) were female. Additionally, more than half (23/41, 56%) were thinking about quitting, 29% (12/41) had set a quit date, and 27% (11/41) had used electronic cigarettes in the past 30 days. Themes derived from the qualitative analysis of peer-written messages were (1) behavioral strategies, (2) seeking help, (3) improvements in quality of life, (4) attitudes and expectations, and (5) mindfulness/religious or spiritual practices. Under the behavioral strategies theme, distraction strategies were the most frequently suggested strategies (referenced 84 times in the 318 messages), followed by use of evidence-based treatments/cessation strategies. Within the seeking help theme, subthemes included seeking help or support from family/friends or close social networks (referenced 56 times) and health care professionals (referenced 22 times). The most frequent subthemes that emerged from improvements in the quality of life theme included improving one’s health (referenced 22 times) and quality of life (referenced 21 times). Subthemes that emerged from the attitude and expectations theme included practicing positive self-talk (referenced 27 times), autonomy/independence from the smoking habit (referenced six times), and financial cost of smoking (referenced five times). The two subthemes that emerged from the mindfulness/religious or spiritual practices theme were use of self-awareness techniques (referenced 36 times) and religious or spiritual practices to cope (referenced 13 times). Conclusions: Our approach to adapt a prior peer-message intervention to African American smokers yielded a set of evidence-based messages that may be suitable for smokers at all phases of motivation to quit (ready to quit or not ready to quit). In future research, we plan to assess the impact of texting these messages to African American smokers in a smoking cessation trial. %M 33929332 %R 10.2196/21481 %U https://formative.jmir.org/2021/4/e21481 %U https://doi.org/10.2196/21481 %U http://www.ncbi.nlm.nih.gov/pubmed/33929332 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e24184 %T Gender Differences in Satisfaction With a Text Messaging Program (Text4Hope) and Anticipated Receptivity to Technology-Based Health Support During the COVID-19 Pandemic: Cross-sectional Survey Study %A Shalaby,Reham %A Vuong,Wesley %A Hrabok,Marianne %A Gusnowski,April %A Mrklas,Kelly %A Li,Daniel %A Snaterse,Mark %A Surood,Shireen %A Cao,Bo %A Li,Xin-Min %A Greiner,Russell %A Greenshaw,Andrew James %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 7807144315, agyapong@ualberta.ca %K COVID-19 %K Text4Hope %K satisfaction %K mobile phone %K text %K anxiety %K depression %K stress, pandemic %K e-mental health %K gender %D 2021 %7 15.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In March 2020, Text4Hope—a community health service—was provided to Alberta residents. This free service aims to promote psychological resilience and alleviate pandemic-associated stress, anxiety, and depression symptoms during the COVID-19 pandemic. Objective: This study aimed to evaluate the feedback, satisfaction, experience, and perceptions of Text4Hope subscribers and to examine any differences based on gender after subscribers received 6 weeks of daily supportive text messages. Additionally, this study examined subscribers’ anticipated receptivity to technology-based medical services that could be offered during major crises, emergencies, or pandemics. Methods: Individuals self-subscribed to Text4Hope to receive daily supportive text messages for 3 months. Subscribers were invited to complete a web-based survey at 6 weeks postintervention to provide service satisfaction–related information. Overall satisfaction was assessed on a scale of 0-10, and satisfaction scores were analyzed using a related-measures t test. Likert scale satisfaction responses were used to assess various aspects of the Text4Hope program. Gender differences were analyzed using one-way analysis of variance (ANOVA) and Chi-square analyses. Results: A total of 2032 subscribers completed the baseline and 6-week surveys; 1788 (88%) were female, 219 (10.8%) were male, and 25 (1.2%) were other gender. The mean age of study participants was 44.58 years (SD 13.45 years). The mean overall satisfaction score was 8.55 (SD 1.78), suggesting high overall satisfaction with Text4Hope. The ANOVA analysis, which was conducted using the Welch test (n=1716), demonstrated that females had significantly higher mean satisfaction scores than males (8.65 vs 8.11, respectively; mean difference=0.546; 95% CI 0.19 to 0.91; P<.001) and nonsignificantly lower satisfaction scores than other gender respondents (mean difference=−0.938; 95% CI −0.37 to 2.25; P=.15). More than 70% of subscribers agreed that Text4Hope helped them cope with stress (1334/1731, 77.1%) and anxiety (1309/1728, 75.8%), feel connected to a support system (1400/1729, 81%), manage COVID-19–related issues (1279/1728, 74%), and improve mental well-being (1308/1731, 75.6%). Similarly, subscribers agreed that messages were positive, affirmative, and succinct. Messages were always or often read by 97.9% (1681/1716) of respondents, and more than 20% (401/1716, 23.4%) always or often returned to messages. The majority of subscribers (1471/1666, 88.3%) read the messages and either reflected upon them or took a positive action. Subscribers welcomed almost all technology-based services as part of their health care during crisis or emergency situations. Text4Hope was perceived to be effective by many female subscribers, who reported higher satisfaction and improved coping after receiving text messages for 6 weeks. Conclusions: Respondents affirmed the high quality of the text messages with their positive feedback. Technology-based services can provide remotely accessible and population-level interventions that align with the recommended physical distancing practices for pandemics. Text4Hope subscriber feedback revealed high satisfaction and acceptance at 6 weeks postintervention. International Registered Report Identifier (IRRID): RR2-10.2196/19292 %M 33750738 %R 10.2196/24184 %U https://mhealth.jmir.org/2021/4/e24184 %U https://doi.org/10.2196/24184 %U http://www.ncbi.nlm.nih.gov/pubmed/33750738 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e21127 %T Brief Interventions via Electronic Health Record Messaging for Population-Based Suicide Prevention: Mixed Methods Pilot Study %A Whiteside,Ursula %A Richards,Julie %A Simon,Gregory E %+ NowMattersNow.org, 1645 140th Ave NE, Suite A41053, Bellevue, WA, 98005, United States, 1 206 679 6349, ursulawhiteside@gmail.com %K suicide %K suicide prevention %K dialectical behavior therapy %K caring message %K web-based %K NowMattersNow.org %K prevention %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: New opportunities to create and evaluate population-based selective prevention programs for suicidal behavior are emerging in health care settings. Standard depression severity measures recorded in electronic medical records (EMRs) can be used to identify patients at risk for suicide and suicide attempt, and promising interventions for reducing the risk of suicide attempt in at-risk populations can be adapted for web-based delivery in health care. Objective: This study aims to evaluate a pilot of a psychoeducational program, focused on developing emotion regulation techniques via a web-based dialectical behavior therapy (DBT) skills site, including four DBT skills, and supported by secure message coaching, including elements of caring messages. Methods: Patients were eligible based on the EMR-documented responses to the Patient Health Questionnaire indicating suicidal thoughts. We measured feasibility via the proportion of invitees who opened program invitations, visited the web-based consent form page, and consented; acceptability via qualitative feedback from participants about the DBT program; and engagement via the proportion of invitees who began DBT skills as well as the number of website visits for DBT skills and the degree of site engagement. Results: A total of 60 patients were invited to participate. Overall, 93% (56/60) of the patients opened the invitation and 43% (26/60) consented to participate. DBT skills website users visited the home page on an average of 5.3 times (SD 6.0). Procedures resulted in no complaints and some participant feedback emphasizing the usefulness of DBT skills. Conclusions: This study supports the potential of using responses to patient health questionnaires in EMRs to identify a high-risk population and offer key elements of caring messages and DBT adapted for a low-intensity intervention. A randomized trial evaluating the effectiveness of this program is now underway (ClinicalTrials.gov: NCT02326883). %M 33843599 %R 10.2196/21127 %U https://formative.jmir.org/2021/4/e21127 %U https://doi.org/10.2196/21127 %U http://www.ncbi.nlm.nih.gov/pubmed/33843599 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e23989 %T Text Messaging Intervention for Young Smokers Experiencing Homelessness: Lessons Learned From a Randomized Controlled Trial %A Linnemayr,Sebastian %A Zutshi,Rushil %A Shadel,William %A Pedersen,Eric %A DeYoreo,Maria %A Tucker,Joan %+ RAND Corporation, 1776 Main Street, Santa Monica, CA, , United States, 1 310 393 0411 ext 6734, slinnema@rand.org %K smokers %K quitting %K text messaging %K homeless %K young adults %K cessation resources %K peer support %K smoking rate %K smartphone %D 2021 %7 1.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smoking rates are significantly higher among young people experiencing homelessness than in the general population. Despite a willingness to quit, homeless youth have little success in doing so on their own, and existing cessation resources tailored to this population are lacking. Homeless youth generally enjoy the camaraderie and peer support that group-based programs offer, but continuous in-person support during a quit attempt can be prohibitively expensive. Objective: This study aimed to assess the feasibility and acceptability of an automated text messaging intervention (TMI) as an adjunct to group-based cessation counseling and provision of nicotine patches to help homeless youth quit smoking. This paper outlines the lessons learned from the implementation of the TMI intervention. Methods: Homeless youth smokers aged 18 to 25 years who were interested in quitting (n=77) were recruited from drop-in centers serving homeless youth in the Los Angeles area. In this pilot randomized controlled trial, all participants received a group-based cessation counseling session and nicotine patches, with 52% (40/77) randomly assigned to receive 6 weeks of text messages to provide additional support for their quit attempt. Participants received text messages on their own phone rather than receiving a study-issued phone for the TMI. We analyzed baseline and follow-up survey data as well as back-end data from the messaging platform to gauge the acceptability and feasibility of the TMI among the 40 participants who received it. Results: Participants had widespread (smart)phone ownership—16.4% (36/219) were ineligible for study participation because they did not have a phone that could receive text messages. Participants experienced interruptions in their phone use (eg, 44% [16/36] changed phone numbers during the follow-up period) but reported being able to receive the majority of messages. These survey results were corroborated by back-end data (from the program used to administer the TMI) showing a message delivery rate of about 95%. Participant feedback points to the importance of carefully crafting text messages, which led to high (typically above 70%) approval of most text messaging components of the intervention. Qualitative feedback indicated that participants enjoyed the group counseling session that preceded the TMI and suggested including more such group elements into the intervention. Conclusions: The TMI was well accepted and feasible to support smoking cessation among homeless youth. Given high rates of smartphone ownership, the next generation of phone-based smoking cessation interventions for this population should consider using approaches beyond text messages and focus on finding ways to develop effective approaches to include group interaction using remote implementation. Given overall resource constraints and in particular the exigencies of the currently ongoing COVID-19 epidemic, phone-based interventions are a promising approach to support homeless youth, a population urgently in need of effective smoking cessation interventions. Trial Registration: ClinicalTrials.gov NCT03874585; https://clinicaltrials.gov/ct2/show/NCT03874585 International Registered Report Identifier (IRRID): RR2-10.1186/s13722-020-00187-6 %M 33792551 %R 10.2196/23989 %U https://mhealth.jmir.org/2021/4/e23989 %U https://doi.org/10.2196/23989 %U http://www.ncbi.nlm.nih.gov/pubmed/33792551 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e18460 %T System Architecture for "Support Through Mobile Messaging and Digital Health Technology for Diabetes" (SuMMiT-D): Design and Performance in Pilot and Randomized Controlled Feasibility Studies %A Chi,Yuan %A Velardo,Carmelo %A Allen,Julie %A Robinson,Stephanie %A Riga,Evgenia %A Judge,David %A Tarassenko,Lionel %A Farmer,Andrew J %+ Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Old Road Campus Research Building, Headington, Oxford, OX3 7DQ, United Kingdom, 44 01865 617675, yuan.chi@eng.ox.ac.uk %K type 2 diabetes %K short message service %K health-related behavior %K mobile health %K mHealth %K mobile phone %D 2021 %7 26.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Diabetes is a highly prevalent long-term condition with high morbidity and mortality rates. People with diabetes commonly worry about their diabetes medicines and do not always take them regularly as prescribed. This can lead to poor diabetes control. The Support Through Mobile Messaging and Digital Health Technology for Diabetes (SuMMiT-D) study aims to deliver brief messages as tailored interventions to support people with type 2 diabetes in better use of their diabetes medicines and to improve treatment adherence and health outcomes. Objective: This paper describes the overall architecture of a tailored intervention delivery system used in the pilot and randomized controlled feasibility studies of SuMMiT-D and reports its performance. Methods: The SuMMiT-D system includes several platforms and resources to recruit participants and deliver messages as tailored interventions. Its core component is called the clinical system and is responsible for interacting with the participants by receiving and sending SMS text messages from and to them. The personalization and tailoring of brief messages for each participant is based on a list of built-in commands that they can use. Results: For the pilot study, a total of 48 participants were recruited; they had a median age of 64 years (first quartile, third quartile [Q1, Q3: 54.5, 69]). For the feasibility study, a total of 209 participants were recruited and randomly assigned to either the control or intervention group; they had a median age of 65 years (Q1, Q3: 56, 71), with 41.1% (86/209) being female. The participants used the SuMMiT-D system for up to 6 months (26 weeks) and had a wide range of different interactions with the SuMMiT-D system while tailored interventions were being delivered. For both studies, we had low withdrawal rates: only 4.2% and 5.3% for the pilot and feasibility studies, respectively. Conclusions: A system was developed to successfully deliver brief messages as tailored health interventions to more than 250 people with type 2 diabetes via SMS text messages. On the basis of the low withdrawal rates and positive feedback received, it can be inferred that the SuMMiT-D system is robust, user-friendly, useful, and positive for most participants. From the two studies, we found that online recruitment was more efficient than recruitment via postal mail; a regular SMS text reminder (eg, every 4 weeks) can potentially increase the participants’ interactions with the system. Trial Registration: ISRCTN Registry ISRCTN13404264; http://www.isrctn.com/ISRCTN13404264 %M 33769299 %R 10.2196/18460 %U https://formative.jmir.org/2021/3/e18460 %U https://doi.org/10.2196/18460 %U http://www.ncbi.nlm.nih.gov/pubmed/33769299 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e27138 %T Effectiveness of a Postpartum Text Message Program (Essential Coaching for Every Mother) on Maternal Psychosocial Outcomes: Protocol for a Randomized Controlled Trial %A Dol,Justine %A Aston,Megan %A McMillan,Douglas %A Tomblin Murphy,Gail %A Campbell-Yeo,Marsha %+ Faculty of Health, Dalhousie University, 6299 South St, Halifax, NS, B3H 4R2, Canada, 1 902 470 2640, Justine.dol@dal.ca %K text message %K mobile health %K postpartum education %K self-efficacy %K social support %K postpartum anxiety %K postpartum depression %D 2021 %7 25.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Women experience changes both physically and psychologically during their transition to motherhood. The postnatal period is a critical time for women to develop maternal self-efficacy. Mobile health interventions may offer a way to reach women during this critical period to offer support and information. Essential Coaching for Every Mother is a text message program that seeks to educate and support women during the first 6 weeks postpartum. Objective: The primary effectiveness objective is to compare the effectiveness of the Essential Coaching for Every Mother program on maternal psychosocial outcomes (self-efficacy, social support, postpartum depression, and postpartum anxiety) immediately after the intervention and 6 months postpartum, collectively as well as stratified by parity. The primary implementation objective is to evaluate the implementation extent and quality of the Essential Coaching for Every Mother program. Methods: This will be a hybrid type 1 effectiveness-implementation randomized controlled trial. A total of 140 mothers-to-be or new mothers from Nova Scotia will be recruited and randomized to the intervention or control arm, stratified by parity. The intervention arm will receive the Essential Coaching for Every Mother program, which consists of 53 messages sent twice a day for the first 2 weeks and daily for weeks 3 through 6. The control group will receive usual care. Messages are personalized based on the infant’s age and the woman’s self-selected preference for breastfeeding or formula feeding and tailored with the infant’s name and gender. Women can enroll in the program if they are ≥37 weeks pregnant or within 10 days postpartum, with the first message designed to be sent on the second evening after birth. The actual number of messages received will vary based on the timing of enrollment and the infant’s date of birth. Participants will complete questionnaires assessing self-efficacy, social support, and postpartum depression and anxiety at baseline (enrollment after birth) and 6 weeks (postintervention) and 6 months postpartum. Implementation data will be collected throughout the trial, and evaluation feedback will be collected at 6 weeks from women who received the intervention. Results: Recruitment for this study started on January 5, 2021, and is currently ongoing, with an anticipated date of recruitment completion of January 2022. Conclusions: This study will assess the effectiveness of a postpartum text message program to improve maternal self-efficacy and social support while decreasing postpartum depression and anxiety. It will also shed light on the implementation effectiveness of the program. Trial Registration: ClinicalTrials.gov NCT04730570; https://clinicaltrials.gov/ct2/show/NCT04730570 International Registered Report Identifier (IRRID): DERR1-10.2196/27138 %M 33764309 %R 10.2196/27138 %U https://www.researchprotocols.org/2021/3/e27138 %U https://doi.org/10.2196/27138 %U http://www.ncbi.nlm.nih.gov/pubmed/33764309 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e22647 %T A Novel Remote Follow-Up Tool Based on an Instant Messaging/Social Media App for the Management of Patients With Low Anterior Resection Syndrome: Pilot Prospective Self-Control Study %A Liu,Fan %A Guo,Peng %A Su,Xiangqian %A Cui,Ming %A Jiang,Jianlong %A Wang,Suo %A Yu,Zhouman %A Zhou,Runhe %A Ye,Yingjiang %+ Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, 6A ward, Department of Gastroenterological Surgery, Peking University People's Hospital, No 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China, 86 10 88326600, yingjiangye@pkuph.edu.cn %K instant messaging social media %K rectal cancer %K low anterior resection syndrome %K follow-up %K telephone interview %D 2021 %7 19.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Low anterior resection syndrome (LARS) is a common functional disorder that develops after patients with rectal cancer undergo anal preservation surgery. Common approaches to assess the symptoms of patients with LARS are often complex and time-consuming. Instant messaging/social media has great application potential in LARS follow-up, but has been underdeveloped. Objective: The aim of this study was to compare data between a novel instant messaging/social media follow-up system and a telephone interview in patients with LARS and to analyze the consistency of the instant messaging/social media platform. Methods: Patients with R0 resectable rectal cancer who accepted several defecation function visits via the instant messaging/social media platform and agreed to a telephone interview after the operation using the same questionnaire including subjective questions and LARS scores were included. Differences between the 2 methods were analyzed in pairs and the diagnostic consistency of instant messaging/social media was calculated based on telephone interview results. Results: In total, 21 questionnaires from 15 patients were included. The positive rates of defecation dissatisfaction, life restriction, and medication use were 10/21 (48%), 11/21 (52%), and 8/21 (38%) for telephone interview and 10/21 (48%), 13/21 (62%), and 5/21 (24%) for instant messaging/social media, respectively. No statistically significant difference was observed between instant messaging/social media and telephone interview in terms of total LARS score (mean 22.4 [SD 11.9] vs mean 24.7 [SD 10.7], P<.21) and LARS categories (Z=–0.264, P=.79); however, instant messaging/social media showed a more negative tendency. The kappa values of 3 subjective questions were 0.618, 0.430, and 0.674, respectively. The total LARS scores were consistent between both groups (Pearson coefficient 0.760, P<.001; category correlation coefficient 0.570, P=.005). Patients with major LARS had highly consistent results, with sensitivity, specificity, kappa value, and P value of 77.8%, 91.7%, 0.704, and .001, respectively. Conclusions: Instant messaging/social media can be a major LARS screening method. However, further research on information accuracy and user acceptance is needed before implementing a mature system. Trial Registration: ClinicalTrials.gov NCT03009747; https://clinicaltrials.gov/ct2/show/NCT03009747 %M 33739295 %R 10.2196/22647 %U https://mhealth.jmir.org/2021/3/e22647 %U https://doi.org/10.2196/22647 %U http://www.ncbi.nlm.nih.gov/pubmed/33739295 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e23058 %T Motivation to Participate in Precision Health Research and Acceptability of Texting as a Recruitment and Intervention Strategy Among Vietnamese Americans: Qualitative Study %A Ta Park,Van %A Kim,Amber %A Cho,In Hyang %A Nam,Bora %A Nguyen,Khue %A Vuong,Quyen %A Periyakoil,Vyjeyanthi S %A Hong,Y Alicia %+ Department of Community Health Systems, School of Nursing, University of California, San Francisco, 2 Koret Way, N511S, San Francisco, CA, 94143, United States, 1 415 514 3318, van.park@ucsf.edu %K Vietnamese Americans %K texting %K precision health %K qualitative research %K mobile phone %D 2021 %7 11.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The largest effort undertaken in precision health research is the Precision Medicine Initiative (PMI), also known as the All of Us Research Program, which aims to include 1 million or more participants to be a part of a diverse database that can help revolutionize precision health research studies. Research participation from Asian Americans and Pacific Islanders in precision health research is, however, limited; this includes Vietnamese Americans, especially those with limited English proficiency. PMI engagement efforts with underserved communities, including members of minority populations or individuals who have experienced health disparities such as Vietnamese Americans with limited English proficiency, may help to enrich the diversity of the PMI. Objective: The aim of this study is to examine the attitudes towards and perceptions of precision health, motivations and barriers to participation in precision health research, and acceptability of SMS text messaging as a recruitment and intervention strategy among underserved Vietnamese Americans. Methods: A community sample of 37 Vietnamese Americans completed a survey and participated in one of 3 focus groups classified by age (18-30, 31-59, and ≥60 years) on topics related to precision health, participation in precision health research, texting or social media use experience, and insights on how to use text messages for recruitment and intervention. Participants were recruited via community organizations that serve Vietnamese Americans, flyers, word of mouth, and Vietnamese language radio announcements. Results: Most participants had little knowledge of precision health initially. After brief education, they had positive attitudes toward precision health, although the motivation to participate in precision health research varied by age and prior experience of research participation. The main motivators to participate included the desire for more knowledge and more representation of Vietnamese Americans in research. Participants were open to receiving text messages as part of their research participation and provided specific suggestions on the design and delivery of such messages (eg, simple, in both English and Vietnamese). Examples of barriers included misinterpretation of messages, cost (to send text messages), and preferences for different texting platforms across age groups. Conclusions: This study represents one of the first formative research studies to recruit underserved Vietnamese Americans to precision health research. It is critical to understand target communities’ motivations and barriers to participation in research. Delivering culturally appropriate text messages via age-appropriate texting and social media platforms may be an effective recruitment and intervention strategy. The next step is to develop and examine the feasibility of a culturally tailored precision health texting strategy for Vietnamese Americans. %M 33704080 %R 10.2196/23058 %U https://mhealth.jmir.org/2021/3/e23058 %U https://doi.org/10.2196/23058 %U http://www.ncbi.nlm.nih.gov/pubmed/33704080 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e23843 %T A Patient-Initiated Digital COVID-19 Contact Notification Tool (TellYourContacts): Evaluation Study %A Okpara,Kelechi S %A Hecht,Jennifer %A Wohlfeiler,Dan %A Prior,Matthew %A Klausner,Jeffrey D %+ David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, United States, 1 (310) 825 6373, kokpara@mednet.ucla.edu %K patient-led digital contact notification %K COVID-19 %K digital contact tracing %K contact notification website %D 2021 %7 5.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Contact notification is a method used to control the spread of infectious disease. In this process, a patient who tests positive for an infectious disease and public health officials work to identify the patient’s close contacts, notify them of their risk of possible exposure to the disease, and provide resources to facilitate the decreased spreading of disease. Contact notification can be done physically in person, via phone call, or digitally through the use of media such as SMS text messages and email. When alerts are made through the latter, it is called digital contact notification. Objective: For this study, we aim to perform a preliminary evaluation of the use of the TellYourContacts website, a digital contact notification tool for COVID-19 that can be used confidentially and anonymously. We will gather information about the number of website users and message senders, the types of messages sent, and the geographic distribution of senders. Methods: Patients who chose to get tested for COVID-19 and subsequently tested positive for the disease were alerted of their positive results through Curative Inc (a COVID-19 testing laboratory) and Healthvana (a results disclosure app). Included in the notification was a link to the TellYourContacts website and a message encouraging the person who tested positive for COVID-19 to use the website to alert their close contacts of exposure risk. Over the course of three months, from May 18, 2020, to August 17, 2020, we used Google Analytics and Microsoft Excel to record data on the number of website users and message senders, types of messages sent, and geographic distribution of the senders. Results: Over the course of three months, 9130 users accessed the website and 1474 unique senders sent a total of 1957 messages, which included 1820 (93%) SMS text messages and 137 (7%) emails. Users sent messages from 40 US states, with the majority of US senders residing in California (49%). Conclusions: We set out to determine if individuals who test positive for COVID-19 will use the TellYourContacts website to notify their close contacts of COVID-19 exposure risk. Our findings reveal that, during the observation period, each unique sender sent an average of 1.33 messages. The TellYourContacts website offers an additional method that individuals can and will use to notify their close contacts about a recent COVID-19 diagnosis. %M 33621189 %R 10.2196/23843 %U https://formative.jmir.org/2021/3/e23843 %U https://doi.org/10.2196/23843 %U http://www.ncbi.nlm.nih.gov/pubmed/33621189 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e22732 %T Text Messaging and Web-Based Survey System to Recruit Patients With Low Back Pain and Collect Outcomes in the Emergency Department: Observational Study %A Amorim,Anita Barros %A Coombs,Danielle %A Richards,Bethan %A Maher,Chris G %A Machado,Gustavo C %+ Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Level 7 East, Susan Wakil Health Building D18, Camperdown, Sydney, 2006, Australia, 61 0401399572, anita.amorim@sydney.edu.au %K emergency department %K clinical trial %K low back pain %K acute pain %K data collection %K patient recruitment %K short message service %K patient reported outcome measures %K mobile phone %D 2021 %7 4.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Low back pain (LBP) is a frequent reason for emergency department (ED) presentations, with a global prevalence of 4.4%. Despite being common, the number of clinical trials investigating LBP in the ED is low. Recruitment of patients in EDs can be challenging because of the fast-paced and demanding ED environment. Objective: The aim of this study is to describe the recruitment and response rates using an SMS text messaging and web-based survey system supplemented by telephone calls to recruit patients with LBP and collect health outcomes in the ED. Methods: An automated SMS text messaging system was integrated into Research Electronic Data Capture and used to collect patient-reported outcomes for an implementation trial in Sydney, Australia. We invited patients with nonserious LBP who presented to participating EDs at 1, 2, and 4 weeks after ED discharge. Patients who did not respond to the initial SMS text message invitation were sent a reminder SMS text message or contacted via telephone. The recruitment rate was measured as the proportion of patients who agreed to participate, and the response rate was measured as the proportion of participants completing the follow-up surveys at weeks 2 and 4. Regression analyses were used to explore factors associated with response rates. Results: In total, 807 patients with nonserious LBP were invited to participate and 425 (53.0%) agreed to participate. The week 1 survey was completed by 51.5% (416/807) of participants. At week 2, the response rate was 86.5% (360/416), and at week 4, it was 84.4% (351/416). Overall, 60% of the surveys were completed via SMS text messaging and on the web and 40% were completed via telephone. Younger participants and those from less socioeconomically disadvantaged areas were more likely to respond to the survey via the SMS text messaging and web-based system. Conclusions: Using an SMS text messaging and web-based survey system supplemented by telephone calls is a viable method for recruiting patients with LBP and collecting health outcomes in the ED. This hybrid system could potentially reduce the costs of using traditional recruitment and data collection methods (eg, face-to-face, telephone calls only). International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2017-019052 %M 33661125 %R 10.2196/22732 %U https://mhealth.jmir.org/2021/3/e22732 %U https://doi.org/10.2196/22732 %U http://www.ncbi.nlm.nih.gov/pubmed/33661125 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 3 %P e18607 %T A Chatbot for Perinatal Women’s and Partners’ Obstetric and Mental Health Care: Development and Usability Evaluation Study %A Chung,Kyungmi %A Cho,Hee Young %A Park,Jin Young %+ Department of Psychiatry, Yonsei University College of Medicine, Yongin Severance Hospital, Yonsei University Health System, 363, Dongbaekjukjeon-daero, Giheung-gu, Yongin-si, Republic of Korea, 82 31 5189 8148, empathy@yuhs.ac %K chatbot %K mobile phone %K instant messaging %K mobile health %K perinatal care %K usability %K user experience %K usability testing %D 2021 %7 3.3.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: To motivate people to adopt medical chatbots, the establishment of a specialized medical knowledge database that fits their personal interests is of great importance in developing a chatbot for perinatal care, particularly with the help of health professionals. Objective: The objectives of this study are to develop and evaluate a user-friendly question-and-answer (Q&A) knowledge database–based chatbot (Dr. Joy) for perinatal women’s and their partners’ obstetric and mental health care by applying a text-mining technique and implementing contextual usability testing (UT), respectively, thus determining whether this medical chatbot built on mobile instant messenger (KakaoTalk) can provide its male and female users with good user experience. Methods: Two men aged 38 and 40 years and 13 women aged 27 to 43 years in pregnancy preparation or different pregnancy stages were enrolled. All participants completed the 7-day-long UT, during which they were given the daily tasks of asking Dr. Joy at least 3 questions at any time and place and then giving the chatbot either positive or negative feedback with emoji, using at least one feature of the chatbot, and finally, sending a facilitator all screenshots for the history of the day’s use via KakaoTalk before midnight. One day after the UT completion, all participants were asked to fill out a questionnaire on the evaluation of usability, perceived benefits and risks, intention to seek and share health information on the chatbot, and strengths and weaknesses of its use, as well as demographic characteristics. Results: Despite the relatively higher score of ease of learning (EOL), the results of the Spearman correlation indicated that EOL was not significantly associated with usefulness (ρ=0.26; P=.36), ease of use (ρ=0.19; P=.51), satisfaction (ρ=0.21; P=.46), or total usability scores (ρ=0.32; P=.24). Unlike EOL, all 3 subfactors and the total usability had significant positive associations with each other (all ρ>0.80; P<.001). Furthermore, perceived risks exhibited no significant negative associations with perceived benefits (ρ=−0.29; P=.30) or intention to seek (SEE; ρ=−0.28; P=.32) or share (SHA; ρ=−0.24; P=.40) health information on the chatbot via KakaoTalk, whereas perceived benefits exhibited significant positive associations with both SEE and SHA. Perceived benefits were more strongly associated with SEE (ρ=0.94; P<.001) than with SHA (ρ=0.70; P=.004). Conclusions: This study provides the potential for the uptake of this newly developed Q&A knowledge database–based KakaoTalk chatbot for obstetric and mental health care. As Dr. Joy had quality contents with both utilitarian and hedonic value, its male and female users could be encouraged to use medical chatbots in a convenient, easy-to-use, and enjoyable manner. To boost their continued usage intention for Dr. Joy, its Q&A sets need to be periodically updated to satisfy user intent by monitoring both male and female user utterances. %M 33656442 %R 10.2196/18607 %U https://medinform.jmir.org/2021/3/e18607 %U https://doi.org/10.2196/18607 %U http://www.ncbi.nlm.nih.gov/pubmed/33656442 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e22950 %T Older Adult Peer Support Specialists’ Age-Related Contributions to an Integrated Medical and Psychiatric Self-Management Intervention: Qualitative Study of Text Message Exchanges %A Mbao,Mbita %A Collins-Pisano,Caroline %A Fortuna,Karen %+ Dartmouth College, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States, 1 603 722 5727, karen.L.Fortuna@dartmouth.edu %K older adults %K peer support %K self-management %K mobile technology %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Middle-aged and older adults with mental health conditions have a high likelihood of experiencing comorbid physical health conditions, premature nursing home admissions, and early death compared with the general population of adults aged 50 years or above. An emerging workforce of peer support specialists aged 50 years or above or “older adult peer support specialists” is increasingly using technology to deliver peer support services to address both the mental health and physical health needs of middle-aged and older adults with a diagnosis of a serious mental illness. Objective: This exploratory qualitative study examined older adult peer support specialists’ text message exchanges with middle-aged and older adults with a diagnosis of a serious mental illness and their nonmanualized age-related contributions to a standardized integrated medical and psychiatric self-management intervention. Methods: Older adult peer support specialists exchanged text messages with middle-aged and older adults with a diagnosis of a serious mental illness as part of a 12-week standardized integrated medical and psychiatric self-management smartphone intervention. Text message exchanges between older adult peer support specialists (n=3) and people with serious mental illnesses (n=8) were examined (mean age 68.8 years, SD 4.9 years). A total of 356 text messages were sent between older adult peer support specialists and service users with a diagnosis of a serious mental illness. Older adult peer support specialists sent text messages to older participants’ smartphones between 8 AM and 10 PM on weekdays and weekends. Results: Five themes emerged from text message exchanges related to older adult peer support specialists’ age-related contributions to integrated self-management, including (1) using technology to simultaneously manage mental health and physical health issues; (2) realizing new coping skills in late life; (3) sharing roles as parents and grandparents; (4) wisdom; and (5) sharing lived experience of difficulties with normal age-related changes (emerging). Conclusions: Older adult peer support specialists’ lived experience of aging successfully with a mental health challenge may offer an age-related form of peer support that may have implications for promoting successful aging in older adults with a serious mental illness. %M 33650979 %R 10.2196/22950 %U https://formative.jmir.org/2021/3/e22950 %U https://doi.org/10.2196/22950 %U http://www.ncbi.nlm.nih.gov/pubmed/33650979 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e19239 %T Interplay of Support, Comparison, and Surveillance in Social Media Weight Management Interventions: Qualitative Study %A Chang,Leanne %A Chattopadhyay,Kaushik %A Li,Jialin %A Xu,Miao %A Li,Li %+ Department of Endocrinology and Metabolism, Ningbo First Hospital, 59 Liuting Street, Ningbo, Zhejiang 315010, China, 86 574 8708 5588, lilyningbo@163.com %K obesity %K social comparison %K social media %K social support %K surveillance %K weight control %D 2021 %7 1.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There has been a significant increase in the trend of using social media as a platform to deliver weight management interventions. This illustrates a need to develop a holistic understanding of doctor-patient communication and peer-to-peer communication in social media interventions and to determine their influences on weight management for people with overweight or obesity. Such studies will highlight how social media can be more effectively integrated into weight management programs to enhance individuals’ short-term and long-term weight management behaviors. Objective: The aim of this study was to examine patients’ experiences with doctor-patient communication and peer interactions in a social media–based (WeChat) weight management program, and to describe the interplay of three social influence factors—social support, social comparison, and surveillance—in their weight control practices. The program, designed and implemented by the research team located in a tertiary referral hospital in a southeastern province in China, included both diet and physical activity components that targeted people with overweight or obesity. Methods: We conducted in-depth interviews with 32 program participants of different ages (mean 35.6, SD 7.7 years), gender (18 women), duration of program membership (mean 1.4 years), and weight loss outcomes (54% weight loss to 9% weight gain). All interview data were audio-recorded, transcribed, and translated using the translation-backtranslation technique. Nvivo software was used to facilitate the coding process. Results: Results of thematic analysis indicated the distinct functions of professionally led support and peer support. Professional support was presented in the form of knowledge infusion, efficacy enhancement, and provision of timely feedback. Peer support fostered empathy and sense of belonging, and had a mutually reinforcing relationship with peer comparison and peer-based surveillance. Peer comparison enhanced motivation and positive competition. However, it also reinforced negative group norms, and resulted in downturns in reference standards and collective inactivity. Social media surveillance prompted participants’ reactions to the gaze from medical professionals and peers that could be encouraging or inhibiting. Surveillance enhanced vigilance with weight control norms; however, its influence weakened when participants chose to fake weight data and turn off notifications. Findings from this study illustrated the interrelated and fluctuating influences of support, comparison, and surveillance. Conclusions: The interactive traits of social media eased the practices of social support and social comparison, and created new forms of surveillance. This study contributes to an in-depth understanding of social media influences on individuals’ weight control behaviors. Practical implications of the study concern improved strategies for maintaining the positive dynamics of social media interactions and preventing negative resistance to surveillance technology. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900025861; http://www.chictr.org.cn/showprojen.aspx?proj=42497 %M 33646130 %R 10.2196/19239 %U https://mhealth.jmir.org/2021/3/e19239 %U https://doi.org/10.2196/19239 %U http://www.ncbi.nlm.nih.gov/pubmed/33646130 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e24165 %T Effects of COVID-19 Emergency Alert Text Messages on Practicing Preventive Behaviors: Cross-sectional Web-Based Survey in South Korea %A Lee,Minjung %A You,Myoungsoon %+ Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 880 2773, msyou@snu.ac.kr %K COVID-19 %K coronavirus %K preventive behaviors %K text message %K mobile phone %K alert %K prevention %K behavior %K public health %K survey %D 2021 %7 25.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Sending emergency messages via mobile phone text messaging can be a promising communication tool to rapidly disseminate information and promote preventive behavior among the public during epidemic outbreaks. The battle to overcome COVID-19 is not yet over; thus, it is essential that the public practices preventive measures to prevent the spread of COVID-19. Objective: This study aimed to investigate the effectiveness of reading and obtaining information via emergency alert SMS text messages and their effects on the individual's practice of preventive behaviors during the early stages of the COVID-19 outbreak in South Korea. Methods: A cross-sectional web-based survey comprising 990 participants was conducted over 3 days (March 25-27, 2020). A multivariable logistic regression analysis revealed the sociodemographic factors that might influence the behavior of reading emergency alert text messages. A hierarchical linear regression model estimated the associations between reading emergency alert text messages for each precautionary behavior practiced against COVID-19. Additionally, the indirect effects of reading the text messages on each precautionary behavior via psychological factors (ie, perceived risk and response efficacy) were calculated. All data were weighted according to the 2019 Korea census data. Results: Overall, 49.2% (487/990) of the participants reported that they always read emergency alert text messages and visited the linked website to obtain more information. Factors such as female sex (odds ratio [OR] 1.68, 95% CI 1.28-2.21) and older age (30-39 years: OR 2.02, 95% CI 1.25-3.28; 40-49 years: OR 2.84, 95% CI 1.80-4.47; 50-59 years: OR 3.19, 95% CI 2.01-5.06; 60 years and above: OR 3.12, 95% CI 2.00-4.86 versus 18-29 years) were identified to be associated with a higher frequency of reading the text messages. Participants who always read the text messages practiced wearing facial masks (β=.074, P=.01) more frequently than those who did not. In terms of social distancing, participants who reported they always read the text messages avoided crowded places (β=.078, P=.01) and canceled or postponed social gatherings (β=.103, P<.001) more frequently than those who did not read the text messages. Furthermore, reading text messages directly and indirectly affected practicing precautionary behaviors, as the mediation effect of response efficacy between reading text messages and practicing preventive behaviors was significant. Conclusions: Our findings suggest that emergency alert text messages sent to individuals' mobile phones are timely and effective strategies for encouraging preventive behavior in public. Sending emergency alert text messages to provide the public with accurate and reliable information could be positively considered by the health authorities, which might reduce the negative impact of infodemics. %M 33544691 %R 10.2196/24165 %U https://www.jmir.org/2021/2/e24165 %U https://doi.org/10.2196/24165 %U http://www.ncbi.nlm.nih.gov/pubmed/33544691 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e19478 %T Suitability of Text-Based Communications for the Delivery of Psychological Therapeutic Services to Rural and Remote Communities: Scoping Review %A Dwyer,Anne %A de Almeida Neto,Abílio %A Estival,Dominique %A Li,Weicong %A Lam-Cassettari,Christa %A Antoniou,Mark %+ The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Locked Bag 1797, Penrith, 2751, Australia, 61 97726673, m.antoniou@westernsydney.edu.au %K mental health services %K text messaging %K counseling %K mobile health %K natural language processing %D 2021 %7 24.2.2021 %9 Review %J JMIR Ment Health %G English %X Background: People living in rural and remote areas have poorer access to mental health services than those living in cities. They are also less likely to seek help because of self-stigma and entrenched stoic beliefs about help seeking as a sign of weakness. E-mental health services can span great distances to reach those in need and offer a degree of privacy and anonymity exceeding that of traditional face-to-face counseling and open up possibilities for identifying at-risk individuals for targeted intervention. Objective: This scoping review maps the research that has explored text-based e-mental health counseling services and studies that have used language use patterns to predict mental health status. In doing so, one of the aims was to determine whether text-based counseling services have the potential to circumvent the barriers faced by clients in rural and remote communities using technology and whether text-based communications, in particular, can be used to identify individuals at risk of psychological distress or self-harm. Methods: We conducted a comprehensive electronic literature search of PsycINFO, PubMed, ERIC, and Web of Science databases for articles published in English through November 2020. Results: Of the 9134 articles screened, 70 met the eligibility criteria and were included in the review. There is preliminary evidence to suggest that text-based, real-time communication with a qualified therapist is an effective form of e-mental health service delivery, particularly for individuals concerned with stigma and confidentiality. There is also converging evidence that text-based communications that have been analyzed using computational linguistic techniques can be used to accurately predict progress during treatment and identify individuals at risk of serious mental health conditions and suicide. Conclusions: This review reveals a clear need for intensified research into the extent to which text-based counseling (and predictive models using modern computational linguistics tools) may help deliver mental health treatments to underserved groups such as regional communities, identify at-risk individuals for targeted intervention, and predict progress during treatment. Such approaches have implications for policy development to improve intervention accessibility in at-risk and underserved populations. %M 33625373 %R 10.2196/19478 %U https://mental.jmir.org/2021/2/e19478 %U https://doi.org/10.2196/19478 %U http://www.ncbi.nlm.nih.gov/pubmed/33625373 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e17262 %T Evaluating a Mobile Phone–Delivered Text Message Reminder Intervention to Reduce Infant Vaccination Dropout in Arua, Uganda: Protocol for a Randomized Controlled Trial %A Ehlman,Daniel C %A Magoola,Joseph %A Tanifum,Patricia %A Wallace,Aaron S %A Behumbiize,Prosper %A Mayanja,Robert %A Luzze,Henry %A Yukich,Joshua %A Daniels,Danni %A Mugenyi,Kevin %A Baryarama,Fulgentius %A Ayebazibwe,Nicholas %A Conklin,Laura %+ Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, United States, 1 4046398224, dehlman@cdc.gov %K immunization %K vaccination %K reminder system %K mHealth %K short message service %K text messages %K cell phone %K mobile phone %K vaccination dropout %K vaccination timeliness %D 2021 %7 24.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Globally, suboptimal vaccine coverage is a public health concern. According to Uganda’s 2016 Demographic and Health Survey, only 49% of 12- to 23-month-old children received all recommended vaccinations by 12 months of age. Innovative ways are needed to increase coverage, reduce dropout, and increase awareness among caregivers to bring children for timely vaccination. Objective: This study evaluates a personalized, automated caregiver mobile phone–delivered text message reminder intervention to reduce the proportion of children who start but do not complete the vaccination series for children aged 12 months and younger in select health facilities in Arua district. Methods: A two-arm, multicenter, parallel group randomized controlled trial was conducted in four health facilities providing vaccination services in and around the town of Arua. Caregivers of children between 6 weeks and 6 months of age at the time of their first dose of pentavalent vaccine (Penta1; containing diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type b antigens) were recruited and interviewed. All participants received the standard of care, defined as the health worker providing child vaccination home-based records to caregivers as available and providing verbal instruction of when to return for the next visit. At the end of each day, caregivers and their children were randomized by computer either to receive or not receive personalized, automated text message reminders for their subsequent vaccination visits according to the national schedule. Text message reminders for Penta2 were sent 2 days before, on the day of, and 2 days after the scheduled vaccination visit. Reminders for Penta3 and the measles-containing vaccine were sent on the scheduled day of vaccination and 5 and 7 days after the scheduled day. Study personnel conducted postintervention follow-up interviews with participants at the health facilities during the children’s measles-containing vaccine visit. In addition, focus group discussions were conducted to assess caregiver acceptability of the intervention, economic data were collected to evaluate the incremental costs and cost-effectiveness of the intervention, and health facility record review forms were completed to capture service delivery process indicators. Results: Of the 3485 screened participants, 1961 were enrolled from a sample size of 1962. Enrollment concluded in August 2016. Follow-up interviews of study participants, including data extraction from the children’s vaccination cards, data extraction from the health facility immunization registers, completion of the health facility record review forms, and focus group discussions were completed by December 2017. The results are expected to be released in 2021. Conclusions: Prompting health-seeking behavior with reminders has been shown to improve health intervention uptake. Mobile phone ownership continues to grow in Uganda, so their use in vaccination interventions such as this study is logical and should be evaluated with scientifically rigorous study designs. Trial Registration: ClinicalTrials.gov NCT04177485; https://clinicaltrials.gov/ct2/show/NCT04177485 International Registered Report Identifier (IRRID): DERR1-10.2196/17262 %M 33625372 %R 10.2196/17262 %U https://www.researchprotocols.org/2021/2/e17262 %U https://doi.org/10.2196/17262 %U http://www.ncbi.nlm.nih.gov/pubmed/33625372 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e18288 %T Acceptability of a Mobile Health Behavior Change Intervention for Cancer Survivors With Obesity or Overweight: Nested Mixed Methods Study Within a Randomized Controlled Trial %A Groarke,Jenny M %A Richmond,Janice %A Mc Sharry,Jenny %A Groarke,AnnMarie %A Harney,Owen M %A Kelly,Mary Grace %A Walsh,Jane C %+ Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, 18-30 Malone Road, Belfast, BT71NN, United Kingdom, 44 28 90974886, j.groarke@qub.ac.uk %K mHealth %K self-management %K text messaging %K activity tracker %K exercise %K diet %K overweight %K obesity %K cancer survivors %K qualitative research %K mobile phone %D 2021 %7 16.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A significant proportion of cancer survivors have overweight or obesity. Although this has negative implications for health, weight management is not a standard component of oncology aftercare. Mobile health (mHealth) technology, in combination with behavior change techniques (BCTs), has the potential to support positive lifestyle changes. Few studies have been carried out with cancer survivors; therefore, the acceptability of these tools and techniques requires further investigation. Objective: The aim of this study is to examine the acceptability of a behavior change intervention using mHealth for cancer survivors with a BMI of 25 or more and to gather constructive feedback from participants. Methods: The intervention consisted of educational sessions and an 8-week physical activity goal setting intervention delivered using mobile technology (ie, Fitbit activity monitor plus SMS contact). In the context of a two-arm randomized controlled trial, semistructured interviews were conducted to assess the retrospective acceptability of the intervention from the perspective of the recipients. The theoretical framework for the acceptability of health care interventions was used to inform a topic guide. The interviews were transcribed and analyzed using thematic analysis. A quantitative survey was also conducted to determine the acceptability of the intervention. A total of 13 participants were interviewed, and 36 participants completed the quantitative survey. Results: The results strongly support the acceptability of the intervention. The majority of the survey respondents held a positive attitude toward the intervention (35/36, 97%). In qualitative reports, many of the intervention components were enjoyed and the mHealth components (ie, Fitbit and goal setting through text message contact) were rated especially positively. Responses were mixed as to whether the burden of participating in the intervention was high (6/36, 17%) or low (5/36, 14%). Participants perceived the intervention as having high efficacy in improving health and well-being (34/36, 94%). Most respondents said that they understood how the intervention works (35/36, 97%), and qualitative data show that participants’ understanding of the aim of the intervention was broader than weight management and focused more on moving on psychologically from cancer. Conclusions: On the basis of the coherence of responses with theorized aspects of intervention acceptability, we are confident that this intervention using mHealth and BCTs is acceptable to cancer survivors with obesity or overweight. Participants made several recommendations concerning the additional provision of social support. Future studies are needed to assess the feasibility of delivery in clinical practice and the acceptability of the intervention to those delivering the intervention. International Registered Report Identifier (IRRID): RR2-10.2196/13214 %M 33591290 %R 10.2196/18288 %U http://mhealth.jmir.org/2021/2/e18288/ %U https://doi.org/10.2196/18288 %U http://www.ncbi.nlm.nih.gov/pubmed/33591290 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e26190 %T Analyzing Digital Evidence From a Telemental Health Platform to Assess Complex Psychological Responses to the COVID-19 Pandemic: Content Analysis of Text Messages %A Hull,Thomas D %A Levine,Jacob %A Bantilan,Niels %A Desai,Angel N %A Majumder,Maimuna S %+ Talkspace, 2578 Broadway #607, New York, NY, 10025, United States, 1 4802548815, tdh732@mail.harvard.edu %K digital phenotyping %K COVID-19 %K telehealth %K digital mental health %K natural language processing %K machine learning %K mental health %K phenotyping %K burden %K treatment %K symptom %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The novel COVID-19 disease has negatively impacted mortality, economic conditions, and mental health. These impacts are likely to continue after the COVID-19 pandemic ends. There are no methods for characterizing the mental health burden of the COVID-19 pandemic, and differentiating this burden from that of the prepandemic era. Accurate illness detection methods are critical for facilitating pandemic-related treatment and preventing the worsening of symptoms. Objective: We aimed to identify major themes and symptom clusters in the SMS text messages that patients send to therapists. We assessed patients who were seeking treatment for pandemic-related distress on Talkspace, which is a popular telemental health platform. Methods: We used a machine learning algorithm to identify patients’ pandemic-related concerns, based on their SMS text messages in a large, digital mental health service platform (ie, Talkspace). This platform uses natural language processing methods to analyze unstructured therapy transcript data, in parallel with brief clinical assessment methods for analyzing depression and anxiety symptoms. Results: Our results show a significant increase in the incidence of COVID-19–related intake anxiety symptoms (P<.001), but no significant differences in the incidence of intake depression symptoms (P=.79). During our transcript analyses, we identified terms that were related to 24 symptoms outside of those included in the diagnostic criteria for anxiety and depression. Conclusions: Our findings for Talkspace suggest that people who seek treatment during the pandemic experience more severe intake anxiety than they did before the COVID-19 outbreak. It is important to monitor the symptoms that we identified in this study and the symptoms of anxiety and depression, to fully understand the effects of the COVID-19 pandemic on mental health. %M 33502999 %R 10.2196/26190 %U http://formative.jmir.org/2021/2/e26190/ %U https://doi.org/10.2196/26190 %U http://www.ncbi.nlm.nih.gov/pubmed/33502999 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e12218 %T Effectiveness of Text Message Reminders on Adherence to Inhaled Therapy in Patients With Asthma: Prospective Multicenter Randomized Clinical Trial %A Almonacid,Carlos %A Melero,Carlos %A López Viña,Antolín %A Cisneros,Carolina %A Pérez de Llano,Luis %A Plaza,Vicente %A García-Rivero,Juan Luis %A Romero Falcón,Auxiliadora %A Ramos,Jacinto %A Bazús González,Teresa %A Andrés Prado,María %A Muriel,Alfonso %+ Department of Respiratory Medicine, Instituto Ramón y Cajal de Investigación Sanitaria, University of Alcala de Henares, Ctra. De Colmenar Viejo, km. 9,100, Madrid, , Spain, 34 655 534 475, caralmsan@gmail.com %K asthma %K adherence %K SMS %K control %K cell phone %K inhaler %K Smartinhaler %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor adherence to inhaled medication in asthma patients is of great concern. It is one of the main reasons for inadequate asthma control. Objective: The goal of the research was to determine if motivational messages using short message service (SMS, or text) improved adherence to inhaled medication in patients with asthma. Methods: A prospective multicenter randomized parallel-group clinical trial was conducted in 10 asthma clinics in Spain. Adherence was assessed with electronic monitors (Smartinhaler, Adherium Ltd) connected to inhalers. Patients in the SMS group received psychologist-developed motivational messages every 3 days for 6 months. Results: There were 53 patients in the SMS group and 88 patients in the control group. After 6 months, mean electronic adherence was 70% (SD 17%) in the intervention group and 69% (SD 17%) in the control group (P=.82). Significant differences between the study groups in morning and evening adherence to inhaled therapy, asthma control, exhaled nitric oxide levels, or improvement of lung functions were not observed. Conclusions: Motivational messages were not useful to improve adherence to inhaled asthma medication compared with usual care. %M 33560235 %R 10.2196/12218 %U http://formative.jmir.org/2021/2/e12218/ %U https://doi.org/10.2196/12218 %U http://www.ncbi.nlm.nih.gov/pubmed/33560235 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e25062 %T An Asynchronous, Mobile Text-Based Platform (XatJove Anoia) for Providing Health Services to Teenagers: Protocol for a Quasiexperimental Study %A Sauch Valmaña,Glòria %A Vidal-Alaball,Josep %A Garcia Furió,Victoria %A Testoni,Giorgia %A Espelt,Albert %A Exposito,Katarin %A Saigí-Rubió,Francesc %A Carré,Núria %A Sanz,Ikuska %A Vicens,Victor %+ Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Carrer Pica d'Estats, 36, Sant Fruitós de Bages, 08272, Spain, 34 6930040, jvidal.cc.ics@gencat.cat %K mHealth %K telehealth %K teenager %K health promotion and sexual health %K health promotion %K sexual health %D 2021 %7 3.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Due to the COVID-19 pandemic, it is more essential than ever to implement protective measures in primary care centers to ensure patients’ safety. This protocol describes a quasiexperimental study on the use of a mobile chat platform as a clinical consultation tool for adolescents and primary health care physicians. Objective: The purpose of the quasiexperimental study is to demonstrate that the use of mobile phones and messaging apps increases the number of health consultations. The study will be performed as part of the Health and School program in the Anoia region. Methods: The quasiexperimental study will compare the number of face-to-face consultations to the number of consultations conducted on XatJove Anoia, as part of the Health in Schools program in the Anoia region. The study will involve the use of a new communication platform (ie, XatJove Anoia) for health care professionals and adolescents, and data on the number of face-to-face consultations will be collected as part of the same program in another region. Data will be collected from secondary schools during the academic year 2020-2021. Statistical analyses will be performed on the data that users will enter in the registration form. These data will be collected by means of a questionnaire, which will be submitted once the questionnaire is closed. The questionnaire will consist of multiple-choice questions, which will allow numerical values to be assigned to various responses in order to carry out statistical analyses. Results: The study is projected to start at the beginning of November 2020 and finish in June 2021, which is when data analysis is expected to start. Conclusions: The results of the quasiexperimental study may assist in the development and planning of school health programs. Trial Registration: ClinicalTrials.gov NCT04562350; https://clinicaltrials.gov/ct2/show/NCT04562350. International Registered Report Identifier (IRRID): PRR1-10.2196/25062 %M 33533729 %R 10.2196/25062 %U https://www.researchprotocols.org/2021/2/e25062 %U https://doi.org/10.2196/25062 %U http://www.ncbi.nlm.nih.gov/pubmed/33533729 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e23690 %T A Tailored Web- and Text-Based Intervention to Increase Physical Activity for Latino Men: Protocol for a Randomized Controlled Feasibility Trial %A Gans,Kim M %A Dulin,Akilah %A Palomo,Vanessa %A Benitez,Tanya %A Dunsiger,Shira %A Dionne,Laura %A Champion,Gregory %A Edgar,Rachelle %A Marcus,Bess %+ Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT, 06269-1058, United States, 1 8604863865, kim.gans@uconn.edu %K physical activity %K Latino %K Hispanic %K men %K eHealth %K expert system %K internet %K text messaging %K mobile phone %K social media %D 2021 %7 29.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Latino men in the United States report low physical activity (PA) levels and related health conditions (eg, diabetes and obesity). Engaging in regular PA can reduce the risk of chronic diseases and yield many health benefits; however, there is a paucity of interventions developed exclusively for Latino men. Objective: To address the need for culturally relevant PA interventions, this study aims to develop and evaluate Hombres Saludables, a 6-month theory-based, tailored web- and text message-based PA intervention in Spanish for Latino men. This protocol paper describes the study design, intervention, and evaluation methods for Hombres Saludables. Methods: Latino men aged 18-65 years were randomized to either the individually tailored PA internet intervention arm or the nutrition and wellness internet control arm. The PA intervention included 2 check-in phone calls; automated SMS text messages; a pedometer; a 6-month gym membership; access to a private Facebook group; and an interactive website with PA tracking, goal setting, and individually tailored PA content. The primary outcomes were feasibility, acceptability, and efficacy (minutes per week of total moderate-to-vigorous PA assessed via the ActiGraph GT3X+ accelerometer worn at the waist and 7-day physical activity recall at baseline and 6 months). Secondary outcomes examined potential moderators (eg, demographics, acculturation, and environmental variables) and mediators (eg, self-efficacy and cognitive and behavioral processes of change) of treatment effects at 6 months post randomization. Results: This study was funded in September 2016. Initial institutional review board approval was received in February 2017, and focus groups and intervention development were conducted from April 2017 to January 2018. Recruitment for the clinical trial was carried out from February 2018 to July 2019. Baseline data collection was carried out from February 2018 to October 2019, with a total of 43 participants randomized. Follow-up data were collected through April 2020. Data cleaning and analysis are ongoing. Conclusions: We developed and tested protocols for a highly accessible, culturally and linguistically relevant, theory-driven PA intervention for Latino men. Hombres Saludables used an innovative, interactive, web- and text message–based intervention for improving PA among Latino men, an underserved population at risk of low PA and related chronic disease. If the intervention demonstrates feasibility, acceptability, and preliminary efficacy, we will refine and evaluate it in a larger randomized control trial. Trial Registration: Clinicaltrials.gov: NCT03196570; https://clinicaltrials.gov/ct2/show/NCT03196570 International Registered Report Identifier (IRRID): DERR1-10.2196/23690 %M 33512327 %R 10.2196/23690 %U http://www.researchprotocols.org/2021/1/e23690/ %U https://doi.org/10.2196/23690 %U http://www.ncbi.nlm.nih.gov/pubmed/33512327 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e19506 %T Optimizing an Obesity Treatment Using the Multiphase Optimization Strategy Framework: Protocol for a Randomized Factorial Trial %A Bennett,Gary G %A Steinberg,Dori %A Bolton,Jamiyla %A Gallis,John A %A Treadway,Cayla %A Askew,Sandy %A Kay,Melissa C %A Pollak,Kathryn I %A Turner,Elizabeth L %+ Duke Global Health Institute, Duke University, 310 Trent Drive, Room 236, Durham, NC, 27708, United States, 1 9193954119, jamiyla.bolton@duke.edu %K text message %K digital health %K weight loss %K personalized %D 2021 %7 18.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Effective weight loss interventions exist, yet few can be scaled up for wide dissemination. Further, none has been fully delivered via text message. We used the multiphase optimization strategy (MOST) to develop multicomponent interventions that consist only of active components, those that have been experimentally determined to impact the chosen outcome. Objective: The goal of this study is to optimize a standalone text messaging obesity intervention, Charge, using the MOST framework to experimentally determine which text messaging components produce a meaningful contribution to weight change at 6 months. Methods: We designed a 6-month, weight loss texting intervention based on our interactive obesity treatment approach (iOTA). Participants are randomized to one of 32 experimental conditions to test which standalone text messaging intervention components produce a meaningful contribution to weight change at 6 months. Results: The project was funded in February 2017; enrollment began in January 2018 and data collection was completed in June 2019. Data analysis is in progress and first results are expected to be submitted for publication in 2021. Conclusions: Full factorial trials are particularly efficient in terms of cost and logistics when leveraged for standalone digital treatments. Accordingly, MOST has the potential to promote the rapid advancement of digital health treatments. Subject to positive findings, the intervention will be low cost, immediately scalable, and ready for dissemination. This will be of great potential use to the millions of Americans with obesity and the providers who treat them. Trial Registration: ClinicalTrials.gov NCT03254940; https://clinicaltrials.gov/ct2/show/NCT03254940 International Registered Report Identifier (IRRID): RR1-10.2196/19506 %M 33459600 %R 10.2196/19506 %U http://www.researchprotocols.org/2021/1/e19506/ %U https://doi.org/10.2196/19506 %U http://www.ncbi.nlm.nih.gov/pubmed/33459600 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e19109 %T Young People’s Experiences Using an On-Demand Mobile Health Sexual and Reproductive Health Text Message Intervention in Kenya: Qualitative Study %A Mwaisaka,Jefferson %A Gonsalves,Lianne %A Thiongo,Mary %A Waithaka,Michael %A Sidha,Hellen %A Alfred,Otieno %A Mukiira,Carol %A Gichangi,Peter %+ International Centre for Reproductive Health, Kenya, Tom Mboya Street, Mombasa, Kenya, 254 723 206 132, jeffmwaisaka@gmail.com %K mHealth %K mobile phones %K sexual and reproductive health %K Kenya %D 2021 %7 15.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital health usability assessments can help explain how well mobile health (mHealth) apps targeting young people with sexual and reproductive health (SRH) information performed and whether the intended purpose was achieved. However, few digital health assessments have been conducted to evaluate young people’s perceptions regarding mHealth system interactions and content relevance on a wide range of SRH topics. In addition, the majority of randomized controlled trials (RCTs) have focused on push messaging platforms; therefore, the mHealth field lacks sufficient RCTs investigating on-demand mHealth SRH platforms. Objective: The objective of this study was to explore young people’s experiences using an on-demand SRH mHealth platform in Kenya. Methods: We used qualitative data related to the usability of an mHealth platform, Adolescent/Youth Reproductive Mobile Access and Delivery Initiatives for Love and Life Outcome (ARMADILLO), collected at the end of the intervention period. A total of 30 in-depth interviews (IDIs) were held with the intervention participants (15 women and 15 men) to elicit their experiences, opinions, and perspectives on the design and content of the ARMADILLO platform. The study participants were randomly selected from a list of intervention arm participants to participate in the IDIs. The interviews were later transcribed verbatim, translated into English, and coded and analyzed thematically using NVivo version 12 software (QSR International). Results: Respondents reported varied user experiences and levels of satisfaction, ranging from ease of use by the majority of the respondents to systematic frustrations that prevented some participants from progressing to other stages. Interesting features of the mHealth platform included the immediate response participants received when requesting messages, weekly remunerated quizzes, and perceived ability of educative and informative content and messages to change behaviors. Proposed enhancements to the platform included revising some concepts and words for easy understanding and increasing the interactivity of the platform, whereby young people could seek clarity when they came across difficult terms or had additional questions about the information they received. Conclusions: The importance of understanding the range of health literacy and technological variations when dealing with young people cannot be overemphasized. Young people, as mHealth end users, must be considered throughout intervention development to achieve optimum functionality. In addition, young people targeted with mHealth SRH interventions must be sensitized to the interactions on mHealth platforms or any other digital health apps if implemented in a nonresearch setting for optimal use by the targeted audience. %M 33448930 %R 10.2196/19109 %U http://mhealth.jmir.org/2021/1/e19109/ %U https://doi.org/10.2196/19109 %U http://www.ncbi.nlm.nih.gov/pubmed/33448930 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e23592 %T A Text Messaging Intervention for Coping With Social Distancing During COVID-19 (StayWell at Home): Protocol for a Randomized Controlled Trial %A Figueroa,Caroline Astrid %A Hernandez-Ramos,Rosa %A Boone,Claire Elizabeth %A Gómez-Pathak,Laura %A Yip,Vivian %A Luo,Tiffany %A Sierra,Valentín %A Xu,Jing %A Chakraborty,Bibhas %A Darrow,Sabrina %A Aguilera,Adrian %+ School of Social Welfare, University of California Berkeley, 105 Havilland Hall, Berkeley, CA, 94709, United States, 1 5106436669, c.a.figueroa@berkeley.edu %K COVID-19 %K mental health %K depression %K reinforcement learning %K microrandomized trial %D 2021 %7 14.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social distancing is a crucial intervention to slow down person-to-person transmission of COVID-19. However, social distancing has negative consequences, including increases in depression and anxiety. Digital interventions, such as text messaging, can provide accessible support on a population-wide scale. We developed text messages in English and Spanish to help individuals manage their depressive mood and anxiety during the COVID-19 pandemic. Objective: In a two-arm randomized controlled trial, we aim to examine the effect of our 60-day text messaging intervention. Additionally, we aim to assess whether the use of machine learning to adapt the messaging frequency and content improves the effectiveness of the intervention. Finally, we will examine the differences in daily mood ratings between the message categories and time windows. Methods: The messages were designed within two different categories: behavioral activation and coping skills. Participants will be randomized into (1) a random messaging arm, where message category and timing will be chosen with equal probabilities, and (2) a reinforcement learning arm, with a learned decision mechanism for choosing the messages. Participants in both arms will receive one message per day within three different time windows and will be asked to provide their mood rating 3 hours later. We will compare self-reported daily mood ratings; self-reported depression, using the 8-item Patient Health Questionnaire; and self-reported anxiety, using the 7-item Generalized Anxiety Disorder scale at baseline and at intervention completion. Results: The Committee for the Protection of Human Subjects at the University of California Berkeley approved this study in April 2020 (No. 2020-04-13162). Data collection began in April 2020 and will run to April 2021. As of August 24, 2020, we have enrolled 229 participants. We plan to submit manuscripts describing the main results of the trial and results from the microrandomized trial for publication in peer-reviewed journals and for presentations at national and international scientific meetings. Conclusions: Results will contribute to our knowledge of effective psychological tools to alleviate the negative effects of social distancing and the benefit of using machine learning to personalize digital mental health interventions. Trial Registration: ClinicalTrials.gov NCT04473599; https://clinicaltrials.gov/ct2/show/NCT04473599 International Registered Report Identifier (IRRID): DERR1-10.2196/23592 %M 33370721 %R 10.2196/23592 %U http://www.researchprotocols.org/2021/1/e23592/ %U https://doi.org/10.2196/23592 %U http://www.ncbi.nlm.nih.gov/pubmed/33370721 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e16508 %T Text Message Interventions in Adolescent Mental Health and Addiction Services: Scoping Review %A MacDougall,Sarah %A Jerrott,Susan %A Clark,Sharon %A Campbell,Leslie Anne %A Murphy,Andrea %A Wozney,Lori %+ Mental Health and Addictions, Policy and Planning, Nova Scotia Health, 200 Pleasant Street, Dartmouth, NS, B2Y 3S3, Canada, 1 (902) 471 5463, lori.wozney@nshealth.ca %K adolescent %K mental health %K eHealth %K text messaging %K SMS %K information science %K cell phone %K implementation %K review %D 2021 %7 8.1.2021 %9 Review %J JMIR Ment Health %G English %X Background: The vast majority of adolescent mental health and substance use disorders go undiagnosed and undertreated. SMS text messaging is increasingly used as a method to deliver adolescent health services that promote psychological well-being and aim to protect adolescents from adverse experiences and risk factors critical for their current and future mental health. To date, there has been no comprehensive synthesis of the existing literature on the extent, range, and implementation contexts of these SMS text message interventions. Objective: The objective of this scoping review was to map and categorize gaps in the current body of peer-reviewed research around the use of SMS text messaging–based interventions for mental health and addiction services among adolescents. Methods: A scoping review was conducted according to Levac’s adaptation of Arksey and O’Malley’s methodological framework for scoping reviews in six iterative stages. A search strategy was cocreated and adapted for five unique databases. Studies were screened using Covidence software. The PICO (patient, intervention, comparator, outcome) framework and input from multiple stakeholder groups were used to structure and pilot a data extraction codebook. Data were extracted on study methodology and measures, intervention design, and implementation characteristics, as well as policy, practice, and research implications. Results: We screened 1142 abstracts. Of these, 31 articles published between 2013 and 2020 were eligible for inclusion. Intervention engagement was the most common type of outcome measured (18/31), followed by changes in cognitions (16/31; eg, disease knowledge, self-awareness) and acceptability (16/31). Interventions were typically delivered in less than 12 weeks, and adolescents received 1-3 messages per week. Bidirectional messaging was involved in 65% (20/31) of the studies. Limited descriptions of implementation features (eg, cost, policy implications, technology performance) were reported. Conclusions: The use of SMS text messaging interventions is a rapidly expanding area of research. However, lack of large-scale controlled trials and theoretically driven intervention designs limits generalizability. Significant gaps in the literature were observed in relation to implementation considerations, cost, clinical workflow, bidirectionality of texting, and level of personalization and tailoring of the interventions. Given the growth of mobile phone–based interventions for this population, a rigorous program of large-scale, well-designed trials is urgently required. %M 33416504 %R 10.2196/16508 %U https://mental.jmir.org/2021/1/e16508 %U https://doi.org/10.2196/16508 %U http://www.ncbi.nlm.nih.gov/pubmed/33416504 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e23725 %T Prevalence of Mental Illnesses in Domestic Violence Police Records: Text Mining Study %A Karystianis,George %A Simpson,Annabeth %A Adily,Armita %A Schofield,Peter %A Greenberg,David %A Wand,Handan %A Nenadic,Goran %A Butler,Tony %+ School of Population Health, University of New South Wales, Level 3, Samuels Building, Gate 11, Botany Street, UNSW Kensington Campus, Sydney, 2052, Australia, 61 (2) 9385 3811, g.karystianis@unsw.edu.au %K text mining %K mental illnesses %K domestic violence %K police data %K trend analysis %D 2020 %7 24.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The New South Wales Police Force (NSWPF) records details of significant numbers of domestic violence (DV) events they attend each year as both structured quantitative data and unstructured free text. Accessing information contained in the free text such as the victim’s and persons of interest (POI's) mental health status could be useful in the better management of DV events attended by the police and thus improve health, justice, and social outcomes. Objective: The aim of this study is to present the prevalence of extracted mental illness mentions for POIs and victims in police-recorded DV events. Methods: We applied a knowledge-driven text mining method to recognize mental illness mentions for victims and POIs from police-recorded DV events. Results: In 416,441 police-recorded DV events with single POIs and single victims, we identified 64,587 events (15.51%) with at least one mental illness mention versus 4295 (1.03%) recorded in the structured fixed fields. Two-thirds (67,582/85,880, 78.69%) of mental illnesses were associated with POIs versus 21.30% (18,298/85,880) with victims; depression was the most common condition in both victims (2822/12,589, 22.42%) and POIs (7496/39,269, 19.01%). Mental illnesses were most common among POIs aged 0-14 years (623/1612, 38.65%) and in victims aged over 65 years (1227/22,873, 5.36%). Conclusions: A wealth of mental illness information exists within police-recorded DV events that can be extracted using text mining. The results showed mood-related illnesses were the most common in both victims and POIs. Further investigation is required to determine the reliability of the mental illness mentions against sources of diagnostic information. %M 33361056 %R 10.2196/23725 %U http://www.jmir.org/2020/12/e23725/ %U https://doi.org/10.2196/23725 %U http://www.ncbi.nlm.nih.gov/pubmed/33361056 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e21602 %T Grocery Delivery of Healthy Foods to Pregnant Young Women With Low Incomes: Feasibility and Acceptability Mixed Methods Study %A Locher,Ione %A Waselewski,Marika %A Sonneville,Kendrin %A Resnicow,Ken %A Chang,Tammy %+ University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, United States, 1 734 730 4636, tachang@med.umich.edu %K pregnancy %K adolescent %K young adult %K female %K gestational weight gain %K diet %K food preferences %K text messaging %K feasibility studies %D 2020 %7 24.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor maternal diets increase the risk of excess gestational weight gain which can contribute to serious intergenerational morbidity for both the mother and infant. Pregnant young women with low incomes have disproportionately high rates of inadequate fruit and vegetable consumption as well as excess weight gains during pregnancy. Objective: Our aim was to describe the feasibility and acceptability of Special Delivery, a longitudinal nutrition intervention that delivers healthy foods to pregnant youth (aged 14-24 years) with low incomes. Methods: The Special Delivery pilot study, conducted in Michigan, enrolled pregnant young women with low incomes. Study participants were sent twice-monthly grocery deliveries consisting of US $35 worth of healthy foods, primarily fruits and vegetables. Between grocery deliveries, participants received daily SMS text message prompts to confirm receipt of delivery and document diet and weight. Program feasibility was assessed by the number of grocery orders placed, delivered, and confirmed by participants. Qualitative interviews and SMS text message data were used to determine acceptability by assessing participants’ perspectives on grocery delivery, participants’ perspectives on dietary impact of the program, and foods consumed by participants. Results: A total of 27 participants were enrolled in the pilot study. The mean age was 20.3 years (SD 2.0), and 59.3% (16/27) were African American or Black. During the pilot, 263 deliveries were sent with 98.5% (259/263) successful deliveries and 89.4% (235/263) deliveries confirmed by participants. Participants reported that grocery delivery was convenient; that delivered foods were high quality; and that the program improved their diet, increased access to healthy foods, and promoted healthy habits during pregnancy. Conclusions: A grocery delivery–based weight gain and nutrition intervention is both feasible and acceptable among low-income pregnant youth. Grocery deliveries were successfully completed and participants were willing and able to receive grocery deliveries, eat the healthy foods that were delivered, and communicate via SMS text message with study coordinators. The Special Delivery program warrants further evaluation for efficacy in promoting healthy weight gain for low-income youth during pregnancy. %M 33361055 %R 10.2196/21602 %U http://formative.jmir.org/2020/12/e21602/ %U https://doi.org/10.2196/21602 %U http://www.ncbi.nlm.nih.gov/pubmed/33361055 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e15524 %T An Interactive Text Message Survey as a Novel Assessment for Bedtime Routines in Public Health Research: Observational Study %A Kitsaras,George %A Goodwin,Michaela %A Allan,Julia %A Kelly,Michael %A Pretty,Iain %+ University of Manchester, Dental Health Unit, Williams House Manchester Science Park, Manchester, M15 6SE, United Kingdom, 44 01612261211, georgios.kitsaras@manchester.ac.uk %K digital technologies %K mobile health %K child %K well-being %K development %K assessment %K bedtime routines %K P4 health care %K text survey %D 2020 %7 21.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Traditional research approaches, especially questionnaires and paper-based assessments, limit in-depth understanding of the fluid dynamic processes associated with child well-being and development. This includes bedtime routine activities such as toothbrushing and reading a book before bed. The increase in innovative digital technologies alongside greater use and familiarity among the public creates unique opportunities to use these technical developments in research. Objective: This study aimed to (1) examine the best way of assessing bedtime routines in families and develop an automated, interactive, text message survey assessment delivered directly to participants’ mobile phones and (2) test the assessment within a predominately deprived sociodemographic sample to explore retention, uptake, feedback, and effectiveness. Methods: A public and patient involvement project showed clear preference for interactive text surveys regarding bedtime routines. The developed interactive text survey included questions on bedtime routine activities and was delivered for seven consecutive nights to participating parents’ mobile phones. A total of 200 parents participated. Apart from the completion of the text survey, feedback was provided by participants, and data on response, completion, and retention rates were captured. Results: There was a high retention rate (185/200, 92.5%), and the response rate was high (160/185, 86.5%). In total, 114 participants provided anonymized feedback. Only a small percentage (5/114, 4.4%) of participants reported problems associated with completing the assessment. The majority (99/114, 86.8%) of participants enjoyed their participation in the study, with an average satisfaction score of 4.6 out of 5. Conclusions: This study demonstrated the potential of deploying SMS text message–based surveys to capture and quantify real-time information on recurrent dynamic processes in public health research. Changes and adaptations based on recommendations are crucial next steps in further exploring the diagnostic and potential intervention properties of text survey and text messaging approaches. %M 33346734 %R 10.2196/15524 %U http://publichealth.jmir.org/2020/4/e15524/ %U https://doi.org/10.2196/15524 %U http://www.ncbi.nlm.nih.gov/pubmed/33346734 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e22423 %T Changes in Stress, Anxiety, and Depression Levels of Subscribers to a Daily Supportive Text Message Program (Text4Hope) During the COVID-19 Pandemic: Cross-Sectional Survey Study %A Agyapong,Vincent Israel Ouoku %A Hrabok,Marianne %A Vuong,Wesley %A Shalaby,Reham %A Noble,Jasmine Marie %A Gusnowski,April %A Mrklas,Kelly J %A Li,Daniel %A Urichuk,Liana %A Snaterse,Mark %A Surood,Shireen %A Cao,Bo %A Li,Xin-Min %A Greiner,Russell %A Greenshaw,Andrew James %+ Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 780 215 7771, agyapong@ualberta.ca %K COVID-19 %K mobile technology %K text %K anxiety %K depression %K stress %K outbreak %K pandemic %K mental health %K outreach %D 2020 %7 18.12.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: In addition to the obvious physical medical impact of COVID-19, the disease poses evident threats to people’s mental health, psychological safety, and well-being. Provision of support for these challenges is complicated by the high number of people requiring support and the need to maintain physical distancing. Text4Hope, a daily supportive SMS text messaging program, was launched in Canada to mitigate the negative mental health impacts of the pandemic among Canadians. Objective: This paper describes the changes in the stress, anxiety, and depression levels of subscribers to the Text4Hope program after 6 weeks of exposure to daily supportive SMS text messages. Methods: We used self-administered, empirically supported web-based questionnaires to assess the demographic and clinical characteristics of Text4Hope subscribers. Perceived stress, anxiety, and depression were measured with the 10-Item Perceived Stress Scale (PSS-10), the Generalized Anxiety Disorder–7 (GAD-7) scale, and the Patient Health Questionnaire–9 (PHQ-9) scale at baseline and sixth week time points. Moderate or high perceived stress, likely generalized anxiety disorder, and likely major depressive disorder were assessed using cutoff scores of ≥14 for the PSS-10, ≥10 for the GAD-7, and ≥10 for the PHQ-9, respectively. At 6 weeks into the program, 766 participants had completed the questionnaires at both time points. Results: At the 6-week time point, there were statistically significant reductions in mean scores on the PSS-10 and GAD-7 scales but not on the PHQ-9 scale. Effect sizes were small overall. There were statistically significant reductions in the prevalence rates of moderate or high stress and likely generalized anxiety disorder but not likely major depressive disorder for the group that completed both the baseline and 6-week assessments. The largest reductions in mean scores and prevalence rates were for anxiety (18.7% and 13.5%, respectively). Conclusions: Text4Hope is a convenient, cost-effective, and accessible means of implementing a population-level psychological intervention. This service demonstrated significant reductions in anxiety and stress levels during the COVID-19 pandemic and could be used as a population-level mental health intervention during natural disasters and other emergencies. International Registered Report Identifier (IRRID): RR2-10.2196/19292 %M 33296330 %R 10.2196/22423 %U http://mental.jmir.org/2020/12/e22423/ %U https://doi.org/10.2196/22423 %U http://www.ncbi.nlm.nih.gov/pubmed/33296330 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e21592 %T A Culturally Adapted SMS Text Messaging Intervention to Promote Antiretroviral Therapy Adherence Among African Americans: Protocol for a Single-Arm Trial %A Kohli,Maulika %A Pasipanodya,Elizabeth C %A Montoya,Jessica L %A Marquine,Maria %A Hoenigl,Martin %A Serrano,Vanessa %A Cushman,Clint %A Garcia,Rogelio %A Kua,John %A Gant,Verna %A Rojas,Sarah %A Moore,David J %+ HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson St # B, San Diego, CA, 92103, United States, 1 619 543 5093, djmoore@health.ucsd.edu %K medication adherence %K behavior modification %K short message service %K mHealth %K HIV/AIDS %D 2020 %7 10.12.2020 %9 Original Paper %J JMIR Res Protoc %G English %X Background: African Americans are disproportionally affected by HIV and have poorer rates of antiretroviral therapy (ART) adherence compared to other racial or ethnic groups in the United States. Factors associated with poor HIV disease outcomes are commonly associated with sociostructural barriers that prevent engagement with and retention in HIV care. SMS text messaging interventions to promote ART adherence among predominantly non-Hispanic White persons with HIV (PWH) have been shown to be efficacious; however, limited research has been devoted to culturally tailoring interventions for underrepresented racial/ethnic groups. Considering African Americans show poorer engagement along the HIV care continuum, we developed an individualized and culturally tailored two-way SMS text messaging intervention to improve ART adherence and associated virologic suppression among African American PWH. Objective: In this paper we describe the protocol of a culturally tailored individualized Texting for Adherence Building (iTAB) intervention in a 24- to 48-week, single-arm study. Methods: We developed a culturally tailored iTAB intervention, which we are implementing in a 24- to 48-week, single-arm study. Participants were recruited from the Family Health Centers of San Diego (FHCSD), a federally qualified health center. Patient inclusion criteria were (1) receiving care at the FHCSD, (2) living with HIV, (3) self-identification as Black, African American, or of African ancestry, (4) English speaking, (5) age 18 or older, (6) currently on ART, and (7) able to provide informed consent. Study enrollment began in November 2017 and closed in July 2019. A total of 90 participants from the FHCSD enrolled in the iTAB intervention, and we anticipate completing data collection in July 2020. Participants were assisted in individualizing and customizing their SMS text message preferences at the baseline study visit. Self-assessment measures are collected at baseline, interim, and final study visits. Problems related to sending/receiving SMS text messages and barriers to ART adherence are assessed at each interim study visit. The FHCSD staff monitors and tracks participants’ daily SMS text message responses to ART adherence reminders using a clinical dashboard. Results: We hypothesize that the proportion of individuals achieving HIV virologic suppression (viral load <40 copies/mL) will be greater at the end of the intervention period compared to the proportion prior to study implementation. Additionally, we anticipate that rates of virologic suppression at the end of the intervention among participants receiving iTAB will be comparable to those among the general FHCSD non-African American population who did not receive iTAB. Finally, we anticipate a high response rate to iTAB SMS text messages as well as positive participant feedback at the end of the intervention with regard to the acceptability of, satisfaction with, and perceived efficacy of iTAB. Conclusions: The iTAB intervention is a novel individualized two-way SMS text messaging intervention that has been culturally tailored for use among African Americans with HIV. We anticipate that iTAB will demonstrate efficacy in future randomized control trials and will be supportive of medication adherence among other populations facing health disparities. International Registered Report Identifier (IRRID): DERR1-10.2196/21592 %M 33300885 %R 10.2196/21592 %U https://www.researchprotocols.org/2020/12/e21592 %U https://doi.org/10.2196/21592 %U http://www.ncbi.nlm.nih.gov/pubmed/33300885 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e19137 %T Awareness Development and Usage of Mobile Health Technology Among Individuals With Hypertension in a Rural Community of Bangladesh: Randomized Controlled Trial %A Jahan,Yasmin %A Rahman,Md Moshiur %A Faruque,Abu S G %A Chisti,Mohammod Jobayer %A Kazawa,Kana %A Matsuyama,Ryota %A Moriyama,Michiko %+ Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Minami-ku, Kasumi-cho, Hiroshima-shi, Hiroshima, 7340046, Japan, 81 0822575365, dr.yasminjahan@gmail.com %K mobile health %K hypertension %K behavior changes %K awareness development %K lifestyle %K Bangladesh %D 2020 %7 7.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Hypertension (HTN) is a major modifiable risk factor and the leading cause of premature deaths globally. The lack of awareness and knowledge have been identified as risk factors in low- and middle-income countries including Bangladesh. Recently, the use of mobile phone SMS text messaging is found to have an important positive impact on HTN management. Objective: The study aimed to develop awareness and knowledge in order to enhance lifestyle behavior changes among individuals with HTN in a rural community of Bangladesh by using health education and mobile health (mHealth) technology (SMS text messaging). Methods: A prospective randomized 5-month intervention, open-label (1:1), parallel-group trial was implemented among the individuals with HTN aged 35 years or older. Both men and women were included. Between August 2018 and July 2019, we enrolled 420 participants, selected from a tertiary level health facility and through door-to-door visits by community health workers. After block randomization, they were assigned to either the intervention group (received SMS text messaging and health education; n=209) or the control group (received only health education; n=211). The primary outcome was the evaluation of self-reported behavior changes (salt intake, fruits and vegetables intake, physical activity, and blood pressure [BP], and body weight monitoring behaviors). The secondary outcomes were measurements of actual salt intake and dietary salt excretion, blood glucose level, BP values, and quality of life (QOL). Results: During the study period, a total of 8 participants were dropped, and the completion rate was 98.0% (412/420). The adherence rates were significantly higher (9%) among the control group regarding salt intake (P=.04) and physical activity behaviors (P<.03), and little differences were observed in other behaviors. In primary outcome, the focused behavior, salt intake less than 6 g/day, showed significant chronological improvement in both groups (P<.001). The fruits intake behavior steadily improved in both groups (P<.001). Participants in both groups had a custom of vegetables intake everyday/week. Physical activity suddenly increased and continued until the study end (P<.001 in both groups). Both BP and body weight monitoring status increased from baseline to 1 month but decreased afterward (P<.001). In case of secondary outcomes, significant chronological changes were observed in food salt concentration and urinary salinity between the groups (P=.01). The mean systolic BP and diastolic BP significantly chronologically decreased in both groups (systolic BP, P=.04; diastolic BP, P=.02.P<.05). All of these supported self-reported behavior changes. For the QOL, both groups showed significant improvement over the study periods (P<.001). Conclusions: Based on these results, we suggest that face-to-face health education requires integration of home health care provision and more relevant and timely interactive SMS text messages to increase the effectiveness of the intervention. Besides, community awareness can be created to encourage “low-salt culture” and educate family members. Trial Registration: Bangladesh Medical Research Council (BMRC) 06025072017; ClinicalTrials.gov NCT03614104; https://clinicaltrials.gov/ct2/show/NCT03614104 and UMIN-CTR R000033736; https://tinyurl.com/y48yfcoo International Registered Report Identifier (IRRID): RR2-10.2196/15523 %M 33284129 %R 10.2196/19137 %U https://www.jmir.org/2020/12/e19137 %U https://doi.org/10.2196/19137 %U http://www.ncbi.nlm.nih.gov/pubmed/33284129 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e22493 %T Patient Interaction Phenotypes With an Automated Remote Hypertension Monitoring Program and Their Association With Blood Pressure Control: Observational Study %A Davoudi,Anahita %A Lee,Natalie S %A Chivers,Corey %A Delaney,Timothy %A Asch,Elizabeth L %A Reitz,Catherine %A Mehta,Shivan J %A Chaiyachati,Krisda H %A Mowery,Danielle L %+ National Clinician Scholars Program, University of Pennsylvania, 423 Guardian Drive, 13th Floor, Blockley Hall, Philadelphia, PA , United States, 1 215 898 6237, natalie.lee@pennmedicine.upenn.edu %K text messaging %K hypertension %K telemedicine %K cluster analysis %D 2020 %7 3.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Automated texting platforms have emerged as a tool to facilitate communication between patients and health care providers with variable effects on achieving target blood pressure (BP). Understanding differences in the way patients interact with these communication platforms can inform their use and design for hypertension management. Objective: Our primary aim was to explore the unique phenotypes of patient interactions with an automated text messaging platform for BP monitoring. Our secondary aim was to estimate associations between interaction phenotypes and BP control. Methods: This study was a secondary analysis of data from a randomized controlled trial for adults with poorly controlled hypertension. A total of 201 patients with established primary care were assigned to the automated texting platform; messages exchanged throughout the 4-month program were analyzed. We used the k-means clustering algorithm to characterize two different interaction phenotypes: program conformity and engagement style. First, we identified unique clusters signifying differences in program conformity based on the frequency over time of error alerts, which were generated to patients when they deviated from the requested text message format (eg, ###/## for BP). Second, we explored overall engagement styles, defined by error alerts and responsiveness to text prompts, unprompted messages, and word count averages. Finally, we applied the chi-square test to identify associations between each interaction phenotype and achieving the target BP. Results: We observed 3 categories of program conformity based on their frequency of error alerts: those who immediately and consistently submitted texts without system errors (perfect users, 51/201), those who did so after an initial learning period (adaptive users, 66/201), and those who consistently submitted messages generating errors to the platform (nonadaptive users, 38/201). Next, we observed 3 categories of engagement style: the enthusiast, who tended to submit unprompted messages with high word counts (17/155); the student, who inconsistently engaged (35/155); and the minimalist, who engaged only when prompted (103/155). Of all 6 phenotypes, we observed a statistically significant association between patients demonstrating the minimalist communication style (high adherence, few unprompted messages, limited information sharing) and achieving target BP (P<.001). Conclusions: We identified unique interaction phenotypes among patients engaging with an automated text message platform for remote BP monitoring. Only the minimalist communication style was associated with achieving target BP. Identifying and understanding interaction phenotypes may be useful for tailoring future automated texting interactions and designing future interventions to achieve better BP control. %M 33270032 %R 10.2196/22493 %U https://www.jmir.org/2020/12/e22493 %U https://doi.org/10.2196/22493 %U http://www.ncbi.nlm.nih.gov/pubmed/33270032 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e22631 %T Mobile Texting and Lay Health Supporters to Improve Schizophrenia Care in a Resource-Poor Community in Rural China (LEAN Trial): Randomized Controlled Trial Extended Implementation %A Cai,Yiyuan %A Gong,Wenjie %A He,Hua %A Hughes,James P %A Simoni,Jane %A Xiao,Shuiyuan %A Gloyd,Stephen %A Lin,Meijuan %A Deng,Xinlei %A Liang,Zichao %A He,Wenjun %A Dai,Bofeng %A Liao,Jing %A Hao,Yuantao %A Xu,Dong (Roman) %+ School of Public Health, Sun Yat-sen University, No 74 Zhongshan Road 2, Yuexiu District, Guangzhou, China, 86 020 87335523, haoyt@mail.sysu.edu.cn %K medication adherence %K mobile texting %K lay health worker %K resource-poor community %K primary health care %K quality of care %K mHealth %K schizophrenia %D 2020 %7 1.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Schizophrenia is a severe and disabling condition that presents a dire health equity challenge. Our initial 6-month trial (previously reported) using mobile texting and lay health supporters, called LEAN, significantly improved medication adherence from 0.48 to 0.61 (adjusted mean 0.11, 95% CI 0.03 to 0.20, P=.007) for adults with schizophrenia living in a resource-poor village in rural China. Objective: We explored the effectiveness of our texting program in improving participants’ medication adherence, functioning, and symptoms in an extended implementation of the intervention after its initial phase. Methods: In an approximated stepped-wedge wait-list design randomized controlled trial, 277 community-dwelling villagers with schizophrenia were assigned 1:1 in phase 1 into intervention and wait-list control groups. The intervention group received (1) lay health supporters (medication or care supervisors), (2) e-platform (mobile-texting reminders and education message) access, (3) a token gift for positive behavioral changes, and (4) integration with the existing government community-mental health program (the 686 Program) while the wait-listed control group initially only received the 686 Program. Subsequently (in the extended period), both groups received the LEAN intervention plus the 686 Program. The primary outcome was antipsychotic medication adherence (percentage of dosages taken over the past month assessed by unannounced home-based pill counts). The secondary outcomes were symptoms measured during visits to 686 Program psychiatrists using the Clinical Global Impression scale for schizophrenia and functioning measured by trained student assessors using the World Health Organization Disability Assessment Schedule 2.0. Other outcomes included data routinely collected in the 686 Program system (refill records, rehospitalization due to schizophrenia, death for any reason, suicide, wandering, and violent behaviors). We used intention-to-treat analysis and missing data were imputed. A generalized estimating equation model was used to assess program effects on antipsychotics medication adherence, symptoms, and functioning. Results: Antipsychotics medication adherence improved from 0.48 in the control period to 0.58 in the extended intervention period (adjusted mean difference 0.11, 95% CI 0.04 to 0.19; P=.004). We also noted an improvement in symptoms (adjusted mean difference –0.26, 95% CI –0.50 to –0.02; P=.04; Cohen d effect size 0.20) and a reduction in rehospitalization (0.37, 95% CI 0.18 to 0.76; P=.007; number-needed-to-treat 8.05, 95% CI 4.61 to 21.41). There was no improvement in functioning (adjusted mean difference 0.02, 95% CI –0.01 to 0.06; P=.18; Cohen d effect size 0.04). Conclusions: In an extended implementation, our intervention featuring mobile texting messages and lay health workers in a resource-poor community setting was more effective than the 686 Program alone in improving medication adherence, improving symptoms, and reducing rehospitalization. Trial Registration: Chinese Clinical Trial Registry; ChiCTR-ICR-15006053 https://tinyurl.com/y5hk8vng %M 33258788 %R 10.2196/22631 %U https://www.jmir.org/2020/12/e22631 %U https://doi.org/10.2196/22631 %U http://www.ncbi.nlm.nih.gov/pubmed/33258788 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 7 %N 2 %P e18860 %T Exploring Attitudes and Experiences of People With Knee Osteoarthritis Toward a Self-Directed eHealth Intervention to Support Exercise: Qualitative Study %A Nelligan,Rachel K %A Hinman,Rana S %A Teo,Pek Ling %A Bennell,Kim L %+ Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, 161 Barry Street, Parkville, 3010, Australia, 61 3 8344 4135, k.bennell@unimelb.edu.au %K text messaging %K mobile phone %K knee osteoarthritis %K exercise %K qualitative %K pain %D 2020 %7 26.11.2020 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Knee osteoarthritis (OA) is a highly prevalent and debilitating condition. Exercise is a recommended treatment because of its effectiveness at improving pain and function. However, exercise is underutilized in OA management. Difficulty accessing health care has been identified as a key barrier to exercise uptake. Innovative and scalable methods of delivering exercise treatments to people with knee OA are needed. We developed a self-directed eHealth intervention to enable and encourage exercise participation. The effectiveness of this intervention on pain and function in people with knee OA is being evaluated in a randomized clinical trial. Objective: This study aimed to explore the attitudes and experiences of people with knee OA who accessed the self-directed eHealth intervention and the features perceived as useful to facilitate self-directed exercise. Methods: This was a qualitative study embedded within a randomized controlled trial. Individual, semistructured phone interviews were conducted with 16 people with knee OA who had accessed a 24-week eHealth intervention (website and behavior change SMS program) designed to support exercise participation. Interviews were audiorecorded, transcribed verbatim, and thematically analyzed using an inductive approach. Results: Five themes arose: (1) technology easy to use and follow (website ease of use, SMS ease of use), (2) facilitators to exercise participation (credible OA and exercise information, website features, prescribed exercises simple to do unsupervised, freedom to adapt the exercise to suit needs, influence of other health care experiences), (3) sense of support and accountability (SMS good reminder and prompt, accountable, SMS tone and automation could trigger negative emotions [eg, guilt or shame], inability to contact someone when needed), (4) positive outcomes (knee symptom improvements, confidence to self-manage, encouraged active living), (5) suggestions for real-world application (provided by a health professional preferred, should be provided at subsidized or low out-of-pocket cost). Conclusions: People with knee OA had mostly positive experiences with and attitudes towards the use of an eHealth intervention that supported exercise participation independent of a health professional. A human connection associated with the eHealth intervention appeared important. %M 33242021 %R 10.2196/18860 %U http://rehab.jmir.org/2020/2/e18860/ %U https://doi.org/10.2196/18860 %U http://www.ncbi.nlm.nih.gov/pubmed/33242021 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e18364 %T Gamified Text Messaging Contingent on Device-Measured Steps: Randomized Feasibility Study of a Physical Activity Intervention for Cancer Survivors %A Robertson,Michael C %A Lyons,Elizabeth J %A Liao,Yue %A Baum,Miranda L %A Basen-Engquist,Karen M %+ Department of Behavioral Science, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, United States, 1 713 745 3123, kbasenen@mdanderson.org %K cancer survivors %K physical activity %K motivation %K self-control %K mobile health %K mobile phone %K technology %D 2020 %7 24.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity can confer diverse benefits on cancer survivors. Unfortunately, many cancer survivors are not sufficiently active. The efficacy of physical activity interventions for this population may be increased by grounding them in Self-Determination Theory (SDT). Combining game design elements with wearable technologies may be a useful and scalable approach to targeting SDT constructs to promote cancer survivors’ physical activity. Objective: The primary aim of this study is to evaluate the feasibility and acceptability of Steps2Health, a physical activity intervention for cancer survivors. It also aims to investigate the effects of the intervention on motivation, physical activity, and step count. Methods: We randomized 78 insufficiently active cancer survivors to an experimental or comparison group. All participants received a physical activity tracker. The experimental group participants also received a set sequence of multimedia messaging service messages that were triggered in real time by meeting predetermined cumulative step count totals. Messages presented information about a virtual journey and included photographs and vivid descriptions of locations to increase autonomous motivation. Additional messages targeted perceptions of relatedness (eg, role modeling) and competence (eg, facilitating mastery experiences). We administered pre- and postintervention surveys and conducted 15 individual interviews to evaluate the intervention. We performed directed content analysis of qualitative data and conducted mixed effects linear modeling to investigate participants’ changes in motivation, self-reported physical activity, and device-measured step counts. Results: There was minimal loss to follow-up (3/78, 4%), the device wear rate was high (2548/3044, 83.71% of days), and technical problems with messaging based on real-time step counts were limited. Our qualitative data analysis revealed 3 overarching themes: accessibility, autonomous motivation, and relatedness. Participants successfully navigated the technological aspects and game design elements of the intervention. Participants found messages targeting autonomous motivation and competence or self-efficacy to be enjoyable and compelling, but one feasibility criterion for participant engagement (response rate to text messages) was not met. Messages targeting relatedness were less highly rated than the messages targeting autonomous motivation and competence or self-efficacy. During the intervention, both groups increased their motivation for physical activity (B=0.16; 95% CI 0.01 to 0.30; P=.04; d=0.49), and assignment to the experimental group was associated with increased self-reported leisure activity score (B=10.78; 95% CI 3.54 to 18.02; P=.005; d=0.64). The experimental group had greater increases in daily step counts over time (B=322.08; 95% CI 54.01 to 590.15; P=.02; d=0.28). Conclusions: This study supports the feasibility of using real-time game design elements to target SDT constructs and increase cancer survivors’ physical activity. Overall, our findings support the acceptability of the Steps2Health intervention, but fostering active participant engagement and targeting relatedness may present additional challenges. Steps2Health may help cancer survivors increase their physical activity levels. %M 33231551 %R 10.2196/18364 %U https://mhealth.jmir.org/2020/11/e18364 %U https://doi.org/10.2196/18364 %U http://www.ncbi.nlm.nih.gov/pubmed/33231551 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 11 %P e22047 %T Implementation and Evaluation of a Text Message–Based Addiction Counseling Program (Text4Hope-Addiction Support): Protocol for a Questionnaire Study %A Agyapong,Vincent Israel Opoku %A Hrabok,Marianne %A Vuong,Wesley %A Gusnowski,April %A Shalaby,Reham %A Surood,Shireen %A Greenshaw,Andrew J %A Aulakh,Avininder %A Abba-Aji,Adam %A Singh,Mohit %+ Division of Community Psychiatry, Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 7807144315, agyapong@ualberta.ca %K addiction %K support drugs %K alcohol %K Text4Hope %K mobile phones %K text messaging %K anxiety %K depression %K mHealth %K COVID-19 %D 2020 %7 17.11.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: With the emergence of the COVID-19 pandemic, providing counseling to people with drug or alcohol addiction while maintaining physical distance has been challenging. This protocol describes the use of text messaging (as used in the Text4Hope-Addiction Support program) as a convenient, evidence-based, cost-effective, and accessible population-level mental health intervention with high user satisfaction proven in prior research. Objective: The project goal is to implement a program of daily supportive text messaging (Text4Hope-Addiction Support) to reduce drug or alcohol cravings as well as anxiety and depression, typically associated with alcohol and substance use disorders. The aim of this study is to evaluate the prevalence of cravings, anxiety, and depressive symptoms; demographic correlates of the same; and the outcomes of the Text4Hope-Addiction Support intervention in mitigating cravings, anxiety, and depressive symptoms. Methods: Self-administered, anonymous, online questionnaires will be used to assess cravings for the primary substance of addiction (Brief Substance Craving Scale), anxiety (Generalized Anxiety Disorder-7), and depressive symptoms (Patient Health Questionnaire-9). Data will be collected at baseline (onset of receiving text messages), program midpoint (6 weeks), and program end (12 weeks). Results: As of October 2020, data collection is in progress; and it is expected to be completed by fall 2021. Data analysis will include parametric and nonparametric techniques, focusing on primary outcomes (ie, cravings, anxiety, and depressive symptoms) and metrics of use, including the number of subscribers and user satisfaction. Conclusions: This Text4Hope-Addiction Support project will provide key information regarding the prevalence rates of cravings, anxiety, and depressive symptoms among persons with alcohol and substance use disorders; demographic correlates of cravings, anxiety, and depression; and outcome data related to this scalable population-level intervention. Information from this study will be valuable for addiction care practitioners; it will inform the policy and decision making regarding population-level addiction treatment and support during emergencies. International Registered Report Identifier (IRRID): DERR1-10.2196/22047 %M 33200993 %R 10.2196/22047 %U http://www.researchprotocols.org/2020/11/e22047/ %U https://doi.org/10.2196/22047 %U http://www.ncbi.nlm.nih.gov/pubmed/33200993 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 5 %N 4 %P e20532 %T Secondary Impact of Social Media via Text Message Screening for Type 2 Diabetes Risk in Kuwait: Survey Study %A Alqabandi,Naeema %A Al-Ozairi,Ebaa %A Ahmed,Adel %A Ross,Edgar L %A Jamison,Robert N %+ Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, 850 Boylston Street, Suite 320, Chestnut Hill, MA, 02467, United States, 1 617 732 9046, elross@bwh.harvard.edu %K SMS %K Short text message interventions %K mHealth %K smartphone %K Type 2 diabetes mellitus %K prevention %D 2020 %7 12.11.2020 %9 Original Paper %J JMIR Diabetes %G English %X Background: Type 2 diabetes mellitus (T2DM) is an international problem of alarming epidemic proportions. T2DM can develop due to multiple factors, and it usually begins with prediabetes. Fortunately, this disease can be prevented by following a healthy lifestyle. However, many health care systems fail to properly educate the public on disease prevention and to offer support in embracing behavioral interventions to prevent diabetes. SMS messaging has been combined with cost-effective ways to reach out to the population at risk for medical comorbidities. To our knowledge, the use of nationwide SMS messaging in the Middle East as a screening tool to identify individuals who might be at risk of developing T2DM has not been reported in the literature. Objective: The primary aim of this study was to assess the feasibility of conducting a series of SMS messaging campaigns directed at random smartphone users in Kuwait for the detection and prevention of T2DM. It was predicted that 1% of those receiving the text message would find it relevant and participate in the study. The secondary aim of this study was to assess the incidence of participation of those who were forwarded the initial text message by family members and friends. Methods: In this study, 5 separate text message screening campaigns were launched inviting recipients to answer 6 questions to determine the risk of developing T2DM. If subjects agreed to participate, a link to the prediabetes screening test devised by the Centers for Disease Control and Prevention was automatically transmitted to their mobile devices. Those identified as high risk were invited to participate in a diabetes prevention program. Results: A total of 180,000 SMSs were sent to approximately 6% of the adult population in Kuwait. Of these, 0.14% (260/180,000) of the individuals who received the SMS agreed to participate, of whom 58.8% (153/260) completed the screening. Surprisingly, additional surveys were completed by 367 individuals who were invited via circulated SMS messages forwarded by family members and friends. Altogether, 23.3% (121/520) qualified and agreed to participate in a diabetes prevention program. The majority of those who chose to participate in the prevention program were overweight, aged 45-65 years, and reported being less physically active than those who chose not to participate (χ22=42.1, P<.001). Conclusions: Although health care screening via text messaging was found to have limited effectiveness by itself, it exhibited increased reach through shared second-party social media messaging. Despite the fact a subpopulation at possible risk of developing T2DM could be reached via text messaging, most responders were informed about the screening campaign by family and friends. Future research should be designed to tap into the benefits of social media use in health risk campaigns. %M 33180021 %R 10.2196/20532 %U https://diabetes.jmir.org/2020/4/e20532 %U https://doi.org/10.2196/20532 %U http://www.ncbi.nlm.nih.gov/pubmed/33180021 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e19159 %T Network Support Using Social Networking Services to Increase Exercise Adherence Among Korean-Chinese Middle-Aged Migrant Women: Mixed Methods Study %A Lee,Hyeyeon %A Lee,Hyeonkyeong %A Kim,Youlim %A Kim,Sookyung %A Lee,Young-Me %+ Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1 Yonse-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2228 3373, hlee39@yuhs.ac %K SNS %K social support %K network support %K exercise adherence %K social-cognitive factors %K text mining %D 2020 %7 5.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Social networking services (SNSs) are recognized to be a promising approach to easily deliver health interventions and to enhance social support for exercise adherence. However, the patterns and aspects of social support through SNSs have not been reported and their influence on other social-cognitive factors remains inconclusive. Objective: Our objective is to explore how social support delivered through SNSs impacts interactions among Korean-Chinese (KC) middle-aged women and to identify how this approach influences social-cognitive factors for exercise (eg, sense of community, self-efficacy for exercise, and social support for exercise). Methods: A mixed methods design was used. Text analysis of SNS messages and text mining using the Korean Natural Language Application (KoALA) were conducted. Social-cognitive factors (eg, sense of community, self-efficacy for exercise, and social support for exercise) were assessed at baseline and after 12 weeks using a structured questionnaire. A comparison of social-cognitive factors at baseline and at 12 weeks was conducted to identify any potential significant changes, using the Wilcoxon signed-rank test. Results: A total of 259 SNS messages were collected from 24 KC women, distributed among four chat groups, who participated in a 12-week walking intervention program between August and October 2018. The individual average frequency of chatting via the SNS was 10.79 (range 0-34) and the most frequent type of social support through the SNS was network support (172/259, 66.4%). The most common words extracted from the SNS were Health, Exercise, Participation, and We. Overall, the perceived levels of sense of community (P<.001) and social support for exercise (P=.002) were significantly increased at 12 weeks compared with baseline. Group 1 (P=.03) and Group 4 (P=.03), whose members demonstrated the highest frequency of network support, experienced a significant increase only in the level of sense of community. Conclusions: By integrating these data and conducting a mixed methods analysis, we observed that among the types of social support, network support was a key point for the promotion of social-cognitive factors in increasing exercise adherence. Therefore, network support through SNS-based interventions should be considered as a useful strategy to help vulnerable migrant populations make changes to exercise behaviors. %M 33151155 %R 10.2196/19159 %U https://mhealth.jmir.org/2020/11/e19159 %U https://doi.org/10.2196/19159 %U http://www.ncbi.nlm.nih.gov/pubmed/33151155 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e19953 %T Effect of a Text Messaging–Based Educational Intervention on Cesarean Section Rates Among Pregnant Women in China: Quasirandomized Controlled Trial %A Su,Yanfang %A Heitner,Jesse %A Yuan,Changzheng %A Si,Yafei %A Wang,Dan %A Zhou,Zhiying %A Zhou,Zhongliang %+ School of Public Policy and Administration, Xi’an Jiaotong University, 28# Xianning West Road, Xi'an, China, 86 18291498261, zzliang1981@xjtu.edu.cn %K cesarean section %K short message service %K SMS text messaging %K quasirandomized controlled trial %K mobile health %D 2020 %7 3.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Consensus exists that appropriate regional cesarean rates should not exceed 15% of births, but China’s cesarean rate exceeds 50% in some areas, prompting numerous calls for its reduction. At present, China’s 2016 two-child policy has heightened the implications of national cesarean section trends. Objective: This study leveraged pervasive cellular phone access amongst Chinese citizens to test the effect of a low-cost and scalable prenatal advice program on cesarean section rates. Methods: Participants were pregnant women presenting for antenatal care at a clinic in Xi’an, China. Assignment was quasirandomized and utilized factorial assignment based on the expecting mother’s birthday. Participants were assigned to one of the following four groups, with each receiving a different set of messages: (1) a comparison group that received only a few “basic” messages, (2) a group receiving messages primarily regarding care seeking, (3) a group receiving messages primarily regarding good home prenatal practices, and (4) a group receiving text messages of all groups. Messages were delivered throughout pregnancy and were tailored to each woman’s gestational week. The main outcome was the rates of cesarean delivery reported in the intervention arms. Data analysts were blinded to treatment assignment. Results: In total, 2115 women completed the trial and corresponding follow-up surveys. In the unadjusted analysis, the group receiving all texts was associated with an odds ratio of 0.77 (P=.06), though neither the care seeking nor good home prenatal practice set yielded a relevant impact. Adjusting for potentially confounding covariates showed that the group with all texts sent together was associated with an odds ratio of 0.67 (P=.01). Notably, previous cesarean section evoked an odds ratio of 11.78 (P<.001), highlighting that having a cesarean section predicts future cesarean section in a subsequent pregnancy. Conclusions: Sending pregnant women in rural China short informational messages with integrated advice regarding both care-seeking and good home prenatal practices appears to reduce women’s likelihood of undergoing cesarean section. Reducing clear medical indications for cesarean section seems to be the strongest potential pathway of the effect. Cesarean section based on only maternal request did not seem to occur regularly in our study population. Preventing unnecessary cesarean section at present may have a long-term impact on future cesarean section rates. Trial Registration: ClinicalTrials.gov NCT02037087; https://clinicaltrials.gov/ct2/show/NCT02037087. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2015-011016 %M 33141099 %R 10.2196/19953 %U https://mhealth.jmir.org/2020/11/e19953 %U https://doi.org/10.2196/19953 %U http://www.ncbi.nlm.nih.gov/pubmed/33141099 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e18922 %T Effectiveness of Internet-Based Multicomponent Interventions for Patients and Health Care Professionals to Improve Clinical Outcomes in Type 2 Diabetes Evaluated Through the INDICA Study: Multiarm Cluster Randomized Controlled Trial %A Ramallo-Fariña,Yolanda %A García-Bello,Miguel Angel %A García-Pérez,Lidia %A Boronat,Mauro %A Wägner,Ana M %A Rodríguez-Rodríguez,Leticia %A de Pablos-Velasco,Pedro %A Llorente Gómez de Segura,Ignacio %A González- Pacheco,Himar %A Carmona Rodríguez,Montserrat %A Serrano-Aguilar,Pedro %A , %+ Canary Islands Health Research Institute Foundation (FIISC), Camino La Candelaria 44, Tenerife, 38109, Spain, 34 +34 922 478266, yramfar@sescs.es %K behavior modification %K primary care %K type 2 diabetes mellitus %K patients adherence %K eHealth %D 2020 %7 2.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Type 2 diabetes mellitus (T2DM) is a chronic disease in which health outcomes are related to decision making by patients and health care professionals. Objective: This study aims to assess the effectiveness of internet-based multicomponent interventions to support decision making of all actors involved in the care of patients with T2DM in primary care. Methods: The INDICA study is an open, community-based, multicenter trial with random allocation to usual care or the intervention for patients, the intervention for health care professionals in primary care, or the combined intervention for both. In the intervention for patients, participants received an educational group program and were monitored and supported by logs, a web-based platform, and automated SMS. Those in the intervention for professionals also received an educational program, a decision support tool embedded in the electronic clinical record, and periodic feedback about patients’ results. A total of 2334 people with T2DM, regardless of glycated hemoglobin (HbA1c) levels and without diabetes-related complications, were included. The primary end point was change in HbA1c level. The main analysis was performed using multilevel mixed models. Results: For the overall sample, the intervention for patients attained a significant mean reduction in HbA1c levels of ‒0.27 (95% CI ‒0.45 to ‒0.10) at month 3 and ‒0.26 (95% CI ‒0.44 to ‒0.08) at month 6 compared with usual care, which remained marginally significant at month 12. A clinically relevant reduction in HbA1c level was observed in 35.6% (191/537) of patients in the intervention for patients and 26.0% (152/586) of those in usual care at month 12 (P=.006). In the combined intervention, HbA1c reduction was significant until month 18 (181/557, 32.6% vs 140/586, 23.9%; P=.009). Considering the subgroup of patients uncontrolled at baseline, all interventions produced significant reductions in HbA1c levels across the entire study period: ‒0.49 (95% CI ‒0.70 to ‒0.27) for the intervention for patients, ‒0.35 (95% CI ‒0.59 to ‒0.14) for the intervention for professionals, and ‒0.35 (95% CI ‒0.57 to ‒0.13) for the combined intervention. Differences in HbA1c for the area under the curve considering the entire period were significant for the intervention for patients and the combined intervention compared with usual care (P=.03 for both). Compared with usual care, the intervention for professionals and the combined intervention had significant longer-term reductions in systolic and diastolic blood pressure. Conclusions: In uncontrolled patients, the intervention for patients at baseline provided clinically relevant and significant longer-term reductions of HbA1c levels. The intervention for professionals and combined intervention also improved the cardiovascular risk profile of patients. Trial Registration: ClinicalTrials.gov NCT01657227; https://clinicaltrials.gov/ct2/show/NCT01657227 %M 33136059 %R 10.2196/18922 %U https://mhealth.jmir.org/2020/11/e18922 %U https://doi.org/10.2196/18922 %U http://www.ncbi.nlm.nih.gov/pubmed/33136059 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e22485 %T Using ADAPT-ITT to Modify a Telephone-Based HIV Prevention Intervention for SMS Delivery: Formative Study %A Davis,Teaniese %A DiClemente,Ralph Joseph %A Prietula,Michael %+ Goizueta Business School & Hubert Department of Global Health, Emory University, Goizueta Business School, 1300 Clifton Road, Atlanta, GA, 30322, United States, 1 7709009034, mj.prietula@emory.edu %K short message service %K HIV %K African Americans %K adolescent %K female %K texting %K mHealth %K ADAPT-ITT framework %K intervention study %K health status disparities %K young adult %K risk reduction behavior %D 2020 %7 6.10.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: African American adolescent females are disproportionately affected by sexually transmitted infections (STIs) and HIV. Given the elevated risk of STIs and HIV in African American women, there is an urgent need to identify innovative strategies to enhance the adoption and maintenance of STI and HIV preventive behaviors. Texting is a promising technology for creating preventive maintenance interventions (PMIs) that extend the efficacy of the original intervention. However, little guidance in public health literature is available for developing this type of application. Objective: This paper describes a formative pilot study that incorporates user experience methods to design and test PMI texts for Afiya, an original evidence-based intervention (EBI) specifically designed for African American adolescent females. This study aims to describe the adaptation process of health educator–led phone calling to text-based communication. Methods: The formative process followed the assessment, decision, adaptation, production, topical experts-integration, training, testing (ADAPT-ITT) framework for adapting EBIs and using them in a new setting, for a new target population or a modified intervention strategy. This study presents the details of how the phases of the ADAPT-ITT framework were applied to the design of the adaptation. An advisory board was constituted from the target population, consisting of 6 African American women aged 18-24 years, participating in formative activities for 12 weeks, and involving components of the PMI design. As Afiya included a telephone-based PMI, developers of the original Afiya phone scripts crafted the initial design of the SMS-based texts and texting protocol. The advisory board participated in the 1-day Afiya workshop, followed by 4 weeks of texting PMI messages and a midcourse focus group, followed by 4 more weeks of texting PMI messages, ultimately ending with a final focus group. At the advisory board’s request, this phase included an optional, additional week of text-based PMI messages. Results: The methods provided a rich source of data and insights into the fundamental issues involved when constructing SMS-based PMI for this target population and for this EBI. Prior contact and context are essential as the health educator was identified as a key persona in the process and the messages were situated in the original (workshop) context. Narrative adaptations for personas emerged from advisory board discussions. Suggestions on how to expand the PMI to current, specific social contexts indicated that the use of narrative analysis is warranted. Conclusions: The use of existing EBIs incorporating telephone-based PMI scripts facilitated the initial design of the texts, with a subsequent narrative analysis of the advisory board data providing additional adjustments given the actual context. Additional examination of the advisory board feedback revealed that personas would offer insight into and opportunities for a persona-specific modification of texting narratives. %M 32831178 %R 10.2196/22485 %U https://formative.jmir.org/2020/10/e22485 %U https://doi.org/10.2196/22485 %U http://www.ncbi.nlm.nih.gov/pubmed/32831178 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e18351 %T An Interactive Text Messaging Intervention to Improve Adherence to Option B+ Prevention of Mother-to-Child HIV Transmission in Kenya: Cost Analysis %A Chen,Yilin %A Ronen,Keshet %A Matemo,Daniel %A Unger,Jennifer A %A Kinuthia,John %A John-Stewart,Grace %A Levin,Carol %+ Department of Global Health, University of Washington, 1959 NE Pacific St, Seattle, WA, 98105, United States, 1 206 744 3790, clevin@uw.edu %K mHealth %K cost analysis %K prevention of mother-to-child transmission %K antiretroviral therapy adherence %K Kenya %K mobile phone %D 2020 %7 2.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) approaches offer potentially affordable ways to support the care of HIV-infected patients in overstretched health care systems. However, only few studies have analyzed the costs associated with mHealth solutions for HIV care. Objective: The aim of this study was to estimate the total incremental costs and incremental cost per beneficiary of an interactive SMS text messaging support intervention within a clinical trial. Methods: The Mobile WAChX trial (NCT02400671) evaluates an interactive semiautomated SMS text messaging intervention to improve adherence to antiretroviral therapy and retention in care among peripartum women infected with HIV in Kenya to reduce the mother-to-child transmission of HIV. Women were randomized to receive one-way versus two-way SMS text messages. Messages were sent weekly, and these messages included motivational and educational content and visit reminders; two-way messaging enabled prompt consultation with the nurse as needed. Microcosting methods were used to collect resource-use data related to implementing the Mobile WAChX SMS text messaging intervention. At 2 sites (Nairobi and Western Kenya), we conducted semistructured interviews with health personnel to identify startup and recurrent activities by obtaining information on the personnel, supplies, and equipment. Data on expenditures and prices from project expense reports, administrative records, and published government salary data were included to estimate the total incremental costs. Using a public provider perspective, we estimated incremental unit costs per beneficiary and per contact during 2017. Results: The weighted average annual incremental costs for the two-way SMS text messaging group were US $3725 per facility, US $62 per beneficiary, and US $0.85 per contact to reach 115 beneficiaries. For the one-way SMS text messaging group, the weighted average annual incremental costs were US $2542 per facility, US $41 per beneficiary, and US $0.66 per contact to reach 117 beneficiaries. The largest cost shares were for the personnel: 48.2% (US $1794/US $3725) in two-way and 32.4% (US $825/US $2542) in one-way SMS text messaging groups. Costs associated with software development and communication accounted for 29.9% (US $1872/US $6267) of the costs in both intervention arms (US $1042 vs US $830, respectively). Conclusions: Cost information for budgeting and financial planning is relevant for implementing mHealth interventions in national health plans. Given the proportion of costs related to systems development, it is likely that costs per beneficiary will decline with the scale-up of the interventions. %M 33006562 %R 10.2196/18351 %U https://mhealth.jmir.org/2020/10/e18351 %U https://doi.org/10.2196/18351 %U http://www.ncbi.nlm.nih.gov/pubmed/33006562 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 10 %P e19720 %T Evaluating the Efficacy of a Mobile App (Drinks:Ration) and Personalized Text and Push Messaging to Reduce Alcohol Consumption in a Veteran Population: Protocol for a Randomized Controlled Trial %A Leightley,Daniel %A Rona,Roberto J %A Shearer,James %A Williamson,Charlotte %A Gunasinghe,Cerisse %A Simms,Amos %A Fear,Nicola T %A Goodwin,Laura %A Murphy,Dominic %+ King's College London, King's Centre for Military Health Research, 10 Cutcombe Road, London, SE5 9RJ, United Kingdom, 44 20 7848 5351, daniel.leightley@kcl.ac.uk %K alcohol misuse %K smartphone %K intervention %K SMS text messaging %K push notifications %D 2020 %7 2.10.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alcohol misuse is higher in the UK Armed Forces than in the general population. Previous research has shown that interventions delivered via smartphones are efficacious in promoting self-monitoring of alcohol use, have utility in reducing alcohol consumption, and have a broad reach. Objective: This single-blinded randomized controlled trial (RCT) aims to assess the efficacy of a 28-day brief alcohol intervention delivered via a smartphone app (Drinks:Ration) in reducing weekly self-reported alcohol consumption between baseline and 3-month follow-up among veterans who drink at a hazardous or harmful level and receive or have received support for mental health symptoms in a clinical setting. Methods: In this two-arm, single-blinded RCT, a smartphone app that includes interactive features designed to enhance participants’ motivation and personalized messaging is compared with a smartphone app that provides only government guidance on alcohol consumption. The trial will be conducted in a veteran population that has sought help through Combat Stress, a UK veteran’s mental health charity. Recruitment, consent, and data collection will be carried out automatically through the Drinks:Ration platform. The primary outcome is the change in self-reported weekly alcohol consumption between baseline (day 0) and 3-month follow-up (day 84) as measured using the Time-Line Follow back for Alcohol Consumption. Secondary outcome measures include (1) change in the baseline to 3-month follow-up (day 84) Alcohol Use Disorder Identification Test score and (2) change in the baseline to 3-month follow-up (day 84) World Health Organization Quality of Life-BREF score to assess the quality of adjusted life years. Process evaluation measures include (1) app use and (2) usability ratings as measured by the mHealth App Usability Questionnaire. The primary and secondary outcomes will also be reassessed at the 6-month follow-up (day 168) to assess the longer-term benefits of the intervention, which will be reported as a secondary outcome. Results: The study will begin recruitment in October 2020 and is expected to require 12 months to complete. The study results will be published in 2022. Conclusions: This study assesses whether a smartphone app is efficacious in reducing self-reported alcohol consumption in a veteran population that has sought help through Combat Stress using personalized messaging and interactive features. This innovative approach, if successful, may provide a means to deliver a low-cost health promotion program that has the potential to reach large groups, in particular those who are geographically dispersed, such as military personnel. Trial Registration: ClinicalTrials.gov NCT04494594; https://clinicaltrials.gov/ct2/show/NCT04494594 International Registered Report Identifier (IRRID): PRR1-10.2196/19720 %M 33006569 %R 10.2196/19720 %U https://www.researchprotocols.org/2020/10/e19720 %U https://doi.org/10.2196/19720 %U http://www.ncbi.nlm.nih.gov/pubmed/33006569 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 9 %P e16127 %T One-Way and Two-Way Mobile Phone Text Messages for Treatment Adherence Among Patients With HIV: Protocol for a Randomized Controlled Trial %A Nsagha,Dickson Shey %A Siysi,Vincent Verla %A Ekobo,Same %A Egbe,Thomas Obinchemti %A Kibu,Odette Dzemo %+ Department of Public Health and Hygiene, University of Buea, PO Box 63, Buea, Cameroon, 237 677499429, nsaghads@hotmail.com %K HIV %K antiretroviral therapy %K short message service %K adherence %D 2020 %7 30.9.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Incomplete adherence to antiretroviral therapy (ART) is one of the factors that contribute to HIV drug resistance, and it is a major problem for the public health system in controlling the HIV pandemic. There is emerging evidence that SMS can play an important role in health care delivery among patients with HIV on ART, especially in resource-limited settings. Objective: This paper aims to assess the impact of two-way and one-way SMS text messaging on adherence to HIV treatment. We hypothesized that sending weekly text messages through the one-way and two-way SMS text messaging approach will improve adherence to ART among patients with HIV and improve associated clinical outcomes (quality of life). Methods: A randomized controlled trial is being carried out among participants with HIV who have been on ART for at least one month from an accredited treatment center, namely the Buea Regional Hospital and Kumba District Hospital of South West Region, Cameroon. Participants with HIV, both male and female, aged 21 years and older make up a sample size of 207. The interventions involved the use of mobile phone text messages. Before commencing the intervention, a focus group discussion was carried out among the participants to understand their perception about the use of SMS-based interventions to improve adherence. A total of 246 participants were randomized to receive either a one-way text message (SMS sent to a recipient without recipient sending a reply) or two-way text message (SMS sent to a recipient and recipient sends a reply) or the control (no SMS, only standard care). Data on adherence and quality of life were collected at baseline and after 6 months and will be analyzed using SPSS version 21, while qualitative data will be analyzed using Atlas.ti 7.5. Results: Data collection began in September 2019 with focus group discussions and baseline data collection. After 1 month of baseline data collection, the intervention began in October 2019, and postintervention data were collected after 6 months (March 2020). At the end of the study, we will be able to understand the perception of patients toward SMS text messaging–based interventions and also assess the impact of one-way and two-way SMS text messages on treatment adherence among patients with HIV and on associated clinical outcomes (quality of life). Conclusions: The impact of SMS text messaging varies across different settings. The results from this study will determine the perception of patients toward an SMS text messaging–based intervention and its impact on adherence to ART. International Registered Report Identifier (IRRID): DERR1-10.2196/16127 %M 32996886 %R 10.2196/16127 %U http://www.researchprotocols.org/2020/9/e16127/ %U https://doi.org/10.2196/16127 %U http://www.ncbi.nlm.nih.gov/pubmed/32996886 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21749 %T Behavior Change Text Messages for Home Exercise Adherence in Knee Osteoarthritis: Randomized Trial %A Bennell,Kim %A Nelligan,Rachel K %A Schwartz,Sarah %A Kasza,Jessica %A Kimp,Alexander %A Crofts,Samuel JC %A Hinman,Rana S %+ Department of Physiotherapy, University of Melbourne, Centre for Health, Exercise and Sports Medicine, Level 7, Alan Gilbert Building, 161 Barry St, Carlton, 3053, Australia, 61 383444135, k.bennell@unimelb.edu.au %K knee osteoarthritis %K exercise %K patient compliance %K mobile phone %K randomized controlled trial %D 2020 %7 28.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Exercise is a core recommended treatment for knee osteoarthritis (OA), yet adherence declines, particularly following cessation of clinician supervision. Objective: This study aims to evaluate whether a 24-week SMS intervention improves adherence to unsupervised home exercise in people with knee OA and obesity compared with no SMS. Methods: A two-group superiority randomized controlled trial was performed in a community setting. Participants were people aged 50 years with knee OA and BMI ≥30 kg/m2 who had undertaken a 12-week physiotherapist-supervised exercise program as part of a preceding clinical trial. Both groups were asked to continue their home exercise program unsupervised three times per week for 24 weeks and were randomly allocated to a behavior change theory–informed, automated, semi-interactive SMS intervention addressing exercise barriers and facilitators or to control (no SMS). Primary outcomes were self-reported home exercise adherence at 24 weeks measured by the Exercise Adherence Rating Scale (EARS) Section B (0-24, higher number indicating greater adherence) and the number of days exercised in the past week (0-3). Secondary outcomes included self-rated adherence (numeric rating scale), knee pain, physical function, quality of life, global change, physical activity, self-efficacy, pain catastrophizing, and kinesiophobia. Results: A total of 110 participants (56 SMS group and 54 no SMS) were enrolled and 99 (90.0%) completed both primary outcomes (48/56, 86% SMS group and 51/54, 94% no SMS). At 24 weeks, the SMS group reported higher EARS scores (mean 16.5, SD 6.5 vs mean 13.3, SD 7.0; mean difference 3.1, 95% CI 0.8-5.5; P=.01) and more days exercised in the past week (mean 1.8, SD 1.2 vs mean 1.3, SD 1.2; mean difference 0.6, 95% CI 0.2-1.0; P=.01) than the control group. There was no evidence of between-group differences in secondary outcomes. Conclusions: An SMS program increased self-reported adherence to unsupervised home exercise in people with knee OA and obesity, although this did not translate into improved clinical outcomes. Trial Registration: Australian New Zealand Clinical Trials Registry 12617001243303; https://tinyurl.com/y2ud7on5 International Registered Report Identifier (IRRID): RR2-10.1186/s12891-019-2801-z %M 32985994 %R 10.2196/21749 %U http://www.jmir.org/2020/9/e21749/ %U https://doi.org/10.2196/21749 %U http://www.ncbi.nlm.nih.gov/pubmed/32985994 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e16958 %T SMS Text Messages for Parents for the Prevention of Child Drowning in Bangladesh: Acceptability Study %A Hossain,Md Mosharaf %A Mani,Kulanthayan %A Mat Min,Ruhani %+ Safe Kids Malaysia and Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia, 60 0397692398, kulan@upm.edu.my %K acceptability %K SMS %K drowning %K parents %D 2020 %7 23.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In many cases, greater use is being made of mobile phone text messages as a means of communication between patients and health care providers in countries around the world. Objective: We studied the use of mobile phones and the factors related to the acceptability of text messages for parents for the prevention of child drowning in Bangladesh. Methods: From a randomized controlled trial involving 800 parents, 10% (80/800) were selected, and socioeconomic status, mobile phone use, and acceptability of SMS text messages for drowning prevention were measured. Participants with at least one child under 5 years of age were selected from rural areas in Rajshahi District in Bangladesh. Mobile phone–based SMS text messages were sent to the participants. Multivariate regression was used to determine the factors related to the acceptability of text messages for the prevention of child drowning in Bangladesh. Results: The acceptability of SMS text messages for the prevention of child drowning in Bangladesh was significantly lower among women (odds ratio [OR] 0.50, 95% CI 0.12-1.96, P=.02) than among men, lower for parents older than 30 years (OR 0.17, 95% CI 0.14-1.70, P=.01) compared to parents younger than 30 years, higher among parents who had an education (OR 1.63, 95% CI 1.11-5.80, P=.04) than among illiterate parents, and higher among parents with a monthly household income over 7000 Bangladeshi Taka (approximately US $82.54; OR 1.27, 95% CI 1.06-1.96, P=.05) than among parents whose monthly income was less than 7000 Bangladeshi Taka. Conclusions: The high percentage of mobile phone use and the acceptability of SMS text messages for parents for the prevention of child drowning are encouraging, in terms of identifying the best strategy for using such technologies, and deserve further evaluation. %M 32965224 %R 10.2196/16958 %U http://mhealth.jmir.org/2020/9/e16958/ %U https://doi.org/10.2196/16958 %U http://www.ncbi.nlm.nih.gov/pubmed/32965224 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e15307 %T Identifying Mobile Health Engagement Stages: Interviews and Observations for Developing Brief Message Content %A Burns,Kara %A Nicholas,Rebekah %A Beatson,Amanda %A Chamorro-Koc,Marianella %A Blackler,Alethea %A Gottlieb,Udo %+ School of Advertising, Marketing and Public Relations, QUT Business School, Queensland University of Technology, George St, Brisbane, QLD, 4000, Australia, 61 414294967, drkaraburns@gmail.com %K mobile health %K text messaging %K social media %K mobile phone %K health communication %D 2020 %7 22.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Interest in mobile health (mHealth) has increased recently, and research suggests that mHealth devices can enhance end-user engagement, especially when used in conjunction with brief message content. Objective: This research aims to explore the stages of engagement framework for mHealth devices and develop a method to generate brief message content to promote sustained user engagement. This study uses the framework by O’Brien and Toms as a point of departure, where engagement is defined as the uptake or the use of an mHealth device. The framework is a linear repeatable process, including point of engagement, period of engagement, disengagement, and re-engagement. Each stage is characterized by attributes related to a person’s technology experience. Although the literature has identified stages of engagement for health-related technology, few studies explore mHealth engagement. Furthermore, little research has determined a method for creating brief message content at each stage in this engagement journey. Methods: Interviews and observations from 19 participants who used mHealth technologies (apps, devices, or wellness websites) in a solo capacity were recruited for sample group 1. In sample group 2, interviews, and observations from 25 participants using mHealth technologies in a group capacity through the Global Corporate Challenge were used. These samples were investigated at 3 time points in both research contexts. The results underwent deductive-inductive thematic analysis for the engagement stages’ framework and attributes. Results: In addition to the 4 stages identified by O’Brien and Toms, 2 additional stages, self-management and limited engagement, were identified. Self-management captures where users had disengaged from their technology but were still engaged with their health activity. Limited engagement captures where group mHealth users had minimal interaction with their mHealth technology but continued to engage in a group fitness activity. The results revealed that mHealth engagement stages were nonlinear and embedded in a wider engagement context and that each stage was characterized by a combination of 49 attributes that could be organized into 8 themes. Themes documented the total user experience and included technology usability, technology features, technology aesthetics, use motivations, health awareness, goal setting, social support, and interruptions. Different themes were found to have more relevance at different engagement stages. Knowing themes and attributes at all engagement stages allows technology developers and health care professionals to generate relevant brief message content informed by a person-centered approach. Conclusions: This research extends an existing engagement stages framework and identifies attributes and themes relevant to mHealth technology users’ total user experience and incorporates concepts derived from health, business studies, and information systems literature. In addition, we offer a practical 5-step process based on a person-centered approach to develop mHealth technology brief message content for sustained engagement. %M 32960181 %R 10.2196/15307 %U http://www.jmir.org/2020/9/e15307/ %U https://doi.org/10.2196/15307 %U http://www.ncbi.nlm.nih.gov/pubmed/32960181 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e17563 %T Implementing Facilitated Access to a Text Messaging, Smoking Cessation Intervention Among Swedish Patients Having Elective Surgery: Qualitative Study of Patients’ and Health Care Professionals’ Perspectives %A Thomas,Kristin %A Bendtsen,Marcus %A Linderoth,Catharina %A Bendtsen,Preben %+ Department of Health, Medicine and Caring Sciences, Linköping University, 58381, Linköping, , Sweden, 46 13282546, kristin.thomas@liu.se %K mHealth %K mobile health %K text messages %K health care %K smoking cessation %K patients with elective surgery %K implementation %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is strong evidence that short-term smoking cessation before surgery can reduce postoperative morbidity. There are, however, several structural problems in health care systems concerning how to implement smoking cessation interventions in routine practice for preoperative patients. Objective: This study aimed to analyze the implementation of a text messaging, smoking cessation intervention targeting patients having elective surgery. Implementation of facilitated access (ie, referral from practitioners) and the perceived usefulness among patients were investigated. Elective surgery is defined as scheduled, nonacute surgery. Methods: A qualitative study was carried out at two medium-sized hospitals in the south of Sweden. The implementation of facilitated access was investigated during a 12-month period from April 2018 to April 2019. Facilitated access was conceptualized as specialists recommending the text messaging intervention to patients having elective surgery. Implementation was explored in terms of perceptions about the intervention and behaviors associated with implementation; that is, how patients used the intervention and how specialists behaved in facilitating usage among patients. Two focus groups with smoking cessation specialists and 10 individual interviews with patients were carried out. Qualitative content analysis was used to analyze the data. Results: Two main categories were identified from the focus group data with smoking cessation specialists: implementation approach and perceptions about the intervention. The first category, implementation approach, referred to how specialists adapted their efforts to situational factors and to the needs and preferences of patients, and how building of trust with patients was prioritized. The second category, perceptions about the intervention, showed that specialists thought the content and structure of the text messaging intervention felt familiar and worked well as a complement to current practice. Two categories were identified from the patient interview data: incorporating new means of support from health care and determinants of use. The first category referred to how patients adopted and incorporated the intervention into their smoking cessation journey. Patients were receptive, shared the text messages with friends and family, humanized the text messages, and used the messages as a complement to other strategies to quit smoking. The second category, determinants of use, referred to aspects that influenced how and when patients used the intervention and included the following: timing of the intervention and text messages, motivation to change, and perceptions of the mobile phone medium. Conclusions: Smoking cessation specialists adopted an active role in implementing the intervention by adapting their approach and fitting the intervention into existing routines. Patients showed strong motivation to change and openness to incorporate the intervention into their behavior change journey; however, the timing of the intervention and messages were important in optimizing the support. A text messaging, smoking cessation intervention can be a valuable and feasible way to reach smoking patients having elective surgery. %M 32945772 %R 10.2196/17563 %U https://mhealth.jmir.org/2020/9/e17563 %U https://doi.org/10.2196/17563 %U http://www.ncbi.nlm.nih.gov/pubmed/32945772 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e18118 %T Protocol Development for HMU! (HIV Prevention for Methamphetamine Users), a Study of Peer Navigation and Text Messaging to Promote Pre-Exposure Prophylaxis Adherence and Persistence Among People Who Use Methamphetamine: Qualitative Focus Group and Interview Study %A McMahan,Vanessa M %A Frank,Noah %A Buckler,Smitty %A Violette,Lauren R %A Baeten,Jared M %A Banta-Green,Caleb J %A Barnabas,Ruanne V %A Simoni,Jane %A Stekler,Joanne D %+ San Francisco Department of Public Health, Center on Substance Use and Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, United States, 1 628 217 7469, vanessa.mcmahan@sfdph.org %K pre-exposure prophylaxis %K methamphetamine %K text messaging %K peer navigation %K men who have sex with men %K transgender people %D 2020 %7 14.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Cisgender men who have sex with men (MSM) and transgender people (TGP) who use methamphetamine are disproportionately impacted by HIV acquisition. Pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV, and interventions that support PrEP persistence and adherence should be evaluated among MSM and TGP who use methamphetamine. Objective: We conducted formative work to inform the development of text messaging and peer navigation interventions to support PrEP persistence and adherence among MSM and TGP who use methamphetamine. In this paper, we describe how the findings from these focus groups and interviews were used to refine the study interventions and protocol for the Hit Me Up! study (HMU!; HIV Prevention in Methamphetamine Users). Methods: Between October 2017 and March 2018, we conducted two focus groups and three in-depth interviews with MSM and TGP who use methamphetamine or who have worked with people who use methamphetamine. During these formative activities, we asked participants about their opinions on the proposed interventions, education and recruitment materials, and study design. We focused on how we could develop peer navigation and text messaging interventions that would be culturally appropriate and acceptable to MSM and TGP who use methamphetamine. Transcripts were reviewed by two authors who performed a retrospective content analysis to describe which specific opinions and recommendations influenced protocol development and the refinement of the interventions. Results: Overall, participants thought that MSM and TGP would be interested in participating in the study, although they expected recruitment and retention to be challenging. Participants thought that the peer navigator should be someone who is nonjudgmental, has experience with people who use methamphetamine, and is patient and flexible. There was consensus that three text messages per day were appropriate, adherence reminders should be straightforward, all messages should be nonjudgmental, and participants should be able to tailor the timing and content of the text messages. These suggestions were incorporated into the study interventions via the hiring and training process and into the development of the text library, platform selection, and customizability of messages. Conclusions: It is important to include the opinions and insights of populations most impacted by HIV to develop PrEP interventions with the greatest chance of success. Our formative work generated several recommendations that were incorporated into the interventions and protocol development for our ongoing study. Trial Registration: ClinicalTrials.gov NCT03584282; https://clinicaltrials.gov/ct2/show/NCT03584282 %M 32924952 %R 10.2196/18118 %U http://formative.jmir.org/2020/9/e18118/ %U https://doi.org/10.2196/18118 %U http://www.ncbi.nlm.nih.gov/pubmed/32924952 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e17659 %T Exploring the Use of Mobile Health to Improve Community-Based Health and Nutrition Service Utilization in the Hills of Nepal: Qualitative Study %A Acharya,Ajay %A Cunningham,Kenda %A Manandhar,Shraddha %A Shrestha,Niva %A Chen,Mario %A Weissman,Amy %+ Asia Pacific Regional Office, Family Health International 360, 19th Floor, Tower 3, Sindhorn Building, 130-132 Wireless Road, Lumpini, Phatumwan, Bangkok, 10330, Thailand, 66 2 263 5200 ext 20226, aweissman@fhi360.org %K mobile health %K text messages %K SMS text message %K qualitative study %K Nepal %K health and nutrition services %K health mothers’ group %K female community health volunteers %K mobile phone %D 2020 %7 11.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: With mobile phone coverage and ownership expanding globally, mobile health (mHealth) interventions are increasingly being used to improve coverage and quality of health and nutrition services. However, evidence on mHealth intervention feasibility and factors to consider during program design is limited in low- and middle-income countries like Nepal. Objective: This study aimed to examine the potential of using text messages to improve health and nutrition services by exploring mobile phone ownership and sharing; mobile phone use and skills; and interest, preferences, and limitations regarding mHealth interventions. Methods: We conducted 35 in-depth interviews with 1000-day women (the period from conception to a child’s second birthday), health facility staff, and female community health volunteers (FCHVs), as well as eight focus group discussions with health facility staff, FCHVs, and 1000-day household decision-makers (ie, husbands, mothers-in-law, and fathers-in-law). We also conducted a mobile phone skills test. We employed thematic analysis using framework matrices and analytical memos. Results: The study included 70 study participants, of whom 68 (97%) had a mobile phone, and phone sharing was uncommon. Use of text messages was most commonly reported by 1000-day women and health facility staff than household decision-makers and FCHVs. More than 8 in 10 participants (54/64, 84%) could dial numbers, and the majority (28/34, 82%) of 1000-day women, health facility staff, and male decision-makers could also read and write text messages. We found that 1000-day women preferred educational and reminder messages, whereas health facility staff and FCHVs desired educational and motivational messages. Participants suggested different types of texts for 1000-day women, families, FCHVs, and health facility staff, and reported less value for texts received from unknown phone numbers. Conclusions: A text message–based mHealth intervention is acceptable in the hills of Nepal and has the potential to improve community health and nutrition service utilization, particularly by sending meeting reminders and by providing information. Our findings contribute to text message–based mHealth intervention design in under-resourced settings. %M 32915151 %R 10.2196/17659 %U http://www.jmir.org/2020/9/e17659/ %U https://doi.org/10.2196/17659 %U http://www.ncbi.nlm.nih.gov/pubmed/32915151 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e14346 %T Efficiency of Text Message Contact on Medical Safety in Outpatient Surgery: Retrospective Study %A Peuchot,Jeremy %A Allard,Etienne %A Dureuil,Bertrand %A Veber,Benoit %A Compère,Vincent %+ Department of Anesthesiology and Critical Care, Rouen University Hospital, 1 rue de Germont, Rouen, France, 33 02 32 88 82 83, Vincent.compere@chu-rouen.fr %K outpatient surgery %K short message service (SMS) %K patient information %K organizational %K cost %K unanticipated admission %K preoperative instructions %D 2020 %7 10.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Establishing pre- and postoperative contact with patients is part of successful medical management in outpatient surgery. In France, this is mostly done via telephone. Automated information with short message service (SMS) reminders might be an interesting alternative to increase the rate of compliance with preoperative instructions, but no study has shown the safety of this approach. Objective: The objective of this study was to evaluate the impact of pre- and postoperative automated information with SMS reminders on medical safety in outpatient surgery. Methods: We conducted a retrospective, single-center, nonrandomized, controlled study with a before-after design. All adult patients who had outpatient surgery between September 2016 and December 2017 in our university hospital center were included. Before April 2017, patients were contacted by telephone by an outpatient surgery nurse. After April 2017, patients were contacted by SMS reminder. All patients were contacted the day before and the day after surgery. Patients contacted by SMS reminder were also contacted on day 7 after surgery. The primary end point was the conversion rate to full-time hospitalization. Secondary end points were hospitalization causes (anesthetic, surgical, organizational) and hospitalization costs. Results: A total of 4388 patients were included, 2160 before and 2228 after the introduction of SMS reminders. The conversion rate to full-time hospitalization was 34/4388 (0.77%) with a difference between SMS group (8/2228, 0.36%) and telephone group (26/2160, 1.20%). The cost of SMS reminders was estimated as half that of telephone calls. Conclusions: In this work, we report a decrease in the rate of conversion to full-time hospitalization with the use of pre- and postoperative SMS reminders. This new approach could represent a safe and cost-effective method in an outpatient surgery setting. %M 32909948 %R 10.2196/14346 %U https://mhealth.jmir.org/2020/9/e14346 %U https://doi.org/10.2196/14346 %U http://www.ncbi.nlm.nih.gov/pubmed/32909948 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 5 %N 3 %P e15835 %T Intervention Enhancement Strategies Among Adults With Type 2 Diabetes in a Very Low–Carbohydrate Web-Based Program: Evaluating the Impact With a Randomized Trial %A Saslow,Laura R %A Moskowitz,Judith Tedlie %A Mason,Ashley E %A Daubenmier,Jennifer %A Liestenfeltz,Bradley %A Missel,Amanda L %A Bayandorian,Hovig %A Aikens,James E %A Kim,Sarah %A Hecht,Frederick M %+ Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 2178 400 North Ingalls Street, Ann Arbor, MI, 48109, United States, 1 7347647836, saslowl@umich.edu %K type 2 diabetes %K diet, ketogenic %K text messages %K self-management %D 2020 %7 9.9.2020 %9 Original Paper %J JMIR Diabetes %G English %X Background: Adults with type 2 diabetes may experience health benefits, including glycemic control and weight loss, from following a very low–carbohydrate, ketogenic (VLC) diet. However, it is unclear which ancillary strategies may enhance these effects. Objective: This pilot study aims to estimate the effect sizes of 3 intervention enhancement strategies (text messages, gifts, and breath vs urine ketone self-monitoring) that may improve outcomes of a 12-month web-based ad libitum VLC diet and lifestyle intervention for adults with type 2 diabetes. The primary intervention also included other components to improve adherence and well-being, including positive affect and mindfulness as well as coaching. Methods: Overweight or obese adults (n=44; BMI 25-45 kg/m2) with type 2 diabetes (glycated hemoglobin [HbA1c] ≥6.5%), who had been prescribed either no glucose-lowering medications or metformin alone, participated in a 12-month web-based intervention. Using a 2×2×2 randomized factorial design, we compared 3 enhancement strategies: (1) near-daily text messages about the intervention’s recommended behaviors (texts n=22 vs no texts n=22), (2) mailed gifts of diet-relevant foods and cookbooks (6 rounds of mailed gifts n=21 vs no gifts n=23), and (3) urine- or breath-based ketone self-monitoring (urine n=21 vs breath n=23). We assessed HbA1c and weight at baseline and at 4, 8, and 12 months. We evaluated whether each strategy exerted a differential impact on HbA1c and weight at 12 months against an a priori threshold of Cohen d of 0.5 or greater. Results: We retained 73% (32/44) of the participants at 12 months. The intervention, across all conditions, led to improvements in glucose control and reductions in body weight at the 12-month follow-up. In intent-to-treat (ITT) analyses, the mean HbA1c reduction was 1.0% (SD 1.6) and the mean weight reduction was 5.3% (SD 6.0), whereas among study completers, these reductions were 1.2% (SD 1.7) and 6.3% (SD 6.4), respectively, all with a P value of less than .001. In ITT analyses, no enhancement strategy met the effect size threshold. Considering only study completers, 2 strategies showed a differential effect size of at least a d value of 0.5 or greater Conclusions: Text messages, gifts of food and cookbooks, and urine-based ketone self-monitoring may potentially enhance the glycemic or weight loss benefits of a web-based VLC diet and lifestyle intervention for individuals with type 2 diabetes. Future research could investigate other enhancement strategies to help create even more effective solutions for the treatment of type 2 diabetes. Trial Registration: ClinicalTrials.gov NCT02676648; http://clinicaltrials.gov/ct2/show/NCT02676648 %M 32902391 %R 10.2196/15835 %U http://diabetes.jmir.org/2020/3/e15835/ %U https://doi.org/10.2196/15835 %U http://www.ncbi.nlm.nih.gov/pubmed/32902391 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e14739 %T mHealth Interventions to Promote Anti-Retroviral Adherence in HIV: Narrative Review %A Lee,Stephen B %A Valerius,Joanne %+ Department of Medicine, Division of Infectious Diseases, University of Saskatchewan College of Medicine, Regina General Hospital, Unit 4E, Regina, SK, S4P 0W5, Canada, 1 306 766 4247, leestephenz@gmail.com %K mHealth %K HIV %K antiretroviral %K adherence %K mobile phone %D 2020 %7 28.8.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Antiretrovirals (ARVs) are key in the management of HIV. Although no cure exists, ARVs help patients live healthy lives and prevent transmission to others. Adherence to complex regimens is paramount to outcomes and in avoiding the emergence of drug-resistant viruses. The goal of therapy is to reach an undetectable viral load. However, adherence is a common problem, stemming from issues such as mental health, chaotic home situations, and busy work schedules. Mobile health (mHealth) represents a new approach in improving medication adherence, and multiple studies have been performed in this area. Objective: This study aims to review the current implementation of mHealth in the management of HIV among different groups of patients. Methods: We used PubMed, Academic Search Elite, and 1 journal database with various search terms to review the current implementation of mHealth in HIV care. Results: Titles and abstracts were screened, and 61 papers were identified and fully reviewed. The literature was divided into lower- and higher-income nations, as defined by the United Nations. A total of 20 studies with quantitative results were identified, with 10 being text- and SMS-based interventions (the majority of these being in lower-income countries) and 8 being smartphone-based apps (primarily in higher-income countries). The majority of these studies determined whether there was an effect on adherence or biochemical parameters (viral load and CD4 count). Various qualitative studies have also been conducted, and many have focused on determining the specific design of interventions that were successful (frequency of messaging, types of messages, etc) as well as priorities for patients with regard to mHealth interventions. Conclusions: There seems to be a role of mHealth in the management of HIV in lower-income nations; however, the optimal design of an intervention needs to be delineated. In higher-income countries, where the 2 significant risk factors were injection drugs and men who have sex with men, the benefit was less clear, and more research is needed. %M 32568720 %R 10.2196/14739 %U https://mhealth.jmir.org/2020/8/e14739 %U https://doi.org/10.2196/14739 %U http://www.ncbi.nlm.nih.gov/pubmed/32568720 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 8 %P e15680 %T Improving Retention in Care and Promoting Adherence to HIV Treatment: Protocol for a Multisite Randomized Controlled Trial of Mobile Phone Text Messaging %A Tanue,Elvis Asangbeng %A Nsagha,Dickson Shey %A Theophile,Nana Njamen %A Assob,Jules Clement Nguedia %+ Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, PO Box 12, Buea, 00237, Cameroon, 237 677499429, dsnsagha@gmail.com %K adherence %K antiretroviral %K HIV %K randomized controlled trial %K retention in care %K text messaging %D 2020 %7 27.8.2020 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The World Health Organization has prioritized the use of new technologies to assist in health care delivery in resource-limited settings. Findings suggest that the use of SMS on mobile phones is an advantageous application in health care delivery, especially in communities with an increasing use of this device. Objective: The main aim of this trial is to assess whether sending weekly motivational text messages (SMS) through mobile phones versus no text messaging will improve retention in care and promote adherence to treatment and health outcomes among patients receiving HIV treatment in Fako Division of Cameroon. Methods: This is a multisite randomized controlled single-blinded trial. Computer-generated random block sizes shall be used to produce a randomization list. Participants shall be randomly allocated into the intervention and control groups determined by serially numbered sealed opaque envelopes. The 156 participants will either receive the mobile phone text message or usual standard of care. We hypothesize that sending weekly motivational SMS reminders will produce a change in behavior to enhance retention; treatment adherence; and, hence, health outcomes. Participants shall be evaluated and data collected at baseline and then at 2, 4, and 6 months after the launch of the intervention. Text messages shall be sent out, and the delivery will be recorded. Primary outcome measures are retention in care and adherence to treatment. Secondary outcomes are clinical (weight, body mass index), biological (virologic suppression, tuberculosis coinfection), quality of life, treatment discontinuation, and mortality. The analysis shall be by intention-to-treat. Analysis of covariates shall be performed to determine factors influencing outcomes. Results: Recruitment and random allocation are complete; 160 participants were allocated into 3 groups (52 in the single SMS, 55 in the double SMS, and 53 in the control). Data collection and analysis are ongoing, and statistical results will be available by the end of August 2019. Conclusions: The interventions will contribute to an improved understanding of which intervention types can be feasible in improving retention in care and promoting adherence to antiretroviral therapy. Trial Registration: Pan African Clinical Trial Registry in South Africa PACTR201802003035922; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3035 International Registered Report Identifier (IRRID): DERR1-10.2196/15680 %M 32852282 %R 10.2196/15680 %U http://www.researchprotocols.org/2020/8/e15680/ %U https://doi.org/10.2196/15680 %U http://www.ncbi.nlm.nih.gov/pubmed/32852282 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e17191 %T Two-Way Text Messaging to Support Self-Care and Delivery of an Online Sexual Health Service: Mixed Methods Evaluation %A Shanks,Sarah %A Morelli,Alessandra %A Ardines,Elena %A Holdsworth,Gillian %A Baraitser,Paula %+ SH:24, 35a Westminster Bridge Road, London, SE1 7JB, United Kingdom, 1 02076202250, sshanks@nhs.net %K SMS %K text message %K digital health %K sexual health %K self-care %K mobile phone %D 2020 %7 20.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital health care is increasingly used to improve health service accessibility and reduce costs. Remote health care requires a significant self-management role for service users, and this generates information provision and support needs that should be reflected in service planning. SMS text messaging offers a convenient and low-cost method of communication and is increasingly used across digital health care services to provide remote support. Objective: The aim of this study was to quantify the number of messages generated through user interaction with a two-way SMS text messaging support service within an online sexual health service and to thematically explore the content of the messages and type of support required to facilitate self-management. Methods: The content of all SMS text messages received by an online sexual health service was analyzed from April 4, 2018, to July 5, 2018. Messages were classified as being either administrative or clinical in nature and service or user initiated. For those messages that were both clinical and user initiated, a qualitative thematic analysis was completed to fully describe the content of the interactions. Results: A total of 267 actionable messages were generated per 1000 orders requested through the service. Of the 8562 messages, 5447 (63.62%) messages were administrative and 3115 (36.38%) were clinical. Overall, 4306 of the 8562 messages (50.29%) responded to service-generated queries reflecting the public health and clinical responsibilities of an online provider, and 4256 (49.71%) were user-generated queries, demonstrating a willingness by users to proactively engage with a two-way SMS text messaging support service. Of the 3115 clinical messages, 968 (31.08%) clinical messages were user initiated and shared personal and complex clinical information, including requests for help with the self-testing process and personalized clinical advice relating to symptoms and treatment. Conclusions: This study demonstrates the willingness of users of an online sexual health service to engage with two-way SMS text messaging and provides insight into the quantity and nature of the support required to facilitate service delivery and self-care. Further work is required to understand the range of clinical problems that can be managed within this medium. %M 32815820 %R 10.2196/17191 %U http://mhealth.jmir.org/2020/8/e17191/ %U https://doi.org/10.2196/17191 %U http://www.ncbi.nlm.nih.gov/pubmed/32815820 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19861 %T Text Messaging Adherence Intervention for Adolescents and Young Adults with Chronic Kidney Disease: Pilot Randomized Controlled Trial and Stakeholder Interviews %A Eaton,Cyd %A Comer,Margaret %A Pruette,Cozumel %A Psoter,Kevin %A Riekert,Kristin %+ Pulmonary & Critical Care Medicine, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD, 21224, United States, 1 410 550 3988, ceaton4@jhmi.edu %K medication adherence %K mobile health %K pediatrics %K kidney diseases %K kidney %K mHealth %K adherence %K adolescent %K young adult %K intervention %D 2020 %7 14.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Up to one-third of adolescents and young adults (11-21 years old) with chronic kidney disease exhibit suboptimal rates of adherence to renal-protective antihypertensive medications. Mobile health interventions may promote higher adherence to these medicines in these individuals, but empirical research is needed to inform best practices for applying these modalities. Objective: In this multiphase investigation, we developed and tested a theoretically informed text messaging intervention based on the COM-B model, a well-established health intervention framework stating that capability, opportunity, and motivation interactively modify health behaviors, to improve participants’ antihypertensive medication adherence in a pilot randomized controlled trial. Qualitative data on user experiences were obtained. Methods: In phase 1, intervention messages (Reminder+COM-B Message) were developed via stakeholder engagement of participants and pediatric nephrologists. In phase 2, the Reminder+COM-B Message intervention was tested against a Reminder-only Message active control condition in an 8-week pilot randomized controlled trial. The primary outcome was daily electronically monitored antihypertensive medication adherence and secondary outcomes included pre-post participant surveys of adherence self-efficacy, adherence barriers, outcome expectancies for taking medicine, and motivation for and importance of taking medicine. In phase 3, qualitative interviews related to user experiences were conducted with participants in the Reminder+COM-B Message intervention group. Results: Following phase 1, 34 participants (mean age 16.59 years, 41% female, 38% African American/Black, 35% hypertension diagnosis) completed the phase 2 pilot randomized controlled trial (n=18 in the Reminder+COM-B Message intervention group, n=16 in the Reminder-only Message active control group). All participants in the Reminder+COM-B Message intervention group completed a phase 3 qualitative interview. Overall, study procedures were feasible and the Reminder+COM-B Message intervention was acceptable to the participants (eg, 15/18 participants reported reading the majority of messages sent to them, 0/18 reported that the messages reduced their desire to take medicine). Prerandomization, there were no significant group differences in the rate of change in daily adherence over time. However, postrandomization, there was a significant group by time interaction (B=.01, P=.04) in which daily adherence decreased significantly over time in the Reminder-only Message active control group but remained stable in the Reminder+COM-B Message intervention group. There were no significant differences between groups in pre-post changes in survey responses. Qualitative interviews revealed participants’ perceptions of how the Reminder+COM-B Message intervention changed adherence behavior and highlighted several areas for improving the intervention (eg, adapt messaging timing, intensity, and content to match daily adherence, send praise when medicine is taken). Conclusions: The Reminder+COM-B Message intervention was feasible and acceptable to adolescents/young adults and demonstrated potential to promote participants’ daily medication adherence beyond simple reminders. Further research is needed to determine the Reminder+COM-B Message intervention’s mechanisms of adherence behavior change and to incorporate qualitative participant feedback into a modified version of this intervention to enhance its acceptability. Trial Registration: ClinicalTrials.gov NCT03651596; https://clinicaltrials.gov/ct2/show/NCT03651596 %M 32795983 %R 10.2196/19861 %U http://www.jmir.org/2020/8/e19861/ %U https://doi.org/10.2196/19861 %U http://www.ncbi.nlm.nih.gov/pubmed/32795983 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e18793 %T A Tailored Motivational Messages Library for a Mobile Health Sleep Behavior Change Support System to Promote Continuous Positive Airway Pressure Use Among Patients With Obstructive Sleep Apnea: Development, Content Validation, and Testing %A Alismail,Sarah %A Olfman,Lorne %+ Claremont Graduate University, 150 E 10th St, Claremont, CA, , United States, 1 909 621 8000, sarah.alismail@cgu.edu %K obstructive sleep apnea %K mHealth %K tailored messages %K CPAP therapy %K extended parallel process model %D 2020 %7 12.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Continuous positive airway pressure (CPAP) therapy is the most effective treatment for obstructive sleep apnea (OSA). Despite the reported benefits of CPAP therapy in treating OSA, its effectiveness is reduced by less-than-optimal adherence or use. Up to 50% of patients who accept CPAP therapy fail to adhere to it. As a lack of commitment to CPAP therapy is one of the most significant factors that hinder OSA treatment effectiveness, patient motivation and education are critical to help alleviate the problem of poor CPAP adherence or use. Objective: This study aims to support the development of mobile health interventions or information systems solutions to promote CPAP adherence and use among patients with OSA through development, content validation, and testing of tailored motivational messages. Methods: In phase 1, an initial library of 60 messages was developed to promote CPAP use among patients with OSA. In phase 2, draft messages were evaluated for content validation testing for relevance and clarity by research and clinical experts. In phase 3, patients with OSA (N=24) were recruited through a Qualtrics panel to rate the perceived persuasiveness of the messages in terms of threat and efficacy perceptions, as per their computed extended parallel process model (EPPM) response states. The average score of the ratings was calculated for each message. The messages were sorted according to their average (from highest to lowest) to select the best 12 messages for each tailored set based on the potential responses from the EPPM. Results: In phase 1, 60 messages were developed based on the existing literature and a review of existing materials. In phase 2, the enumerated content validity of the messages was established through the use of the content validity index for items. A total of 57 messages were found to have acceptable content relevance and clarity. In phase 3, patients with OSA perceived the final library of 48 messages to be persuasive. Conclusions: After the process of content validation and testing, the final library of messages met the criteria for clarity, relevance, and perceived persuasiveness. This study emphasizes the importance of developing and validating the content of motivational messages, grounded in EPPM theory, across the 4 possible response states in terms of high or low efficacy and threat perceptions. %M 32784176 %R 10.2196/18793 %U https://mhealth.jmir.org/2020/8/e18793 %U https://doi.org/10.2196/18793 %U http://www.ncbi.nlm.nih.gov/pubmed/32784176 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e19529 %T Mobile Fotonovelas Within a Text Message Outreach: An Innovative Tool to Build Health Literacy and Influence Behaviors in Response to the COVID-19 Pandemic %A Brar Prayaga,Rena %A Prayaga,Ram S %+ mPulse Mobile, Inc, 16530 Ventura Blvd, Suite 500, Encino, CA, 91436, United States, 1 888 678 5735, rena@mpulsemobile.com %K text messaging %K SMS %K mobile fotonovelas %K COVID-19 %K social isolation %K social support %K health behaviors %K health literacy %K health plans %D 2020 %7 10.8.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X With all 50 US states reporting cases of coronavirus disease (COVID-19), people around the country are adapting and stepping up to the challenges of the pandemic; however, they are also frightened, anxious, and confused about what they can do to avoid exposure to the disease. Usual habits have been interrupted as a result of the crisis, and consumers are open to suggestions and strategies to help them change long-standing attitudes and behaviors. In response, a novel and innovative mobile communication capability was developed to present health messages in English and Spanish with links to fotonovelas (visual stories) that are accessible, easy to understand across literacy levels, and compelling to a diverse audience. While SMS text message outreach has been used to build health literacy and provide social support, few studies have explored the benefits of SMS text messaging combined with visual stories to influence health behaviors and build knowledge and self-efficacy. In particular, this approach can be used to provide vital information, resources, empathy, and support to the most vulnerable populations. This also allows providers and health plans to quickly reach out to their patients and members without any additional resource demands at a time when the health care system is severely overburdened. %M 32716894 %R 10.2196/19529 %U http://mhealth.jmir.org/2020/8/e19529/ %U https://doi.org/10.2196/19529 %U http://www.ncbi.nlm.nih.gov/pubmed/32716894 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 5 %N 3 %P e17794 %T Evaluation of a Text Messaging Intervention to Support Self-Management of Diabetes During Pregnancy Among Low-Income, Minority Women: Qualitative Study %A Yee,Lynn %A Taylor,Shaneah %A Young,Maria %A Williams,Makayla %A Niznik,Charlotte %A Simon,Melissa %+ Northwestern University, 250 E Superior Street, #5-2145, Chicago, IL, 60611, United States, 1 3124724685, lynn.yee@northwestern.edu %K gestational diabetes mellitus %K type 2 diabetes mellitus %K mobile health %K text messaging %K mobile phone %K pregnancy %D 2020 %7 10.8.2020 %9 Original Paper %J JMIR Diabetes %G English %X Background: Given the growing burden of diabetes in underserved communities and the complexity of diabetes self-management during pregnancy, the development of interventions to support low-income pregnant women with diabetes is urgently needed. Objective: This study aims to develop and pilot test a theory-driven curriculum of SMS text messaging for diabetes support and education during pregnancy. Methods: This was a prospective pilot investigation of a novel SMS text messaging intervention offered to pregnant women with pregestational or gestational diabetes mellitus and publicly funded prenatal care. Prior work yielded a conceptual model of diabetes self-management barriers and support factors in this population, which was used to guide curriculum development along with health behavior theories. Participants received three supportive or educational one-way text messages per week during pregnancy. In-depth semistructured interviews were performed at study exit to solicit feedback on the program. Narrative data were analyzed using the constant comparative technique to identify themes and subthemes. Results: Participants (N=31 enrolled and n=26 completed both interviews) consistently reported that SMS text messaging provided enhanced motivation for diabetes self-care, reduced diabetes-related social isolation, increased perceived diabetes-associated knowledge, enhanced comfort with the health care team, and reduced logistical burdens of diabetes during pregnancy. Participants requested enhanced interactive and customizable features in future intervention iterations. Conclusions: Pregnant women with diabetes who were enrolled in this pilot study of an SMS text messaging curriculum for diabetes support described enhanced motivation, knowledge, and comfort with diabetes self-care activities as a result of the health education intervention. The next steps include enriching the interactive features of the intervention and investigating the effect of the intervention on perinatal outcomes. %M 32773367 %R 10.2196/17794 %U http://diabetes.jmir.org/2020/3/e17794/ %U https://doi.org/10.2196/17794 %U http://www.ncbi.nlm.nih.gov/pubmed/32773367 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16634 %T Explaining Differences in the Acceptability of 99DOTS, a Cell Phone–Based Strategy for Monitoring Adherence to Tuberculosis Medications: Qualitative Study of Patients and Health Care Providers %A Thomas,Beena E %A Kumar,J Vignesh %A Onongaya,Chidiebere %A Bhatt,Spurthi N %A Galivanche,Amith %A Periyasamy,Murugesan %A Chiranjeevi,M %A Khandewale,Amit Subhash %A Ramachandran,Geetha %A Shah,Daksha %A Haberer,Jessica E %A Mayer,Kenneth H %A Subbaraman,Ramnath %+ Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave, MV237, Boston, MA, 02111, United States, 1 6176360985, ramnath.subbaraman@tufts.edu %K tuberculosis %K medication adherence %K mobile phone %K mHealth %K implementation science %K qualitative research %D 2020 %7 31.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: 99DOTS is a cell phone–based strategy for monitoring tuberculosis (TB) medication adherence that has been rolled out to more than 150,000 patients in India’s public health sector. A considerable proportion of patients stop using 99DOTS during therapy. Objective: This study aims to understand reasons for variability in the acceptance and use of 99DOTS by TB patients and health care providers (HCPs). Methods: We conducted qualitative interviews with individuals taking TB therapy in the government program in Chennai and Vellore (HIV-coinfected patients) and Mumbai (HIV-uninfected patients) across intensive and continuation treatment phases. We conducted interviews with HCPs who provide TB care, all of whom were involved in implementing 99DOTS. Interviews were transcribed, coded using a deductive approach, and analyzed with Dedoose 8.0.35 software (SocioCultural Research Consultants, LLC). The findings of the study were interpreted using the unified theory of acceptance and use of technology, which highlights 4 constructs associated with technology acceptance: performance expectancy, effort expectancy, social influences, and facilitating conditions. Results: We conducted 62 interviews with patients with TB, of whom 30 (48%) were HIV coinfected, and 31 interviews with HCPs. Acceptance of 99DOTS by patients was variable. Greater patient acceptance was related to perceptions of improved patient-HCP relationships from increased phone communication, TB pill-taking habit formation due to SMS text messaging reminders, and reduced need to visit health facilities (performance expectancy); improved family involvement in TB care (social influences); and from 99DOTS leading HCPs to engage positively in patients’ care through increased outreach (facilitating conditions). Lower patient acceptance was related to perceptions of reduced face-to-face contact with HCPs (performance expectancy); problems with cell phone access, literacy, cellular signal, or technology fatigue (effort expectancy); high TB- and HIV-related stigma within the family (social influences); and poor counseling in 99DOTS by HCPs or perceptions that HCPs were not acting upon adherence data (facilitating conditions). Acceptance of 99DOTS by HCPs was generally high and related to perceptions that the 99DOTS adherence dashboard and patient-related SMS text messaging alerts improve quality of care, the efficiency of care, and the patient-HCP relationship (performance expectancy); that the dashboard is easy to use (effort expectancy); and that 99DOTS leads to better coordination among HCPs (social influences). However, HCPs described suboptimal facilitating conditions, including inadequate training of HCPs in 99DOTS, unequal changes in workload, and shortages of 99DOTS medication envelopes. Conclusions: In India’s government TB program, 99DOTS had high acceptance by HCPs but variable acceptance by patients. Although some factors contributing to suboptimal patient acceptance are modifiable, other factors such as TB- and HIV-related stigma and poor cell phone accessibility, cellular signal, and literacy are more difficult to address. Screening for these barriers may facilitate targeting of 99DOTS to patients more likely to use this technology. %M 32735220 %R 10.2196/16634 %U http://mhealth.jmir.org/2020/7/e16634/ %U https://doi.org/10.2196/16634 %U http://www.ncbi.nlm.nih.gov/pubmed/32735220 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e12655 %T Patient and Provider Cocreation of Mobile Texting Apps to Support Behavioral Health: Usability Study %A Arevian,Armen C %A O'Hora,Jennifer %A Rosser,James %A Mango,Joseph D %A Miklowitz,David J %A Wells,Kenneth B %+ Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 10920 Wilshire Blvd, Suite 300, Los Angeles, CA, , United States, 1 310 794 3732, AArevian@mednet.ucla.edu %K mobile health %K community-based participatory research %K app development %K technology platforms %K personalized medicine %K behavioral health %K mobile phone %D 2020 %7 29.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile technologies hold potential for improving the quality of care and engagement of patients. However, there are considerable challenges in ensuring that technologies are relevant, useful, and engaging. While end users such as patients and providers are increasingly involved in the design of health technologies, there are limited examples of their involvement in directly creating technologies for their personal use. Objective: We aim to evaluate the feasibility and acceptability of patients and providers creating mobile texting apps to support treatment goals. Methods: In an 11-month usability study, we enrolled 4 providers and 28 patients in an intensive outpatient program for obsessive-compulsive disorder. Patients and providers created their own mobile texting apps using a visual app development platform. A subsample of 10 patients and 4 providers completed a usability measure. Results: Participants created a total of 360 unique mobile text messages (1787 total messages sent). There were 4 types of messages identified, including personalized reminders, clinical exposures, interactive prompts, and encouraging/informational messages. A total of 9 out of 10 (90%) patients agreed that the messages were relevant to their recovery, and 8 out of 10 (80%) agreed that the messages were effective at helping complete treatment plans. Conclusions: Enabling patients and providers to cocreate apps for their own use by using a visual application platform is feasible and holds potential for increasing the relevance, sustainability, and effectiveness of digital health technologies. %M 32723714 %R 10.2196/12655 %U http://mhealth.jmir.org/2020/7/e12655/ %U https://doi.org/10.2196/12655 %U http://www.ncbi.nlm.nih.gov/pubmed/32723714 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16783 %T The Cedar Project - Mobile Phone Use and Acceptability of Mobile Health Among Young Indigenous People Who Have Used Drugs in British Columbia, Canada: Mixed Methods Exploratory Study %A Jongbloed,Kate %A Pearce,Margo E %A Thomas,Vicky %A Sharma,Richa %A Pooyak,Sherri %A Demerais,Lou %A Lester,Richard T %A Schechter,Martin T %A Spittal,Patricia M %A , %+ School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada, 1 604 875 2345 ext 5944, spittal@sm.hivnet.ubc.ca %K Indigenous %K mobile health %K mHealth %K text messaging %K substance use %K HIV/AIDS %D 2020 %7 27.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Indigenous leaders continue to be concerned about high rates of HIV and barriers to HIV treatment among young Indigenous people involved in substance use. Growing evidence suggests that using mobile phones for health (mHealth) may be a powerful way to support connection with health services, including HIV prevention and treatment. Objective: This study examined the patterns of mobile phone ownership and use among young Indigenous people who have used drugs living with or vulnerable to HIV and explored the acceptability of mHealth to support access to health care in this population. Methods: The Cedar Project is a cohort study involving young Indigenous people who have used drugs in Vancouver and Prince George, British Columbia. This mixed methods exploratory study involved 131 Cedar Project participants enrolled in our WelTel mHealth program. At enrollment, participants completed a questionnaire related to mobile phone use and interest in mHealth. Data were linked to Cedar Project questionnaires and serodata. We present comparative statistics (quantitative) and results of a rapid thematic analysis (qualitative) related to mobile phone patterns and interest in receiving mHealth. Results: Less than half of the participants (59/130; 45.4%) reported owning a phone. Among those with a phone, the majority owned a smartphone (46/59; 78%). Most participants with a phone reported having an unlimited texting plan (39/55; 71%), using the internet on their phone (44/59; 75%), and texting daily (44/55; 80%). A majority reported that using a mobile phone for health would be invaluable (120/130; 92.3%). There were no differences in mHealth acceptance between participants who owned a phone and those who did not (P>.99). All but one participant living with HIV felt using a mobile phone would be helpful for their health, while a small proportion of HIV-negative participants remained unsure (1.9% vs 11.7%; P=.047). In response to open-ended questions asking why using a mobile phone may be helpful for health, participants identified a diverse set of anticipated benefits: (1) connection for emotional, mental, and spiritual support, (2) connection to family, (3) staying in touch and/or being reachable, (4) overcoming current barriers to phone use, (5) convenience, privacy, and safety, and (6) access to health care and emergency services. Conclusions: We observed high acceptance and interest in using mobile phone technology for health despite low rates of personal mobile phone connectivity among young Indigenous people who have used drugs living with and vulnerable to HIV in British Columbia, Canada. Mobile phones were viewed as a way to support connections and relationships that are seen as critical to health and well-being among young Indigenous people in this study. Findings may be useful for health care providers preparing to scale up mHealth programs to support HIV prevention and treatment in this population. %M 32716311 %R 10.2196/16783 %U https://mhealth.jmir.org/2020/7/e16783 %U https://doi.org/10.2196/16783 %U http://www.ncbi.nlm.nih.gov/pubmed/32716311 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17534 %T User Engagement Among Diverse Adults in a 12-Month Text Message–Delivered Diabetes Support Intervention: Results from a Randomized Controlled Trial %A Nelson,Lyndsay A %A Spieker,Andrew %A Greevy,Robert %A LeStourgeon,Lauren M %A Wallston,Kenneth A %A Mayberry,Lindsay S %+ Department of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Suite 450, Nashville, TN, 37203, United States, 1 6158757621, lyndsay.a.nelson@vumc.org %K engagement %K text messaging %K mobile health %K mHealth %K mobile phone %K technology %K diabetes mellitus, type 2 %K self-management %K self-care %K medication adherence %D 2020 %7 21.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Text message–delivered interventions are a feasible and scalable approach for improving chronic disease self-care and reducing health disparities; however, information on long-term user engagement with these interventions is limited. Objective: The aim of this study is to examine user engagement in a 12-month text message–delivered intervention supporting diabetes self-care, called REACH (Rapid Education/Encouragement And Communications for Health), among racially and socioeconomically diverse patients with type 2 diabetes (T2D). We explored time trends in engagement, associations between patient characteristics and engagement, and whether the addition of a human component or allowing patients to change their text frequency affected engagement. Qualitative data informed patients’ subjective experience of their engagement. Methods: We recruited patients with T2D for a randomized trial evaluating mobile phone support relative to enhanced treatment as usual. This analysis was limited to participants assigned to the intervention. Participants completed a survey and hemoglobin A1c (HbA1c) test and received REACH text messages, including self-care promotion texts, interactive texts asking about medication adherence, and adherence feedback texts. For the first 6 months, texts were sent daily, and half of the participants also received monthly phone coaching. After 6 months, coaching stopped, and participants had the option to receive fewer texts for the subsequent 6 months. We defined engagement via responses to the interactive texts and responses to a follow-up interview. We used regression models to analyze associations with response rate and thematic and structural analysis to understand participants’ reasons for responding to the texts and their preferred text frequency. Results: The participants were, on average, aged 55.8 (SD 9.8) years, 55.2% (137/248) female, and 52.0% (129/248) non-White; 40.7% (101/248) had ≤ a high school education, and 40.7% (101/248) had an annual household income 50% (8 studies) and >85% (3 studies) of contact points, respectively. Text messages were heterogeneous, with a median of 1.5 text messages sent per week (range: 1-21). A total of 4 studies utilized two-way text message communication with health professionals Of the 8 studies, 7 demonstrated reductions in BMI or BMI z-score in the intervention group compared with the control at the end of the final follow-up. The effect was only statistically significant in 1 study at 6 months. Over 6 months, reductions in BMI (kg/m2) ranged from 1.3% to 4.5% and BMI z-score ranged from 4.2% to 28.1%. Overall quality of the studies was low. Conclusions: Further research is required to elucidate the effectiveness and potential impact of text message interventions on weight and weight-related behaviors in adolescents. %M 32348264 %R 10.2196/15849 %U http://mhealth.jmir.org/2020/5/e15849/ %U https://doi.org/10.2196/15849 %U http://www.ncbi.nlm.nih.gov/pubmed/32348264 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 5 %P e17345 %T Augmenting Safety Planning With Text Messaging Support for Adolescents at Elevated Suicide Risk: Development and Acceptability Study %A Czyz,Ewa K %A Arango,Alejandra %A Healy,Nathaniel %A King,Cheryl A %A Walton,Maureen %+ Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI, 48109, United States, 1 7346476727, ewac@umich.edu %K adolescents %K suicide %K text messaging %K safety planning %D 2020 %7 25.5.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Suicide is the second leading cause of death among adolescents. A critical need exists for developing promising interventions for adolescents after psychiatric hospitalization who are at a high risk of experiencing repeated suicidal behaviors and related crises. The high-risk period following psychiatric hospitalization calls for cost-effective and scalable continuity of care approaches to support adolescents’ transition from inpatient care. Text messages have been used to improve a wide range of behavioral and health outcomes and may hold promise as an accessible continuity of care strategy for youth at risk of suicide. Objective: In this study of 40 adolescents at elevated suicide risk, we report on the iterative development and acceptability of a text-based intervention designed to encourage adaptive coping and safety plan adherence in the high-risk period following psychiatric hospitalization. Methods: Adolescents (aged 13-17 years) who were hospitalized because of last-month suicide attempts or last-week suicidal ideation took part in either study phase 1 (n=25; 19/25, 76% female), wherein message content was developed and revised on the basis of feedback obtained during hospitalization, or study phase 2 (n=15; 11/15, 73% female), wherein text messages informed by phase 1 were further tested and refined based on feedback obtained daily over the course of a month after discharge (n=256 observations) and during an end-of-study phone interview. Results: Quantitative and qualitative feedback across the 2 study phases pointed to the acceptability of text-based support. Messages were seen as having the potential to be helpful with the transition after hospitalization, with adolescents indicating that texts may serve as reminders to use coping strategies, contribute to improvement in mood, and provide them with a sense of encouragement and hope. At the same time, some adolescents expressed concerns that messages may be insufficient for all teens or circumstances. In phase 2, the passage of time did not influence adolescents’ perception of messages in the month after discharge (P=.74); however, there were notable daily level associations between the perception of messages and adolescents’ affect. Specifically, higher within-person (relative to adolescents’ own average) anger was negatively related to liking text messages (P=.005), whereas within-person positive affect was associated with the perception of messages as more helpful (P=.04). Conclusions: Text-based support appears to be an acceptable continuity of care strategy to support adolescents’ transition after hospitalization. The implications of study findings are discussed. Future work is needed to evaluate the impact of text-based interventions on suicide-related outcomes. %M 32160150 %R 10.2196/17345 %U http://mental.jmir.org/2020/5/e17345/ %U https://doi.org/10.2196/17345 %U http://www.ncbi.nlm.nih.gov/pubmed/32160150 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16019 %T Efficacy of Text Messaging and Personal Consultation by Pharmacy Students Among Adults With Hypertension: Randomized Controlled Trial %A Zhai,Panpan %A Hayat,Khezar %A Ji,Wenjing %A Li,Qian %A Shi,Li %A Atif,Naveel %A Xu,Sen %A Li,Pengchao %A Du,Qianqian %A Fang,Yu %+ Department of Pharmacy Administration and Clinical Pharmacy, Xi'an Jiaotong University, No 76 Yanta West Road, Xi’an, 710061, China, 86 2982655132, yufang@mail.xjtu.edu.cn %K medication adherence %K text messaging %K hypertension %K consultation %K pharmacy students %D 2020 %7 20.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Hypertension is one of the leading risk factors for ischemic heart diseases, and high rates of hypertension prevalence have either remained the same or increased in developing countries in recent years. Unfortunately, about 20% to 50% of patients with chronic diseases have been nonadherent to their drug therapy. SMS text messaging and pharmacy student–led consultations have the potential to help patients manage their blood pressure (BP). Objective: The aim of this study was to assess the effectiveness, feasibility, and acceptability of SMS text messaging and consultation to manage the BP of Chinese patients with hypertension. Methods: We conducted a two-arm cluster randomized controlled trial among patients with hypertension in Xi’an City, Shaanxi Province, China, and recruited 384 patients from 8 community health care centers. Patients were randomized into an intervention group to receive SMS text messages and consultations or into a control group to receive usual care for 3 months. We sent SMS text messages at 3-day intervals and collected data at baseline (including demographics, clinical outcomes, medication complexity, side effects, patient behavior, knowledge about hypertension, BP, and medication adherence) and the 3-month follow-up (including BP, medication adherence, and knowledge about hypertension). Results: We assessed 445 patients with hypertension and excluded 61 patients who were not eligible or who had not filled out their questionnaires. The mean age of the patients was 68.5 (SD 7.9) years in the intervention group and 69.4 (SD 9.7) years in the control group, and the sample was primarily female (265/384, 69.0%). Patients in the intervention group showed significant improvements in systolic BP (SBP; mean 134.5 mm Hg, SD 15.5 mm Hg vs mean 140.7 mm Hg, SD 15.2 mm Hg; P=.001), medication adherence (mean 7.4, SD 1.2 vs mean 7.0, SD 1.3; P=.04), and knowledge about hypertension (mean 6.3, SD 0.9 vs mean 5.9, SD 1.2; P=.004) compared with those in the control group. In measures of diastolic BP (DBP), the two arms showed nonsignificant improvements (mean 78.2 mm Hg, SD 9.0 mm Hg vs mean 77.2 mm Hg, SD 10.3 mm Hg; P=.06). In total, 176 patients had controlled BP at the 3-month follow-up (98 patients in the intervention group vs 78 patients in the control group), but it was nonsignificant (P=.08). Conclusions: The use of SMS text messaging and consultation to manage SBP and improve medication adherence is effective, feasible, and acceptable among Chinese patients with hypertension, although a significant difference was not observed with regard to DBP. It is important to maximize the potential of SMS text messaging and consultation by increasing the feasibility and acceptance of mobile interventions and conduct a cost-effectiveness analysis on this method. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900026862; http://www.chictr.org.cn/showproj.aspx?proj=42717. %M 32432556 %R 10.2196/16019 %U https://www.jmir.org/2020/5/e16019 %U https://doi.org/10.2196/16019 %U http://www.ncbi.nlm.nih.gov/pubmed/32432556 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 5 %P e16237 %T An Automated Mobile Mood Tracking Technology (Mood 24/7): Validation Study %A Kumar,Anupama %A Wang,Michael %A Riehm,Alison %A Yu,Eileen %A Smith,Ted %A Kaplin,Adam %+ Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Room 121, 600 N Wolfe Street, Meyer Building, Baltimore, MD, 21287-0005, United States, 1 4106143307, akaplin@jhmi.edu %K depression %K text messaging %K patient monitoring %K mobile phone %K short message service %K ecological momentary assessment %K digital health %D 2020 %7 20.5.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Electronic tracking has been utilized for a variety of health conditions. Previous studies have shown that there is higher adherence to electronic methods vs paper-and-pencil tracking modalities. Electronic tracking also ensures that there are no back-filled entries, where patients have—to appear compliant—entered their responses retrospectively just before their visits with their health care provider. On the basis of the recognition of an unmet need for a Web-based automated platform to track psychiatric outcomes, Johns Hopkins University partnered with Health Central (a subsidiary of Remedy Health Media LLC) to develop Mood 24/7, an electronic, mobile, automated, SMS-based mood tracker. This is a pilot study to validate the use of Mood 24/7 in anticipation of clinical trials to demonstrate the therapeutic benefit on patients’ health outcomes of utilizing digital mood-tracking technology. Objective: Mood 24/7 is an electronic mood-monitoring platform developed to accurately and efficiently track mood over time through automated daily SMS texts or emails. This study was designed to assess the accuracy and validity of Mood 24/7 in an outpatient psychiatric setting. Methods: This pilot study involved a retrospective chart review for depressed outpatients (N=9) to compare their self-reported Mood 24/7 daily mood ratings with their psychiatrist’s independent clinical mood assessment at the time of the patient’s visit. Their mood ratings via Mood 24/7 were collected over 36 weeks. In addition, a mixed model analysis was applied to compare the weekly Montgomery-Åsberg Depression Rating Scale (MADRS) scores with Mood 24/7 scores over an average of 3 months. Results: A 97.2% (315/324) digital mood reporting adherence was found over 36 weeks, and a significant correlation (r=0.86, P<.001) was observed between patients’ Mood 24/7 scores and their psychiatrist’s blinded clinical assessment of the patient’s mood when seen in the clinic. In addition, a significant concordance (intraclass correlation of 0.69, 95% CI 0.33-0.91, P<.001) was observed in the mixed model analysis of the clinician-administered MADRS vs Mood 24/7 scores over time. Conclusions: Our chart review and mixed model analyses demonstrate that Mood 24/7 is a valid instrument for convenient, simple, noninvasive, and accurate longitudinal mood assessment in the outpatient clinical setting. %M 32432558 %R 10.2196/16237 %U https://mental.jmir.org/2020/5/e16237 %U https://doi.org/10.2196/16237 %U http://www.ncbi.nlm.nih.gov/pubmed/32432558 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16629 %T A Highly Tailored Text and Voice Messaging Intervention to Improve Medication Adherence in Patients With Either or Both Hypertension and Type 2 Diabetes in a UK Primary Care Setting: Feasibility Randomized Controlled Trial of Clinical Effectiveness %A Kassavou,Aikaterini %A Mirzaei,Venus %A Brimicombe,James %A Edwards,Simon %A Massou,Efthalia %A Prevost,A Toby %A Griffin,Simon %A Sutton,Stephen %+ The University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR, United Kingdom, 44 1223330456, kk532@medschl.cam.ac.uk %K medication adherence %K hypertension %K type 2 diabetes %K text messaging %K interactive voice response %D 2020 %7 19.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The efficacy of a highly tailored digital intervention to support medication adherence and feasibility to support clinical effectiveness as an adjunct to the primary care setting has not been evaluated. Objective: This trial aimed to assess the behavioral efficacy of a highly tailored digital intervention to support medication adherence and to evaluate the feasibility of its clinical effectiveness, in patients with either or both hypertension and type 2 diabetes. We also examined quality of life and mechanisms of behavior change. Intervention fidelity, engagement, and satisfaction were also explored. Methods: This was a multicenter, individually randomized controlled trial of 2 parallel groups: an intervention group that received a highly tailored text message and interactive voice response intervention for 12 weeks, and a control group that received usual care. Medication adherence was measured using self-reports and assessor-blinded practice records of a repeat prescription. Systolic blood pressure and glucose levels were assessed by nurses blinded to group allocation during practice visits at 3 months follow-up. Questionnaires obtained data to assess intervention mechanisms of action and satisfaction and digital log files captured data to evaluate fidelity and engagement. Results: A total of 135 nonadherent patients (62/135, 46% female; 122/135, 90.3%; aged above 50 years) were randomly allocated in the intervention (n=79) or in the control group (n=56); of whom 13% (18/135) were lost at follow-up. Medication adherence was significantly improved in the intervention group compared with the control group (t116=2.27; P=.02, 2-tailed). Systolic blood pressure was 0.6 mmHg (95% CI −7.423 to 6.301), and hemoglobin A1c was 4.5 mmol/mol (95% CI −13.099 to 4.710) lower in the intervention group compared with the control group. Changes in intentional nonadherence and nonintentional nonadherence explained the improvements in medication adherence in the intervention group (beta=.074, SE=0.464; P=.04), but not in the control group (beta=.00, SE 1.35; P=.37). The intervention had 100% fidelity, a median of 12 days of engagement, and 76% overall satisfaction. Conclusions: Our trial is the first that has been conducted in the United Kingdom and showed that among nonadherent patients with either or both hypertension and type 2 diabetes, a highly tailored digital intervention was effective at improving treatment adherence and feasible to obtain clinically meaningful outcomes. Changes in intentional and nonintentional nonadherence predicted the improvements in medication adherence. The intervention had high fidelity, engagement, and satisfaction. Future research using a rigorous design is needed to evaluate the clinical effectiveness and cost-effectiveness of the intervention in primary care. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 10668149; http://www.controlled-trials.com/ISRCTN10668149. %M 32427113 %R 10.2196/16629 %U http://www.jmir.org/2020/5/e16629/ %U https://doi.org/10.2196/16629 %U http://www.ncbi.nlm.nih.gov/pubmed/32427113 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e15989 %T Use of Brief Messages Based on Behavior Change Techniques to Encourage Medication Adherence in People With Type 2 Diabetes: Developmental Studies %A Bartlett,Yvonne Kiera %A Farmer,Andrew %A Rea,Rustam %A French,David P %+ Manchester Centre for Health Psychology, University of Manchester, Coupland 1 Building, Oxford Road, Manchester, United Kingdom, 44 161 306 5436, kiera.bartlett@manchester.ac.uk %K behavior change %K behavior change techniques %K type 2 diabetes, brief messages %K mHealth %K medication adherence %D 2020 %7 13.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Brief messages are a promising way to improve adherence to medication for people with type 2 diabetes. However, it is often unclear how messages have been developed and their precise content, making it difficult to ascertain why certain messages are successful and some are not. Objective: The goal of the research was to develop messages that have proven fidelity to specified evidence-derived behavior change techniques (BCTs) and are acceptable to people with type 2 diabetes. Methods: Four studies were conducted: (1) a workshop (n=21) where behavioral change researchers and health care professionals developed messages based on specific BCTs or beliefs or concerns related to taking medication, (2) a focus group study with people with type 2 diabetes (n=23) to assess acceptability of the approach, (3) a survey to ascertain the acceptability of a subset of messages to people with type 2 diabetes (n=61) and, (4) a survey with behavior change researchers to assess the fidelity of a subset of messages to their intended BCT (n=18). Results: In study 1, 371 messages based on 38 BCTs and beliefs/concerns were developed. Workshop participants rated BCTs to be relevant to medication adherence (mean 7.12/10 [SD 1.55]) and messages to have good fidelity (mean 7.42/10 [SD 1.19]). In study 2, the approach of providing medication adherence support through text messages was found to be acceptable. In study 3, mean acceptability of all BCTs was found to be above the midpoint (mean 3.49/5 [SD 0.26]). In study 4, mean fidelity for all BCTs was found to be above the midpoint (mean 7.61/10 [SD 1.38]). Conclusions: A library of brief messages acceptable to people with type 2 diabetes and representative of specific evidence-derived BCTs was developed. This approach allowed brief messages to be developed with known content that can be used to test theory. %M 32401214 %R 10.2196/15989 %U https://www.jmir.org/2020/5/e15989 %U https://doi.org/10.2196/15989 %U http://www.ncbi.nlm.nih.gov/pubmed/32401214 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e16297 %T Using the Preparation Phase of the Multiphase Optimization Strategy to Develop a Messaging Component for Weight Loss: Formative and Pilot Research %A Pfammatter,Angela Fidler %A Marchese,Sara Hoffman %A Pellegrini,Christine %A Daly,Elyse %A Davidson,Miriam %A Spring,Bonnie %+ Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 North Lake Shore Drive, Suite 1400, Chicago, IL, 60611, United States, 1 312 503 1574, angela@northwestern.edu %K weight loss %K body weight %K text messaging %K optimization %K automation %D 2020 %7 13.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile messaging is often used in behavioral weight loss interventions, yet little is known as to the extent to which they contribute to weight loss when part of a multicomponent treatment package. The multiphase optimization strategy (MOST) is a framework that researchers can use to systematically investigate interventions that achieve desirable outcomes given specified constraints. Objective: This study describes the use of MOST to develop a messaging intervention as a component to test as part of a weight loss treatment package in a subsequent optimization trial. Methods: On the basis of our conceptual model, a text message intervention was created to support self-regulation of weight-related behaviors. We tested the messages in the ENLIGHTEN feasibility pilot study. Adults with overweight and obesity were recruited to participate in an 8-week weight loss program. Participants received a commercially available self-monitoring smartphone app, coaching calls, and text messages. The number and frequency of text messages sent were determined by individual preferences, and weight was assessed at 8 weeks. Results: Participants (n=9) in the feasibility pilot study lost 3.2% of their initial body weight over the 8-week intervention and preferred to receive 1.8 texts per day for 4.3 days per week. Researcher burden in manually sending messages was high, and the cost of receiving text messages was a concern. Therefore, a fully automated push notification system was developed to facilitate sending tailored daily messages to participants to support weight loss. Conclusions: Following the completion of specifying the conceptual model and the feasibility pilot study, the message intervention went through a final iteration. Theory and feasibility pilot study results during the preparation phase informed critical decisions about automation, frequency, triggers, and content before inclusion as a treatment component in a factorial optimization trial. Trial Registration: ClinicalTrials.gov NCT01814072; https://clinicaltrials.gov/ct2/show/NCT01814072 %M 32347804 %R 10.2196/16297 %U http://formative.jmir.org/2020/5/e16297/ %U https://doi.org/10.2196/16297 %U http://www.ncbi.nlm.nih.gov/pubmed/32347804 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e15587 %T Message Delivery for the Treatment of Posttraumatic Stress Disorder: Longitudinal Observational Study of Symptom Trajectories %A Malgaroli,Matteo %A Hull,Thomas Derrick %A Wiltsey Stirman,Shannon %A Resick,Patricia %+ NYU Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, United States, 1 6467544030, matteo.malgaroli@nyulangone.org %K PTSD %K telemedicine %K messaging %K textmessaging %K psychotherapy %K telehealth %K digital health %D 2020 %7 29.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Individuals with posttraumatic stress disorder (PTSD) face symptoms that can hinder access to treatment, such as avoidance and guilt. Telemedicine offers a technological solution to increase access to mental health care and overcome barriers to treatment. Although an increasing body of literature focused on synchronous telehealth (eg, live video), no studies have examined the delivery of PTSD treatment via two-way multimedia messages (ie, texting or messaging). Objective: The aim of this study was to conduct a longitudinal observation of treatment for PTSD delivered using two-way asynchronous messaging. We also sought to identify individual and treatment characteristics that could predict the observed outcome differences. Methods: Outpatients diagnosed with PTSD (N=475) received interventions from licensed therapists, which were delivered via messaging once or more than once per day, 5 days a week for 12 weeks. PTSD symptoms were assessed every 3 weeks using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-5. Trajectories of PTSD symptoms were identified using growth mixture modeling (GMM). Using logistic regression, the demographic, treatment, and messaging characteristics of patient groups that improved were compared with the characteristics of patient groups that did not improve. Results: The GMM identified 4 trajectories of PTSD symptoms: moderate improvement (197/475, 41.4%), high symptoms (197/475, 41.4%), chronic symptoms (61/475, 12.9%), and acute improvement (20/475, 4.3%). Patients with a clinically significant reduction in PTSD symptoms (231/475, 48.6%) were more likely to communicate via video (odds ratio [OR] 1.01, 95% CI 1.01-1.05; P=.03), have a higher working alliance with their therapist (OR 1.03, 95% CI 1.01-1.05; P=.02), and be at their first treatment experience (OR 2.03, 95% CI 1.18-3.54; P=.01). Treatment adherence was associated with greater therapeutic alliance (OR 1.07, 95% CI 1.03-1.10; P<.001), education (OR 2.13, 95% CI 1.13-4.03; P=.02), and more patient-generated messages per week (OR 1.08, 95% CI 1.04-1.13; P<.001). Conclusions: Multimedia message delivery for PTSD treatment showed symptom-reduction rates similar to traditional forms of treatment delivery, suggesting further study of messaging as a treatment medium. Most patients completed an 8-week course, reflecting the acceptability of messaging interventions. Delivering treatment via two-way messaging offers increased opportunities for widespread access to mental health care. %M 32347814 %R 10.2196/15587 %U http://www.jmir.org/2020/4/e15587/ %U https://doi.org/10.2196/15587 %U http://www.ncbi.nlm.nih.gov/pubmed/32347814 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e17328 %T The Development and Evaluation of a Text Message Program to Prevent Perceived Insufficient Milk Among First-Time Mothers: Retrospective Analysis of a Randomized Controlled Trial %A Demirci,Jill R %A Suffoletto,Brian %A Doman,Jack %A Glasser,Melissa %A Chang,Judy C %A Sereika,Susan M %A Bogen,Debra L %+ Department of Health Promotion & Development, University of Pittsburgh School of Nursing, 3500 Victoria St, Suite 440, Pittsburgh, PA, 15261, United States, 1 4126489236, Jvr5@pitt.edu %K breast feeding %K perceived insufficient milk %K text messaging %K short message service %K cell phone %K mobile phone %K telemedicine %K mHealth %K randomized controlled trial %D 2020 %7 29.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Several recent trials have examined the feasibility and efficacy of automated SMS text messaging to provide remote breastfeeding support to mothers, but these texting systems vary in terms of design features and outcomes examined. Objective: This study examined user engagement with and feedback on a theory-grounded SMS text messaging intervention intended to prevent perceived insufficient milk (PIM)—the single, leading modifiable cause of unintended breastfeeding reduction and cessation. Methods: We recruited 250 nulliparous individuals intending to breastfeed between 13 and 25 weeks of pregnancy in southwestern Pennsylvania. Participants were randomly assigned with equal allocation to either an SMS intervention to prevent PIM and unintended breastfeeding reduction or cessation (MILK, a Mobile, semiautomated text message–based Intervention to prevent perceived Low or insufficient milK supply; n=126) or a control group receiving general perinatal SMS text messaging–based support via the national, free Text4Baby system (n=124). Participants in both groups received SMS text messages 3 to 7 times per week from 25 weeks of pregnancy to 8 weeks postpartum. The MILK intervention incorporated several automated interactivity and personalization features (eg, keyword texting for more detailed information on topics and branched response logic) as well as an option to receive one-on-one assistance from an on-call study lactation consultant. We examined participant interactions with the MILK system, including response rates to SMS text messaging queries. We also sought participant feedback on MILK content, delivery preferences, and overall satisfaction with the system via interviews and a remote survey at 8 weeks postpartum. Results: Participants randomized to MILK (87/124, 70.2% white and 84/124, 67.7% college educated) reported that MILK texts increased their breastfeeding confidence and helped them persevere through breastfeeding problems. Of 124 participants, 9 (7.3%) elected to stop MILK messages, and 3 (2.4%) opted to reduce message frequency during the course of the study. There were 46 texts through the MILK system for individualized assistance from the study lactation consultant (25/46, 54% on weekends or after-hours). The most commonly texted keywords for more detailed information occurred during weeks 4 to 6 postpartum and addressed milk volume intake and breastfeeding and sleep patterns. MILK participants stated a preference for anticipatory guidance on potential breastfeeding issues and less content addressing the benefits of breastfeeding. Suggested improvements included extending messaging past 8 weeks, providing access to messaging for partners, and tailoring content based on participants’ pre-existing breastfeeding knowledge and unique breastfeeding trajectory. Conclusions: Prenatal and postpartum evidence–based breastfeeding support delivered via semiautomated SMS text messaging is a feasible and an acceptable intervention for first-time mothers. To optimize engagement with digital breastfeeding interventions, enhanced customization features should be considered. Trial Registration: ClinicalTrials.gov NCT02724969; https://clinicaltrials.gov/ct2/show/NCT02724969 %M 32347815 %R 10.2196/17328 %U https://mhealth.jmir.org/2020/4/e17328 %U https://doi.org/10.2196/17328 %U http://www.ncbi.nlm.nih.gov/pubmed/32347815 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e18064 %T Comparison of a Collective Intelligence Tailored Messaging System on Smoking Cessation Between African American and White People Who Smoke: Quasi-Experimental Design %A Faro,Jamie M %A Nagawa,Catherine S %A Allison,Jeroan A %A Lemon,Stephenie C %A Mazor,Kathleen M %A Houston,Thomas K %A Sadasivam,Rajani S %+ Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation St, The Albert Sherman Center, Worcester, MA, United States, 1 774 455 4672, jamie.faro@umassmed.edu %K machine learning %K computer-tailored health communication %K smoking cessation %K health disparities %D 2020 %7 27.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Patient Experience Recommender System for Persuasive Communication Tailoring (PERSPeCT) is a machine learning recommender system with a database of messages to motivate smoking cessation. PERSPeCT uses the collective intelligence of users (ie, preferences and feedback) and demographic and smoking profiles to select motivating messages. PERSPeCT may be more beneficial for tailoring content to minority groups influenced by complex, personally relevant factors. Objective: The objective of this study was to describe and evaluate the use of PERSPeCT in African American people who smoke compared with white people who smoke. Methods: Using a quasi-experimental design, we compared African American people who smoke with a historical cohort of white people who smoke, who both received up to 30 emailed tailored messages over 65 days. People who smoke rated the daily message in terms of perceived influence on quitting smoking for 30 days. Our primary analysis compared daily message ratings between the two groups using a t test. We used a logistic model to compare 30-day cessation between the two groups and adjusted for covariates. Results: The study included 119 people who smoke (African Americans, 55/119; whites, 64/119). At baseline, African American people who smoke were significantly more likely to report allowing smoking in the home (P=.002); all other characteristics were not significantly different between groups. Daily mean ratings were higher for African American than white people who smoke on 26 of the 30 days (P<.001). Odds of quitting as measured by 30-day cessation were significantly higher for African Americans (odds ratio 2.3, 95% CI 1.04-5.53; P=.03) and did not change after adjusting for allowing smoking at home. Conclusions: Our study highlighted the potential of using a recommender system to personalize for African American people who smoke. Trial Registration: ClinicalTrials.gov NCT02200432; https://clinicaltrials.gov/ct2/show/NCT02200432 International Registered Report Identifier (IRRID): RR2-10.2196/jmir.6465 %M 32338619 %R 10.2196/18064 %U http://mhealth.jmir.org/2020/4/e18064/ %U https://doi.org/10.2196/18064 %U http://www.ncbi.nlm.nih.gov/pubmed/32338619 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e14270 %T Temporal Dynamics of Treatment Receipt in a Text Message Intervention for Physical Activity: Single-Group, Within-Person Trial %A Conroy,David E %A Yang,Chih-Hsiang %A Lanza,Stephanie T %A Smyth,Joshua M %A Lagoa,Constantino M %+ Department of Kinesiology, The Pennsylvania State University, 266 Rec Hall, University Park, PA, 16802, United States, 1 814 863 3451, conroy@psu.edu %K short message service %K patient engagement %K mHealth %K physical activity %K sedentary behavior %D 2020 %7 22.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile technology has increased the reach of health behavior interventions but raised new challenges in assessing the fidelity of treatment receipt. Fidelity can be compromised if participant fatigue or burden reduces engagement, leading to missed or delayed treatments for just-in-time interventions. Objective: This study aimed to investigate the temporal dynamics of text message receipt confirmations. Methods: Community-dwelling adults (N=10) were sent five text messages daily for 4 months (5598 messages sent in total), with a financial incentive to confirm receipt of 75% or more messages. Results: Overall, the message receipt confirmation rate was very high (5504/5598, 98.32%) and timely (eg, two-thirds of confirmations within 2 min). Confirmation times were slightly slower on weekends (vs weekdays) and as a function of the cumulative time in the study. Neither time of message delivery nor message content was associated with message confirmation latencies. Conclusions: Participants receiving financial incentives to confirm text message receipt exhibit extremely high and fast confirmation rates, although receipt confirmations were somewhat less timely on weekends (vs weekdays) and later in the intervention. The social calendar and treatment fatigue should be considered when planning text message–based interventions, especially if treatments are intended for a just-in-time delivery that requires extended engagement and precise timing. %M 32319957 %R 10.2196/14270 %U http://mhealth.jmir.org/2020/4/e14270/ %U https://doi.org/10.2196/14270 %U http://www.ncbi.nlm.nih.gov/pubmed/32319957 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e15789 %T British South Asian Patients’ Perspectives on the Relevance and Acceptability of Mobile Health Text Messaging to Support Medication Adherence for Type 2 Diabetes: Qualitative Study %A Prinjha,Suman %A Ricci-Cabello,Ignacio %A Newhouse,Nikki %A Farmer,Andrew %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, , United Kingdom, 44 (0)7774 629231, suman.prinjha@phc.ox.ac.uk %K type 2 diabetes %K South Asians %K text messages %K self-management %K medication adherence %K mobile health %K mHealth %K eHealth %D 2020 %7 20.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The prevalence of type 2 diabetes (T2D) is greater in South Asian populations and health outcomes are poorer compared with other ethnic groups. British South Asians are up to six times more likely to have T2D than the general population, to develop the condition at a younger age, and to experience diabetes-related complications. Interventions to support people in managing their condition can potentially reduce debilitating complications. Evidence to support the use of digital devices in T2D management, including mobile phones, has shown positive impacts on glycemic control. There is increasing recognition that health interventions that are culturally adapted to the needs of specific groups are more likely to be relevant and acceptable, but evidence to support the effectiveness of adapted interventions is limited and inconclusive. Objective: This formative study aimed to explore the perceptions and views of British South Asian patients with T2D on mobile health SMS text messaging to support medication adherence, aimed at the general UK population. Methods: Eight exploratory focus groups were conducted in Leicester, the United Kingdom, between September 2017 and March 2018. A diverse sample of 67 adults took part. Results: British South Asian people with T2D who use digital devices, including mobile phones, felt that short messages to support medication adherence would be acceptable and relevant, but they also wanted messages that would support other aspects of self-management too. Participants were particularly interested in content that met their information needs, including information about South Asian foods, commonly used herbs and spices, natural and herbal approaches used in the United Kingdom and in South Asia, and religious fasting. Short messages delivered in English were perceived to be acceptable, often because family members could translate for those unable to read or understand the messages. Suggestions to support patients unable to understand short messages in English included having them available in different formats, and disseminated in face-to-face groups for those who did not use digital devices. Conclusions: Exploring the views of British South Asian patients about SMS text messaging aimed at the general UK population is important in maximizing the potential of such an intervention. For such a digital system to meet the needs of UK South Asian populations, it may also have to include culturally relevant messages sent to those who opt to receive them. It is equally important to consider how to disseminate message content to patients who do not use digital devices to help reduce health inequalities. %M 32310150 %R 10.2196/15789 %U http://mhealth.jmir.org/2020/4/e15789/ %U https://doi.org/10.2196/15789 %U http://www.ncbi.nlm.nih.gov/pubmed/32310150 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e16496 %T Treatment Adherence and Secondary Prevention of Ischemic Stroke Among Discharged Patients Using Mobile Phone- and WeChat-Based Improvement Services: Cohort Study %A Zhang,Yuanjin %A Fan,Dongsheng %A Ji,Hong %A Qiao,Shudong %A Li,Xia %+ Neurology Department, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, China, 86 01082265694, dsfan2010@aliyun.com %K stroke %K secondary prevention %K WeChat %K self-monitoring %D 2020 %7 15.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Real-world studies have indicated that adherence is important for guaranteeing medication effectiveness. Few studies have tested the feasibility and efficacy of WeChat-based improvement services, via mobile phone, in secondary prevention-specific follow-up among discharged stroke patients. Objective: We evaluated a quadruple-domain, WeChat-based service for ischemic stroke secondary prevention designed to improve treatment adherence of discharged patients. This service focuses on sending reminders for drug use, blood pressure recording, and glucose recording; it also records medication use. We compared the endpoint event rate between WeChat self-monitoring and traditional monitoring. Methods: A cohort study was used to determine the feasibility of a physician-assisted, WeChat-based improvement service and follow-up self-monitoring platform for the secondary prevention of ischemic stroke. The platform was developed by the Peking University Third Hospital based on the information-motivation-behavioral skills model. The overall adherence rate was calculated as the proportion of medication doses verified via uploading. The ischemic endpoint event rate and medication noncompliance rate were compared between traditional prevention monitoring and WeChat self-monitoring. Factors influencing adherence were summarized. Results: The 1-year follow-up event rate of the WeChat self-monitoring group was 11.9% (12/101), which was less than that of the traditional group (21/157, 13.4%). Compared with the traditional group, the risk ratio of the WeChat group was 0.983 (95% CI 0.895-1.080); this difference was not noted to be significant. The 1-year medication noncompliance ratio tended to be lower in the WeChat monitoring group (3/101, 3.0%) than in the traditional group (11/157, 7.0%; χ2=1.9, df=1, P=.16). Of the platform registry participants, 89.7% (210/234: 167 hospital-based and 43 community-based participants) adhered to inputting information into WeChat for 8-96 weeks. The average adherence time was 16.54 (SD 0.80, range 2-24) months. The average decrease in adherence was 4 participants (1.1%) per month. Being a member of a community-based population was an influencing factor for good adherence at the 2-year follow-up (OR 2.373, 95% CI 1.019-5.527, P=.045), whereas transient ischemic attack was an influencing factor for poor adherence at the 2-year follow-up (OR 0.122, 95% CI 0.016-0.940, P=.04). Conclusions: Use of WeChat self-monitoring showed a trend of increasing medication compliance and decreasing ischemic endpoint event rate compared with traditional monitoring. However, there were ceiling effects in the outcomes, and a relatively small sample size was used. Male participants displayed better adherence to WeChat self-monitoring. The community-based population displayed good adherence when using WeChat self-monitoring. Trial Registration: ClinicalTrials.gov NCT02618265; https://clinicaltrials.gov/ct2/show/NCT02618265 %M 32293574 %R 10.2196/16496 %U https://mhealth.jmir.org/2020/4/e16496 %U https://doi.org/10.2196/16496 %U http://www.ncbi.nlm.nih.gov/pubmed/32293574 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e15806 %T A Smartphone-Based Health Care Chatbot to Promote Self-Management of Chronic Pain (SELMA): Pilot Randomized Controlled Trial %A Hauser-Ulrich,Sandra %A Künzli,Hansjörg %A Meier-Peterhans,Danielle %A Kowatsch,Tobias %+ Department of Applied Psychology, University of Applied Sciences Zurich, Pfingstweidstrasse 96, Zurich, 8005, Switzerland, 41 58 934 84 ext 51, sandra.hauser-ulrich@zhaw.ch %K conversational agent %K chatbot %K digital health %K pain self-management %K cognitive behavior therapy %K smartphone %K psychoeducation %K text-based %K health care %K chronic pain %D 2020 %7 3.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Ongoing pain is one of the most common diseases and has major physical, psychological, social, and economic impacts. A mobile health intervention utilizing a fully automated text-based health care chatbot (TBHC) may offer an innovative way not only to deliver coping strategies and psychoeducation for pain management but also to build a working alliance between a participant and the TBHC. Objective: The objectives of this study are twofold: (1) to describe the design and implementation to promote the chatbot painSELfMAnagement (SELMA), a 2-month smartphone-based cognitive behavior therapy (CBT) TBHC intervention for pain self-management in patients with ongoing or cyclic pain, and (2) to present findings from a pilot randomized controlled trial, in which effectiveness, influence of intention to change behavior, pain duration, working alliance, acceptance, and adherence were evaluated. Methods: Participants were recruited online and in collaboration with pain experts, and were randomized to interact with SELMA for 8 weeks either every day or every other day concerning CBT-based pain management (n=59), or weekly concerning content not related to pain management (n=43). Pain-related impairment (primary outcome), general well-being, pain intensity, and the bond scale of working alliance were measured at baseline and postintervention. Intention to change behavior and pain duration were measured at baseline only, and acceptance postintervention was assessed via self-reporting instruments. Adherence was assessed via usage data. Results: From May 2018 to August 2018, 311 adults downloaded the SELMA app, 102 of whom consented to participate and met the inclusion criteria. The average age of the women (88/102, 86.4%) and men (14/102, 13.6%) participating was 43.7 (SD 12.7) years. Baseline group comparison did not differ with respect to any demographic or clinical variable. The intervention group reported no significant change in pain-related impairment (P=.68) compared to the control group postintervention. The intention to change behavior was positively related to pain-related impairment (P=.01) and pain intensity (P=.01). Working alliance with the TBHC SELMA was comparable to that obtained in guided internet therapies with human coaches. Participants enjoyed using the app, perceiving it as useful and easy to use. Participants of the intervention group replied with an average answer ratio of 0.71 (SD 0.20) to 200 (SD 58.45) conversations initiated by SELMA. Participants’ comments revealed an appreciation of the empathic and responsible interaction with the TBHC SELMA. A main criticism was that there was no option to enter free text for the patients’ own comments. Conclusions: SELMA is feasible, as revealed mainly by positive feedback and valuable suggestions for future revisions. For example, the participants’ intention to change behavior or a more homogenous sample (eg, with a specific type of chronic pain) should be considered in further tailoring of SELMA. Trial Registration: German Clinical Trials Register DRKS00017147; https://tinyurl.com/vx6n6sx, Swiss National Clinical Trial Portal: SNCTP000002712; https://www.kofam.ch/de/studienportal/suche/70582/studie/46326. %M 32242820 %R 10.2196/15806 %U http://mhealth.jmir.org/2020/4/e15806/ %U https://doi.org/10.2196/15806 %U http://www.ncbi.nlm.nih.gov/pubmed/32242820 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e17734 %T Optimizing Text Messages to Promote Engagement With Internet Smoking Cessation Treatment: Results From a Factorial Screening Experiment %A Graham,Amanda L %A Papandonatos,George D %A Jacobs,Megan A %A Amato,Michael S %A Cha,Sarah %A Cohn,Amy M %A Abroms,Lorien C %A Whittaker,Robyn %+ Innovations Center, Truth Initiative, 900 G Street, NW, 4th Floor, Washington, DC, 20001, United States, 1 12024545938, agraham@truthinitiative.org %K smoking cessation %K tobacco dependence %K internet %K text messaging %D 2020 %7 2.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Smoking remains a leading cause of preventable death and illness. Internet interventions for smoking cessation have the potential to significantly impact public health, given their broad reach and proven effectiveness. Given the dose-response association between engagement and behavior change, identifying strategies to promote engagement is a priority across digital health interventions. Text messaging is a proven smoking cessation treatment modality and a powerful strategy to increase intervention engagement in other areas of health, but it has not been tested as an engagement strategy for a digital cessation intervention. Objective: This study examined the impact of 4 experimental text message design factors on adult smokers’ engagement with an internet smoking cessation program. Methods: We conducted a 2×2×2×2 full factorial screening experiment wherein 864 participants were randomized to 1 of 16 experimental conditions after registering with a free internet smoking cessation program and enrolling in its automated text message program. Experimental factors were personalization (on/off), integration between the web and text message platforms (on/off), dynamic tailoring of intervention content based on user engagement (on/off), and message intensity (tapered vs abrupt drop-off). Primary outcomes were 3-month measures of engagement (ie, page views, time on site, and return visits to the website) as well as use of 6 interactive features of the internet program. All metrics were automatically tracked; there were no missing data. Results: Main effects were detected for integration and dynamic tailoring. Integration significantly increased interactive feature use by participants, whereas dynamic tailoring increased the number of features used and page views. No main effects were found for message intensity or personalization alone, although several synergistic interactions with other experimental features were observed. Synergistic effects, when all experimental factors were active, resulted in the highest rates of interactive feature use and the greatest proportion of participants at high levels of engagement. Measured in terms of standardized mean differences (SMDs), effects on interactive feature use were highest for Build Support System (SMD 0.56; 95% CI 0.27 to 0.81), Choose Quit Smoking Aid (SMD 0.38; 95% CI 0.10 to 0.66), and Track Smoking Triggers (SMD 0.33; 95% CI 0.05 to 0.61). Among the engagement metrics, the largest effects were on overall feature utilization (SMD 0.33; 95% CI 0.06 to 0.59) and time on site (SMD 0.29; 95% CI 0.01 to 0.57). As no SMD >0.30 was observed for main effects on any outcome, results suggest that for some outcomes, the combined intervention was stronger than individual factors alone. Conclusions: This factorial experiment demonstrates the effectiveness of text messaging as a strategy to increase engagement with an internet smoking cessation intervention, resulting in greater overall intervention dose and greater exposure to the core components of tobacco dependence treatment that can promote abstinence. Trial Registration: ClinicalTrials.gov NCT02585206; https://clinicaltrials.gov/ct2/show/NCT02585206. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2015-010687 %M 32238338 %R 10.2196/17734 %U https://www.jmir.org/2020/4/e17734 %U https://doi.org/10.2196/17734 %U http://www.ncbi.nlm.nih.gov/pubmed/32238338 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e15863 %T Effectiveness of One-Way Text Messaging on Attendance to Follow-Up Cervical Cancer Screening Among Human Papillomavirus–Positive Tanzanian Women (Connected2Care): Parallel-Group Randomized Controlled Trial %A Linde,Ditte S %A Andersen,Marianne S %A Mwaiselage,Julius %A Manongi,Rachel %A Kjaer,Susanne K %A Rasch,Vibeke %+ Department of Clinical Research, University of Southern Denmark, Kløvervænget 10, 10th Fl, Odense, 5000, Denmark, 45 61666564, dsondergaard@health.sdu.dk %K telemedicine %K cervical cancer %K HPV %K early detection of cancer %K Africa %D 2020 %7 2.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Rapid human papillomavirus (HPV) DNA testing is an emerging cervical cancer screening strategy in resource-limited countries, yet it requires follow-up of women who test HPV positive. Objective: This study aimed to determine if one-way text messages improved attendance to a 14-month follow-up cervical cancer screening among HPV-positive women. Methods: This multicenter, parallel-group randomized controlled trial was conducted at 3 hospitals in Tanzania. Eligible participants were aged between 25 and 60 years, had tested positive to a rapid HPV test during a patient-initiated screening, had been informed of their HPV result, and had a private mobile phone with a valid number. Participants were randomly assigned in a 1:1 ratio to the intervention or control group through an incorporated algorithm in the text message system. The intervention group received one-way text messages, and the control group received no text messages. The primary outcome was attendance at a 14-month health provider-initiated follow-up screening. Participants were not blinded, but outcome assessors were. The analysis was based on intention to treat. Results: Between August 2015 and July 2017, 4080 women were screened for cervical cancer, of which 705 were included in this trial—358 women were allocated to the intervention group, and 347 women were allocated to the control group. Moreover, 16 women were excluded before the analysis because they developed cervical cancer or died (8 from each group). In the intervention group, 24.0% (84/350) women attended their follow-up screening, and in the control group, 23.8% (80/335) women attended their follow-up screening (risk ratio 1.02, 95% CI 0.79-1.33). Conclusions: Attendance to a health provider-initiated follow-up cervical cancer screening among HPV-positive women was strikingly low, and one-way text messages did not improve the attendance rate. Implementation of rapid HPV testing as a primary screening method at the clinic level entails the challenge of ensuring a proper follow-up of women. Trial Registration: ClinicalTrials.gov NCT02509702; https://clinicaltrials.gov/ct2/show/NCT02509702. International Registered Report Identifier (IRRID): RR2-10.2196/10.2196/15863 %M 32238335 %R 10.2196/15863 %U http://www.jmir.org/2020/4/e15863/ %U https://doi.org/10.2196/15863 %U http://www.ncbi.nlm.nih.gov/pubmed/32238335 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e15098 %T Efficacy of a Mobile Texting App (HepTalk) in Encouraging Patient Participation in Viral Hepatitis B Care: Development and Cohort Study %A Hyun,Chul %A McMenamin,Joseph %A Ko,Okhyun %A Kim,Soonsik %+ The Center for Viral Hepatitis, 35 Van Nostrand Avenue, Englewood, NJ, 07631, United States, 1 845 661 1477, chulhyunmd@gmail.com %K chronic hepatitis B %K hepatitis B virus infection %K linkage to care %K mobile texting app %K remote consultation %D 2020 %7 1.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chronic hepatitis B virus (HBV) infection is a major cause of liver-related morbidity and mortality among Asian Americans in the United States. Despite the available resources, a majority of HBV-infected individuals are not able to access adequate health care owing to numerous barriers. Objective: This study aimed to assess the efficacy of a newly developed mobile texting app (HepTalk) in overcoming these barriers and improving patient engagement and health care access among HBV-infected and nonimmune individuals. Methods: HepTalk was employed for two-way communication between participants and patient navigators. A total of 82 Korean American participants who were either HBV infected or nonimmune to HBV, identified from a community hepatitis B campaign in New York, were enrolled in the study. After informed consent was obtained, both the frequency and themes of the text messages were evaluated. The effects of this communication on linkage to care at the end of the 6-month intervention period were analyzed and discussed. Results: On average, patient navigators sent and received 14 and 8 messages per participant, respectively, during the 6-month period. The themes of the messages were similar to the following 4 categories: finding providers, scheduling appointments with providers, health education, and financial issues. Of the 82 participants, 78 were linked to care within 6 months (a 95% linkage rate). Conclusions: HepTalk may be employed as an effective and strategic tool to facilitate communicative interaction between patients and patient navigators or health care providers, thereby improving patient engagement and health care access. %M 32234704 %R 10.2196/15098 %U https://mhealth.jmir.org/2020/4/e15098 %U https://doi.org/10.2196/15098 %U http://www.ncbi.nlm.nih.gov/pubmed/32234704 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e16680 %T Use of Telephone and Digital Channels to Engage Socioeconomically Disadvantaged Adults in Health Disparities Research Within a Social Service Setting: Cross-Sectional Study %A Alcaraz,Kassandra I %A Vereen,Rhyan N %A Burnham,Donna %+ Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams Street NW, Atlanta, GA, 30303, United States, 1 4044178019, kassandra.alcaraz@cancer.org %K cross-sectional studies %K electronic mail %K health status disparities %K health care disparities %K internet %K mobile phone %K telephone %K text messaging %K social services %D 2020 %7 1.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Engaging socioeconomically disadvantaged populations in health research is vital to understanding and, ultimately, eliminating health-related disparities. Digital communication channels are increasingly used to recruit study participants, and recent trends indicate a growing need to partner with the social service sector to improve population health. However, few studies have recruited participants from social service settings using multiple digital channels. Objective: This study aimed to recruit and survey 3791 adult clients of a social service organization via telephone and digital channels. This paper aimed to describe recruitment outcomes across five channels and compare participant characteristics by recruitment channel type. Methods: The Cancer Communication Channels in Context Study recruited and surveyed adult clients of 2-1-1, a social service–focused information and referral system, using five channels: telephone, website, text message, web-based live chat, and email. Participants completed surveys administered either by phone (if recruited by phone) or on the web (if recruited from digital channels, ie, website, text message, Web-based live chat, or email). Measures for the current analysis included demographic and health characteristics. Results: A total of 3293 participants were recruited, with 1907 recruited by phone and 1386 recruited from digital channels. Those recruited by phone had a moderate study eligibility rate (42.23%) and the highest survey completion rate (91.24%) of all channels. Individuals recruited by text message had a high study eligibility rate (94.14%) yet the lowest survey completion rate (74.0%) of all channels. Sample accrual goals were achieved for phone, text message, and website recruitment. Multivariable analyses found differences in participant characteristics by recruitment channel type. Compared with participants recruited by phone, those recruited from digital channels were younger (adjusted odds ratio [aOR] 0.96, 95% CI 0.96-0.97) and more likely to be female (aOR 1.52, 95% CI 1.23-1.88), married (aOR 1.52, 95% CI 1.22-1.89), and other than non-Hispanic black (aOR 1.48, 95% CI 1.22-1.79). Those recruited via phone also were more likely to have more than a high school education (aOR 2.17, 95% CI 1.67-2.82), have a household income ≥US $25,000 a year (aOR 2.02, 95% CI 1.56-2.61), and have children living in the home (aOR 1.26, 95% CI 1.06-1.51). Additionally, participants recruited from digital channels were less likely than those recruited by phone to have public health insurance (aOR 0.75, 95% CI 0.62-0.90) and more likely to report better overall health (aOR 1.52, 95% CI 1.27-1.83 for good-to-excellent health). Conclusions: Findings indicate the feasibility and utility of recruiting socioeconomically disadvantaged adults from the social service sector using multiple communication channels, including digital channels. As social service–based health research evolves, strategic recruitment using a combination of traditional and digital channels may be warranted to avoid underrepresentation of highly medically vulnerable individuals, which could exacerbate disparities in health. %M 32234699 %R 10.2196/16680 %U https://www.jmir.org/2020/4/e16680 %U https://doi.org/10.2196/16680 %U http://www.ncbi.nlm.nih.gov/pubmed/32234699 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 3 %P e14190 %T Effectiveness of an Ecological Momentary Intervention for Reducing Risky Alcohol Consumption Among Young Adults: Protocol for a Three-Arm Randomized Controlled Trial %A Wright,Cassandra %A Dietze,Paul M %A Kuntsche,Emmanuel %A Livingston,Michael %A Agius,Paul A %A Room,Robin %A Raggatt,Michelle %A Hellard,Margaret %A Lim,Megan S C %+ Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia, 61 392822173, cassandra.wright@burnet.edu.au %K alcohol %K brief intervention %K young adult %K alcohol drinking %K prevention and control %K mobile phone %D 2020 %7 31.3.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Recent research has investigated the utility of mobile phone–delivered interventions for reducing risky single-occasion drinking, also known as binge drinking. In the past five years, focus has been placed on ecological momentary interventions (EMIs), which aim to deliver intervention content in correspondence to real-time assessments of behavior, also known as ecological momentary assessments (EMAs). Objective: This study aims to assess the effect of a fully automated, tailored, mobile phone–delivered EMI termed Mobile Intervention for Drinking in Young people (MIDY) on young people's risky single-occasion drinking behavior. Methods: We will use a three-armed randomized controlled trial design to determine the impact of MIDY on peak consumption of alcohol among young people. A list of mobile telephone numbers for random digit dialing will be generated, and researchers will telephone potential participants to screen for eligibility. Participants will be randomized into one of three intervention groups. For 6 weeks, EMI, EMA, and attention control groups will complete hourly EMA surveys on their mobile phones on Friday and Saturday nights. EMI participants will receive personalized feedback in the form of text messages corresponding to their EMA survey responses, which focus on alcohol consumption, spending, and mood. EMA participants will not receive feedback. A third group will also complete EMA and receive feedback text messages at the same time intervals, but these will be focused on sedentary behavior and technology use. All groups will also complete a short survey on Saturday and Sunday mornings, with the primary outcome measure taken on Sunday mornings. A more detailed survey will be sent on the final Sunday of the 6-week period, and then again 1 year after recruitment. Results: The primary outcome measure will be an observed change (ie, reduction) in the mean peak number of drinks consumed in a single night over the 6-week intervention period between the EMI and attention control groups as measured in the weekly EMA. We expect to see a greater reduction in mean peak drinking in the EMI group compared to that in the attention control group. As a secondary aim, we will assess whether mean peak drinking is reduced in the EMA group compared to the attention control group. We will use a random-effects mixed-modeling approach using maximum-likelihood estimation to provide estimates of differences in peak drinking across time periods between those receiving the intervention (EMI) and attention control participants. An intention-to-treat approach will be taken for the analysis. Individuals and study groups will be modeled as random and fixed factors, respectively. Conclusions: This study extends our previous work investigating the efficacy of a mobile EMI (MIDY) for reducing risky drinking among young adults in Australia, and will add to the expanding literature on the use of mobile interventions for reducing risky alcohol consumption. Trial Registration: Australian New Zealand Clinical Trials Registration (ANZCTR): ACTRN12617001509358p; http://www.anzctr.org.au/ACTRN12617001509358p.aspx International Registered Report Identifier (IRRID): DERR1-10.2196/14190 %M 32229471 %R 10.2196/14190 %U http://www.researchprotocols.org/2020/3/e14190/ %U https://doi.org/10.2196/14190 %U http://www.ncbi.nlm.nih.gov/pubmed/32229471 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e17282 %T Text Messaging as a Screening Tool for Depression and Related Conditions in Underserved, Predominantly Minority Safety Net Primary Care Patients: Validity Study %A Jin,Haomiao %A Wu,Shinyi %+ Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 S Olive Street, Suite 1400, Los Angeles, CA, 90015, United States, 1 2138216441, haomiaoj@usc.edu %K depression %K diabetes mellitus %K comorbidity %K screening %K primary care %K health information technology %K mobile health %K text messaging %K patient reported outcome measures %D 2020 %7 26.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: SMS text messaging is an inexpensive, private, and scalable technology-mediated assessment mode that can alleviate many barriers faced by the safety net population to receive depression screening. Some existing studies suggest that technology-mediated assessment encourages self-disclosure of sensitive health information such as depressive symptoms while other studies show the opposite effect. Objective: This study aimed to evaluate the validity of using SMS text messaging to screen depression and related conditions, including anxiety and functional disability, in a low-income, culturally diverse safety net primary care population. Methods: This study used a randomized design with 4 study groups that permuted the order of SMS text messaging and the gold standard interview (INTW) assessment. The participants for this study were recruited from the participants of the prior Diabetes-Depression Care-management Adoption Trial (DCAT). Depression was screened by using the 2-item and 8-item Patient Health Questionnaire (PHQ-2 and PHQ-8, respectively). Anxiety was screened by using the 2-item Generalized Anxiety Disorder scale (GAD-2), and functional disability was assessed by using the Sheehan Disability Scale (SDS). Participants chose to take up the assessment in English or Spanish. Internal consistency and test-retest reliability were evaluated by using Cronbach alpha and intraclass correlation coefficient (ICC), respectively. Concordance was evaluated by using an ICC, a kappa statistic, an area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity. A regression analysis was conducted to examine the association between the participant characteristics and the differences in the scores between the SMS text messaging and INTW assessment modes. Results: Overall, 206 participants (average age 57.1 [SD 9.18] years; females: 119/206, 57.8%) were enrolled. All measurements except the SMS text messaging–assessed PHQ-2 showed Cronbach alpha values ≥.70, indicating acceptable to good internal consistency. All measurements except the INTW-assessed SDS had ICC values ≥0.75, indicating good to excellent test-retest reliability. For concordance, the PHQ-8 had an ICC of 0.73 and AUROC of 0.93, indicating good concordance. The kappa statistic, sensitivity, and specificity for major depression (PHQ-8 ≥8) were 0.43, 0.60, and 0.86, respectively. The concordance of the shorter PHQ-2, GAD-2, and SDS scales was poor to fair. The regression analysis revealed that a higher level of personal depression stigma was associated with reporting higher SMS text messaging–assessed PHQ-8 and GAD-2 scores than the INTW-assessed scores. The analysis also determined that the differences in the scores were associated with marital status and personality traits. Conclusions: Depression screening conducted using the longer PHQ-8 scale via SMS text messaging demonstrated good internal consistency, test-retest reliability, and concordance with the gold standard INTW assessment mode. However, care must be taken when deploying shorter scales via SMS text messaging. Further regression analysis supported that a technology-mediated assessment, such as SMS text messaging, may create a private space with less pressure from the personal depression stigma and therefore encourage self-disclosure of depressive symptoms. Trial Registration: ClinicalTrials.gov NCT01781013; https://clinicaltrials.gov/ct2/show/NCT01781013 International Registered Report Identifier (IRRID): RR2-10.2196/12392 %M 32213473 %R 10.2196/17282 %U http://www.jmir.org/2020/3/e17282/ %U https://doi.org/10.2196/17282 %U http://www.ncbi.nlm.nih.gov/pubmed/32213473 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e15875 %T Patient Uptake, Experience, and Satisfaction Using Web-Based and Face-to-Face Hearing Health Services: Process Evaluation Study %A Ratanjee-Vanmali,Husmita %A Swanepoel,De Wet %A Laplante-Lévesque,Ariane %+ Department of Speech-Language Pathology & Audiology, University of Pretoria, Lynnwood Rd & Roper Street, Pretoria, 0001, South Africa, 27 124204280, dewet.swanepoel@up.ac.za %K audiology %K hearing loss %K internet-based intervention %K patient outcome assessment %K patient satisfaction %K telemedicine %K text messaging %K eHealth %K mHealth %K social media %K patient-centered care %D 2020 %7 20.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Globally, access to hearing health care is a growing concern with 900 million people estimated to suffer from disabling hearing loss by 2050. Hearing loss is one of the most common chronic health conditions, yet access to hearing health care is limited. Incorporating Web-based (voice calling, messaging, or emailing) service delivery into current treatment pathways could improve access and allow for better scalability of services. Current electronic health studies in audiology have focused on technical feasibility, sensitivity, and specificity of diagnostic hearing testing and not on patient satisfaction, experiences, and sustainable models along the entire patient journey. Objective: This study aimed to investigate a hybrid (Web-based and face-to-face) hearing health service in terms of uptake, experience, and satisfaction in adult patients with hearing loss. Methods: A nonprofit hearing research clinic using online and face-to-face services was implemented in Durban, South Africa, using online recruitment from the clinic’s Facebook page and Google AdWords, which directed persons to an online Web-based hearing screening test. Web-based and face-to-face care pathways included assessment, treatment, and rehabilitation. To evaluate the service, an online survey comprising (1) a validated satisfaction measurement tool (Short Assessment of Patient Satisfaction), (2) a process evaluation of all the 5 steps completed, and (3) personal preferences of communication methods used vs methods preferred was conducted, which was sent to 46 patients who used clinic services. Results: Of the patients invited, 67% (31/46) completed the survey with mean age 66 years, (SD 16). Almost all patients, 92% (30/31) reported that the online screening test assisted them in seeking hearing health care. Approximately 60% (18/31) of the patients accessed the online hearing screening test from an Android device. Patients stayed in contact with the audiologist mostly through WhatsApp instant messaging (27/31, 87%), and most patients (25/31, 81%) preferred to use this method of communication. The patients continuing with hearing health care were significantly older and had significantly poorer speech recognition abilities compared with the patients who discontinued seeking hearing health care. A statistically significant positive result (P=.007) was found between age and the number of appointments per patient. Around 61% (19/31) of patients previously completed diagnostic testing at other practices, with 95% (18/19) rating the services at the hybrid clinic as better. The net promoter score was 87, indicating that patients were highly likely to recommend the hybrid clinic to friends and family. Conclusions: This study applied Web-based and face-to-face components into a hybrid clinic and measured an overall positive experience with high patient satisfaction through a process evaluation. The findings support the potential of a hybrid clinic with synchronous and asynchronous modes of communication to be a scalable hearing health care model, addressing the needs of adults with hearing loss globally. %M 32196459 %R 10.2196/15875 %U http://www.jmir.org/2020/3/e15875/ %U https://doi.org/10.2196/15875 %U http://www.ncbi.nlm.nih.gov/pubmed/32196459 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 3 %P e14652 %T Developing SMS Content to Promote Papanicolaou Triage Among Women Who Performed HPV Self-collection Test: Qualitative Study %A Sanchez Antelo,Victoria %A Kohler,Racquel E %A Curotto,Mariana %A Viswanath,Kasisomayajula "Vish" %A Paolino,Melisa %A Arrossi,Silvina %+ Centro de Estudios de Estado y Sociedad, Sánchez de Bustamante, 27, C1173AAA, Buenos Aires, Argentina, 54 1148651707, silviarrossi2020@gmail.com %K text messaging %K cell phone use %K telemedicine %K human papillomavirus DNA tests %K triage %K health behavior %K Argentina %D 2020 %7 6.3.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: SMS interventions are effective in promoting a variety of health behaviors; however, there is limited information regarding the use of SMS for cervical cancer screening and follow-up care. The Application of Communication and Information Technologies to Self-Collection study aims to evaluate a multicomponent mobile health intervention to increase triage adherence among women with human papillomavirus (HPV)–positive self-collected tests in Jujuy, Argentina. Here, we describe the formative results used to design the content of the SMS to be tested in the trial. Objective: This study aimed to understand the cultural and contextual elements, women’s beliefs, and perceptions regarding the use of SMS by the health care system and women’s preferences about the message content. Methods: We conducted five focus groups (FGs), stratified by rural or urban residence and age. All participants were aged 30 years or older and had performed HPV self-collection. Participatory techniques, including brainstorming, card-based classification, and discussions were used to debate the advantages and disadvantages of messages. We openly coded the discussions for agreements and preferences regarding the SMS content. Messages for both HPV-negative and HPV-positive women were validated through interviews with health authorities and 14 HPV-tested women. The final versions of the messages were pilot-tested. Results: A total of 48 women participated in the FGs. Participants rejected receiving both negative and positive HPV results by SMS because, for them, the delivery of results should be done in a face-to-face interaction with health professionals. They stressed the importance of the SMS content informing them that results were available for pick up and reflecting the kind of relationship that they have with the community health workers and the nearest health center. Women considered that a personalized SMS was important, as was the use of a formal yet warm tone. Owing to confidentiality issues, not using the word “HPV” was also a key component of the desired SMS content; therefore, the final message included the term “self-collection” without the mention of HPV infection. Results from the validation stage and pilot test showed high acceptability of the final version of the message. Conclusions: The results suggest that SMS is accepted when notifying women about the availability of the HPV test result, but it should not replace the delivery of results in face-to-face, doctor-patient encounters. In addition, messages must be tailored and must have a persuasive tone to motivate women to adhere to the triage. %M 32032940 %R 10.2196/14652 %U https://formative.jmir.org/2020/3/e14652 %U https://doi.org/10.2196/14652 %U http://www.ncbi.nlm.nih.gov/pubmed/32032940 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e15346 %T A Culturally Relevant Smartphone-Delivered Physical Activity Intervention for African American Women: Development and Initial Usability Tests of Smart Walk %A Joseph,Rodney P %A Keller,Colleen %A Vega-López,Sonia %A Adams,Marc A %A English,Rebekah %A Hollingshead,Kevin %A Hooker,Steven P %A Todd,Michael %A Gaesser,Glenn A %A Ainsworth,Barbara E %+ Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 N 3rd St, Phoenix, AZ, 85004, United States, 1 6024960772, rodney.joseph@asu.edu %K eHealth %K mHealth %K exercise %K minority health %K primary prevention %K heart diseases %K African-American %D 2020 %7 2.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smart Walk is a culturally relevant, social cognitive theory–based, smartphone-delivered intervention designed to increase physical activity (PA) and reduce cardiometabolic disease risk among African American (AA) women. Objective: This study aimed to describe the development and initial usability testing results of Smart Walk. Methods: Smart Walk was developed in 5 phases. Phases 1 to 3 focused on initial intervention development, phase 4 involved usability testing, and phase 5 included intervention refinement based on usability testing results. In phase 1, a series of 9 focus groups with 25 AA women (mean age 38.5 years, SD 7.8; mean BMI 39.4 kg/m2, SD 7.3) was used to identify cultural factors associated with PA and ascertain how constructs of social cognitive theory can be leveraged in the design of a PA intervention. Phase 2 included the analysis of phase 1 qualitative data and development of the structured PA intervention. Phase 3 focused on the technical development of the smartphone app used to deliver the intervention. Phase 4 consisted of a 1-month usability trial of Smart Walk (n=12 women; mean age 35.0 years, SD 8.5; mean BMI 40 kg/m2, SD 5.0). Phase 5 included refinement of the intervention based on the usability trial results. Results: The 5-phase process resulted in the development of the Smart Walk smartphone-delivered PA intervention. This PA intervention was designed to target social cognitive theory constructs of behavioral capability, outcome expectations, social support, self-efficacy, and self-regulation and address deep structure sociocultural characteristics of collectivism, racial pride, and body appearance preferences of AA women. Key features of the smartphone app included (1) personal profile pages, (2) multimedia PA promotion modules (ie, electronic text and videos), (3) discussion boards, and (4) a PA self-monitoring tool. Participants also received 3 PA promotion text messages each week. Conclusions: The development process of Smart Walk was designed to maximize the usability, cultural relevance, and impact of the smartphone-delivered PA intervention. %M 32130198 %R 10.2196/15346 %U https://mhealth.jmir.org/2020/3/e15346 %U https://doi.org/10.2196/15346 %U http://www.ncbi.nlm.nih.gov/pubmed/32130198 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 2 %P e14379 %T Expedited Safety Reporting Through an Alert System for Clinical Trial Management at an Academic Medical Center: Retrospective Design Study %A Park,Yu Rang %A Koo,HaYeong %A Yoon,Young-Kwang %A Park,Sumi %A Lim,Young-Suk %A Baek,Seunghee %A Kim,Hae Reong %A Kim,Tae Won %+ Clinical Research Center, Asan Institute of Life Sciences, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea, 82 2 3010 3910, twkimmd@amc.seoul.kr %K clinical trial %K adverse event %K early detection %K patient safety %D 2020 %7 27.2.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Early detection or notification of adverse event (AE) occurrences during clinical trials is essential to ensure patient safety. Clinical trials take advantage of innovative strategies, clinical designs, and state-of-the-art technologies to evaluate efficacy and safety, however, early awareness of AE occurrences by investigators still needs to be systematically improved. Objective: This study aimed to build a system to promptly inform investigators when clinical trial participants make unscheduled visits to the emergency room or other departments within the hospital. Methods: We developed the Adverse Event Awareness System (AEAS), which promptly informs investigators and study coordinators of AE occurrences by automatically sending text messages when study participants make unscheduled visits to the emergency department or other clinics at our center. We established the AEAS in July 2015 in the clinical trial management system. We compared the AE reporting timeline data of 305 AE occurrences from 74 clinical trials between the preinitiative period (December 2014-June 2015) and the postinitiative period (July 2015-June 2016) in terms of three AE awareness performance indicators: onset to awareness, awareness to reporting, and onset to reporting. Results: A total of 305 initial AE reports from 74 clinical trials were included. All three AE awareness performance indicators were significantly lower in the postinitiative period. Specifically, the onset-to-reporting times were significantly shorter in the postinitiative period (median 1 day [IQR 0-1], mean rank 140.04 [SD 75.35]) than in the preinitiative period (median 1 day [IQR 0-4], mean rank 173.82 [SD 91.07], P≤.001). In the phase subgroup analysis, the awareness-to-reporting and onset-to-reporting indicators of phase 1 studies were significantly lower in the postinitiative than in the preinitiative period (preinitiative: median 1 day, mean rank of awareness to reporting 47.94, vs postinitiative: median 0 days, mean rank of awareness to reporting 35.75, P=.01; and preinitiative: median 1 day, mean rank of onset to reporting 47.4, vs postinitiative: median 1 day, mean rank of onset to reporting 35.99, P=.03). The risk-level subgroup analysis found that the onset-to-reporting time for low- and high-risk studies significantly decreased postinitiative (preinitiative: median 4 days, mean rank of low-risk studies 18.73, vs postinitiative: median 1 day, mean rank of low-risk studies 11.76, P=.02; and preinitiative: median 1 day, mean rank of high-risk studies 117.36, vs postinitiative: median 1 day, mean rank of high-risk studies 97.27, P=.01). In particular, onset to reporting was reduced more in the low-risk trial than in the high-risk trial (low-risk: median 4-0 days, vs high-risk: median 1-1 day). Conclusions: We demonstrated that a real-time automatic alert system can effectively improve safety reporting timelines. The improvements were prominent in phase 1 and in low- and high-risk clinical trials. These findings suggest that an information technology-driven automatic alert system effectively improves safety reporting timelines, which may enhance patient safety. %R 10.2196/14379 %U http://medinform.jmir.org/2020/2/e14379/ %U https://doi.org/10.2196/14379 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 2 %P e16481 %T Text Message Behavioral Intervention for Teens on Eating, Physical Activity and Social Wellbeing (TEXTBITES): Protocol for a Randomized Controlled Trial %A Partridge,Stephanie R %A Raeside,Rebecca %A Singleton,Anna C %A Hyun,Karice %A Latham,Zoe %A Grunseit,Alicia %A Steinbeck,Katharine %A Chow,Clara %A Redfern,Julie %+ Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, REN Building Westmead Hospital, Sydney, Australia, 61 88908187, stephanie.partridge@sydney.edu.au %K obesity %K adolescents %K nutrition %K physical activity %K text message %K randomized controlled trial %K mHealth %D 2020 %7 18.2.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Obesity is among the most significant health challenges facing today’s adolescents. Weight gain during adolescence is related to cardiovascular disease, type 2 diabetes, and some cancers in later life. Presently, adolescents living in Australia have limited access to age-appropriate obesity prevention services. Objective: This study aims to investigate whether a two-way text message program, with optional telephone health counseling, improves body mass index (BMI) z score and lifestyle outcomes in adolescents who are overweight. Methods: This study will be a single-blind randomized controlled trial (N=150) comparing a two-way text message intervention, with optional telephone health counseling, to usual care in adolescents (13-18 years old, inclusive) who are overweight (recruited from a pediatric weight management clinic and the broader community in Sydney, Australia). The intervention group will receive a six-month text message program, which consists of two-way, semipersonalized, lifestyle-focused text messages (four messages/week) in addition to usual care. The control group will be assigned to receive usual care. The study also includes a follow-up at 12-months. The primary outcome is a change in BMI z score at six months. Secondary outcomes are changes in waist-to-height ratio, diet, physical and sedentary activity levels, sleep quality, quality of life, self-esteem, self-efficacy, social support, and eating disorder and depression symptoms. Also, we will examine acceptability, utility, and engagement with the program through a study-specific process evaluation questionnaire, semi-structured telephone interviews, and an analysis of health counselor communication logs. The analyses will be performed by the intention-to-treat principle to assess differences between intervention and control groups. Results: The study opened for recruitment in December 2019. Data collection is expected to be completed by December 2021, and the results for the primary outcome are expected to be published in early 2022. Conclusions: This study will test the effectiveness of an interactive two-way text message program compared to usual care in improving BMI z score and lifestyle outcomes in adolescents with overweight. This interactive, innovative, and scalable project also aims to inform future practice and community initiatives to promote obesity prevention behaviors for adolescents. Trial Registration: Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619000389101; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377158&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/16481 %M 32130194 %R 10.2196/16481 %U https://www.researchprotocols.org/2020/2/e16481 %U https://doi.org/10.2196/16481 %U http://www.ncbi.nlm.nih.gov/pubmed/32130194 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e16220 %T The Implementation of a Text Messaging Intervention to Improve HIV Continuum of Care Outcomes Among Persons Recently Released From Correctional Facilities: Randomized Controlled Trial %A Uhrig Castonguay,Breana J %A Cressman,Andrew E %A Kuo,Irene %A Patrick,Rudy %A Trezza,Claudia %A Cates,Alice %A Olsen,Halli %A Peterson,James %A Kurth,Ann %A Bazerman,Lauri B %A Beckwith,Curt G %+ University of North Carolina Center for AIDS Research, Lineberger Cancer Center, University of North Carolina at Chapel Hill, 135 Dauer Drive, Room 313, CB 7440, Chapel Hill, NC, 27599, United States, 1 9198432532, bcastonguay@unc.edu %K criminal justice %K incarcerated populations %K HIV %K acquired immunodeficiency syndrome %K mHealth %K anti-HIV agents %K medication adherence %K retention in care %K implementation science %D 2020 %7 13.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Previously incarcerated individuals have suboptimal linkage and engagement in community HIV care. Mobile health (mHealth) interventions have been shown to be effective in addressing these gaps. In Washington, District of Columbia (DC), we conducted a randomized trial of an SMS text messaging–based mHealth intervention (CARE+ Corrections) to increase linkage to community HIV care and antiretroviral treatment adherence among HIV-infected persons involved in the criminal justice system. Objective: This study aimed to describe the SMS text messaging–based intervention, participant use of the intervention, and barriers and facilitators of implementation. Methods: From August 2013 to April 2015, HIV-positive incarcerated individuals were recruited within the DC Department of Corrections, and persons released in the past 6 months were recruited within the community via street-based recruitment, community partnerships, and referrals. Participants were followed for 6 months and received weekly or daily SMS text messages. Formative research resulted in the development of the content of the messages in 4 categories: HIV Appointment Reminders, Medication Adherence, Prevention Reminders, and Barriers to Care following release from jail. Participants could customize the timing, frequency, and message content throughout the study period. Results: Of the 112 participants enrolled, 57 (50.9%) were randomized to the intervention group and 55 (49.1%) to the control group; 2 control participants did not complete the baseline visit, and were dropped from the study, leaving a total of 110 participants who contributed to the analyses. Study retention was similar across both study arms. Median age was 42 years (IQR 30-50), 86% (49/57) were black or African American, 58% (33/57) were male, 25% (14/57) were female, and 18% (10/57) were transgender. Median length of last incarceration was 4 months (IQR 1.7-9.0), and median lifetime number of times incarcerated was 6.5 (IQR 3.5-14.0). Most participants (32/54, 59%) had a baseline viral load of <200 copies/mL. Nearly all participants (52/57, 91%) chose to use a cell phone provided by the study. The most preferred Appointment Reminder message was Hey how you feeling? Don’t forget to give a call and make your appointment (19/57, 33%). The most preferred Medication Adherence message was Don’t forget your skittles! (31/57, 54%), and 63% (36/57) of participants chose to receive daily (vs weekly) messages from this category at baseline. The most preferred Prevention Reminder message was Stay strong. Stay clean (18/57, 32%). The most preferred Barriers to Care message was Holla at your case manager, they’re here to help (12/57, 22%). Minor message preference differences were observed among participants enrolled in the jail versus those from the community. Conclusions: Participants’ ability to customize their SMS text message plan proved helpful. Further large-scale research on mHealth platforms is needed to assess its efficacy among HIV-infected persons with a history of incarceration. Trial Registration: ClinicalTrials.gov NCT01721226; https://clinicaltrials.gov/ct2/show/NCT01721226 %M 32053119 %R 10.2196/16220 %U https://mhealth.jmir.org/2020/2/e16220 %U https://doi.org/10.2196/16220 %U http://www.ncbi.nlm.nih.gov/pubmed/32053119 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e14737 %T Using Text Messaging to Improve Access to Prenatal Health Information in Urban African American and Afro-Caribbean Immigrant Pregnant Women: Mixed Methods Analysis of Text4baby Usage %A Blackwell,Tenya M %A Dill,LeConte J %A Hoepner,Lori A %A Geer,Laura A %+ Department of Environmental and Occupational Health Sciences, SUNY Downstate Health Sciences University, School of Public Health, 450 Clarkson Avenue, Brooklyn, NY, United States, 1 7182703101, tblackwell@arthurasheinstitute.org %K Text4baby %K mHealth %K pregnancy %K text messaging %K health information %K prenatal health %K disparities %D 2020 %7 13.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Text4baby (T4B) mobile health (mHealth) program is acclaimed to provide pregnant women with greater access to prenatal health care, resources, and information. However, little is known about whether urban African American and Afro-Caribbean immigrant pregnant women in the United States are receptive users of innovative health communication methods or of the cultural and systematic barriers that inhibit their behavioral intent to use T4B. Objective: This study aimed to understand the lived experiences of urban African American and Afro-Caribbean immigrant pregnant women with accessing quality prenatal health care and health information; to assess usage of mHealth for seeking prenatal health information; and to measure changes in participants’ knowledge, perceptions, and behavioral intent to use the T4B mHealth educational intervention. Methods: An exploratory sequential mixed methods study was conducted among pregnant women and clinical professionals for a phenomenological exploration with focus groups, key informants, interviews, and observations. Qualitative themes were aligned with behavioral and information technology communications theoretical constructs to develop a survey instrument used. repeated-measures pre- and post-test design to evaluate changes in participants’ knowledge, attitudes, and beliefs, of mHealth and T4B after a minimum of 4 weeks’ exposure to the text message–based intervention. Triangulation and mixing of both qualitative and quantitative data occurred primarily during the survey development and also during final analysis. Results: A total of 9 women participated in phase 1, and 49 patients signed up for T4B and completed a 31-item survey at baseline and again during follow-up. Three themes were identified: (1) patient-provider engagement, (2) social support, and (3) acculturation. With time as a barrier to quality care, inadequate patient-provider engagement left participants feeling indifferent about the prenatal care and information they received in the clinical setting. Of 49 survey participants, 63% (31/49) strongly agreed that T4B would provide them with extra support during their pregnancy. On a Likert scale of 1 to 5, participants’ perception of the usefulness of T4B ranked at 4.26, and their perception of the compatibility and relative advantage of using T4B ranked at 4.41 and 4.15, respectively. At follow-up, there was a 14% increase in participants reporting their intent to use T4B and a 28% increase from pretest and posttest in pregnant women strongly agreeing to speak more with their doctor about the information learned through T4B. Conclusions: Urban African American and Afro-Caribbean immigrant pregnant women in Brooklyn endure a number of social and ecological determinants like low health literacy, income, and language that serve as barriers to accessing quality prenatal health care and information, which negatively impacts prenatal health behaviors and outcomes. Our study indicates a number of systematic, political, and other microsystem-level factors that perpetuate health inequities in our study population. %M 32053117 %R 10.2196/14737 %U http://mhealth.jmir.org/2020/2/e14737/ %U https://doi.org/10.2196/14737 %U http://www.ncbi.nlm.nih.gov/pubmed/32053117 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e13747 %T Push Notifications From a Mobile App to Improve the Body Composition of Overweight or Obese Women: Randomized Controlled Trial %A Hernández-Reyes,Alberto %A Cámara-Martos,Fernando %A Molina Recio,Guillermo %A Molina-Luque,Rafael %A Romero-Saldaña,Manuel %A Moreno Rojas,Rafael %+ Department of Bromatology and Food Technology, University of Córdoba, Campus Rabanales, Ed Darwin - Anexo, Córdoba, 14014, Spain, 34 957212001, hdezreyes2013@gmail.com %K exercise %K text message %K mobile phone %K mHealth %K health behavior %K behavior maintenance %K physical activity %K push %D 2020 %7 12.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Technology—in particular, access to the Internet from a mobile device—has forever changed the way we relate to others and how we behave in our daily life settings. In recent years, studies have been carried out to analyze the effectiveness of different actions via mobile phone in the field of health: telephone calls, short message service (SMS), telemedicine, and, more recently, the use of push notifications. We have continued to explore ways to increase user interaction with mobile apps, one of the pending subjects in the area of mHealth. By analyzing the data produced by subjects during a clinical trial, we were able to extract behavior patterns and, according to them, design effective protocols in weight loss programs. Objective: A clinical trial was proposed to (1) evaluate the efficacy of push notifications in an intervention aimed at improving the body composition of adult women who are overweight or obese, through a dietary procedure, and (2) analyze the evolution of body composition based on push notifications and prescribed physical activity (PA). Methods: A two-arm randomized controlled trial was carried out. A sample size of 117 adult obese women attended a face-to-face, 30-minute consultation once a week for 6 months. All patients were supplied with an app designed for this study and a pedometer. The control group did not have access to functionalities related to the self-monitoring of weight at home, gamification, or prescription of PA. The intervention group members were assigned objectives to achieve a degree of compliance with diet and PA through exclusive access to specific functionalities of the app and push notifications. The same diet was prescribed for all patients. Three possible PA scenarios were studied for both the control and intervention groups: light physical activity (LPA), moderate physical activity (MPA), and intense physical activity (IPA). For the analysis of three or more means, the analysis of variance (ANOVA) of repeated means was performed to evaluate the effects of the intervention at baseline and at 3 and 6 months. Results: Receiving notifications during the intervention increased body fat loss (mean -12.9% [SD 6.7] in the intervention group vs mean -7.0% [SD 5.7] in the control group; P<.001) and helped to maintain muscle mass (mean -0.8% [SD 4.5] in the intervention group vs mean -3.2% [SD 2.8] in the control group; P<.018). These variations between groups led to a nonsignificant difference in weight loss (mean -7.9 kg [SD 3.9] in the intervention group vs mean -7.1 kg [SD 3.4] in the control group; P>.05). Conclusions: Push notifications have proven effective in the proposed weight loss program, leading women who received them to achieve greater loss of fat mass and a maintenance or increase of muscle mass, specifically among those who followed a program of IPA. Future interventions should include a longer evaluation period; the impact of different message contents, as well as message delivery times and frequency, should also be researched. Trial Registration: ClinicalTrials.gov NCT03911583; https://www.clinicaltrials.gov/ct2/show/NCT03911583 %M 32049065 %R 10.2196/13747 %U http://mhealth.jmir.org/2020/2/e13747/ %U https://doi.org/10.2196/13747 %U http://www.ncbi.nlm.nih.gov/pubmed/32049065 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 1 %P e13513 %T A Dual-Pronged Approach to Improving Heart Failure Outcomes: A Quality Improvement Project %A Johansson,Marcia %A Athilingam,Ponrathi %+ College of Nursing, University of South Florida, 12901 Bruce B Downs, MDC 22, Tampa, FL, 33612, United States, 1 813 974 5289, mjohansson@usf.edu %K heart failure %K mobile messaging %K structured telephone support %K self-care management %K medication adherence %K quality improvement %D 2020 %7 10.2.2020 %9 Original Paper %J JMIR Aging %G English %X Background: Presently, 6.5 million Americans are living with heart failure (HF). These patients are expected to follow a complex self-management regimen at home. Several demographic and psychosocial factors limit patients with HF in following the prescribed self-management recommendations at home. Poor self-care is associated with increased hospital readmissions. Under the Affordable Care Act, there are financial implications related to hospital readmissions for hospitals and programs such as the Program of All-Inclusive Care for the Elderly (PACE) in Pinellas County, Florida. Previous studies and systematic reviews demonstrated improvement in self-management and quality of life (QoL) in patients with HF with structured telephone support (STS) and SMS text messaging. Objective: This study aimed to evaluate the effects of STS and SMS on self-care, knowledge, medication adherence, and QoL of patients with HF. Methods: A prospective quality improvement project using a pre-post design was implemented. Data were collected at baseline, 30 days, and 3 months from 51 patients with HF who were enrolled in PACE in Pinellas County, Florida. All participants received STS and SMS for 30 days. The feasibility and sustained benefit of using STS and SMS was assessed at a 3-month follow-up. Results: A paired t test was used to compare the mean difference in HF outcomes at the baseline and 30-day follow-up, which demonstrated improved HF self-care maintenance (t49=0.66; P=.01), HF knowledge (t49=0.71; P=.01), medication adherence (t49=0.92; P=.01), and physical and mental health measured using Short-Form-12 (SF-12; t49=0.81; P=.01). The results also demonstrated the sustained benefit with improved HF self-care maintenance, self-care management, self-care confidence, knowledge, medication adherence, and physical and mental health (SF-12) at 3 months with P<.05 for all outcomes. Living status and social support had a strong correlation with HF outcomes. Younger participants (aged less than 65 years) performed extremely well compared with older adults. Conclusions: STS and SMS were feasible to use among PACE participants with sustained benefits at 3 months. Implementing STS and SMS may serve as viable options to improve HF outcomes. Improving outcomes with HF affects hospital systems and the agencies that monitor and provide care for outpatients and those in independent or assisted-living facilities. Investigating viable options and support for implementation will improve outcomes. %R 10.2196/13513 %U https://aging.jmir.org/2020/1/e13513 %U https://doi.org/10.2196/13513 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 2 %P e15801 %T The Acceptability of Text Messaging to Help African American Women Manage Anxiety and Depression: Cross-Sectional Survey Study %A McCall,Terika %A Schwartz,Todd A %A Khairat,Saif %+ School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall, CB #7460, Chapel Hill, NC, 27599-7460, United States, 1 9198435413, saif@unc.edu %K African Americans %K women %K anxiety %K depression %K mHealth %K text messaging %D 2020 %7 3.2.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: The rates of mental illness among African American women are comparable with the general population; however, they significantly underutilize mental health services compared with their white counterparts. Previous studies revealed that interventions delivered via text messaging are effective and can be used to increase access to services and resources. More insight into whether or not this modality is acceptable for use to deliver mental health care to help African American women manage anxiety and depression is needed. Objective: This exploratory study aimed to gain insight into the acceptability of using text messaging to help African American women manage anxiety and depression. Methods: A self-administered Web-based survey was launched in June 2018 and closed in August 2018. Eligible participants were African American women (18 years or older) who reside in the United States. Participants were recruited through convenience sampling (eg, email sent via listservs and social media posts). Respondents were provided an anonymous link to the questionnaire. The survey consisted of 53 questions on the following subjects: sociodemographic characteristics, attitudes toward seeking professional psychological help, mobile phone use, and acceptability of using a mobile phone to receive mental health care. Results: The results of this exploratory study (N=101) showed that fewer than half of respondents endorsed the use of text messaging to communicate with a professional to receive help to manage anxiety (49/101, 48.5%) and depression (43/101, 42.6%). Approximately 51.4% (52/101) agreed that having the option to use text messaging to communicate with a professional if they are dealing with anxiety would be helpful. Similarly, 48.5% (49/101) agreed that having the option to use text messaging to communicate with a professional if they are dealing with depression would be helpful. Among participants who agreed that text messaging would be helpful, more than 80% noted being comfortable with its use to receive help for managing anxiety (approximately 86%, 45/52) and depression (approximately 82%, 40/49; highly significant positive association, all P<.001). More than 50% of respondents (56/101, 55.4%) indicated having concerns about using text messaging. No statistically significant associations were found between age and agreement with the use of text messaging to communicate with a professional to receive help for managing anxiety (P=.26) or depression (P=.27). Conclusions: The use of text messaging was not highly endorsed by African American women as an acceptable mode of communication with a professional to help them manage anxiety or depression. Concerns around privacy, confidentiality, and the impersonal feel of communicating about sensitive issues via text messages must be addressed for this modality to be a viable option. The findings of this study demonstrated the need for further research into the use of mobile technology to provide this population with more accessible and convenient options for mental health care. %M 31909720 %R 10.2196/15801 %U https://mental.jmir.org/2020/2/e15801 %U https://doi.org/10.2196/15801 %U http://www.ncbi.nlm.nih.gov/pubmed/31909720 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 3 %N 1 %P e14601 %T An Automated Text Messaging System (Tonsil-Text-To-Me) to Improve Tonsillectomy Perioperative Experience: Exploratory Qualitative Usability and Feasibility Study %A Farias,Nathan %A Rose-Davis,Benjamin %A Hong,Paul %A Wozney,Lori %+ Faculty of Medicine, Dalhousie University, Clinical Research Centre, 5849 University Avenue, Halifax, NS, Canada, 1 902 494 6592, nfarias@dal.ca %K short message service %K tonsillectomy %K pediatric otolaryngology %K perioperative care %D 2020 %7 15.1.2020 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Inexperience and forgetting perioperative care instruction are significant drivers of parental stress during pediatric tonsillectomy care. With the widespread use of mobile technology, parents now desire a system that provides them with information that is timely, accessible, and comprehensive. Tonsil-Text-To-Me (TTTM) is a text messaging system that sends out automated and timed texts to parents of children who are undergoing tonsillectomy. Objective: The objective of this study was to pilot-test TTTM to assess for feasibility and usability and collect suggestions for system improvements desired by parents from a pediatric otolaryngology text message service. Methods: Parents of pediatric patients who were being scheduled for tonsillectomy with or without adenoidectomy were prospectively enrolled. An exploratory qualitative study using a semistructured interview guide was performed after parents received the automated texts 2 weeks before and 1 week after their child’s surgery. Results: A total of 7 parents were interviewed (data saturation was reached). Participants were all of maternal relation to the patient. Overall, all parents felt that the TTTM service was an improvement to the current standard model of information delivery. Parents also reported that the text messages reduced their anxiety and improved their performance when caring for their children during the perioperative period. No parents expressed privacy concerns about receiving texts and regarding the information included in the messages. Service suggestions showed that parents were eager for more information and had a high threshold for message reception regarding their child’s surgical care. Conclusions: All parents expressed enthusiasm for a text message service during their child’s tonsillectomy perioperative period. The care instructions and reminders provided to parents via automated and timed text messages may be a strategy to improve information delivery in a simple and accessible format that could empower families in their own health care. %M 33393931 %R 10.2196/14601 %U https://periop.jmir.org/2020/1/e14601 %U https://doi.org/10.2196/14601 %U http://www.ncbi.nlm.nih.gov/pubmed/33393931 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e16838 %T Digital HIV Care Navigation for Young People Living With HIV in San Francisco, California: Feasibility and Acceptability Study %A Trujillo,Dillon %A Turner,Caitlin %A Le,Victory %A Wilson,Erin C %A Arayasirikul,Sean %+ Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, 5th Floor, San Francisco, CA, 94102, United States, 1 415 554 9000, sean.arayasirikul@gmail.com %K HIV/AIDS %K digital HIV care navigation %K young people living with HIV %K mHealth %D 2020 %7 10.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: HIV continues to be a public health challenge adversely affecting youth and young adults, as they are the fastest-growing group of new HIV infections in the United States and the group with the poorest health outcomes among those living with HIV. HIV prevention science has turned to mobile health as a novel approach to reach and engage young people living with HIV (YPLWH) experiencing barriers to HIV care. Objective: This study aimed to assess the feasibility and acceptability of a text message–based HIV care navigation intervention for YPLWH in San Francisco. Health eNavigation is a 6-month text message–based HIV care navigation where YPLWH are connected to their own HIV care navigator through text messaging to improve engagement in HIV primary care. Digital HIV care navigation included delivery of the following through SMS text messaging: (1) HIV care navigation, (2) health promotion and education, (3) motivational interviewing, and (4) social support. Methods: We evaluated the feasibility and acceptability of a text message–based HIV care navigation intervention among YPLWH. We assessed feasibility using quantitative data for the overall sample (N=120) to describe participant text messaging activity during the intervention. Acceptability was assessed through semistructured, in-depth interviews with a subsample of 16 participants 12 months after enrollment. Interviews were audio-recorded, transcribed, and analyzed using grounded theory. Results: Overall, the text message–based HIV care navigation intervention was feasible and acceptable. The majority of participants exhibited medium or high levels of engagement (50/120 [41.7%] and 26/120 [21.7%], respectively). Of the majority of participants who were newly diagnosed with HIV, 63% (24/38) had medium to high engagement. Similarly, among those who were not newly diagnosed, 63% (52/82) had medium to high engagement. The majority of participants found that the intervention added value to their lives and improved their engagement in HIV care, medication adherence, and viral suppression. Conclusions: Text message–based HIV care navigation is a potentially powerful tool that may help bridge the gaps for linkage and retention and improve overall engagement in HIV care for many YPLWH. Our results indicate that participation in text message–based HIV care navigation is both feasible and acceptable across pervasive structural barriers that would otherwise hinder intervention engagement. %M 31922489 %R 10.2196/16838 %U http://mhealth.jmir.org/2020/1/e16838/ %U https://doi.org/10.2196/16838 %U http://www.ncbi.nlm.nih.gov/pubmed/31922489 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e15592 %T A Web- and Mobile App–Based Mental Health Promotion Intervention Comparing Email, Short Message Service, and Videoconferencing Support for a Healthy Cohort: Randomized Comparative Study %A Renfrew,Melanie Elise %A Morton,Darren Peter %A Morton,Jason Kyle %A Hinze,Jason Scott %A Beamish,Peter James %A Przybylko,Geraldine %A Craig,Bevan Adrian %+ Lifestyle and Health Research Centre, Avondale University College, 582 Freemans Drive, Cooranbong, New South Wales, , Australia, 61 405445151, melrenfrew@gmail.com %K guidance %K health promotion %K eHealth %K short message service %K videoconferencing %D 2020 %7 6.1.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The rapid increase in mental health disorders has prompted a call for greater focus on mental health promotion and primary prevention. Web- and mobile app–based interventions present a scalable opportunity. Little is known about the influence of human support on the outcomes of these interventions. Objective: This study aimed to compare the influence of 3 modes of human support on the outcomes (ie, mental health, vitality, depression, anxiety, stress, life satisfaction, and flourishing) of a 10-week, Web- and mobile app–based, lifestyle-focused mental health promotion intervention among a healthy adult cohort. Methods: Participants were recruited voluntarily using a combination of online and offline advertising. They were randomized, unblinded into 3 groups differentiated by human support mode: Group 1 (n=201): standard—fully automated emails (S); Group 2 (n=202): standard plus personalized SMS (S+pSMS); and Group 3 (n=202): standard plus weekly videoconferencing support (S+VCS), hosted by 1 trained facilitator. Participants accessed the intervention, including the questionnaire, on a Web-based learning management system or through a mobile app. The questionnaire, administered at pre- and postintervention, contained self-reported measures of mental well-being, including the “mental health” and “vitality” subscales from the Short Form Health Survey-36, Depression Anxiety and Stress Scale-21, Diener Satisfaction With Life Scale (SWLS), and Diener Flourishing Scale. Results: Of 605 potential participants, 458 (S: n=157, S+pSMS: n=163, and S+VCS: n=138) entered the study by completing registration and the preintervention questionnaire. At post intervention, 320 out of 458 participants (69.9%; S: n=103, S+pSMS: n=114, and S+VCS: n=103) completed the questionnaire. Significant within-group improvements were recorded from pre- to postintervention in all groups and in every outcome measure (P≤.001). No significant between-group differences were observed for outcomes in any measure: mental health (P=.77), vitality (P=.65), depression (P=.93), anxiety (P=.25), stress (P.57), SWLS (P=.65), and Flourishing Scale (P=.99). Adherence was not significantly different between groups for mean videos watched (P=.42) and practical activity engagement (P=.71). Participation in videoconference support sessions (VCSSs) was low; 37 out of 103 (35.9%) participants did not attend any VCSSs, and only 19 out of 103 (18.4%) attended 7 or more out of 10 sessions. Stratification within the S+VCS group revealed that those who attended 7 or more VCSSs experienced significantly greater improvements in the domains of mental health (P=.006; d=0.71), vitality (P=.005; d=0.73), depression (P=.04; d=0.54), and life satisfaction (P=.046; d=0.50) compared with participants who attended less than 7. Conclusions: A Web- and mobile app–based mental health promotion intervention enhanced domains of mental well-being among a healthy cohort, irrespective of human support. Low attendance at VCSSs hindered the ability to make meaningful between-group comparisons. Supplementing the intervention with VCSSs might improve outcomes when attendance is optimized. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): 12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.aspx %M 31904578 %R 10.2196/15592 %U https://www.jmir.org/2020/1/e15592 %U https://doi.org/10.2196/15592 %U http://www.ncbi.nlm.nih.gov/pubmed/31904578 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 4 %N 1 %P e14963 %T Using Mobile Health Tools to Assess Physical Activity Guideline Adherence and Smoking Urges: Secondary Analysis of mActive-Smoke %A Shan,Rongzi %A Yanek,Lisa R %A Silverman-Lloyd,Luke G %A Kianoush,Sina %A Blaha,Michael J %A German,Charles A %A Graham,Garth N %A Martin,Seth S %+ Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Carnegie 591, Baltimore, MD, 21287, United States, 1 4105020469, smart100@jhmi.edu %K physical activity %K smoking %K mHealth %K fitness trackers %K short message service %D 2020 %7 6.1.2020 %9 Original Paper %J JMIR Cardio %G English %X Background: Rates of cigarette smoking are decreasing because of public health initiatives, pharmacological aids, and clinician focus on smoking cessation. However, a sedentary lifestyle increases cardiovascular risk, and therefore, inactive smokers have a particularly enhanced risk of cardiovascular disease. Objective: In this secondary analysis of mActive-Smoke, a 12-week observational study, we investigated adherence to guideline-recommended moderate-to-vigorous physical activity (MVPA) in smokers and its association with the urge to smoke. Methods: We enrolled 60 active smokers (≥3 cigarettes per day) and recorded continuous step counts with the Fitbit Charge HR. MVPA was defined as a cadence of greater than or equal to 100 steps per minute. Participants were prompted to report instantaneous smoking urges via text message 3 times a day on a Likert scale from 1 to 9. We used a mixed effects linear model for repeated measures, controlling for demographics and baseline activity level, to investigate the association between MVPA and urge. Results: A total of 53 participants (mean age 40 [SD 12] years, 57% [30/53] women, 49% [26/53] nonwhite, and 38% [20/53] obese) recorded 6 to 12 weeks of data. Data from 3633 person-days were analyzed, with a mean of 69 days per participant. Among all participants, median daily MVPA was 6 min (IQR 2-13), which differed by sex (12 min [IQR 3-20] for men vs 3.5 min [IQR 1-9] for women; P=.004) and BMI (2.5 min [IQR 1-8.3] for obese vs 10 min [IQR 3-15] for nonobese; P=.04). The median total MVPA minutes per week was 80 (IQR 31-162). Only 10% (5/51; 95% CI 4% to 22%) of participants met national guidelines of 150 min per week of MVPA on at least 50% of weeks. Adjusted models showed no association between the number of MVPA minutes per day and mean daily smoking urge (P=.72). Conclusions: The prevalence of MVPA was low in adult smokers who rarely met national guidelines for MVPA. Given the poor physical activity attainment in smokers, more work is required to enhance physical activity in this population. %M 31904575 %R 10.2196/14963 %U https://cardio.jmir.org/2020/1/e14963 %U https://doi.org/10.2196/14963 %U http://www.ncbi.nlm.nih.gov/pubmed/31904575 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e16630 %T Old-Fashioned Technology in the Era of “Bling”: Is There a Future for Text Messaging in Health Care? %A Willcox,Jane C %A Dobson,Rosie %A Whittaker,Robyn %+ School of Allied Health, Human Services and Sport, La Trobe University, Plenty Rd, Bundoora, 3083, Australia, 61 94791520, j.willcox@latrobe.edu.au %K text messaging %K mHealth %K behavior change %K digital health %D 2019 %7 20.12.2019 %9 Viewpoint %J J Med Internet Res %G English %X In the quest to discover the next high-technology solution to solve many health problems, proven established technologies are often overlooked in favor of more “technologically advanced” systems that have not been fully explored for their applicability to support behavior change theory, or used by consumers. Text messages or SMS is one example of an established technology still used by consumers, but often overlooked as part of the mobile health (mHealth) toolbox. The purpose of this paper is to describe the benefits of text messages as a health promotion modality and to advocate for broader scale implementation of efficacious text message programs. Text messaging reaches consumers in a ubiquitous real-time exchange, contrasting the multistep active engagement required for apps and wearables. It continues to be the most widely adopted and least expensive mobile phone function. As an intervention modality, text messaging has taught researchers substantial lessons about tailored interactive health communication; reach and engagement, particularly in low-resource settings; and embedding of behavior change models into digital health. It supports behavior change techniques such as reinforcement, prompts and cues, goal setting, feedback on performance, support, and progress review. Consumers have provided feedback to indicate that text messages can provide them with useful information, increase perceived support, enhance motivation for healthy behavior change, and provide prompts to engage in health behaviors. Significant evidence supports the effectiveness of text messages alone as part of an mHealth toolbox or in combination with health services, to support healthy behavior change. Systematic reviews have consistently reported positive effects of text message interventions for health behavior change and disease management including smoking cessation, medication adherence, and self-management of long-term conditions and health, including diabetes and weight loss. However, few text message interventions are implemented on a large scale. There is still much to be learned from investing in text messaging delivered research. When a modality is known to be effective, we should be learning from large-scale implementation. Many other technologies currently suffer from poor long-term engagement, the digital divide within society, and low health and technology literacy of users. Investing in and incorporating the learnings and lessons from large-scale text message interventions will strengthen our way forward in the quest for the ultimate digitally delivered behavior change model. %M 31859678 %R 10.2196/16630 %U http://www.jmir.org/2019/12/e16630/ %U https://doi.org/10.2196/16630 %U http://www.ncbi.nlm.nih.gov/pubmed/31859678 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 12 %P e15758 %T Development and Local Contextualization of Mobile Health Messages for Enhancing Disease Management Among Community-Dwelling Stroke Patients in Rural China: Multimethod Study %A Gong,Enying %A Gu,Wanbing %A Luo,Erdan %A Tan,Liwei %A Donovan,Julian %A Sun,Cheng %A Yang,Ying %A Zang,Longkai %A Bao,Peng %A Yan,Lijing L %+ Global Health Research Center, Duke Kunshan University, No 8 Duke Road, Kunshan, , China, 86 512 3665 7057, lijing.yan@dukekunshan.edu.cn %K phone messages %K stroke %K secondary prevention %K rural population %K China %D 2019 %7 17.12.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Rural China has experienced an increasing health burden because of stroke. Stroke patients in rural communities have relatively poor awareness of and adherence to evidence-based secondary prevention and self-management of stroke. Mobile technology represents an innovative way to influence patient behaviors and improve their self-management. Objective: This study is part of the System-Integrated Technology-Enabled Model of Care (the SINEMA trial) to improve the health of stroke patients in resource-poor settings in China. This study aimed to develop and pilot-test a mobile phone message–based package, as a component of the SINEMA intervention. Methods: The SINEMA trial was conducted in Nanhe County, Hebei Province, China. A total of 4 villages were selected for pretrial contextual research and pilot study. The 5 stages for developing the mobile phone messages were as follows: (1) conducting literature review on existing message banks and analyzing the characteristics of these banks; (2) interviewing stroke patients and caregivers to identify their needs; (3) drafting message contents and designing dispatching algorithms for a 3-month pilot testing; (4) collecting feedback from pilot participants through questionnaire survey and in-depth interviews on facilitators and barriers related to their acceptance and understanding of messages; and (5) finalizing the message-based intervention based on participants’ feedback for the SINEMA trial. Results: On the basis of 5 existing message banks screened out of 120 papers and patients’ needs identified from 32 in-depth interviews among stroke patients and caregivers, we developed a message bank containing 224 messages for a pilot study among 54 community-dwelling stroke patients from 4 villages. Of 54 participants, 51 (response rate: 94.4%) completed the feedback survey after receiving daily messages for 3 months. Participants’ mean age was 68 years (SD 9.2), and about half had never been to school. We observed a higher proportion of participants who were in favor of voice messages (23/42, 54%) than text messages (14/40, 35%). Among participants who received voice messages (n=43) and text messages (n=40), 41 and 30, respectively, self-reported a full or partial understanding of the contents, and 39 (39/43, 91%) and 32 (32/40, 80%), respectively, rated the messages as helpful. Analyses of the 32 interviews further revealed that voice messages containing simple and single-theme content, in plain language, with a repeated structure, a slow playback speed, and recorded in local dialect, were preferred by rural stroke patients. In addition, the dispatching algorithm and tools may also influence the acceptance of message-based interventions. Conclusions: By applying multiple methodologies and conducting a pilot study, we designed and fine-tuned a voice message–based intervention package for promoting secondary prevention among community-dwelling stroke patients in rural China. Design of the content and dispatching algorithm should engage both experts and end users and adequately consider the needs and preferences of recipients. %M 31845901 %R 10.2196/15758 %U https://mhealth.jmir.org/2019/12/e15758 %U https://doi.org/10.2196/15758 %U http://www.ncbi.nlm.nih.gov/pubmed/31845901 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e13025 %T Understanding the Function Constitution and Influence Factors on Communication for the WeChat Official Account of Top Tertiary Hospitals in China: Cross-Sectional Study %A Shen,Lining %A Wang,Shimin %A Chen,Wenqiang %A Fu,Qiang %A Evans,Richard %A Lan,Fuqiang %A Li,Wei %A Xu,Juan %A Zhang,Zhiguo %+ School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, No 13 Hangkong Road, Wuhan, 430030, China, 86 27 83692730, zhangzhiguo@hust.edu.cn %K WeChat official account %K WeChat service account %K social media %K function constitution %K tertiary hospital %K tertiary care centers %K health care %K WeChat communication index %K mobile health %K telemedicine %D 2019 %7 9.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Widespread adoption and continued developments in mobile health care technologies have led to the improved accessibility and quality of medical services. In China, WeChat, an instant messaging and social networking app released by the company Tencent, has developed a specific type of user account called WeChat official account (WOA), which is now widely adopted by hospitals in China. It enables health care providers to connect with local citizens, allowing them to, among other actions, send regular updates through mass circulation. However, with the diversity in function provided by WOA, little is known about its major constitution as well as the influence factors on the WeChat communication index (WCI). The WCI has been widely used in social media impact ranking with various types of WeChat content to fully reflect the dissemination and coverage of tweets as well as the maturity and impact of WOA. Objective: There are two typical WOAs available to users, namely, WeChat subscription account (WSSA) and WeChat service account (WSVA). The biggest difference between them is the frequency of messages transmitted. This study aimed to explore the function constitution of WSVA adopted by top tertiary hospitals in China and the major contributors of the WCI score. Methods: A total of 681 top tertiary hospitals were selected from the Hospital Quality Monitoring System; the WOA of every top tertiary hospital was retrieved in the WeChat app. We divided core functional items of WSVAs using categorical principal component analysis. To elicit the factors that influenced the use of WSVA, quantile regression was employed to analyze the WCI score. Results: From the 668 WOAs identified, adoption of WSVAs (543/668, 81.3%) was more than that of WSSAs (125/668, 18.7%). Functional items of WSVAs were categorized into four clusters: (1) hospital introduction, (2) medical services, (3) visiting assistants, and (4) others. With regard to the influence factors on the WCI, the impact of the activity index of WSVA and the total visiting number of outpatients and emergencies on WCI were statistically significant and positive in all quantiles. However, the year of certification, the type of hospital, the year of public hospital reform, and the number of beds merely affected the WCI at some quantiles. Conclusions: Our findings are considered helpful to tertiary hospitals in developing in-depth functional items that improve patient experience. The tertiary hospitals should take full advantage of times of posting and provide high-quality tweets to meet the various needs of patients. %M 31815674 %R 10.2196/13025 %U https://www.jmir.org/2019/12/e13025 %U https://doi.org/10.2196/13025 %U http://www.ncbi.nlm.nih.gov/pubmed/31815674 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 12 %P e12639 %T Analysis of the Implementation, User Perspectives, and Feedback From a Mobile Health Intervention for Individuals Living With Hypertension (DREAM-GLOBAL): Mixed Methods Study %A Barsky,Jordan %A Hunter,Rebekah %A McAllister,Colin %A Yeates,Karen %A Campbell,Norm %A Liu,Peter %A Perkins,Nancy %A Hua-Stewart,Diane %A Maar,Marion A %A Tobe,Sheldon W %+ Department of Medicine, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Room 380, 1929 Bayview Avenue, Toronto, ON, Canada, 1 416 616 7043, Sheldon.tobe@sunnybrook.ca %K blood pressure %K hypertension %K mHealth %K population groups %K short message service %D 2019 %7 9.12.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: DREAM-GLOBAL (Diagnosing hypertension—Engaging Action and Management in Getting Lower Blood Pressure in Indigenous and low- and middle-income countries) studied a SMS text messaging–based system for blood pressure measurement and hypertension management in Canadian Aboriginal and Tanzanian communities. The use of SMS text messages is an emerging point of interest in global health care initiatives because of their scalability, customizability, transferability, and cost-effectiveness. Objective: The study aim was to assess the effect on the difference in blood pressure reduction of active hypertension management messages or passive health behavior messages. The system was designed to be implemented in remote areas with wireless availability. This study described the implementation and evaluation of technical components, including quantitative data from the transmission of blood pressure measurements and qualitative data collected on the operational aspects of the system from participants, health care providers, and community leadership. Methods: The study was implemented in six remote Indigenous Canadian and two rural Tanzanian communities. Blood pressure readings were taken by a community health worker and transmitted to a mobile phone via Bluetooth, then by wireless to a programmed central server. From the server, the readings were sent to the participant’s own phone as well. Participants also received biweekly tailored SMS text messages on their phones. Quantitative data on blood pressure reading transmissions were collected from the study central server. Qualitative data were collected by surveys, focus groups, and key informant interviews of participants, health care providers, and health leadership. Results: In Canada, between February 2014 and February 2017, 2818 blood pressure readings from 243 patients were transmitted to the central server. In Tanzania, between October 2014 and August 2015, 1165 readings from 130 patients were transmitted to the central server. The use of Bluetooth technology enabled the secure, reliable transmission of information from participants to their health care provider. The timing and frequency were satisfactory to 137 of 187 (73.2%) of participants, supporting the process of sending weekly messages twice on Mondays and Thursdays at 11 am. A total of 97.0% (164/169) of the participants surveyed said they would recommend participation in the DREAM-GLOBAL program to a friend or relative with hypertension. Conclusions: In remote communities, the DREAM-GLOBAL study helped local health care providers deliver a blood pressure management program that enabled patients and community workers to feel connected. The technical components of the study were implemented as planned, and patients felt supported in their management through the SMS text messaging and mobile health program. Technological issues were solved with troubleshooting. Overall, the technical aspects of this research program enhanced clinical care and study evaluation and were well received by participants, health care workers, and community leadership. Trial Registration: Clinicaltrials.gov NCT02111226; https://clinicaltrials.gov/ct2/show/NCT02111226. %M 31815678 %R 10.2196/12639 %U https://mhealth.jmir.org/2019/12/e12639 %U https://doi.org/10.2196/12639 %U http://www.ncbi.nlm.nih.gov/pubmed/31815678 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 2 %P e14518 %T A Pragmatic Internet Intervention to Promote Positive Parenting and School Readiness in Early Childhood: Initial Evidence of Program Use and Satisfaction %A McGoron,Lucy %A Ratner,Hilary Horn %A Knoff,Kathryn AG %A Hvizdos,Erica %A Ondersma,Steven J %+ Wayne State University, The Merrill Palmer Skillman Institute for Child and Family Development, 71 E Ferry St, Detroit, MI, 48202, United States, 1 3136642553, Lucy.K.McGoron@wayne.edu %K child rearing %K child development %D 2019 %7 29.11.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Internet-based parenting programs have the potential to connect families to research-informed materials to promote positive child development. However, such programs can only succeed to the extent that the intended population engages with them. Objective: This study aimed to evaluate engagement in the 5-a-Day Parenting program, a technology-based program designed with low-income families in mind, to promote daily use of 5 specific parenting activities conducive to children’s school readiness. Following earlier pilot data, the program was enhanced with an initial motivational e-intervention and tailored text messages designed to promote engagement. Methods: Parents were recruited from local childcare centers and through a participant registry. We examined rates of receipt of program text messages and use of video-based content on the program website, 3 factors that may affect website use, and satisfaction with key program elements. Results: A total of 360 parents of young children learned about the study and had the opportunity to use the 5-a-Day Parenting website. Of these, 94 parents participated in the study, and 33% (31/94) accessed the video-based content on the website at least once. No association was found between website use and program recruitment approach, program-affiliation message, sociocontextual risk, and baseline use of the five parenting activities. Satisfaction with text messages and video-based content was high. Conclusions: For some parents, technology-based programs appear useful; however, engagement could still be enhanced. Additional research should seek innovative strategies for promoting engagement in Web-based parenting programs. %M 31782739 %R 10.2196/14518 %U http://pediatrics.jmir.org/2019/2/e14518/ %U https://doi.org/10.2196/14518 %U http://www.ncbi.nlm.nih.gov/pubmed/31782739 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e15664 %T Development of MyTeen Text Messaging Program to Support Parents of Adolescents: Qualitative Study %A Chu,Joanna Ting Wai %A Wadham,Angela %A Jiang,Yannan %A Whittaker,Robyn %A Stasiak,Karolina %A Shepherd,Matthew %A Bullen,Christopher %+ National Institute for Health Innovation, University of Auckland, 261 Morrin Road, Glen Innes, Auckland, 1072, New Zealand, 64 3737599, jt.chu@auckland.ac.nz %K programs %K mHealth %K adolescents %K parents %K text messaging %D 2019 %7 20.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Parents play an important role in the lives of adolescents, and supporting and addressing the needs of families continue to be the focus of many researchers and policy makers. Mobile health interventions have great potential for supporting parents at a population level because of their broad reach and convenience. However, limited evidence exists for such interventions for parents of adolescents. This study reports on the formative work conducted with parents and/or primary caregivers to identify their needs and preferences for the development of MyTeen—an SMS text messaging program on promoting parental competence and mental health literacy for parents of adolescents (aged 10-15 years). Objective: The aim of this qualitative study was to explore parents and/or primary caregivers’ perspectives around youth well-being, parenting, and parenting support and their input on the development of MyTeen SMS text messaging parenting intervention. Methods: A total of 5 focus groups (n=45) were conducted with parents or primary caregivers of adolescents aged 10 to 15 years between October and December 2017 in New Zealand. A semistructured interview guideline and prompts were used. Data were audiotaped, transcribed, and analyzed using inductive thematic analysis. Results: Participants were concerned about youth mental health (ie, stigma and increasing demand on adolescents), and a number of parenting challenges (ie, social expectations, time, impact of technology, changes in family communication pattern, and recognizing and talking about mental health issues) were noted. Importantly, participants reported the lack of services and support available for families, and many were not aware of services for parents themselves. A number of recommendations were given on the style, content, and frequency of developing the text messaging program. Conclusions: Findings from this qualitative work informed the development of MyTeen, an SMS text messaging program designed to increase parental competence and improve mental health literacy for parents of adolescents. %M 31746767 %R 10.2196/15664 %U http://mhealth.jmir.org/2019/11/e15664/ %U https://doi.org/10.2196/15664 %U http://www.ncbi.nlm.nih.gov/pubmed/31746767 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e15771 %T Impact of Social Determinants of Health and Demographics on Refill Requests by Medicare Patients Using a Conversational Artificial Intelligence Text Messaging Solution: Cross-Sectional Study %A Brar Prayaga,Rena %A Agrawal,Ridhika %A Nguyen,Benjamin %A Jeong,Erwin W %A Noble,Harmony K %A Paster,Andrew %A Prayaga,Ram S %+ mPulse Mobile, Inc, 16530 Ventura Blvd, Suite 500, Encino, CA, 91436, United States, 1 888 678 5735, rena@mpulsemobile.com %K text messaging %K SMS %K refill adherence %K medication adherence %K Medicare patients %K conversational AI %K social determinants of health %K predictive modeling %K machine learning %K health disparities %D 2019 %7 18.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nonadherence among patients with chronic disease continues to be a significant concern, and the use of text message refill reminders has been effective in improving adherence. However, questions remain about how differences in patient characteristics and demographics might influence the likelihood of refill using this channel. Objective: The aim of this study was to evaluate the efficacy of an SMS-based refill reminder solution using conversational artificial intelligence (AI; an automated system that mimics human conversations) with a large Medicare patient population and to explore the association and impact of patient demographics (age, gender, race/ethnicity, language) and social determinants of health on successful engagement with the solution to improve refill adherence. Methods: The study targeted 99,217 patients with chronic disease, median age of 71 years, for medication refill using the mPulse Mobile interactive SMS text messaging solution from December 2016 to February 2019. All patients were partially adherent or nonadherent Medicare Part D members of Kaiser Permanente, Southern California, a large integrated health plan. Patients received SMS reminders in English or Spanish and used simple numeric or text responses to validate their identity, view their medication, and complete a refill request. The refill requests were processed by Kaiser Permanente pharmacists and support staff, and refills were picked up at the pharmacy or mailed to patients. Descriptive statistics and predictive analytics were used to examine the patient population and their refill behavior. Qualitative text analysis was used to evaluate quality of conversational AI. Results: Over the course of the study, 273,356 refill reminders requests were sent to 99,217 patients, resulting in 47,552 refill requests (17.40%). This was consistent with earlier pilot study findings. Of those who requested a refill, 54.81% (26,062/47,552) did so within 2 hours of the reminder. There was a strong inverse relationship (r10=−0.93) between social determinants of health and refill requests. Spanish speakers (5149/48,156, 10.69%) had significantly lower refill request rates compared with English speakers (42,389/225,060, 18.83%; X21 [n=273,216]=1829.2; P<.001). There were also significantly different rates of refill requests by age band (X26 [n=268,793]=1460.3; P<.001), with younger patients requesting refills at a higher rate. Finally, the vast majority (284,598/307,484, 92.23%) of patient responses were handled using conversational AI. Conclusions: Multiple factors impacted refill request rates, including a strong association between social determinants of health and refill rates. The findings suggest that higher refill requests are linked to language, race/ethnicity, age, and social determinants of health, and that English speakers, whites, those younger than 75 years, and those with lower social determinants of health barriers are significantly more likely to request a refill via SMS. A neural network–based predictive model with an accuracy level of 78% was used to identify patients who might benefit from additional outreach to narrow identified gaps based on demographic and socioeconomic factors. %M 31738170 %R 10.2196/15771 %U http://mhealth.jmir.org/2019/11/e15771/ %U https://doi.org/10.2196/15771 %U http://www.ncbi.nlm.nih.gov/pubmed/31738170 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e14247 %T An Interactive Parent-Targeted Text Messaging Intervention to Improve Oral Health in Children Attending Urban Pediatric Clinics: Feasibility Randomized Controlled Trial %A Borrelli,Belinda %A Henshaw,Michelle %A Endrighi,Romano %A Adams,William G %A Heeren,Timothy %A Rosen,Rochelle K %A Bock,Beth %A Werntz,Scott %+ Center for Behavioral Science Research, Boston University Henry M Goldman School of Dental Medicine, 560 Harrison Ave, 3rd floor, Boston, MA, 02118, United States, 1 617 358 3358, belindab@bu.edu %K oral health %K mHealth %K text message %K dental caries %K health behavior %D 2019 %7 11.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Effective preventive treatments for dental decay exist, but caries experience among preschoolers has not changed, with marked disparities in untreated decay. Despite near-universal use of SMS text messaging, there are no studies using text messages to improve the oral health of vulnerable children. Objective: This randomized controlled feasibility trial aimed to test the effects of oral health text messages (OHT) versus a control (child wellness text messages or CWT). OHT was hypothesized to outperform CWT on improving pediatric oral health behaviors and parent attitudes. Methods: Parents with a child aged <7 years were recruited at urban clinics during pediatric appointments (79% [41/52] below poverty line; 66% [36/55] black) and randomized to OHT (text messages on brushing, dental visits, bottle and sippy cups, healthy eating and sugary beverages, and fluoride) or CWT (text messages on reading, safety, physical activity and development, secondhand smoke, and stress) groups. Automated text messages based on Social Cognitive Theory were sent twice each day for 8-weeks. Groups were equivalent on the basis of the number of text messages sent, personalization, interactivity, and opportunity to earn electronic badges and unlock animated characters. Assessments were conducted at baseline and 8 weeks later. Data were analyzed with linear mixed–effects models. Results: A total of 55 participants were randomized (28 OHT and 27 CWT). Only one participant dropped out during the text message program and 47 (24 OHT and 23 CWT) completed follow up surveys. Response rates exceeded 68.78% (1040/1512) and overall program satisfaction was high (OHT mean 6.3; CWT mean 6.2; 1-7 scale range). Of the OHT group participants, 84% (21/25) would recommend the program to others. Overall program likeability scores were high (OHT mean 5.90; CWT mean 6.0; 1-7 scale range). Participants reported high perceived impact of the OHT program on brushing their child’s teeth, motivation to address their child's oral health, and knowledge of their child's oral health needs (mean 4.7, 4.6, and 4.6, respectively; 1-5 scale range). At follow up, compared with CWT, OHT group participants were more likely to brush their children’s teeth twice per day (odds ratio [OR] 1.37, 95% CI 0.28-6.50) and demonstrated improved attitudes regarding the use of fluoride (OR 3.82, 95% CI 0.9-16.8) and toward getting regular dental checkups for their child (OR 4.68, 95% CI 0.24-91.4). There were modest, but not significant, changes in motivation (F1,53=0.60; P=.45) and self–efficacy (F1,53=0.24; P=.63) to engage in oral health behaviors, favoring OHT (d=0.28 and d=0.16 for motivation and self–efficacy, respectively). Conclusions: The OHT program demonstrated feasibility was well utilized and appealing to the target population and showed promise for efficacy. %M 31710306 %R 10.2196/14247 %U https://mhealth.jmir.org/2019/11/e14247 %U https://doi.org/10.2196/14247 %U http://www.ncbi.nlm.nih.gov/pubmed/31710306 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e14619 %T A Short Message Service Intervention to Support Adherence to Home-Based Strengthening Exercise for People With Knee Osteoarthritis: Intervention Design Applying the Behavior Change Wheel %A Nelligan,Rachel K %A Hinman,Rana S %A Atkins,Lou %A Bennell,Kim L %+ Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville, 3010, Australia, 61 3 8344 0556, k.bennell@unimelb.edu.au %K text messaging %K mobile phone %K knee osteoarthritis %K exercise %D 2019 %7 18.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Knee osteoarthritis is a chronic condition with no known cure. Treatment focuses on symptom management, with exercise recommended as a core component by all clinical practice guidelines. However, long-term adherence to exercise is poor among many people with knee osteoarthritis, which limits its capacity to provide sustained symptom relief. To improve exercise outcomes, scalable interventions that facilitate exercise adherence are needed. SMS (short message service) interventions show promise in health behavior change. The Behavior Change Wheel (BCW) is a widely used framework that provides a structured approach to designing behavior change interventions and has been used extensively in health behavior change intervention design. Objective: The study aimed to describe the development of, and rationale for, an SMS program to support exercise adherence in people with knee osteoarthritis using the BCW framework. Methods: The intervention was developed in two phases. Phase 1 involved using the BCW to select the target behavior and associated barriers, facilitators, and behavior change techniques (BCTs). Phase 2 involved design of the program functionality and message library. Messages arranged into a 24-week schedule were provided to an external company to be developed into an automated SMS program. Results: The target behavior was identified as participation in self-directed home-based strengthening exercise 3 times a week for 24 weeks. A total of 13 barriers and 9 facilitators of the behavior and 20 BCTs were selected to use in the intervention. In addition, 198 SMS text messages were developed and organized into a 24-week automated program that functions by prompting users to self-report the number of home exercise sessions completed each week. Users who reported ≥3 exercise sessions/week (adherent) received positive reinforcement messages. Users who reported <3 exercise sessions/week (nonadherent) were asked to select a barrier (from a list of standardized response options) that best explains why they found performing the exercises challenging in the previous week. This automatically triggers an SMS containing a BCT suggestion relevant to overcoming the selected barrier. Users also received BCT messages to facilitate exercise adherence, irrespective of self-reported adherence. Conclusions: This study demonstrates application of the BCW to guide development of an automated SMS intervention to support exercise adherence in knee osteoarthritis. Future research is needed to assess whether the intervention improves adherence to the prescribed home-based strengthening exercise. %M 31628786 %R 10.2196/14619 %U https://mhealth.jmir.org/2019/10/e14619 %U https://doi.org/10.2196/14619 %U http://www.ncbi.nlm.nih.gov/pubmed/31628786 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e14699 %T Dropout and Abstinence Outcomes in a National Text Messaging Smoking Cessation Intervention for Pregnant Women, SmokefreeMOM: Observational Study %A Kamke,Kristyn %A Grenen,Emily %A Robinson,Cendrine %A El-Toukhy,Sherine %+ Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 7201 Wisconsin Ave, RM 533M, Bethesda, MD, 20814, United States, 1 301 594 4743, sherine.el-toukhy@nih.gov %K smoking cessation %K pregnancy %K women's health %K mHealth %K text messaging intervention %D 2019 %7 7.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Population-level text messaging smoking cessation interventions may reduce racial and ethnic differences in smoking among pregnant women. Objective: Our objective was to examine racial and ethnic differences in dropout, response, and abstinence rates among users of a US national, publicly available text messaging cessation intervention targeting pregnant women, SmokefreeMOM. Methods: Participants were online subscribers to SmokefreeMOM who set a prospective quit date within the 9 months before their due date. We examined demographics, smoking frequency, number of cigarettes smoked per day, and prequit time (up to 14 days of preparation time before quit date) as correlates of response rate and abstinence at 8 time points: quit date, day 7, day 14, day 21, day 28, day 35, day 42 (intervention end), and day 72 (1-month follow-up). We conducted survival analysis of time from quit date to dropout by race and ethnicity. Results: The mean age of the analytic sample of 1288 users was 29.46 (SD 7.11) years. Of these, 65.81% (848/1288) were white, 16.04% (207/1288) were black, 8.86% (114/1288) were Latina, and 9.29% (120/1288) were multiracial, American Indian/Alaska Native, Native Hawaiian Pacific Islander, or other; 82.68% (1065/1288) had some college education or less. Point-prevalence abstinence was 14.51% (157/1082) on quit day, 3.51% (38/1082) at intervention end, and 1.99% (21/1053) at 1-month follow-up. Black users (hazard ratio 0.68, 95% CI 0.51-0.91) and those with a high school degree or less (hazard ratio 0.66, 95% CI 0.49-0.89) or some college education (hazard ratio 0.75, 95% CI 0.57-0.99) were less likely to drop out than whites or users with a bachelor’s degree or higher. Response and abstinence rates were similar across race, ethnicity, and education. Conclusions: Enrollment was low among racial and ethnic minority women but high among less-educated women. Abstinence at intervention end and 1-month follow-up was lower than that in controlled trials of text messaging cessation interventions for pregnant women (range 7%-20%). Increasing the reach, engagement, and effectiveness of SmokefreeMOM, especially among women with high rates of smoking during pregnancy, must be prioritized. %M 31593542 %R 10.2196/14699 %U https://mhealth.jmir.org/2019/10/e14699 %U https://doi.org/10.2196/14699 %U http://www.ncbi.nlm.nih.gov/pubmed/31593542 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e13005 %T Research and Implementation Lessons Learned From a Youth-Targeted Digital Health Randomized Controlled Trial (the ARMADILLO Study) %A Gonsalves,Lianne %A Njeri,Winnie Wangari %A Schroeder,Megan %A Mwaisaka,Jefferson %A Gichangi,Peter %+ Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, Geneva, , Switzerland, 41 795006554, gonsalvesl@who.int %K adolescent health %K sexual and reproductive health %K health communication %K mHealth %K Kenya %K intervention research %D 2019 %7 27.9.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Evidence is lacking on the efficacy of sexual and reproductive health (SRH) communication interventions for youth (aged 15-24 years), especially from low- and middle-income countries. Therefore, the World Health Organization initiated the Adolescent/Youth Reproductive Mobile Access and Delivery Initiative for Love and Life Outcomes (ARMADILLO) program, a free, menu-based, on-demand text message (SMS, short message service) platform providing validated SRH content developed in collaboration with young people. A randomized controlled trial (RCT) assessing the effect of the ARMADILLO intervention on SRH-related outcomes was implemented in Kwale County, Kenya. Objective: This paper describes the implementation challenges related to the RCT, observed during enrollment and the intervention period, and their implications for digital health researchers and program implementers. Methods: This was an open, three-armed RCT. Following completion of a baseline survey, participants were randomized into the ARMADILLO intervention (arm 1), a once-a-week contact SMS text message (arm 2), or usual care (arm 3, no intervention). The intervention period lasted seven weeks, after which participants completed an endline survey. Results: Two study team decisions had significant implications for the success of the trial’s enrollment and intervention implementation: a hands-off participant recruitment process and a design flaw in an initial language selection menu. As a result, three weeks after recruitment began, 660 participants had been randomized; however, 107 (53%) participants in arm 1 and 136 (62%) in arm 2 were “stuck” at the language menu. The research team called 231 of these nonengaging participants and successfully reached 136 to learn reasons for nonengagement. Thirty-two phone numbers were found to be either not linked to our participants (a wrong number) or not in their primary possession (a shared phone). Among eligible participants, 30 participants indicated that they had assumed the introductory message was a scam or spam. Twenty-seven participants were confused by some aspect of the system. Eleven were apathetic about engaging. Twenty-four nonengagers experienced some sort of technical issue. All participants eventually started their seven-week study period. Conclusions: The ARMADILLO study’s implementation challenges provide several lessons related to both researching and implementing client-side digital health interventions, including (1) have meticulous phone data collection protocols to reduce wrong numbers, (2) train participants on the digital intervention in efficacy assessments, and (3) recognize that client-side digital health interventions have analog discontinuation challenges. Implementation lessons were (1) determine whether an intervention requires phone ownership or phone access, (2) digital health campaigns need to establish a credible presence in a busy digital space, and (3) interest in a service can be sporadic or fleeting. Clinical Trial: International Standard Randomized Controlled Trial Number (ISRCTN): 85156148; http://www.isrctn. com/ISRCTN85156148 %M 31573939 %R 10.2196/13005 %U http://mhealth.jmir.org/2019/8/e13005/ %U https://doi.org/10.2196/13005 %U http://www.ncbi.nlm.nih.gov/pubmed/31573939 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e12137 %T Comparing the Efficacy of an Identical, Tailored Smoking Cessation Intervention Delivered by Mobile Text Messaging Versus Email: Randomized Controlled Trial %A Gram,Inger Torhild %A Larbi,Dillys %A Wangberg,Silje Camilla %+ Norwegian Centre for E-health Research, University Hospital of North Norway, SIVA Innovation Centre Tromsø, Sykehusvn 23, Tromsø, 9038, Norway, 47 92401177, inger.gram@ehealthresearch.no %K eHealth %K electronic mail %K mHealth %K mobile phones %K randomized controlled trial %K smoking cessation %K text-messaging %D 2019 %7 27.9.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is a need to deliver smoking cessation support at a population level, both in developed and developing countries. Studies on internet-based and mobile phone–based smoking cessation interventions have shown that these methods can be as effective as other methods of support, and they can have a wider reach at a lower cost. Objective: This randomized controlled trial (RCT) aimed to compare, on a population level, the efficacy of an identical, tailored smoking cessation intervention delivered by mobile text messaging versus email. Methods: We conducted a nationwide 2-arm, double-blinded, fully automated RCT, close to a real-world setting, in Norway. We did not offer incentives to increase participation and adherence or to decrease loss to follow-up. We recruited users of the website, slutta.no, an open, free, multi-component Norwegian internet-based smoking cessation program, from May 2010 until October 2012. Enrolled smokers were considered as having completed a time point regardless of their response status if it was 1, 3, 6, or 12 months post cessation. We assessed 7315 participants using the following inclusion criteria: knowledge of the Norwegian language, age 16 years or older, ownership of a Norwegian cell phone, having an email account, current cigarette smoker, willingness to set a cessation date within 14 days (mandatory), and completion of a baseline questionnaire for tailoring algorithms. Altogether, 6137 participants were eligible for the study and 4378 participants (71.33%) provided informed consent to participate in the smoking cessation trial. We calculated the response rates for participants at the completed 1, 3, 6, and 12 months post cessation. For each arm, we conducted an intention-to-treat (ITT) analysis for each completed time point. The main outcome was 7-day self-reported point prevalence abstinence (PPA) at the completed 6 months post cessation. We calculated effect size of the 7-day self-reported PPA in the text message arm compared with the email arm as odds ratios (ORs) with 95% CIs for the 4 time points post cessation. Results: At 6 months follow-up, 21.06% (384/1823) of participants in the text message arm and 18.62% (333/1788) in the email arm responded (P=.07) to the surveys. In the ITT analysis, 11.46% (209/1823) of participants in the text message arm compared with 10.96% (196/1788) in the email arm (OR 1.05, 95% CI 0.86-1.30) reported to have achieved 7 days PPA. Conclusions: This nationwide, double-blinded, large, fully automated RCT found that 1 in 9 enrolled smokers reported 7-day PPA in both arms, 6 months post cessation. Our study found that identical smoking cessation interventions delivered by mobile text messaging and email may be equally successful at a population level. Trial Registration: ClinicalTrials.gov NCT01103427; https://clinicaltrials.gov/ct2/show/NCT01103427 %M 31573935 %R 10.2196/12137 %U https://mhealth.jmir.org/2019/9/e12137 %U https://doi.org/10.2196/12137 %U http://www.ncbi.nlm.nih.gov/pubmed/31573935 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e15386 %T Using Video Feedback Through Smartphone Instant Messaging in Fundamental Nursing Skills Teaching: Observational Study %A Yang,Xiaoxian %A Xie,Ri-Hua %A Chen,Si %A Yu,Wei %A Liao,Yan %A Krewski,Daniel %A Wen,Shi Wu %+ Department of Nursing, Nanhai Hospital, Southern Medical University, 28 Liguan Rd, Lishui, Foshan, 528244, China, 86 189 2869 7126, xierihua928@hotmail.com %K video feedback %K smartphone %K mobile phone %K student nurses %K fundamental nursing skill %K teaching %D 2019 %7 05.09.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Video feedback has been shown to be an effective teaching tool that can improve student learning when having them view their own performance. However, the literature on the effect of integrating smartphones with video feedback in fundamental nursing skills teaching is sparse. Objective: This study aimed to explore the potential effects of video feedback through smartphone-based instant messaging on teaching undergraduate nursing students fundamental nursing skills. Methods: We conducted a study on teaching fundamental nursing skills to 6 classes of second-year undergraduate nursing students. In 2 classes (the intervention group), the instructor elected to use smartphone-based video feedback to facilitate teaching; instructors in the other 4 classes (the control group) elected to use routine methods of teaching without video feedback. Scores from the final examination, in-class assignments, and the General Self-Efficacy Scale questionnaire were collected and compared between the two groups. Multiple linear regression analysis was performed to estimate the independent effect of video feedback after adjusting for gender, age, and prior experience in the use of WeChat/QQ in learning applications. An ad hoc questionnaire was used for student evaluation of the novel smartphone-based video feedback teaching method. Results: A total of 195 nursing students (65 in the video feedback group and 130 in the control group) completed the study and were included in the final analysis. Mean and standard deviation of scores on the final examination, bed making, aseptic procedure, vital signs measurement, and oxygen therapy were 91.29 (SD 2.36), 90.52 (SD 3.18), 93.23 (SD 3.16), 91.65 (SD 4.21), and 92.06 (SD 3.58), respectively, in the video feedback group and 89.99 (SD 3.12), 81.71 (SD 8.63), 87.12 (SD 5.50), 87.45 (SD 8.00), and 90.37 (SD 6.36), respectively, in the control group (differences were statistically significant). The mean and standard deviation of scores for assignments in catheterization and enema and General Self-Efficacy Scale were 89.69 (SD 3.22), 91.14 (SD 3.15), and 24.52 (SD 5.35), respectively, in the video feedback group and 88.82 (SD 7.48), 90.79 (SD 6.08), and 24.50 (SD 6.16), respectively, in the control group (differences were not statistically significant). The majority (over 98%) of nursing students were satisfied with this smartphone-based video feedback teaching method. Conclusions: Video feedback through smartphone-based instant messaging may be an effective way to improve nursing students’ academic performance and professional skills. %M 31489839 %R 10.2196/15386 %U https://mhealth.jmir.org/2019/9/e15386 %U https://doi.org/10.2196/15386 %U http://www.ncbi.nlm.nih.gov/pubmed/31489839 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e14750 %T Automated Text Messaging With Patients in Department of Veterans Affairs Specialty Clinics: Cluster Randomized Trial %A Yakovchenko,Vera %A Hogan,Timothy P %A Houston,Thomas K %A Richardson,Lorilei %A Lipschitz,Jessica %A Petrakis,Beth Ann %A Gillespie,Chris %A McInnes,D Keith %+ Center for Healthcare Organization and Implementation Research, Bedford Department of Veterans Affairs Medical Center, Department of Veterans Affairs, , Bedford, MA,, United States, 1 781 687 3374, vera.yakovchenko@va.gov %K implementation facilitation %K texting %K veterans %K eHealth %K self-management %K digital health %K digital medicine %D 2019 %7 4.8.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Acceptability of mobile phone text messaging as a means of asynchronous communication between health care systems and patients is growing. The US Department of Veterans Affairs (VA) has adopted an automated texting system (aTS) for national rollout. The aTS allows providers to develop clinical texting protocols to promote patient self-management and allows clinical teams to monitor patient progress between in-person visits. Texting-supported hepatitis C virus (HCV) treatment has not been previously tested. Objective: Guided by the Practical, Robust Implementation and Sustainability Model (PRISM), we developed an aTS HCV protocol and conducted a mixed methods, hybrid type 2 effectiveness implementation study comparing two programs supporting implementation of the aTS HCV protocol for medication adherence in patients with HCV. Methods: Seven VA HCV specialty clinics were randomized to usual aTS implementation versus an augmented implementation facilitation program. Implementation process measures included facilitation metrics, usability, and usefulness. Implementation outcomes included provider and patient use of the aTS HCV protocol, and effectiveness outcomes included medication adherence, health perceptions and behaviors, and sustained virologic response (SVR). Results: Across the seven randomized clinics, there were 293 facilitation events using a core set of nine implementation strategies (157 events in augmented implementation facilitation, 136 events in usual implementation). Providers found the aTS appropriate with high potential for scale-up but not without difficulties in startup, patient selection and recruitment, and clinic workflow integration. Patients largely found the aTS easy to use and helpful; however, low perceived need for self-management support contributed to high declination. Reach and use was modest with 197 patients approached, 71 (36%) enrolled, 50 (25%) authenticated, and 32 (16%) using the aTS. In augmented implementation facilitation clinics, more patients actively used the aTS HCV protocol compared with usual clinic patients (20% vs 12%). Patients who texted reported lower distress about failing HCV treatment (13/15, 87%, vs 8/15, 53%; P=.05) and better adherence to HCV medication (11/15, 73%, reporting excellent adherence vs 6/15, 40%; P=.06), although SVR did not differ by group. Conclusions: The aTS is a promising intervention for improving patient self-management; however, augmented approaches to implementation may be needed to support clinician buy-in and patient engagement. Considering the behavioral, social, organizational, and technical scale-up challenges that we documented, successful and sustained implementation of the aTS may require implementation strategies that operate at the clinic, provider, and patient levels. Trial Registration: Retrospectively registered at ClinicalTrials.gov NCT03898349; https://clinicaltrials.gov/ct2/show/NCT03898349 %M 31444872 %R 10.2196/14750 %U https://www.jmir.org/2019/8/e14750/ %U https://doi.org/10.2196/14750 %U http://www.ncbi.nlm.nih.gov/pubmed/31444872 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 8 %P e12396 %T Mental Health Promotion Among University Students Using Text Messaging: Protocol for a Randomized Controlled Trial of a Mobile Phone–Based Intervention %A Thomas,Kristin %A Bendtsen,Marcus %+ Department of Medical and Health Sciences, Faculty of Medicine, Linköping University, Linköping, 58183, Sweden, 46 13282546, kristin.thomas@liu.se %K mental health %K telemedicine %K students %K randomized controlled trial %D 2019 %7 15.08.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a growing understanding that well-being and mental illness are 2 separate dimensions of mental health. High well-being is associated with decreased risk of disease and mental illness and increased longevity. Objective: This study aims to test the efficacy of a mobile phone–based intervention on positive mental health. Methods: We are conducting a 2-armed randomized controlled trial of university students in Sweden. Recruitment will last for 6 months by digital advertising (eg, university websites). Participants will be randomly allocated to either an intervention (fully automated mobile phone–based mental health intervention) or control group (treatment as usual). The primary outcome will be self-assessed positive mental health (Mental Health Continuum Short Form). Secondary outcomes will be self-assessed depression anxiety symptomatology (Hospital Anxiety Depression Scale). Outcomes will be investigated at baseline, at 3, 6, and 12 months after randomization. Mediators (positive emotions and thoughts) will be investigated at baseline, midintervention, and at follow-ups using 2 single face-valid items. Results: Data will be collected between autumn 2018 and spring 2019. Results are expected to be published in 2020. Conclusions: Strengths of the study include the use of a validated comprehensive instrument to measure positive mental health. Mechanisms of change are also investigated. A potential challenge could be recruitment; however, by setting a prolonged recruitment period, we believe that the study will recruit a sufficient sample. Trial Registration: International Standard Randomized Controlled Trial Number: 54748632; http://www.isrctn.com/ ISRCTN54748632 International Registered Report Identifier (IRRID): PRR1-10.2196/12396 %M 31418426 %R 10.2196/12396 %U https://www.researchprotocols.org/2019/8/e12396/ %U https://doi.org/10.2196/12396 %U http://www.ncbi.nlm.nih.gov/pubmed/31418426 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 8 %P e11165 %T Text-Messaging, Online Peer Support Group, and Coaching Strategies to Optimize the HIV Prevention Continuum for Youth: Protocol for a Randomized Controlled Trial %A Swendeman,Dallas %A Arnold,Elizabeth Mayfield %A Harris,Danielle %A Fournier,Jasmine %A Comulada,W Scott %A Reback,Cathy %A Koussa,Maryann %A Ocasio,Manuel %A Lee,Sung-Jae %A Kozina,Leslie %A Fernández,Maria Isabel %A Rotheram,Mary Jane %A , %+ University of California, Los Angeles, Department of Psychiatry & Biobehavioral Sciences, 10920 Wilshire Blvd, Suite 350, Los Angeles, CA, 90024, United States, 1 3107948128, dswendeman@mednet.ucla.edu %K adolescents %K HIV/AIDS %K mHealth %K homelessness %K MSM %K transgender %K prevention %D 2019 %7 09.08.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: America’s increasing HIV epidemic among youth suggests the need to identify novel strategies to leverage services and settings where youth at high risk (YAHR) for HIV can be engaged in prevention. Scalable, efficacious, and cost-effective strategies are needed, which support youth during developmental transitions when risks arise. Evidence-based behavioral interventions (EBIs) have typically relied on time-limited, scripted, and manualized protocols that were often delivered with low fidelity and lacked evidence for effectiveness. Objective: This study aims to examine efficacy, implementation, and cost-effectiveness of easily mountable and adaptable, technology-based behavioral interventions in the context of an enhanced standard of care and study assessments that implement the guidelines of Centers for Disease Control and Prevention (CDC) for routine, repeat HIV, and sexually transmitted infection (STI) testing for high-risk youth. Methods: Youth aged between 12 and 24 years (n=1500) are being recruited from community-based organizations and clinics serving gay, bisexual, and transgender youth, homeless youth, and postincarcerated youth, with eligibility algorithms weighting African American and Latino youth to reflect disparities in HIV incidence. At baseline and 4-month intervals over 24 months (12 months for lower-risk youth), interviewers monitor uptake of HIV prevention continuum steps (linkage to health care, use of pre- or postexposure prophylaxis, condoms, and prevention services) and secondary outcomes of substance use, mental health, and housing security. Assessments include rapid diagnostic tests for HIV, STIs, drugs, and alcohol. The study is powered to detect modest intervention effects among gay or bisexual male and transgender youth with 70% retention. Youth are randomized to 4 conditions: (1) enhanced standard of care of automated text-messaging and monitoring (AMM) and repeat HIV/STI testing assessment procedures (n=690); (2) online group peer support via private social media plus AMM (n=270); (3) coaching that is strengths-based, youth-centered, unscripted, based on common practice elements of EBI, available over 24 months, and delivered by near-peer paraprofessionals via text, phone, and in-person, plus AMM (n=270); and (4) online group peer support plus coaching and AMM (n=270). Results: The project was funded in September 2016 and enrollment began in May 2017. Enrollment will be completed between June and August 2019. Data analysis is currently underway, and the first results are expected to be submitted for publication in 2019. Conclusions: This hybrid implementation-effectiveness study examines alternative models for implementing the CDC guidelines for routine HIV/STI testing for YAHR of acquiring HIV and for delivering evidence-based behavioral intervention content in modular elements instead of scripted manuals and available over 24 months of follow-up, while also monitoring implementation, costs, and effectiveness. The greatest impacts are expected for coaching, whereas online group peer support is expected to have lower impact but may be more cost-effective. Trial Registration: ClinicalTrials.gov NCT03134833; https://clinicaltrials.gov/ct2/show/NCT03134833 (Archived by WebCite at http://www.webcitation.org/76el0Viw9) International Registered Report Identifier (IRRID): DERR1-10.2196/11165 %M 31400109 %R 10.2196/11165 %U https://www.researchprotocols.org/2019/8/e11165/ %U https://doi.org/10.2196/11165 %U http://www.ncbi.nlm.nih.gov/pubmed/31400109 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e12675 %T Use of Short Messaging Service to Improve Follow-Up for Abnormal Pap Test Results in Minority and Medically Underserved Women in North Carolina: Questionnaire on Attitudes and Acceptability %A Romocki,LaHoma Smith %A Des Marais,Andrea %A Cofie,Leslie %A Anderson,Chelsea %A Curington,Theresa %A Smith,Jennifer Susan %+ Department of Public Health Education, North Carolina Central University, 1801 Fayetteville Street, Durham, NC, 27707, United States, 1 919 530 6404, lromocki@nccu.edu %K cervical cancer %K Pap tests %K abnormal results %K text messaging %K appointment reminders %D 2019 %7 06.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: An estimated one in eight cervical cancer cases are due to a lack of follow-up care for abnormal Pap test results. Low rates of completion of follow-up care particularly affect low-income minority women. The burden of cervical cancer could be reduced through interventions that improve timely colposcopy follow-up and treatment of abnormal screening results. Mobile communications via text messaging present a low-cost opportunity to increase rates of clinic return among women referred to follow-up after obtaining abnormal screening results. Objective: Our aims were to determine the acceptability and feasibility of using text messaging to increase completion of follow-up care following abnormal cervical cancer screening (Pap test) results and to examine factors that may affect the acceptability and use of text messaging to increase communications between health care providers (HCP) and low-income minority women. Methods: The study participants were 15 low-income women who had undergone a Pap test within the preceding 12 months. Semistructured interviews, including open- and closed-ended questions from a validated questionnaire, were conducted by phone or in person. Responses to closed-ended survey items were tabulated, and descriptive statistics were generated using Microsoft Excel. Responses to the open-ended questions were coded and analyzed using NVivo 11 qualitative analysis software. Results: Nearly all participants (14/15, 93%) were comfortable receiving a text message from an HCP stating that their Pap test results were available (<40 years: 100%; ≥40 years: 86%). Over half (8/15; 53%) of the participants were comfortable receiving a text message stating that their Pap test results were abnormal, although many preferred to receive such information via a phone call (6/15; 40%). Most participants (9/15; 60%) believed that receiving a text reminder would make them more likely to attend their appointment. The preferred method for receiving a reminder appeared to vary by age, with older women preferring telephone reminders over text messaging reminders. Analysis of open-ended questions suggested that text messaging appeals to some women due to its wide use and convenience for communicating with HCPs. However, women cited concerns about the confidentiality of messages and barriers to understanding the messages, including the physical capacity to read and accurately interpret the content of the messaging. Conclusions: Most participants indicated a willingness to receive text messages from their HCPs about cervical cancer screening results and believed that text messages were the best way to remind them of appointments for follow-up care. Potential concerns could be addressed by excluding explicit references to the nature of the appointment in the text message in order to avoid disclosure of sensitive health information to unauthorized individuals. Although text messaging seems promising to improve adherence to timely follow-up, personal preferences should be considered by allowing patients to opt-out of text communications. %M 31389334 %R 10.2196/12675 %U https://formative.jmir.org/2019/3/e12675/ %U https://doi.org/10.2196/12675 %U http://www.ncbi.nlm.nih.gov/pubmed/31389334 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e13712 %T Predictors of Retention in an Adult Text Messaging Smoking Cessation Intervention Program: Cohort Study %A Wiseman,Kara P %A Coa,Kisha I %A Prutzman,Yvonne M %+ Tobacco Control Research Branch, Behavioral Research Program, National Cancer Institute, 9606 Medical Center Drive, MSC 9761, Room 3E208, Bethesda, MD, 20892-9761, United States, 1 2402765873, kara.wiseman@nih.gov %K smoking cessation %K text-messaging %K mHealth %K engagement %D 2019 %7 01.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health tools such as text messaging programs can support smoking cessation. However, high rates of disengagement from these tools decrease their effectiveness. Objective: The purpose of this study was to identify user characteristics associated with retention in an adult text messaging smoking cessation intervention. Methods: Adults initiating a quit attempt using the publicly available program SmokefreeTXT between March 6 and June 21, 2016 (n=6215), were included. Data were collected to assess nicotine dependence, frequency of being around other smokers, time of the day for cigarette cravings, extrinsic and intrinsic motivation to quit smoking, confidence in quitting, and long-term intention to be smoke free. Multivariable survival analysis modeling for time to opt out was conducted to identify characteristics associated with opting out over the course of the intervention, adjusting for age, sex, and smoking frequency, reset of the quit date by the user, and the number of days enrolled before initiating the quit attempt. Among those who opted out, multivariable multinomial logistic regression analysis was used to identify predictors of opting out early (within 3 days and between 4 and 7 days into the quit attempt) compared to opting out late (more than 7 days into the quit attempt), adjusting for the same confounders. Results: Survival analyses indicated that younger age, female sex, higher levels of nicotine dependence, lower intention to be smoke free, and enrolling in SmokefreeTXT ≤1 week before initiating the quit attempt were associated with an increased risk of opting out. For example, users who smoked within 5 minutes of waking up were 1.17 times more likely to opt out than those who smoked more than 5 minutes after waking up (95% CI 1.01-1.35). Among users who opted out from SmokefreeTXT, logistic regression modeling indicated that compared to users who were never or rarely around other smokers, those who were sometimes around other smokers had 1.96 times more likely to opt out within the first 3 days of the quit attempt (95% CI 1.18-3.25). In addition, compared to users with high levels of long-term quit intention, users with lower levels of intention had 1.80 times the odds of opting out between 4 and 7 days into the quit attempt (95% CI 1.02-3.18). Users who reset their quit date after initiating a quit attempt were less likely to opt out at either time point compared with those who did not reset their quit date. Conclusions: Several user characteristics are associated with retention in an adult text messaging smoking cessation program. These results provide guidance on potential characteristics that should be addressed in future text messaging smoking cessation programs. Providing additional support to users with these characteristics may increase retention in text messaging programs and ultimately lead to smoking cessation. %M 31373278 %R 10.2196/13712 %U https://mhealth.jmir.org/2019/8/e13712/ %U https://doi.org/10.2196/13712 %U http://www.ncbi.nlm.nih.gov/pubmed/31373278 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e13906 %T Barriers and Facilitators to the Implementation of a Mobile Insulin Titration Intervention for Patients With Uncontrolled Diabetes: A Qualitative Analysis %A Rogers,Erin %A Aidasani,Sneha R %A Friedes,Rebecca %A Hu,Lu %A Langford,Aisha T %A Moloney,Dana N %A Orzeck-Byrnes,Natasha %A Sevick,Mary Ann %A Levy,Natalie %+ Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY, 10016, United States, 1 646 501 3556, erin.rogers@nyulangone.org %K type 2 diabetes %K telemedicine %K implementation science %D 2019 %7 31.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In 2016, a short message service text messaging intervention to titrate insulin in patients with uncontrolled type 2 diabetes was implemented at two health care facilities in New York City. Objective: This study aimed to conduct a qualitative evaluation assessing barriers to and the facilitators of the implementation of the Mobile Insulin Titration Intervention (MITI) program into usual care. Methods: We conducted in-depth interviews with 36 patients enrolled in the MITI program and the staff involved in MITI (n=19) in the two health care systems. Interviews were transcribed and iteratively coded by two study investigators, both inductively and deductively using a codebook guided by the Consolidated Framework for Implementation Research. Results: Multiple facilitator themes emerged: (1) MITI had strong relative advantages to in-person titration, including its convenience and time-saving design, (2) the free cost of MITI was important to the patients, (3) MITI was easy to use and the patients were confident in their ability to use it, (4) MITI was compatible with the patients’ home routines and clinic workflow, (5) the patients and staff perceived MITI to have value beyond insulin titration by reminding and motivating the patients to engage in healthy behaviors and providing a source of patient support, and (6) implementation in clinics was made easy by having a strong implementation climate, communication networks to spread information about MITI, and a strong program champion. The barriers identified included the following: (1) language limitations, (2) initial nurse concerns about the scope of practice changes required to deliver MITI, (3) initial provider knowledge gaps about the program, and (4) provider perceptions that MITI might not be appropriate for some patients (eg, older or not tech-savvy). There was also a theme that emerged during the patient and staff interviews of an unmet need for long-term additional diabetes management support among this population, specifically diet, nutrition, and exercise support. Conclusions: The patients and staff were overwhelmingly supportive of MITI and believed that it had many benefits and that it was compatible with the clinic workflow and patients’ lives. Initial implementation efforts should address staff training and nurse concerns. Future research should explore options for integrating additional diabetes support for patients. %M 31368439 %R 10.2196/13906 %U http://mhealth.jmir.org/2019/7/e13906/ %U https://doi.org/10.2196/13906 %U http://www.ncbi.nlm.nih.gov/pubmed/31368439 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 7 %P e12837 %T Text Messaging to Improve Linkage, Retention, and Health Outcomes Among HIV-Positive Young Transgender Women: Protocol for a Randomized Controlled Trial (Text Me, Girl!) %A Reback,Cathy J %A Fletcher,Jesse B %A Fehrenbacher,Anne E %A Kisler,Kimberly %+ Friends Research Institute, Inc, 1419 North La Brea Avenue, Los Angeles, CA, 90028, United States, 1 323 463 2295, reback@friendsresearch.org %K HIV %K AIDS %K transgender persons %K text messaging %D 2019 %7 29.07.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Transgender women in the United States experience numerous risk factors for HIV acquisition and transmission, including increased rates of homelessness, alcohol and drug use, sex work, and nonprescribed hormone and soft tissue–filler injections. In addition, transgender women face discrimination and social/economic marginalization more intense and deleterious than that experienced by lesbian, gay, or bisexual individuals, further worsening health outcomes. Although little research has been done specifically with young transgender women aged 35 years and younger, existing evidence suggests even further elevated rates of homelessness, substance use, and engagement in HIV transmission risk behaviors relative to their older transgender women and nontransgender young adult counterparts. Young transgender women living with HIV experience a range of barriers that challenge their ability to be successfully linked and retained in HIV care. Objective: The aim of this randomized controlled trial, Text Me, Girl!, is to assess the impact of a 90-day, theory-based, transgender-specific, text-messaging intervention designed to improve HIV-related health outcomes along the HIV care continuum among young (aged 18-34 years) transgender women (N=130) living with HIV/AIDS. Methods: Participants were randomized into either Group A (immediate text message intervention delivery; n=61) or Group B (delayed text message intervention delivery whereby participants were delivered the text-messaging intervention after a 90-day delay period; n=69). Over the course of the 90-day intervention, participants received 270 theory-based text messages that were targeted, tailored, and personalized specifically for young transgender women living with HIV. Participants received 3 messages per day in real time within a 10-hour gradual and automated delivery system. The text-message content was scripted along the HIV care continuum and based on social support theory, social cognitive theory, and health belief model. The desired outcome of Text Me, Girl! was virological suppression. Results: Recruitment began on November 18, 2016, and the first participant was enrolled on December 16, 2016; enrollment closed on May 31, 2018. Intervention delivery ended on November 30, 2018, and follow-up evaluations will conclude on August 31, 2019. Primary outcome analyses will begin immediately following the conclusion of the follow-up evaluations. Conclusions: Text messaging is a communication platform well suited for engaging young transgender women in HIV care because it is easily accessible and widely used, as well as private, portable, and inexpensive. Text Me, Girl! aimed to improve HIV care continuum outcomes among young transgender women by providing culturally responsive text messages to promote linkage, retention, and adherence, with the ultimate goal of achieving viral suppression. The Text Me, Girl! text message library is readily scalable and can be adapted for other hard-to-reach populations. International Registered Report Identifier (IRRID): DERR1-10.2196/12837 %M 31359867 %R 10.2196/12837 %U http://www.researchprotocols.org/2019/7/e12837/ %U https://doi.org/10.2196/12837 %U http://www.ncbi.nlm.nih.gov/pubmed/31359867 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 7 %P e13221 %T Text Message Reminders and Unconditional Monetary Incentives to Improve Measles Vaccination in Western Kenya: Study Protocol for the Mobile and Scalable Innovations for Measles Immunization Randomized Controlled Trial %A Gibson,Dustin G %A Kagucia,E Wangeci %A Were,Joyce %A Obor,David %A Hayford,Kyla %A Ochieng,Benard %+ Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Room E8650, Baltimore, MD, 21205, United States, 1 443 287 8763, dgibso28@jhu.edu %K measles vaccine %K text messaging %K Kenya %K vaccination coverage %D 2019 %7 09.07.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Globally, 21 million children do not receive the measles vaccine each year. With high levels of mobile phone access and ownership, opportunities exist to leverage mobile health technologies to generate demand for immunization. Objective: The aim of the Mobile and Scalable Innovations for Measles Immunization trial is to determine if text message (short message service, SMS) reminders, either with or without mobile phone–based incentives, can improve measles immunization coverage and timeliness in rural western Kenya. Methods: This is a 3-arm, parallel, randomized controlled trial (RCT). Using simple randomization, caregivers in Siaya County, Kenya, will be randomized and evenly allocated to 1 of 3 study arms: (1) control, (2) SMS reminders only, and (3) SMS reminders plus a 150 Kenyan Shilling (KES) incentive. Participants assigned to the SMS group will be sent SMS reminders 3 days before and on the day before the measles immunization visit scheduled for when the child is 9 months of age. Participants in the incentive arm will, in addition to SMS reminders as above, be sent an unconditional 150 KES mobile-money incentive to their mobile phone 3 days before the child becomes 9 months of age. Children will be followed up to the age of 12 months to assess the primary outcome, a measles vaccination by 10 months of age. Log-binomial regressions will be used to calculate relative risks. Results: Enrollment was completed in March 2017. We enrolled 537 caregivers and their infants into the following groups: control (n=179), SMS reminders only (n=179), and SMS reminders plus 150 KES (n=179). Results will be made publicly available in 2020. Conclusions: Few RCTs have examined the effect of text message reminders to improve measles immunization coverage. This is the first study to assess the effect of SMS reminders with and without unconditionally provided mobile-money incentives to improve measles immunization coverage. Trial Registration: ClinicalTrials.gov NCT02904642; https://clinicaltrials.gov/ct2/show/NCT02904642 (Archived by WebCite® at http://www.webcitation.org/78r7AzD2X). International Registered Report Identifier (IRRID): RR1-10.2196/13221 %M 31290405 %R 10.2196/13221 %U http://www.researchprotocols.org/2019/7/e13221/ %U https://doi.org/10.2196/13221 %U http://www.ncbi.nlm.nih.gov/pubmed/31290405 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 7 %P e13152 %T Exploring Young People’s Perceptions of the Effectiveness of Text-Based Online Counseling: Mixed Methods Pilot Study %A Navarro,Pablo %A Bambling,Matthew %A Sheffield,Jeanie %A Edirippulige,Sisira %+ Kids Helpline, Yourtown, 5 Cordova St, Milton, Brisbane, 4064, Australia, 61 800 555 079, pablo.fernandez@uqconnect.edu.au %K mental health %K child health %K adolescent health %K distance counseling %K mhealth %K applied psychology %K psychological processes %D 2019 %7 03.07.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Young people aged 10-24 years are at the highest risk for mental health problems and are the least likely to seek professional treatment. Owing to this population’s high consumption of internet content, electronic mental (e-mental) health services have increased globally, with an aim to address barriers to treatment. Many of these services use text-based online counseling (TBOC), which shows promising results in supporting young people but also greater variance in outcomes compared with adult comparators. Objective: This pilot study qualitatively explored the characteristics of users aged 15-25 years accessing TBOC services, their motivations for access, and their perceptions about factors believed to influence the effectiveness of these modalities. Methods: E-surveys were administered naturalistically to 100 young service users aged 15-25 years who accessed webchat and email counseling services via an Australian e-mental health service. Thematic analysis of qualitative themes and quantitative descriptive and proportional data presented in electronic surveys were examined across the areas of user characteristics, motivations for selecting TBOC modalities, and their perceptions of TBOC effectiveness. Results: Participants were predominately female high school students of Caucasian or European descent from middle socioeconomic status, living with their parents in major cities. Four domains and various themes and subthemes were related to participants’ reasons for accessing TBOC and perceptions of its effectiveness: user characteristics (ie, physical and mental health syndrome and perceived social difficulties), selection factors (ie, safety, avoidance motivation, accessibility, and expectation), factors perceived to increase effectiveness (ie, general therapeutic benefits, positive modality and service factors, and persisting with counseling to increase benefit), and factors perceived to decrease effectiveness (ie, negative modality and service factors, and persisting with counseling despite benefit). Conclusions: Participants were motivated to use TBOC to increase their sense of safety in response to negative perceptions of their social skills and the response of the online counsellor to their presenting problem. By using TBOC services, they also sought to improve their access to mental health services that better met their expectations. Factors that increased effectiveness of TBOC were the counsellor’s interpersonal skills, use of text-based communication, and persisting with beneficial counseling sessions. Factors that reduced TBOC effectiveness were poor timeliness in response to service requests, experiencing no change in their presenting problem, not knowing what postcounseling action to take, and persisting with ineffective counseling sessions. %M 31271149 %R 10.2196/13152 %U https://mental.jmir.org/2019/7/e13152/ %U https://doi.org/10.2196/13152 %U http://www.ncbi.nlm.nih.gov/pubmed/31271149 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e12245 %T Factors Influencing User Engagement of Health Information Disseminated by Chinese Provincial Centers for Disease Control and Prevention on WeChat: Observational Study %A Zhang,Yan %A Xia,Tingsong %A Huang,Lingfeng %A Yin,Mingjuan %A Sun,Mingwei %A Huang,Jingxiao %A Ni,Yu %A Ni,Jindong %+ Guangdong Medical University, No. 1 Xincheng Road, Songshan Lake, Dongguan,, China, 86 769 2289 6570, nijd-gw@gdmu.edu.cn %K WeChat %K WeChat official accounts %K user engagement %K CDC %K health education %D 2019 %7 27.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Social media is currently becoming a new channel for information acquisition and exchange. In China, with the growing popularity of WeChat and WeChat official accounts (WOAs), health promotion agencies have an opportunity to use them for successful information distribution and diffusion online. Objective: We aimed to identify features of articles pushed by WOAs of Chinese provincial Centers for Disease Control and Prevention (CDC) that are associated with user engagement. Methods: We searched and subscribed to 28 WOAs of provincial CDCs. Data for this study consisted of WeChat articles on these WOAs between January 1, 2017 and December 31, 2017. We developed a features frame containing title type, article content, article type, communication skills, number of marketing elements, and article length for each article and coded the data quantitatively using a coding scheme that assigned numeric values to article features. We examined the descriptive characteristics of articles for every WOA and generated descriptive statistics for six article features. The amount of reading and liking was converted into the level of reading and liking by the 75% position. Two-category univariate logistic regression and multivariable logistic regression were conducted to explore associations between the features of the articles and user engagement, operationalized as reading level and liking level. Results: All provincial CDC WOAs provided a total of 5976 articles in 2017. Shanghai CDC articles attracted the most user engagement, and Ningxia CDC articles attracted the least. For all articles, the median reading was 551.5 and the median liking was 10. Multivariable logistic regression analysis revealed that article content, article type, communication skills, number of marketing elements, and article length were associated with reading level and liking level. However, title type was only associated with liking level. Conclusions: How social media can be used to best achieve health information dissemination and public health outcomes is a topic of much discussion and study in the public health community. Given the lack of related studies based on WeChat or official accounts, we conducted this study and found that article content, article type, communication skills, number of marketing elements, article length, and title type were associated with user engagement. Our study may provide public health and community leaders with insight into the diffusion of important health topics of concern. %M 31250833 %R 10.2196/12245 %U http://mhealth.jmir.org/2019/6/e12245/ %U https://doi.org/10.2196/12245 %U http://www.ncbi.nlm.nih.gov/pubmed/31250833 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12657 %T Feasibility of Using Short Message Service and In-Depth Interviews to Collect Data on Contraceptive Use Among Young, Unmarried, Sexually Active Men in Moshi, Tanzania, and Addis Ababa, Ethiopia: Mixed Methods Study With a Longitudinal Follow-Up %A Pima,Francis Maganga %A Oshosen,Martha %A Ngowi,Kennedy Michael %A Habte,Bruck Messele %A Maro,Eusebious %A Teffera,Belete Eshete %A Kisigo,Godfrey %A Swai,Iraseni Ufoo %A Msangi,Salim Semvua %A Ermias,Amha %A Mmbaga,Blandina T %A Both,Rosalijn %A Sumari-de Boer,Marion %+ Department of Clinical Trials, Kilimanjaro Clinical Research Institute, PO Box 2236, Moshi,, United Republic of Tanzania, 255 754331948, m.sumari@kcri.ac.tz %K SMS %K contraceptives %K sexual behavior %K feasibility %K young unmarried men %D 2019 %7 26.06.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Data on contraceptive needs and use among young unmarried men are limited. Conventional ways of data collection may lead to limited and unreliable information on contraceptive use due to sensitivity of the topic, as many young men feel ashamed to discuss their behavior of using contraceptives. As short message service (SMS) is anonymous and a commonly used means of communication, we believe that if deployed, it will create a promising user-friendly method of data collection. Objective: The objective was to investigate the feasibility of using SMS to collect data on sexually active, young, unmarried men’s sexual behavior and contraceptive preferences, practices, and needs in Addis Ababa, Ethiopia, and Moshi, Tanzania. Methods: We enrolled men aged 18-30 years who were students (in Ethiopia and Tanzania), taxi or local bus drivers/assistants (Ethiopia and Tanzania), Kilimanjaro porters (Tanzania), or construction workers (Ethiopia). Young men were interviewed using a topic list on contraceptive use. They were followed up for 6 months by sending fortnightly SMS texts with questions about contraceptive use. If the young men indicated that they needed contraceptives during the reporting period or were not satisfied with the method they used, they were invited for a follow-up interview. At the end of the study, we conducted exit interviews telephonically using a semistructured questionnaire to explore the feasibility, acceptability, and accuracy of using SMS to validate the study findings in both countries. Results: We enrolled 71 young unmarried men—35 in Tanzania and 36 in Ethiopia. In Moshi, 1908 messages were delivered to participants and 1119 SMS responses were obtained. In Ethiopia, however, only 525 messages were sent to participants and 248 replies were received. The question on dating a girl in the past weeks was asked 438 times in Tanzania and received 252 (58%) replies, of which 148 (59%) were “YES.” In Ethiopia, this question was asked 314 times and received 64 (20%) replies, of which 52 (81%) were “YES” (P=.02 for difference in replies between Tanzania and Ethiopia). In Tanzania, the question on contraceptive use was sent successfully 112 times and received 108 (96%) replies, of which 105 (94%) were “YES.” In Ethiopia, the question on contraceptive use was asked 17 times and received only 2 (11%) replies. Exit interviews in Tanzania showed that SMS was accepted as a means of data collection by 22 (88%) of the 25 interviewed participants. Conclusions: Despite network and individual challenges, the SMS system was found to be feasible in Moshi, but not in Addis Ababa. We recommend more research to scale up the method in different groups and regions. %M 31244476 %R 10.2196/12657 %U http://formative.jmir.org/2019/2/e12657/ %U https://doi.org/10.2196/12657 %U http://www.ncbi.nlm.nih.gov/pubmed/31244476 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13059 %T Mindfulness-Based Smoking Cessation Enhanced With Mobile Technology (iQuit Mindfully): Pilot Randomized Controlled Trial %A Spears,Claire Adams %A Abroms,Lorien C %A Glass,Carol R %A Hedeker,Donald %A Eriksen,Michael P %A Cottrell-Daniels,Cherell %A Tran,Binh Q %A Wetter,David W %+ Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, 140 Decatur St SE, Atlanta, GA, 30303, United States, 1 404 413 9335, cspears@gsu.edu %K text messaging %K smoking cessation %K low-income populations %D 2019 %7 24.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mindfulness training shows promise for improving smoking cessation and lapse recovery, and between-session mobile health messages could enhance treatment engagement and effectiveness. Personalized, in-the-moment text messaging support could be particularly useful for low-income smokers with fewer smoking cessation resources. Objective: This pilot study examined the feasibility of a text messaging program (iQuit Mindfully) as an adjunct to in-person Mindfulness-Based Addiction Treatment (MBAT) for smoking cessation. Methods: A total of 71 participants were randomly assigned to MBAT (n=33) or iQuit Mindfully (n=38; MBAT + between-session text messages); of these, 70% (50/71) were African American, and 61% (43/71) had an annual household income of US $30,000 or less. All participants received 8 weekly therapist-led group counseling sessions, nicotine patches, and self-help materials. Outcomes were feasibility (attrition, engagement, and participants’ ratings), participants’ feedback regarding the text messaging intervention, and smoking cessation (assessed in person). Results: Strong retention was achieved (76% [54/71] at the end of treatment, and 89% [63/71] at 1-month follow-up). In the iQuit Mindfully group, engagement was high (88% [29/33] indicated reading all or most texts, and 89% [34/38] engaged in interactive texting), and participants provided positive ratings (on a 1-10 scale, average rating for recommending the program to others was 8.4 [SD 2.5]). Participants indicated benefiting from the texts (eg, appreciating encouraging reminders, coping strategies, and social support) and suggested improvements (eg, more personalization). Overall, biochemically confirmed smoking cessation rates were 22% (12/55) at the end of treatment and 19% (12/62) at 1-month follow-up, with no differences between conditions. Living below the poverty level predicted worse cessation outcomes at 1-month follow-up among participants receiving in-person only treatment (P=.03) but not among those receiving iQuit Mindfully. Conclusions: Text messaging appears to be a feasible and acceptable modality for supporting mindfulness-based smoking cessation treatment. The availability of 24/7 text messaging might be particularly helpful for low-income smokers who have access to fewer cessation resources and experience significant day-to-day barriers to quitting. Trial Registration: ClinicalTrials.gov NCT03029819; https://clinicaltrials.gov/ct2/show/NCT03029819 %M 31237242 %R 10.2196/13059 %U http://mhealth.jmir.org/2019/6/e13059/ %U https://doi.org/10.2196/13059 %U http://www.ncbi.nlm.nih.gov/pubmed/31237242 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 2 %P e13359 %T Prevalence of Schistosoma Haematobium Measured by a Mobile Health System in an Unexplored Endemic Region in the Subprefecture of Torrock, Chad %A Lalaye,Didier %A de Bruijn,Mirjam E %A de Jong,Tom PVM %+ Julius Global Health Center, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, Netherlands, 31 887555555, lalaye84@gmail.com %K Schistosoma haematobium %K prevalence %K Chad %K neglected tropical diseases %K mobile health %D 2019 %7 18.06.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Schistosoma haematobium is a parasitic digenetic trematode responsible for schistosomiasis (also known as bilharzia). The disease is caused by penetration of the skin by the parasite, spread by intermediate host molluscs in stagnant waters, and can be treated by administration of praziquantel. Schistosomiasis is considered to be an important but neglected tropical disease. Objective: The aim of this pilot study was to investigate the prevalence of schistosomiasis in the subprefecture of Torrock, an endemic area in Chad where no earlier investigation had been conducted and no distribution system for pharmacotherapy has ever existed. Methods: This study examined 1875 children aged 1 to 14 years over a period of 1 year. After centrifugation, urine examination was performed by a direct microscopic investigation for eggs. The investigation was conducted with a mobile health (mHealth) approach, using short message service (SMS) for communication among parents, local health workers, a pharmacist, and a medical doctor. An initial awareness campaign requested parents to have their children examined for schistosomiasis. Urine was then collected at home by the parents following the SMS request. Urine results that proved positive were sent to a medical doctor by SMS, who in turn ordered a pharmacist by SMS to distribute praziquantel to the infected children. Results: Direct microscopic examination of urine found 467 positive cases (24.9% of the total sample). Of all male and female samples, 341 (34%) and 127 (14.4%) samples were positive, respectively. The infection rate was equally distributed over age groups. The newly developed mHealth system had a limited level of participation (8%) from an estimated total of 25,000 children in the target group. Conclusions: The prevalence of schistosomiasis in children in the subprefecture of Torrock is moderately high. Efforts will be required to enhance the awareness of parents and to reach a larger percentage of the population. Systematic governmental measures should be put in place as soon as possible to increase awareness in the area and to diagnose and treat cases of schistosomiasis. %M 31215519 %R 10.2196/13359 %U http://publichealth.jmir.org/2019/2/e13359/ %U https://doi.org/10.2196/13359 %U http://www.ncbi.nlm.nih.gov/pubmed/31215519 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e14094 %T A Mobile Health Intervention for Prostate Biopsy Patients Reduces Appointment Cancellations: Cohort Study %A Balakrishnan,Ashwin S %A Nguyen,Hao G %A Shinohara,Katsuto %A Au Yeung,Reuben %A Carroll,Peter R %A Odisho,Anobel Y %+ Department of Urology, University of California San Francisco, 400 Parnassus Ave, San Francisco, CA,, United States, 1 415 476 1611, anobel.odisho@ucsf.edu %K text messaging %K appointments and schedules %K mHealth %K quality improvement %K urology %K prostate neoplasm %D 2019 %7 2.6.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Inadequate patient education and preparation for office-based procedures often leads to delayed care, poor patient satisfaction, and increased costs to the health care system. We developed and deployed a mobile health (mHealth) reminder and education program for patients scheduled for transrectal prostate biopsy. Objective: We aimed to evaluate the impact of an mHealth reminder and education program on appointment cancellation rates, communication frequency, and patient satisfaction. Methods: We developed a text message (SMS, short message service)–based program with seven reminders containing links to Web-based content and surveys sent over an 18-day period (14 days before through 3 days after prostate biopsy). Messages contained educational content, reminders, and readiness questionnaires. Demographic information, appointment cancellations or change data, and patient/provider communication events were collected for 6 months before and after launching the intervention. Patient satisfaction was evaluated in the postintervention cohort. Results: The preintervention (n=473) and postintervention (n=359) cohorts were composed of men of similar median age and racial/ethnic distribution living a similar distance from clinic. The postintervention cohort had significantly fewer canceled or rescheduled appointments (33.8% vs 21.2%, P<.001) and fewer same-day cancellations (3.8% vs 0.5%, P<.001). There was a significant increase in preprocedural telephone calls (0.6 vs 0.8 calls per patient, P=.02) in the postintervention cohort, but not a detectable change in postprocedural calls. The mean satisfaction with the program was 4.5 out of 5 (SD 0.9). Conclusions: An mHealth periprocedural outreach program significantly lowered appointment cancellation and rescheduling and was associated with high patient satisfaction scores with a slight increase in preprocedural telephone calls. This led to fewer underused procedure appointments and high patient satisfaction. %M 31199294 %R 10.2196/14094 %U https://www.jmir.org/2019/6/e14094/ %U https://doi.org/10.2196/14094 %U http://www.ncbi.nlm.nih.gov/pubmed/31199294 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13256 %T Development of a Mobile Health Intervention to Promote Papanicolaou Tests and Human Papillomavirus Vaccination in an Underserved Immigrant Population: A Culturally Targeted and Individually Tailored Text Messaging Approach %A Lee,Hee Yun %A Lee,Mi Hwa %A Sharratt,Monica %A Lee,Sohye %A Blaes,Anne %+ School of Social Work, The University of Alabama, 1022 Little Hall Box 870314, Tuscaloosa, AL, 35401, United States, 1 205 348 6553, hlee94@ua.edu %K uterine cervical cancer %K papanicolaou test %K papillomavirus infections %K papillomavirus vaccines %K text messaging %K Asian American %K immigrants %D 2019 %7 6.6.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Disparities in cervical cancer incidence and mortality signify the need for intervention efforts targeting Korean American immigrant women. Objective: The purpose of this study was to demonstrate how a culturally targeted and tailored mobile text messaging intervention, mobile screening (mScreening), was developed to promote the uptake of Papanicolaou tests and human papillomavirus vaccine among young Korean American immigrant women. Methods: Guided by the Fogg behavior model, the mScreening intervention was developed through a series of focus groups. Braun and Clarke’s thematic analysis was used to identify core themes. Results: Overall, 4 themes were identified: (1) tailored message content (ie, basic knowledge about cervical cancer), (2) an interactive and visual message format (ie, age-appropriate and friendly messages using emoticons), (3) brief message delivery formats to promote participant engagement, and (4) use of an incentive to motivate participation (ie, gift cards). Conclusions: This study demonstrated the processes of gathering culturally relevant information to develop a mobile phone text messaging intervention and incorporating the target population’s perspectives into the development of the intervention. The findings of the study could help guide future intervention development targeting different types of cancer screening in other underserved racial or ethnic groups. %M 31199340 %R 10.2196/13256 %U https://mhealth.jmir.org/2019/6/e13256/ %U https://doi.org/10.2196/13256 %U http://www.ncbi.nlm.nih.gov/pubmed/31199340 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 6 %P e12377 %T Mobile Messaging Support Versus Usual Care for People With Type 2 Diabetes on Glycemic Control: Protocol for a Multicenter Randomized Controlled Trial %A Farmer,Andrew %A Bobrow,Kirsty %A Leon,Natalie %A Williams,Nicola %A Phiri,Enita %A Namadingo,Hazel %A Cooper,Sara %A Prince,John %A Crampin,Amelia %A Besada,Donela %A Daviaud,Emmanuelle %A Yu,Ly-Mee %A Ngoma,Jonathan %A Springer,David %A Pauly,Bruno %A Norris,Shane %A Tarassenko,Lionel %A Nyirenda,Moffat %A Levitt,Naomi %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Primary Care Building, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 1865 289280, andrew.farmer@phc.ox.ac.uk %K randomized controlled trial %K diabetes mellitus %K type 2 diabetes %K mobile health %K treatment adherence %D 2019 %7 30.5.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health outcomes for people treated for type 2 diabetes could be substantially improved in sub-Saharan Africa. Failure to take medicine regularly to treat diabetes has been identified as a major problem. Resources to identify and support patients who are not making the best use of medicine in low- and middle-income settings are scarce. Mobile phones are widely available in these settings, including among people with diabetes; linked technologies, such as short message service (SMS) text messaging, have shown promise in delivering low-cost interventions efficiently. However, evidence showing that these interventions will work when carried out at a larger scale and measuring the extent to which they will improve health outcomes when added to usual care is limited. Objective: The objective of this trial is to test the effectiveness of sending brief, automated SMS text messages for improving health outcomes and medication adherence in patients with type 2 diabetes compared to an active control. Methods: We will carry out a randomized trial recruiting from clinics in two contrasting settings in sub-Saharan Africa: Cape Town, South Africa, and Lilongwe, Malawi. Intervention messages will advise people about the benefits of their diabetes treatment and offer motivation and encouragement around lifestyle and use of medication. We allocated patients, using randomization with a minimization algorithm, to receive either three to four intervention messages per week or non-health-related messages every 6 weeks. We will follow up with participants for 12 months, measuring important risk factors for poor health outcomes and complications in diabetes. This will enable us to estimate potential health benefits, including the primary outcome of hemoglobin A1c (HbA1c) levels as a marker for long-term blood glucose control and a secondary outcome of blood pressure control. We will record the costs of performing these activities and estimate cost-effectiveness. We will also use process evaluation to capture the collection of medication and assess the reception of the intervention by participants and health care workers. Results: Recruitment to the trial began in September 2016 and follow-up of participants was completed in October 2018. Data collection from electronic health records and other routinely collected sources is continuing. The database lock is anticipated in June 2019, followed by analysis and disclosing of group allocation. Conclusions: The knowledge gained from this study will have wide applications and advance the evidence base for effectiveness of mobile phone-based, brief text messaging on clinical outcomes and in large-scale, operational settings. It will provide evidence for cost-effectiveness and acceptability that will further inform policy development and decision making. We will work with a wide network that includes patients, clinicians, academics, industry, and policy makers to help us identify opportunities for informing people about the work and raise awareness of what is being developed and studied. Trial Registration: ISRCTN Registry ISRCTN70768808; http://www.isrctn.com/ISRCTN70768808 (Archived by WebCite at http://www.webcitation.org/786316Zqk) International Registered Report Identifier (IRRID): DERR1-10.2196/12377 %M 31199346 %R 10.2196/12377 %U https://www.researchprotocols.org/2019/6/e12377/ %U https://doi.org/10.2196/12377 %U http://www.ncbi.nlm.nih.gov/pubmed/31199346 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13162 %T SmokefreeTXT for Homeless Smokers: Pilot Randomized Controlled Trial %A Baggett,Travis P %A McGlave,Claire %A Kruse,Gina R %A Yaqubi,Awesta %A Chang,Yuchiao %A Rigotti,Nancy A %+ Tobacco Research and Treatment Center, Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA, 02114, United States, 1 617 643 9314, tbaggett@mgh.harvard.edu %K homeless persons %K cigarette smoking %K smoking cessation %K text messaging %D 2019 %7 04.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Homeless smokers want to quit smoking but face numerous barriers to doing so, including pervasive smoking among peers and a lack of social support for quitting. An SMS (short message service) text messaging intervention could address these challenges by providing virtual daily support for homeless smokers who are trying to quit but coping with multiple triggers to smoke. Objective: This study aimed to assess whether a free SMS text messaging program, added to evidence-based pharmacotherapy and counseling, improved smoking abstinence among homeless adult smokers. Methods: From October 2015 to June 2016, we conducted an 8-week pilot randomized controlled trial (RCT) of nicotine patch therapy and weekly in-person counseling with (n=25) or without (n=25) SmokefreeTXT, a free SMS text messaging service administered by the National Cancer Institute (NCI) at Boston Health Care for the Homeless Program. All participants were provided with a mobile phone and a 2-month prepaid voice and text plan at no cost. SmokefreeTXT enrollees were sent 1 to 5 automated SMS text messages daily for up to 8 weeks and could receive on-demand tips for managing cravings, mood symptoms, and smoking lapses. The primary outcome was smoking abstinence, defined as an exhaled carbon monoxide count of <8 parts per million, assessed 14 times over 8 weeks of follow-up, and analyzed using repeated-measures logistic regression with generalized estimating equations. Other outcomes were use of SmokefreeTXT, assessed by data obtained from NCI; perceptions of SmokefreeTXT, assessed by surveys and qualitative interviews; and mobile phone retention, assessed by self-report. Results: Of the SmokefreeTXT arm participants (n=25), 88% (22) enrolled in the program, but only 56% (14) had confirmed enrollment for ≥2 weeks. Among 2-week enrollees, the median response rate to interactive messages from SmokefreeTXT was 2.1% (interquartile range 0-10.5%). Across all time points, smoking abstinence did not differ significantly between SmokefreeTXT and control arm participants (odds ratio 0.92, 95% CI 0.30-2.84). Of SmokefreeTXT enrollees who completed exit surveys (n=15), two-thirds were very or extremely satisfied with the program. However, qualitative interviews (n=14) revealed that many participants preferred in-person intervention formats over phone-based, found the SMS text messages impersonal and robotic, and felt that the messages were too frequent and repetitive. Only 40% (10/25) of SmokefreeTXT arm participants retained their study-supplied mobile phone for the 8-week duration of the trial, with phone theft being common. Storing and charging phones were cited as challenges. Conclusions: SmokefreeTXT, added to nicotine patch therapy and in-person counseling, did not significantly improve smoking abstinence in this 8-week pilot RCT for homeless smokers. SMS text messaging interventions for this population should be better tuned to the unique circumstances of homelessness and coupled with efforts to promote mobile phone retention over time. Trial Registration: ClinicalTrials.gov NCT02565381; https://clinicaltrials.gov/ct2/show/NCT02565381 (Archived by WebCite at http://www.webcitation.org/78PLpDptZ) %M 31165717 %R 10.2196/13162 %U https://mhealth.jmir.org/2019/6/e13162/ %U https://doi.org/10.2196/13162 %U http://www.ncbi.nlm.nih.gov/pubmed/31165717 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13828 %T A Community-Based Short Message Service Intervention to Improve Mothers’ Feeding Practices for Obesity Prevention: Quasi-Experimental Study %A Jiang,Hong %A Li,Mu %A Wen,Li Ming %A Baur,Louise %A He,Gengsheng %A Ma,Xiaoying %A Qian,Xu %+ School of Public Health, Global Health Institute, Fudan University, 175 Mailbox, 138 Yixueyuan Road, Shanghai, 200032, China, 86 2164179976, h_jiang@fudan.edu.cn %K short message service %K child development %K body mass index %K BMI %K childhood obesity %D 2019 %7 3.6.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The prevalence of childhood obesity is increasing in China, and the effect of mobile phone short message service (SMS) interventions to prevent early childhood obesity needs to be evaluated. Objective: The objective of this study was to assess the effect of an SMS intervention on the prevention of obesity in young children. Methods: A quasi-experimental design SMS intervention was carried out in 4 community health centers (CHCs) in Shanghai, China. A total of 2 CHCs were assigned to the intervention group, and 2 CHCs were assigned to the control group. Mothers in the intervention group received weekly SMS messages on breastfeeding and infant feeding from the third trimester to 12 months postpartum. The primary outcomes were children’s body mass index (BMI), BMI z-score, and weight-for-length z-score at 12 and 24 months. Factors associated with higher BMI and weight-for-length z-score at 24 months were also assessed. Results: A total of 582 expectant mothers were recruited at the beginning of the third gestational trimester. 477 (82.0%) and 467 (80.2%) mothers and their children were followed up to 12 and 24 months postpartum, respectively. There were no significant differences in children’s BMI, BMI z-score, and weight-for-length z-score at 12 and 24 months between the 2 groups. Factors associated with higher BMI, BMI z-score, and weight-for-length z-score at 24 months included higher birth weight, introduction of solid foods before 4 months, and taking a bottle to bed at 12 months. Conclusions: The SMS intervention did not show a significant effect on children’s BMI, BMI z-score, or weight-for-length z-score at 12 and 24 months. Introduction of solid foods before 4 months and taking a bottle to bed at 12 months were significantly and positively correlated with a higher BMI, BMI z-score, and weight-for-length z-score at 24 months. Further studies with more rigorous design are needed to evaluate the effect of SMS interventions on preventing early childhood obesity. %R 10.2196/13828 %U http://mhealth.jmir.org/2019/6/e13828/ %U https://doi.org/10.2196/13828 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 5 %P e12851 %T Personalized Text Messages and Automated Calls for Improving Vaccine Coverage Among Children in Pakistan: Protocol for a Community-Based Cluster Randomized Clinical Trial %A Kazi,Abdul Momin %A Ahsan,Nazia %A Khan,Ayub %A Jamal,Saima %A Kalimuddin,Hussain %A Ghulamhussain,Naveera %A Wajidali,Zabin %A Muqeet,Abdul %A Zaidi,Fabiha %A Subzlani,Meraj %A McKellin,William %A Ali,Asad %A Collet,Jean-Paul %+ Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi,, Pakistan, 92 2134864232, momin.kazi@aku.edu %K routine immunization %K SMS messages %K automated call messages %K cluster randomized clinical trial %K vaccine barriers %K personalized intervention %K cell phones %K vaccination coverage %K mobile health %K text messaging %K developing countries %K parents %D 2019 %7 30.05.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: A major reason for poor childhood vaccine coverage in developing countries is the lack of awareness among parents and caregivers regarding the need for immunization and the importance of completing the entire series of vaccines. Short message service (SMS)–based interventions have been quite effective in different programs such as smoking cessation, treatment adherence, health care scheduled appointment attendance, antenatal care attendance, and compliance to immunization. However, there are limited data from low- and middle-income countries on the role of SMS and automated call–based messages and interventions to improve routine immunization (RI) coverage. Objective: The primary objective of this study is to evaluate whether automated mobile phone–based personalized messages (SMS or automated call) can improve RI uptake at 6, 10, and 14 weeks of age per the expanded program immunization schedule, compared with a usual care control group. Secondary objectives include assessing the effects of different types of automated SMS text or calls on RI coverage at 20 weeks of age. Methods: This is a mixed methods study using a clustered randomized controlled trial with 4 intervention arms and 1 control arm, augmented by qualitative interviews for personalizing the message. The study is being conducted in Pakistan (an urban site in Karachi and a rural site Matiari). In Karachi, 250 administrative structures are taken as 1 cluster, whereas in Matiari, a catchment area of 4 Lady Health Workers is considered as 1 cluster. The intervention targets families to receive weekly 1-way or 2-way (interactive) personalized automated SMS or automated phone call messages regarding vaccination. Possible barriers to vaccination are assessed in each family at the time of inclusion to determine the type of personalized messages that should be sent to the family to increase the chance of a positive response. Finally, in-depth interviews using purposive sampling are conducted before and after the trial to determine the family’s vaccination experience and related factors. Results: All study participants for the cluster randomized trial were enrolled by January 14, 2019. Study exit interviews at 20-weeks follow-up visits will be completed by June 2019. Conclusions: The results of this study will be useful to understand the respective effects of SMS text messages versus automated phone–based communication to improve RI coverage and timelines. Moreover, information regarding families’ perceptions of vaccination and the daily life challenges for timely visits to the vaccine clinic will be used for developing more complex interventions that use mobile phone messages and possibly other approaches to overcome barriers in the uptake of correct and timely immunization practices. Trial Registration: ClinicalTrials.gov NCT03341195; https://clinicaltrials.gov/ct2/show/NCT03341195 (Archived by WebCite at http://www.webcitation.org/78EWA56Uo) International Registered Report Identifier (IRRID): DERR1-10.2196/12851 %M 31148544 %R 10.2196/12851 %U http://www.researchprotocols.org/2019/5/e12851/ %U https://doi.org/10.2196/12851 %U http://www.ncbi.nlm.nih.gov/pubmed/31148544 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e12879 %T Using Mobile Health to Support Clinical Decision-Making to Improve Maternal and Neonatal Health Outcomes in Ghana: Insights of Frontline Health Worker Information Needs %A Amoakoh,Hannah Brown %A Klipstein-Grobusch,Kerstin %A Grobbee,Diederick E %A Amoakoh-Coleman,Mary %A Oduro-Mensah,Ebenezer %A Sarpong,Charity %A Frimpong,Edith %A Kayode,Gbenga A %A Agyepong,Irene Akua %A Ansah,Evelyn K %+ Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, PO Box 85500, Utrecht, 3508 GA, Netherlands, 233 264545762, ansomaame@hotmail.com %K mHealth %K maternal health %K neonatal health %K health care systems %K developing countries %K decision-making %K information retrieval systems %D 2019 %7 24.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Developing and maintaining resilient health systems in low-resource settings like Ghana requires innovative approaches that adapt technology to context to improve health outcomes. One such innovation was a mobile health (mHealth) clinical decision-making support system (mCDMSS) that utilized text messaging (short message service, SMS) of standard emergency maternal and neonatal protocols via an unstructured supplementary service data (USSD) on request of the health care providers. This mCDMSS was implemented in a cluster randomized controlled trial (CRCT) in the Eastern Region of Ghana. Objective: This study aimed to analyze the pattern of requests made to the USSD by health workers (HWs). We assessed the relationship between requests made to the USSD and types of maternal and neonatal morbidities reported in health facilities (HFs). Methods: For clusters in the intervention arm of the CRCT, all requests to the USSD during the 18-month intervention period were extracted from a remote server, and maternal and neonatal health outcomes of interest were obtained from the District Health Information System of Ghana. Chi-square and Fisher exact tests were used to compare the proportion and type of requests made to the USSD by cluster, facility type, and location; whether phones accessing the intervention were shared facility phones or individual-use phones (type-of-phone); or whether protocols were accessed during the day or at night (time-of-day). Trends in requests made were analyzed over 3 6-month periods. The relationship between requests made and the number of cases reported in HFs was assessed using Spearman correlation. Results: In total, 5329 requests from 72 (97%) participating HFs were made to the intervention. The average number of requests made per cluster was 667. Requests declined from the first to the third 6-month period (44.96% [2396/5329], 39.82% [2122/5329], and 15.22% [811/5329], respectively). Maternal conditions accounted for the majority of requests made (66.35% [3536/5329]). The most frequently accessed maternal conditions were postpartum hemorrhage (25.23% [892/3536]), other conditions (17.82% [630/3536]), and hypertension (16.49% [583/3536]), whereas the most frequently accessed neonatal conditions were prematurity (20.08% [360/1793]), sepsis (15.45% [277/1793]), and resuscitation (13.78% [247/1793]). Requests made to the mCDMSS varied significantly by cluster, type of request (maternal or neonatal), facility type and its location, type-of-phone, and time-of-day at 6-month interval (P<.001 for each variable). Trends in maternal and neonatal requests showed varying significance over each 6-month interval. Only asphyxia and sepsis cases showed significant correlations with the number of requests made (r=0.44 and r=0.79; P<.001 and P=.03, respectively). Conclusions: There were variations in the pattern of requests made to the mCDMSS over time. Detailed information regarding the use of the mCDMSS provides insight into the information needs of HWs for decision-making and an opportunity to focus support for HW training and ultimately improved maternal and neonatal health. %M 31127719 %R 10.2196/12879 %U http://mhealth.jmir.org/2019/5/e12879/ %U https://doi.org/10.2196/12879 %U http://www.ncbi.nlm.nih.gov/pubmed/31127719 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 4 %N 2 %P e11343 %T Text Messaging and Type 1 Diabetes Management: Qualitative Study Exploring Interactions Among Patients and Health Care Professionals %A Miele,Francesco %A Clementi,Silvia %A Gennaro,Renzo %A Nicolao,Ilaria %A Romanelli,Tiziana %A Speese,Katja %A Piras,Enrico Maria %+ e-Health Research Unit, Bruno Kessler Foundation, Via Sommarive 18, Trento, 38122, Italy, 39 0461314129, miele@fbk.eu %K mHealth %K text messaging %K type 1 diabetes %K diabetes in pregnancy %K qualitative research %D 2019 %7 10.05.2019 %9 Original Paper %J JMIR Diabetes %G English %X Background: The diffusion of information and communication technologies (ICTs) in type 1 diabetes (T1D) management has generated a debate on the ways in which ICTs can support the patient-provider relationship. Several studies have focused on text messages. Most of the literature proposes quantitative analysis of the impact of text messaging on the clinical conditions of patients and/or their satisfaction with the technology, while the qualitative studies have focused mainly on patients’ perceptions about strengths and weaknesses of this technology. Objective: In contrast to past studies, we adopted a qualitative approach for the in-depth examination of patient-health care professionals’ interactions in text messaging. Methods: The study focused on the use of the Trento Cartella Clinica del Cittadino Diabetes System (TreC-DS), a digital platform with a built-in messaging system, in two diabetes centers, integrating message analysis with interviews with patients and health care professionals. Each center focused on a specific patient profile: the first one focused on pregnant women with T1D and the second one focused on adult patients with poorly controlled diabetes. Results: The main results of the study were as follows: (1) Health care professionals and patients perceived the messaging system as useful for sharing information (ie, pregnant women for prescriptions and adults with poorly controlled diabetes for advice); (2) The content and communication styles of the two centers differed: in the case of pregnant women, interactions via text messaging were markedly prescriptive, while in the case of adult patients with poorly controlled diabetes, they were conceived as open dialogues; and (3) Conversations were initiated mainly by professionals; in the cases considered, it was mainly the diabetes center that decided whether a messaging conversation was needed. Conclusions: The results show how the features of interactions of text messaging changed based on the patient profiles in two different centers. In addition, in both diabetes centers that were involved, the system seems to have laid a foundation for a closer relationship between patients and health care professionals. %M 31094332 %R 10.2196/11343 %U http://diabetes.jmir.org/2019/2/e11343/ %U https://doi.org/10.2196/11343 %U http://www.ncbi.nlm.nih.gov/pubmed/31094332 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e11833 %T A Two-Way Interactive Text Messaging Application for Low-Income Patients with Chronic Medical Conditions: Design-Thinking Development Approach %A Marko-Holguin,Monika %A Cordel,Stephanie Luz %A Van Voorhees,Benjamin William %A Fogel,Joshua %A Sykes,Emily %A Fitzgibbon,Marian %A Glassgow,Anne Elizabeth %+ Department of Pediatrics, College of Medicine, University of Illinois at Chicago, 840 S Wood Street, Chicago, IL, 60612, United States, 1 3124131165, mmarko@uic.edu %K mobile applications %K telemedicine %K patient participation %K patient acceptance of health care %K delivery of health care %K family health %K community health services %K healthcare disparities %K information technology %K cell phone use %D 2019 %7 01.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Two-way interactive text messaging between patient and community health workers (CHWs) through mobile phone SMS (short message service) text messaging is a form of digital health that can potentially enhance patient engagement in young adults and families that have a child with chronic medical conditions such as diabetes mellitus, sickle cell disease, and asthma. These patients have complex needs, and a user-centered way can be useful for designing a tool to address their needs. Objective: The aim of this study was to utilize the user-centered approach of design thinking to develop a two-way interactive communication SMS text messaging tool for communication between patients or caregivers and CHWs. Methods: We applied a design thinking methodology for development of the SMS text messaging tool. We collected qualitative data from 127 patients/caregivers and 13 CHWs, health care professionals, and experts. In total, 4 iterative phases were used to design the final prototype. Results: The design thinking process led to the final SMS text messaging tool that was transformed from a one-dimensional, template-driven prototype (phases 1 and 2) into a dynamic, interactive, and individually tailored tool (phases 3 and 4). The individualized components consider social factors that influence patients’ ability to engage such as transportation issues and appointment reminders. SMS text messaging components also include operational factors to support staff such as patient contact lists, SMS text messaging templates, and technology chat support. Conclusions: Design thinking can develop a tool to meet the engagement needs of patients with complex health care needs and be user-friendly for health care staff. %M 31042152 %R 10.2196/11833 %U https://mhealth.jmir.org/2019/5/e11833/ %U https://doi.org/10.2196/11833 %U http://www.ncbi.nlm.nih.gov/pubmed/31042152 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 4 %P e11800 %T Expanding Access to Depression Treatment in Kenya Through Automated Psychological Support: Protocol for a Single-Case Experimental Design Pilot Study %A Green,Eric P %A Pearson,Nicholas %A Rajasekharan,Sathyanath %A Rauws,Michiel %A Joerin,Angela %A Kwobah,Edith %A Musyimi,Christine %A Bhat,Chaya %A Jones,Rachel M %A Lai,Yihuan %+ Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, United States, 1 919 681 7289, eric.green@duke.edu %K telemedicine %K mental health %K depression %K artificial intelligence %K Kenya %K text messaging %K chatbot %K conversational agent %D 2019 %7 29.04.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Depression during pregnancy and in the postpartum period is associated with a number of poor outcomes for women and their children. Although effective interventions exist for common mental disorders that occur during pregnancy and the postpartum period, most cases in low- and middle-income countries go untreated because of a lack of trained professionals. Task-sharing models such as the Thinking Healthy Program have shown great potential in feasibility and efficacy trials as a strategy for expanding access to treatment in low-resource settings, but there are significant barriers to scale-up. We are addressing this gap by adapting Thinking Healthy for automated delivery via a mobile phone. This new intervention, Healthy Moms, uses an existing artificial intelligence system called Tess (Zuri in Kenya) to drive conversations with users. Objective: The objective of this pilot study is to test the Healthy Moms perinatal depression intervention using a single-case experimental design with pregnant women and new mothers recruited from public hospitals outside of Nairobi, Kenya. Methods: We will invite patients to complete a brief, automated screening delivered via text messages to determine their eligibility. Enrolled participants will be randomized to a 1- or 2-week baseline period and then invited to begin using Zuri. Participants will be prompted to rate their mood via short message service every 3 days during the baseline and intervention periods. We will review system logs and conduct in-depth interviews with participants to study engagement with the intervention, feasibility, and acceptability. We will use visual inspection, in-depth interviews, and Bayesian estimation to generate preliminary data about the potential response to treatment. Results: Our team adapted the intervention content in April and May 2018 and completed an initial prepilot round of formative testing with 10 women from a private maternity hospital in May and June. In preparation for this pilot study, we used feedback from these users to revise the structure and content of the intervention. Recruitment for this protocol began in early 2019. Results are expected toward the end of 2019. Conclusions: The main limitation of this pilot study is that we will recruit women who live in urban and periurban centers in one part of Kenya. The results of this study may not generalize to the broader population of Kenyan women, but that is not an objective of this phase of work. Our primary objective is to gather preliminary data to know how to build and test a more robust service. We are working toward a larger study with a more diverse population. International Registered Report Identifier (IRRID): DERR1-10.2196/11800 %M 31033448 %R 10.2196/11800 %U http://www.researchprotocols.org/2019/4/e11800/ %U https://doi.org/10.2196/11800 %U http://www.ncbi.nlm.nih.gov/pubmed/31033448 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e11832 %T Effect of Serial Anthropometric Measurements and Motivational Text Messages on Weight Reduction Among Workers: Pilot Randomized Controlled Trial %A Chan,Renee %A Nguyen,Matthew %A Smith,Rachel %A Spencer,Sarah %A Pit,Sabrina Winona %+ School Of Medicine, University Centre for Rural Health, Western Sydney University, 62 Uralba Street, Lismore, 2480, Australia, 61 266207570, sabrina.pit@sydney.edu.au %K text messages %K obesity %K waist-hip ratio %K weight reduction programs %K mHealth %D 2019 %7 24.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obesity is an endemic problem with significant health and financial consequences. Text messaging has been shown to be a simple and effective method of facilitating weight reduction. In addition, waist-to-hip ratio (WHR) has emerged as a significant anthropometric measure. However, few studies have examined the effect of serial anthropometric self-measurement combined with text messaging. Objective: The primary aim of this study was to assess whether an 8-week program, consisting of weekly serial self-measurements of waist and hip circumference, combined with motivational text messages, could reduce WHR among Australian workers. Methods: This was a community-based, participant-blinded, staggered-entry, parallel group study. Adult workers with access to mobile phones were eligible and recruited through an open access Web-based survey. Participants were randomly allocated to receive intervention or control messages for 8 weeks. Outcome data were self-assessed through a Web-based survey. Results: A total of 60 participants were randomized with 30 participants each allocated to a control and an intervention group. There was no significant change in WHR (P=.43), and all secondary outcome measures did not differ between the intervention group and the control group at the end of the 8-week intervention. Both groups, however, showed a significant decrease in burnout over time (mean [SE]: pre 4.80 [0.39] vs post 3.36 [0.46]; P=.004). The intervention uptake followed a downward trend. Peak participant replies to weekly self-measurements were received in week 3 (14/23, 61%) and the least in week 8 (8/23, 35%). No harm was found to result from this study. Conclusions: This study is an innovative pilot trial using text messaging and serial anthropometric measurements in weight management. No change was detected in WHRs in Australian workers over 8 weeks; therefore, it could not be concluded whether the intervention affected the primary outcome. However, these results should be interpreted in the context of limited sample size and decreasing intervention uptake over the course of the study. This pilot trial is useful for informing and contributing to the design of future studies and the growing body of literature on serial self-measurements combined with text messaging. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616001496404; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371696&isReview=true (Archived by WebCite at http://www.webcitation.org/73UkKFjSw) %M 31017585 %R 10.2196/11832 %U https://mhealth.jmir.org/2019/4/e11832/ %U https://doi.org/10.2196/11832 %U http://www.ncbi.nlm.nih.gov/pubmed/31017585 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 4 %P e12898 %T Text Messaging Interventions for Reducing Alcohol Consumption Among Harmful and Hazardous Drinkers: Protocol for a Systematic Review and Meta-Analysis %A Bendtsen,Marcus %+ Department of Medical and Health Sciences, Linköping University, Linköping University, Linköping, 58183, Sweden, 46 733140708, marcus.bendtsen@gmail.com %K text messaging %K SMS %K risky drinking %K harmful drinking %K hazardous drinking %K intervention %K systematic review %K meta-analysis %D 2019 %7 23.04.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mobile phone-based interventions have become popular for lifestyle behavior change, particularly the use of text messaging as it is a technology ubiquitous in mobile phones. Reviews and meta-analyses of digital interventions for reducing harmful and hazardous use of alcohol have mainly focused on Web-based interventions; thus, there is a need for a body of evidence to guide health practitioners, policy makers, and researchers with respect to the efficacy of available text messaging interventions. Objective: The aim of this systematic review and meta-analysis is to assess the effectiveness of text messaging interventions for reducing the amount of alcohol consumed among harmful and hazardous drinkers; this is compared to receiving no, minimal, or unrelated health information. Specifically, we ask the following questions: (1) Can interventions consisting of only text messages be effective in reducing alcohol consumption compared to no intervention or a minimal or unrelated intervention? (2) Can interventions consisting of only text messages be effective in reducing the prevalence of risky drinking compared to no intervention or a minimal or unrelated intervention? Methods: Several databases will be searched, including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, the Conference Proceedings Citation Index, ClinicalTrials.gov, OpenGrey, among others. Reports of studies that evaluate text messaging interventions for reducing the amount of alcohol consumed will be included. Primary outcomes of interest will be weekly alcohol consumption and frequency of heavy episodic drinking. The Cochrane Collaboration Risk of Bias tool will be used to assess bias in reports, and the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach will be used to assess the quality of the body of evidence. A narrative review will be presented, and a meta-analysis will be conducted in case of homogeneity among included studies. Results: The systematic review has not yet begun but is expected to start in May of 2019; publication of the final review and meta-analysis is expected at the end of 2019. Conclusions: The technology for text messaging is ubiquitous in mobile phones; thus, the potential reach of interventions utilizing this technique is great. However, there are no meta-analyses to date that limit the scope to the use of text messaging interventions for alcohol consumption reduction. Therefore, the proposed systematic review and meta-analysis will help health practitioners, policy decision makers, researchers, and others to better understand the effects of these interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/12898 %M 31012866 %R 10.2196/12898 %U http://www.researchprotocols.org/2019/4/e12898/ %U https://doi.org/10.2196/12898 %U http://www.ncbi.nlm.nih.gov/pubmed/31012866 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e11842 %T Patients’ and Doctors’ Perceptions of a Mobile Phone–Based Consultation Service for Maternal, Neonatal, and Infant Health Care in Bangladesh: A Mixed-Methods Study %A Alam,Mafruha %A Banwell,Cathy %A Olsen,Anna %A Lokuge,Kamalini %+ National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, Canberra, 2601, Australia, 61 6125 5602, mafruha.alam@gmail.com %K mobile-based consultation %K mHealth %K remote diagnosis %K referral %D 2019 %7 22.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A mobile-based consultation service, or telehealth, can be used for remote consultations with health care professionals for screening, self-care management, and referral. In rural Bangladesh, where there is high demand for scarce male and even scarcer female doctors, remote consultations may help women seeking maternal and child health care. Aponjon is a mHealth service in Bangladesh that provides weekly voice or text messages to pregnant women, new mothers, and family members on various aspects of maternal, neonatal, and infant health. Subscribers can also access a dedicated 24*7 call center to discuss maternal, neonatal, and infant health or emergencies with medically trained doctors. The service provides advice, primary diagnoses, prescriptions, and referrals to subscriber callers. Objective: We investigated the Aponjon service to understand access, acceptability, usability, benefits, and challenges of a mobile phone-based consultation service. Methods: We conducted call log data analysis for September to November 2015 to understand how many unique subscribers accessed the service, who accessed the service, the geographical distribution of callers, and the purpose of the calls. We also conducted a qualitative exploratory substudy of eight married women and eight married men who were subscribers to and accessed the service during this time to understand their experiences. We interviewed 11 doctors from the same service who provided phone consultations to subscribers. Results: Approximately 3894 unique subscribers accessed the service for single or multiple consultations during the study period; 68.36% (2662/3894) of subscribers were from rural households, and 53.00% (2064/3894) of calls were made by pregnant women or new mothers. Approximately 96.08% (5081/5288) calls were nonurgent, 2.69% (142/5288) semiurgent, and 1.23% (65/5288) urgent. Almost 64.7% (134/207) semiurgent or urgent calls came between 8 PM and 8 AM. Callers found the consultation service trustworthy, cost-effective, and convenient. The doctors dispelled misconceptions and promoted good health care practices, regular health check-ups, and responsible use of medicine. They helped families understand the severity of sicknesses and advised them to seek care at health facilities for semiurgent or urgent conditions. The service lacked a pro-poor policy to support talk times of subscribers from poor households and a proper referral system to help patients find the right care at the right facilities. Conclusions: Although a regular messaging service is constrained by a one-way communication system, this service using the same platform, gave subscribers access to an abbreviated “consultation” with medical doctors. The consultations provided subscribers with valued medical advice and support, although they were limited in their population reach and their integration into the wider medical system. Further research is required to understand the impact of advice and referral, cost-effectiveness, and willingness to pay for mHealth consultation services, but this research suggests that these services should be supported or even expanded. %M 31008716 %R 10.2196/11842 %U http://mhealth.jmir.org/2019/4/e11842/ %U https://doi.org/10.2196/11842 %U http://www.ncbi.nlm.nih.gov/pubmed/31008716 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e12547 %T Text Message Responsivity in a 2-Way Short Message Service Pilot Intervention With Adolescent and Young Adult Survivors of Cancer %A Psihogios,Alexandra M %A Li,Yimei %A Butler,Eliana %A Hamilton,Jessica %A Daniel,Lauren C %A Barakat,Lamia P %A Bonafide,Christopher P %A Schwartz,Lisa A %+ The Children's Hospital of Philadelphia, 3501 Civic Center Boulevard, Philadelphia, PA, 19104, United States, 1 267 314 0164, psihogiosa@email.chop.edu %K mHealth %K adolescents %K young adults %K cancer %K chronic illness %K self-management %D 2019 %7 18.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Text message interventions hold promise for adolescents and young adults (AYAs) with chronic health conditions, including childhood cancer survivors; however, engagement is often suboptimal. Limited research has studied mobile health intervention outcomes beyond efficacy. Understanding responsivity to different types of text messages (ie, when a participant texts back) can provide practical, actionable information to optimize engagement in future projects.Objective: Within a 2-way text messaging study in AYAs who recently completed treatment for cancer, we sought to evaluate text message responsivity across different types of text messages. Methods: AYAs who recently completed treatment for cancer (n=26; mean age=16 years; 62% female, 16/26 participants) received 2-way text messages about survivorship health topics over a 16-week period. Using participants’ text message log data, we coded responsivity to text messages and evaluated trends in responsivity to unprompted text messages and prompted text messages of varying content (eg, medication reminders, appointment reminders, and texts about personal experiences as a cancer survivor). Results: Across prompted and unprompted text messages, responsivity rapidly decreased (P ≤.001 and =.01, respectively) and plateaued by the third week of the intervention. However, participants were more responsive to prompted text messages (mean responsivity=46% by week 16) than unprompted messages (mean responsivity=10% by week 16). They also demonstrated stable responsivity to certain prompted content: medication reminders, appointment reminders, goal motivation, goal progress, and patient experience texts. Conclusions: Our methodology of evaluating text message responsivity revealed important patterns of engagement in a 2-way text message intervention for AYA cancer survivors. %M 30998225 %R 10.2196/12547 %U http://mhealth.jmir.org/2019/4/e12547/ %U https://doi.org/10.2196/12547 %U http://www.ncbi.nlm.nih.gov/pubmed/30998225 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 5 %N 1 %P e12058 %T Motivating HIV Providers in Vietnam to Learn: A Mixed-Methods Analysis of a Mobile Health Continuing Medical Education Intervention %A Larson Williams,Anna %A Hawkins,Andrew %A Sabin,Lora %A Halim,Nafisa %A Le Ngoc,Bao %A Nguyen,Viet Ha %A Nguyen,Tam %A Bonawitz,Rachael %A Gill,Christopher %+ Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd Floor, Boston, MA, 02118, United States, 1 617 638 5234, alarsonw@bu.edu %K continuing medical education %K HIV/AIDS %K mHealth %K Vietnam %K health education %K SMS intervention %K telemedicine %K text messaging %D 2019 %7 18.04.2019 %9 Original Paper %J JMIR Med Educ %G English %X Background: The Mobile Continuing Medical Education Project (mCME V.2.0) was a randomized controlled trial designed to test the efficacy of a text messaging (short message service [SMS])–based distance learning program in Vietnam that included daily quiz questions, links to readings and online courses, and performance feedback. The trial resulted in significant increases in self-study behaviors and higher examination scores for intervention versus control participants. Objective: The objective of this mixed-methods study was to conduct qualitative and quantitative investigations to understand participants’ views of the intervention. We also developed an explanatory framework for future trial replication. Methods: At the endline examination, all intervention participants completed a survey on their perspectives of mCME and self-study behaviors. We convened focus group discussions to assess their experiences with the intervention and attitudes toward continuing medical education. Results: A total of 48 HIV specialists in the intervention group completed the endline survey, and 30 participated in the focus group discussions. Survey and focus group data suggested that most clinicians liked the daily quizzes, citing them as convenient mechanisms to convey information in a relevant manner. A total of 43 of the 48 (90%) participants reported that the daily quizzes provided motivation to study for continuing medical education purposes. Additionally, 83% (40/48) of intervention participants expressed that they were better prepared to care for patients with HIV in their communities, compared with 67% (32/48) at baseline. Participation in the online coursework component was low (only 32/48, 67% of intervention participants ever accessed the courses), but most of those who did participate thought the lectures were engaging (26/32, 81%) and relevant (29/32, 91%). Focus group discussions revealed that various factors influenced the clinicians’ decision to engage in higher learning, or “lateral learning,” including the participant’s availability to study, professional relevance of the topic area, and feedback. These variables serve as modifying factors that fit within an adapted version of the health belief model, which can explain behavior change in this context. Conclusions: Qualitative and quantitative endline data suggested that mCME V.2.0 was highly acceptable. Participant behaviors during the trial fit within the health belief model and can explain the intervention’s impact on improving self-study behaviors. The mCME platform is an evidence-based approach with the potential for adoption at a national scale as a method for promoting continuing medical education. Trial Registration: ClinicalTrials.gov NCT02381743; https://clinicaltrials.gov/ct2/show/NCT02381743 %M 30998220 %R 10.2196/12058 %U http://mededu.jmir.org/2019/1/e12058/ %U https://doi.org/10.2196/12058 %U http://www.ncbi.nlm.nih.gov/pubmed/30998220 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e12231 %T Designing a Chatbot for a Brief Motivational Interview on Stress Management: Qualitative Case Study %A Park,SoHyun %A Choi,Jeewon %A Lee,Sungwoo %A Oh,Changhoon %A Kim,Changdai %A La,Soohyun %A Lee,Joonhwan %A Suh,Bongwon %+ Human Centered Computing Lab., Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 31 888 9128, bongwon@snu.ac.kr %K motivational interviewing %K mental health %K conversational agents %K stress management %D 2019 %7 16.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: In addition to addiction and substance abuse, motivational interviewing (MI) is increasingly being integrated in treating other clinical issues such as mental health problems. Most of the many technological adaptations of MI, however, have focused on delivering the action-oriented treatment, leaving its relational component unexplored or vaguely described. This study intended to design a conversational sequence that considers both technical and relational components of MI for a mental health concern. Objective: This case study aimed to design a conversational sequence for a brief motivational interview to be delivered by a Web-based text messaging application (chatbot) and to investigate its conversational experience with graduate students in their coping with stress. Methods: A brief conversational sequence was designed with varied combinations of MI skills to follow the 4 processes of MI. A Web-based text messaging application, Bonobot, was built as a research prototype to deliver the sequence in a conversation. A total of 30 full-time graduate students who self-reported stress with regard to their school life were recruited for a survey of demographic information and perceived stress and a semistructured interview. Interviews were transcribed verbatim and analyzed by Braun and Clarke’s thematic method. The themes that reflect the process of, impact of, and needs for the conversational experience are reported. Results: Participants had a high level of perceived stress (mean 22.5 [SD 5.0]). Our findings included the following themes: Evocative Questions and Clichéd Feedback; Self-Reflection and Potential Consolation; and Need for Information and Contextualized Feedback. Participants particularly favored the relay of evocative questions but were less satisfied with the agent-generated reflective and affirming feedback that filled in-between. Discussing the idea of change was a good means of reflecting on themselves, and some of Bonobot’s encouragements related to graduate school life were appreciated. Participants suggested the conversation provide informational support, as well as more contextualized feedback. Conclusions: A conversational sequence for a brief motivational interview was presented in this case study. Participant feedback suggests sequencing questions and MI-adherent statements can facilitate a conversation for stress management, which may encourage a chance of self-reflection. More diversified sequences, along with more contextualized feedback, should follow to offer a better conversational experience and to confirm any empirical effect. %M 30990463 %R 10.2196/12231 %U https://www.jmir.org/2019/4/e12231/ %U https://doi.org/10.2196/12231 %U http://www.ncbi.nlm.nih.gov/pubmed/30990463 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 4 %N 2 %P e12985 %T Short Message Service Text Message Support for Weight Loss in Patients With Prediabetes: Pragmatic Trial %A Fischer,Henry H %A Durfee,Michael J %A Raghunath,Silvia G %A Ritchie,Natalie D %+ Denver Health and Hospital Authority, 777 Bannock St, Denver, CO, United States, 1 3034364200, henry.fischer@dhha.org %K eHealth %K prediabetes %K texting %K weight loss %D 2019 %7 15.04.2019 %9 Original Paper %J JMIR Diabetes %G English %X Background: To reach all 84.1 million US adults estimated to have prediabetes warrants need for low-cost and less burdensome alternatives to the National Diabetes Prevention Program (NDPP). In a previous randomized controlled trial, we demonstrated the efficacy of a 12-month short message service text message support program called SMS4PreDM amongst individuals with prediabetes. Objective: The study aimed to evaluate the implementation and effectiveness of SMS4PreDM in a pragmatic study following dissemination in a safety net health care system. Methods: English- and Spanish-speaking patients at risk for diabetes (eg, glycated hemoglobin 5.7-6.4) were referred by their providers and offered either NDPP classes, SMS4PreDM, or both. This analysis focuses on weight change among 285 SMS4PreDM-only participants who began the year-long intervention between October 2015 and April 2017 with accompanying pre- and postweights, as compared with 1233 usual-care control patients at risk for diabetes, who were identified from electronic health records during this time but not referred. Weight outcomes included time-related mean weight change and frequency of either ≥3% weight loss or gain. Mixed linear models adjusted for age, gender, race, ethnicity, preferred language, and baseline weight. A secondary analysis was stratified by language. We also assessed implementation factors, including retention and cost. Results: SMS4PreDM participants had high retention (259 of 285 patients or 91.0% completion at 12-months, ) and a time-related mean weight loss of 1.3 pounds (SE 0.74), compared with the control group’s slight mean weight gain of 0.25 pounds (SE 0.59; P=.004). Spanish-speaking SMS4PreDM participants (n=130) had a time-related mean weight loss of 1.11 pounds (SE 1.22) compared with weight gain of 0.96 pounds (SE 1.14) in Spanish-speaking controls (n=382, P<.001). English-speaking intervention participants (n=155) had a comparable time-related mean weight change (–0.89 pounds; SE 0.93) as English-speaking controls (n=828; 0.31 pounds gained; SE 0.62, P=.14). Overall, frequency of achieving ≥3% weight loss was comparable between groups (54 of 285 or 19.0% of SMS4PreDM participants [95% CI 14.8-23.9] vs 266 of 1233 or 21.6% of controls [95% CI 19.3-24.0]; P=.33). Nonetheless, more controls had ≥3% weight gain compared with intervention participants (337 of 1233 or 27.3% of controls [95% CI 24.9-29.9] vs 57 of 285 or 20.0% of SMS4PreDM participants [95% CI 16.8-25.1]; P=.01). SMS4PreDM delivery costs were US $100.92 per participant. Conclusions: Although SMS4PreDM was relatively low cost to deliver and demonstrated high retention, weight loss outcomes may not be sufficient to serve as a population health strategy. %M 30985289 %R 10.2196/12985 %U http://diabetes.jmir.org/2019/2/e12985/ %U https://doi.org/10.2196/12985 %U http://www.ncbi.nlm.nih.gov/pubmed/30985289 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e10904 %T Text Messaging to Enhance Behavioral Health Treatment Engagement Among Justice-Involved Youth: Qualitative and User Testing Study %A Tolou-Shams,Marina %A Yonek,Juliet %A Galbraith,Katharine %A Bath,Eraka %+ Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA,, United States, 1 415 206 2212, marina.tolou-shams@ucsf.edu %K juvenile delinquency %K treatment adherence and compliance %K mental health %K short message service text messaging %D 2019 %7 05.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mental health and substance use disorders are highly prevalent in justice-involved youth, yet only 8% of court-involved, nonincarcerated (CINI) youth in need of treatment receive it. Dual diagnosis (co-occurring psychiatric and substance use disorders) in justice-involved youth is highly predictive of recidivism. Identifying novel approaches, such as the use of mobile health (mHealth) technologies, to close this gap between need and receipt of behavioral health treatment for the CINI population could potentially offset rates of reoffending into adulthood. Text-messaging (short message service, SMS) interventions have demonstrated efficacy in improving treatment adherence and other associated outcomes in other vulnerable youth populations, but development and testing of mHealth interventions to improve behavioral health treatment rates and outcomes for CINI youth are lacking. Objective: This study aimed to collect qualitative data from key stakeholders to inform the development of a theoretically grounded, family-based text-messaging (SMS) intervention targeting CINI youth’s behavioral health treatment engagement; additionally, the aim was to conduct end-user testing over 6 months with CINI youth and caregivers to determine intervention feasibility and acceptability. Methods: CINI youth and caregivers were referred from a California-based Juvenile Probation Department and community-based provider organizations providing services for justice-involved youth. Eligibility criteria included the following: being a justice-involved youth or a caregiver of a justice-involved youth, English speaking, youth aged 13 to 17 years old and either referred to or currently attending mental health or substance use treatment, and youth and caregiver have access to a cell phone with text-messaging capability. Results: Overall, 28 individuals participated in focus groups and interviews—8 youth, 5 caregivers, and 15 juvenile justice (JJ) personnel. Three major themes emerged: (1) texting among JJ personnel and CINI youth and caregivers in their caseload is common but not systematic, (2) stigma and privacy are perceived as barriers to texting youth about behavioral health treatment appointments, and (3) messages should be short, simple, relatable, positive, and personalized. In total, 9 participants (7 youth and 2 caregivers) participated in end-user testing and rated the intervention as useful, helpful, and supportive. Conclusions: Text messaging (SMS) is an acceptable and feasible means of reminding CINI youth to attend behavioral health treatment appointments. Future implementation challenges include making text messaging (SMS) personalized and tailored but not resource intensive (eg, requiring one-to-one, 24/7 human contact) and identifying which systems will deliver and sustain the intervention. Text messaging (SMS) among justice personnel, youth, and their caregivers is already widespread, but lack of clear guidelines about privacy, confidentiality, and information sharing poses ethical conundrums. Future hybrid-type research designs that explore the efficacy of the intervention while also studying ethical, system, and policy-level factors associated with using digital health interventions to improve CINI youth outcomes is a key next step. %M 30950808 %R 10.2196/10904 %U https://mhealth.jmir.org/2019/4/e10904/ %U https://doi.org/10.2196/10904 %U http://www.ncbi.nlm.nih.gov/pubmed/30950808 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 4 %P e11794 %T An Interactive Voice Response and Text Message Intervention to Improve Blood Pressure Control Among Individuals With Hypertension Receiving Care at an Urban Indian Health Organization: Protocol and Baseline Characteristics of a Pragmatic Randomized Controlled Trial %A Schroeder,Emily B %A Moore,Kelly %A Manson,Spero M %A Baldwin,Megan A %A Goodrich,Glenn K %A Malone,Allen S %A Pieper,Lisa E %A Xu,Stanley %A Fort,Meredith M %A Johnson,David %A Son-Stone,Linda %A Steiner,John F %+ Kaiser Permanente Colorado, Institute for Health Research, 2550 S Parker Road, Suite 200, Aurora, CO, 80014, United States, 1 303 636 2478, emily.b.schroeder@kp.org %K Indians, North American %K hypertension %K urban health %K pragmatic clinical trial %K text messages %D 2019 %7 02.04.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Efficient and effective strategies for treating chronic health conditions such as hypertension are particularly needed for under-resourced clinics such as Urban Indian Health Organizations (UIHOs). Objective: The objective of the Controlling Blood Pressure Trial is to assess the impact of an interactive voice response and text message (IVR-T) intervention compared with usual care among individuals with hypertension receiving care at a UIHO in Albuquerque, New Mexico. This manuscript presents the baseline characteristics of individuals enrolled in the trial and compares their characteristics with those in the hypertension registry who did not enroll in the trial. Methods: A hypertension registry developed from the clinic’s electronic health record was used for recruitment. Potentially eligible participants were contacted by letter and then by phone. Those who expressed interest completed an in-person baseline visit that included a baseline survey and blood pressure measurement using standardized procedures. Individuals randomized to the intervention group could opt to receive either automated text messages or automated phone calls in either English or Spanish. The messages include reminders of upcoming appointments at First Nations Community HealthSource, requests to reschedule recently missed appointments, monthly reminders to refill medications, and weekly motivational messages to encourage self-care, appointment keeping, and medication taking for hypertension. Individuals in the IVR-T arm could opt to nominate a care partner to also receive notices of upcoming and missed appointments. Individuals in the IVR-T arm were also offered a home blood pressure monitor. Follow-up visits will be conducted at 6 months and 12 months. Results: Over a 9.5-month period from April 2017 to January 2018, 295 participants were enrolled from a recruitment list of 1497 individuals. The enrolled cohort had a mean age of 53 years, was 25.1% (74/295) American Indian or Alaska Native and 51.9% (153/295) Hispanic, and 39.0% (115/295) had a baseline blood pressure greater than or equal to 140/90 mmHg. Overall, the differences between those enrolled in the trial and patients with hypertension who were ineligible, those who could not be reached, or those who chose not to enroll were minimal. Enrolled individuals had a slightly lower blood pressure (129/77 mmHg vs 132/79 mmHg; P=.04 for systolic blood pressure and P=.01 for diastolic blood pressure), were more likely to self-pay for their care (26% vs 10%; P<.001), and had a more recent primary care visit (164 days vs 231 days; P<.001). The enrolled cohort reported a high prevalence of poor health, low socioeconomic status, and high levels of basic material needs. Conclusions: The Controlling Blood Pressure Trial has successfully enrolled a representative sample of individuals receiving health care at a UIHO. Trial follow-up will conclude in February 2019. Trial Registration: ClinicalTrials.gov NCT03135405; http://clinicaltrials.gov/ct2/show/NCT03135405 (Archived by WebCite http://www.webcitation.org/76H2B4SO6) International Registered Report Identifier (IRRID): DERR1-10.2196/11794 %M 30938688 %R 10.2196/11794 %U https://www.researchprotocols.org/2019/4/e11794/ %U https://doi.org/10.2196/11794 %U http://www.ncbi.nlm.nih.gov/pubmed/30938688 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 2 %P e11666 %T An Automated Text-Messaging Platform for Enhanced Retention and Data Collection in a Longitudinal Birth Cohort: Cohort Management Platform Analysis %A Barry,Caroline M %A Sabhlok,Aditi %A Saba,Victoria C %A Majors,Alesha D %A Schechter,Julia C %A Levine,Erica L %A Streicher,Martin %A Bennett,Gary G %A Kollins,Scott H %A Fuemmeler,Bernard F %+ Cancer Prevention and Control, Department of Health Behavior and Policy, Virginia Commonwealth University, PO Box 980149, 830 E Main St, Richmond, VA, 23219, United States, 1 8048288892, bernard.fuemmeler@vcuhealth.org %K data collection %K longitudinal studies %K mobile health %K text messaging %D 2019 %7 02.04.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Traditional methods for recruiting and maintaining contact with participants in cohort studies include print-based correspondence, which can be unidirectional, labor intensive, and slow. Leveraging technology can substantially enhance communication, maintain engagement of study participants in cohort studies, and facilitate data collection on a range of outcomes. Objective: This paper provides an overview of the development process and design of a cohort management platform (CMP) used in the Newborn Epigenetic STudy (NEST), a large longitudinal birth cohort study. Methods: The platform uses short message service (SMS) text messaging to facilitate interactive communication with participants; it also semiautomatically performs many recruitment and retention procedures typically completed by research assistants over the course of multiple study follow-up visits. Results: Since February 2016, 302 participants have consented to enrollment in the platform and 162 have enrolled with active engagement in the system. Daily reminders are being used to help improve adherence to the study’s accelerometer wear protocol. At the time of this report, 213 participants in our follow-up study who were also registered to use the CMP were eligible for the accelerometer protocol. Preliminary data show that texters (138/213, 64.8%), when compared to nontexters (75/213, 35.2%), had significantly longer average accelerometer-wearing hours (165.6 hours, SD 56.5, vs 145.3 hours, SD 58.5, P=.01) when instructed to wear the devices for 1 full week. Conclusions: This platform can serve as a model for enhancing communication and engagement with longitudinal study cohorts, especially those involved in studies assessing environmental exposures. %M 30938689 %R 10.2196/11666 %U https://publichealth.jmir.org/2019/2/e11666/ %U https://doi.org/10.2196/11666 %U http://www.ncbi.nlm.nih.gov/pubmed/30938689 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e11397 %T Using Text Messaging, Social Media, and Interviews to Understand What Pregnant Youth Think About Weight Gain During Pregnancy %A DeJonckheere,Melissa %A Nichols,Lauren P %A Vydiswaran,VG Vinod %A Zhao,Xinyan %A Collins-Thompson,Kevyn %A Resnicow,Kenneth %A Chang,Tammy %+ Department of Family Medicine, University of Michigan, 1018 Fuller St, Ann Arbor, MI, 48104, United States, 1 (734) 998 7120, mjdejonckheere@gmail.com %K methods %K adolescents %K weight gain %K pregnancy %K text messaging %K social media %K natural language processing %D 2019 %7 01.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The majority of pregnant youth gain more weight than recommended by the National Academy of Medicine guidelines. Excess weight gain during pregnancy increases the risk of dangerous complications during delivery, including operative delivery and stillbirth, and contributes to the risk of long-term obesity in both mother and child. Little is known regarding youth’s perceptions of and knowledge about weight gain during pregnancy. Objective: The aim of this study was to describe the feasibility and acceptability of 3 novel data collection and analysis strategies for use with youth (social media posts, text message surveys, and semistructured interviews) to explore their experiences during pregnancy. The mixed-methods analysis included natural language processing and thematic analysis. Methods: To demonstrate the feasibility and acceptability of this novel approach, we used descriptive statistics and thematic qualitative analysis to characterize participation and engagement in the study. Results: Recruitment of 54 pregnant women aged between 16 and 24 years occurred from April 2016 to September 2016. All participants completed at least 1 phase of the study. Semistructured interviews had the highest rate of completion, yet all 3 strategies were feasible and acceptable to pregnant youth. Conclusions: This study has described a novel youth-centered strategy of triangulating 3 sources of mixed-methods data to gain a deeper understanding of a health behavior phenomenon among an at-risk population of youth. %M 30932869 %R 10.2196/11397 %U https://formative.jmir.org/2019/2/e11397/ %U https://doi.org/10.2196/11397 %U http://www.ncbi.nlm.nih.gov/pubmed/30932869 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e12191 %T Examining Development Processes for Text Messaging Interventions to Prevent Cardiovascular Disease: Systematic Literature Review %A Ricci-Cabello,Ignacio %A Bobrow,Kirsten %A Islam,Sheikh Mohammed Shariful %A Chow,Clara K %A Maddison,Ralph %A Whittaker,Robyn %A Farmer,Andrew J %+ Balearic Islands Health Research Institute, Carretera de Valldemossa, 79, Hospital Universitari Son Espases, Edifici S., Palma de Mallorca, 07120, Spain, 34 697750971, nacho.ricci.cabello@gmail.com %K systematic review %K cardiovascular disease %K telemedicine %K text messaging %K methods %D 2019 %7 29.03.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Interventions delivered by mobile phones have the potential to prevent cardiovascular disease (CVD) by supporting behavior change toward healthier lifestyles and treatment adherence. To allow replication and adaptation of these interventions across settings, it is important to fully understand how they have been developed. However, the development processes of these interventions have not previously been systematically examined. Objective: This study aimed to systematically describe and compare the development process of text messaging interventions identified in the Text2PreventCVD systematic review. Methods: We extracted data about the development process of the 9 interventions identified in the Text2PreventCVD systematic review. Data extraction, which was guided by frameworks for the development of complex interventions, considered the following development stages: intervention planning, design, development, and pretesting. Following data extraction, we invited the developers of the interventions to contribute to our study by reviewing the accuracy of the extracted data and providing additional data not reported in the available publications. Results: A comprehensive description of the development process was available for 5 interventions. Multiple methodologies were used for the development of each intervention. Intervention planning involved gathering information from stakeholder consultations, literature reviews, examination of relevant theory, and preliminary qualitative research. Intervention design involved the use of behavior change theories and behavior change techniques. Intervention development involved (1) generating message content based on clinical guidelines and expert opinions; (2) conducting literature reviews and primary qualitative research to inform decisions about message frequency, timing, and level of tailoring; and (3) gathering end-user feedback concerning message readability, intervention acceptability, and perceived utility. Intervention pretesting involved pilot studies with samples of 10 to 30 participants receiving messages for a period ranging from 1 to 4 weeks. Conclusions: The development process of the text messaging interventions examined was complex and comprehensive, involving multiple studies to guide decisions about the scope, content, and structure of the interventions. Additional research is needed to establish whether effective messaging systems can be adapted from work already done or whether this level of development is needed for application in other conditions and settings. %M 30924790 %R 10.2196/12191 %U http://mhealth.jmir.org/2019/3/e12191/ %U https://doi.org/10.2196/12191 %U http://www.ncbi.nlm.nih.gov/pubmed/30924790 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e9240 %T Design and Evaluation of Personalized Motivational Messages by a Virtual Agent that Assists in Post-Traumatic Stress Disorder Therapy %A Tielman,Myrthe L %A Neerincx,Mark A %A Brinkman,Willem-Paul %+ Delft University of Technology, Van Mourik Broekmanweg 6, Delft,, Netherlands, 31 643545851, m.l.tielman@tudelft.nl %K mental health %K motivation %K trust %K user-computer interface %K PTSD %K computer assisted therapy %D 2019 %7 27.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Systems incorporating virtual agents can play a major role in electronic-mental (e-mental) health care, as barriers to care still prevent some patients from receiving the help they need. To properly assist the users of these systems, a virtual agent needs to promote motivation. This can be done by offering motivational messages. Objective: The objective of this study was two-fold. The first was to build a motivational message system for a virtual agent assisting in post-traumatic stress disorder (PTSD) therapy based on domain knowledge from experts. The second was to test the hypotheses that (1) computer-generated motivating messages influence users’ motivation to continue with therapy, trust in a good therapy outcome, and the feeling of being heard by the agent and (2) personalized messages outperform generic messages on these factors. Methods: A system capable of generating motivational messages was built by analyzing expert (N=13) knowledge on what types of motivational statements to use in what situation. To test the 2 hypotheses, a Web-based study was performed (N=207). Participants were asked to imagine they were in a certain situation, specified by the progression of their symptoms and initial trust in a good therapy outcome. After this, they received a message from a virtual agent containing either personalized motivation as generated by the system, general motivation, or no motivational content. They were asked how this message changed their motivation to continue and trust in a good outcome as well as how much they felt they were being heard by the agent. Results: Overall, findings confirmed the first hypothesis, as well as the second hypothesis for the measure feeling of being heard by the agent. Personalization of the messages was also shown to be important in those situations where the symptoms were getting worse. In these situations, personalized messages outperformed general messages both in terms of motivation to continue and trust in a good therapy outcome. Conclusions: Expert input can successfully be used to develop a personalized motivational message system. Messages generated by such a system seem to improve people’s motivation and trust in PTSD therapy as well as the user’s feeling of being heard by a virtual agent. Given the importance of motivation, trust, and therapeutic alliance for successful therapy, we anticipate that the proposed system can improve adherence in e-mental therapy for PTSD and that it can provide a blueprint for the development of an adaptive system for persuasive messages based on expert input. %M 30916660 %R 10.2196/jmir.9240 %U http://www.jmir.org/2019/3/e9240/ %U https://doi.org/10.2196/jmir.9240 %U http://www.ncbi.nlm.nih.gov/pubmed/30916660 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e11498 %T Combining Real-Time Ratings With Qualitative Interviews to Develop a Smoking Cessation Text Messaging Program for Primary Care Patients %A Kruse,Gina %A Park,Elyse R %A Shahid,Naysha N %A Abroms,Lorien %A Haberer,Jessica E %A Rigotti,Nancy A %+ Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street 16th Fl, Boston, MA, 02114, United States, 1 617 724 3157, gkruse@mgh.harvard.edu %K text messaging %K smoking cessation %K primary care %D 2019 %7 26.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Text messaging (short message service, SMS) interventions show promise as a way to help cigarette smokers quit. Few studies have examined the effectiveness of text messaging (SMS) programs targeting smokers associated with primary care or hospital settings. Objective: This study aimed to develop a text messaging (SMS) program targeting primary care smokers. Methods: Adult smokers in primary care were recruited from February 2017 to April 2017. We sent patients 10 to 11 draft text messages (SMS) over 2 days and asked them to rate each message in real time. Patients were interviewed daily by telephone to discuss ratings, message preferences, and previous experiences with nicotine replacement therapy (NRT). Content analysis of interviews was directed by a step-wise text messaging (SMS) intervention development process and the Information-Motivation-Behavioral Skills model of medication adherence. Results: We sent 149 text messages (SMS) to 15 patients. They replied with ratings for 93% (139/149) of the messages: 134 (96%, 134/139) were rated as clear or useful and 5 (4%, 5/139) as unclear or not useful. Patients’ preferences included the addition of graphics, electronic cigarette (e-cigarette) content, and use of first names. Regarding NRT, patients identified informational gaps around safety and effectiveness, preferred positively framed motivational messages, and needed behavioral skills to dose and dispose of NRT. Conclusions: Patients recommended text message (SMS) personalization, inclusion of e-cigarette information and graphics, and identified barriers to NRT use. Combining real-time ratings with telephone interviews is a feasible method for incorporating primary care patients’ preferences into a behavioral text messaging (SMS) program. %M 30912755 %R 10.2196/11498 %U http://mhealth.jmir.org/2019/3/e11498/ %U https://doi.org/10.2196/11498 %U http://www.ncbi.nlm.nih.gov/pubmed/30912755 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e11306 %T Child Maltreatment Disclosure to a Text Messaging–Based Crisis Service: Content Analysis %A Schwab-Reese,Laura %A Kanuri,Nitya %A Cash,Scottye %+ Department of Health and Kinesiology, Purdue University, Lambert Fieldhouse 106B, 800 W Stadium Ave, West Lafayette, IN, 47907, United States, 1 7654966723, lschwabr@purdue.edu %K child maltreatment %K disclosure %K SMS %K text message %D 2019 %7 25.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Disclosure is a difficult but important process for victims of child maltreatment. There is limited research on child maltreatment disclosure. Young people have been reluctant to disclose victimization to adults, but short message service (SMS) crisis services may represent one novel method of engaging young people around sensitive topics. Objective: The purpose of this study was to determine characteristics of child maltreatment disclosure to an SMS-based crisis service. Methods: We conducted a content analysis of all conversations (N=244) that resulted in a mandatory report by an SMS-based crisis service between October 2015 and July 2017. We coded characteristics of the disclosure process, including the reason for initial contact, phrase used to disclose abuse, perpetrator, type of abuse, and length of victimization. After identifying terms used by young people to disclose child abuse, we randomly selected and analyzed 50 conversations using those terms to determine if use of the terms differed between conversations that did and did not result in mandatory report. Results: Parents were the most common perpetrator. Physical abuse was the most common form of abuse discussed in the initial abuse disclosure (106/244, 43.4%), followed by psychological abuse (83/244, 34.0%), sexual abuse (38/244, 15.6%), and neglect (15/244, 6.1%). More than half of the texters discussed abuse or other significant family issues in the first message. An explicit description of the experience or definite language, such as abuse, rape, and molested, was common in disclosures. Conclusions: Early disclosure, combined with explicit language, may suggest at least a portion of young victims are actively seeking safe ways to talk about their experiences with abuse, rather than incidentally sharing experiences while seeking support for other issues. SMS text messaging may be a valuable way to engage with young people around sensitive topics, but these approaches will require careful consideration in their development, implementation, and evaluation to ensure a positive experience for young people. %M 30907745 %R 10.2196/11306 %U http://mhealth.jmir.org/2019/3/e11306/ %U https://doi.org/10.2196/11306 %U http://www.ncbi.nlm.nih.gov/pubmed/30907745 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 4 %N 1 %P e10350 %T Perceptions and Acceptability of Text Messaging for Diabetes Care in Primary Care in Argentina: Exploratory Study %A Moyano,Daniela %A Morelli,Daniela %A Santero,Marilina %A Belizan,Maria %A Irazola,Vilma %A Beratarrechea,Andrea %+ Institute for Clinical Effectiveness and Health Policy (IECS), Dr Emilio Ravignani 2024, Buenos Aires, C1414CPV, Argentina, 54 114777 8767, dmoyano@iecs.org.ar %K mobile phones %K short message service %K diabetes mellitus %K public health %K qualitative research %D 2019 %7 18.03.2019 %9 Original Paper %J JMIR Diabetes %G English %X Background: Engagement in self-care behaviors that are essential to optimize diabetes care is challenging for many patients with diabetes. mHealth interventions have been shown to be effective in improving health care outcomes in diabetes. However, more research is needed on patient perceptions to support these interventions, especially in resource settings in low- and middle-income countries. Objective: The goal of the research was to explore perceptions and acceptability of a short message service (SMS) text messaging intervention for diabetes care in underserved people with diabetes in Argentina. Methods: A qualitative exploratory methodology was adopted as part of the evaluation of a program to strengthen diabetes services in primary care clinics located in low-resource settings. The diabetes program included a text messaging intervention for people with diabetes. A total of 24 semistructured telephone interviews were conducted with people with diabetes. Results: Twenty-four middle-aged persons with diabetes were interviewed. Acceptability was considered adequate in terms of its actual use, frequency, and the role of texts as a reminder. We found that text messages could be a mediating device in the patient’s learning processes. Also, being exposed to the texts seemed to help bring about changes in risk perception and care practices and to function as psychosocial support. Another relevant finding was the role of text messaging as a potential facilitator in diabetes care. In this sense, we observed a strong association between receiving text messages and having a better patient-physician relationship. Additionally, social barriers that affect diabetes care such as socioeconomic and psychosocial vulnerability were identified. Conclusions: Our findings show positive contributions of a text messaging intervention for the care of people with diabetes. We consider that an SMS strategy has potential to be replicated in other contexts. However, further studies are needed to explore its sustainability and long-term impact from the perspective of patients. %M 30882362 %R 10.2196/10350 %U http://diabetes.jmir.org/2019/1/e10350/ %U https://doi.org/10.2196/10350 %U http://www.ncbi.nlm.nih.gov/pubmed/30882362 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e11108 %T Perspectives on Acceptance and Use of a Mobile Health Intervention for the Prevention of Atherosclerotic Cardiovascular Disease in Singapore: Mixed-Methods Study %A Haldane,Victoria %A Tan,Yao Guo %A Teo,Krichelle Wei Qi %A Koh,Joel Jun Kai %A Srivastava,Aastha %A Cheng,Rui Xiang %A Yap,Yi Cheng %A Ong,Pei-Shi %A van Dam,Rob M %A Foo,Jie Min %A Müller-Riemenschneider,Falk %A Koh,Gerald Choon-Huat %A Perel,Pablo %A Legido-Quigley,Helena %+ Institute of Health Policy, Management & Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, ON, M5T 3M6, Canada, 1 416 978 4326, v.haldane@mail.utoronto.ca %K atherosclerosis %K mHealth %K eHealth %K patient-centered care %K patient acceptance of health care %K medication adherence %D 2019 %7 14.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cardiovascular disease, including atherosclerotic cardiovascular disease (ASCVD), is a growing public health threat globally and many individuals remain undiagnosed, untreated, and uncontrolled. Simultaneously, mobile health (mHealth) interventions using short messaging service (SMS) have gained popularity globally. There is an opportunity for innovative approaches such as mHealth to encourage and enable adherence to medications for ASCVD and its risk factors. Objective: This study aimed to understand mobile technology acceptance, use, and facilitating conditions among the study population ahead of the design of an mHealth intervention. Methods: Using data from a mixed-methods study conducted in Singapore, we conducted a cross-sectional survey with 100 participants and in-depth, semistructured interviews with 20 patients. All participants were over the age of 40 years with ASCVD or its risk factors. Interviews were conducted in English and Mandarin and if needed translated to English. Nvivo 11 (QSR International) was used for analyses. Results: Participants reported their perspectives on technology use and preferences, including low or sporadic mobile phone use and usability concerns including small screen and text size, among others; the benefit of previous mHealth use in creating a favorable opinion of SMS for health information; trust in both the source of mHealth SMS, as well as in treatment; the formation of habits; and fear of sequelae or death for facilitating intention to use an mHealth intervention and adhere to medication. We also highlighted a case that underscored the importance of the period after diagnosis in habit forming as an opportunity for an mHealth intervention. Conclusions: We explored both technology- and adherence-related factors that influence a patient’s intention to use an mHealth intervention for adherence to ASCVD medication in Singapore. We highlighted the importance of identifying the right opportunity to engage with patients and promote an mHealth intervention for adherence, such as immediately following diagnosis when patients are establishing medication-taking habits. %M 30869651 %R 10.2196/11108 %U http://mhealth.jmir.org/2019/3/e11108/ %U https://doi.org/10.2196/11108 %U http://www.ncbi.nlm.nih.gov/pubmed/30869651 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e11070 %T Get Healthy, Stay Healthy: Evaluation of the Maintenance of Lifestyle Changes Six Months After an Extended Contact Intervention %A Fjeldsoe,Brianna S %A Goode,Ana D %A Phongsavan,Philayrath %A Bauman,Adrian %A Maher,Genevieve %A Winkler,Elisabeth %A Job,Jennifer %A Eakin,Elizabeth G %+ Cancer Prevention Research Centre, School of Public Health, The University of Queensland, Herston Road, Herston, Brisbane,, Australia, 61 733655163, j.job@uq.edu.au %K maintenance %K mHealth %K physical activity %K exercise %K diet %K overweight %K body mass index %K text messages %D 2019 %7 12.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Extended intervention contact after an initial, intensive intervention is becoming accepted as best practice in behavioral weight control interventions. Whether extended contact mitigates weight regain in the longer term or it simply delays weight regain until after the extended intervention contact ceases is not clear. Objective: This study aimed to evaluate, in multiple ways, maintenance of weight, diet, and physical activity outcomes following Get Healthy, Stay Healthy (GHSH), a text message–delivered extended contact intervention. Methods: Clients completing the Get Healthy Service (GHS) lifestyle telephone coaching program were randomized to receive GHSH (n=114) or standard care (no additional contact, n=114) and were assessed at baseline (following completion of GHS), 6 months (following completion of GHSH), and 12 months (noncontact maintenance follow-up). At all 3 assessments, participants self-reported their body weight, waist circumference, physical activity (walking and moderate and vigorous sessions/week), and dietary behaviors (fruit and vegetable serves/day, cups of sweetened drinks per day, takeaway meals per week; fat, fiber, and total indices from the Fat and Fiber Behavior Questionnaire). Moderate-to-vigorous physical activity (MVPA) was also assessed via accelerometry. Maintenance was examined multiple ways: (1) using traditional methods to assess and compare group averages after some period of noncontact (ie, at 12 months), (2) using a novel approach to assess and compare group average changes over the first 6 months of noncontact, and (3) exploring individual participant changes (increase/decrease/no change) over the first 6 months of noncontact. Results: Retention over the 12-month trial was high (92.5%, 211/228). Participants had a mean (SD) age of 53.4 (SD 12.3) years and a baseline body mass index of 29.2 (SD 5.9) kg/m2. The between-group differences detected at 6 months were still present and statistically significant at 12 months for bodyweight (−1.33 kg [−2.61 to −0.05]) and accelerometer-assessed MVPA (24.9 min/week [5.8-44.0]). None of the other outcomes were significantly favored compared with the control group at 12 months. Changes over their first 6 months of noncontact for the GHSH group were significantly better than the control group in terms of accelerometer-measured MVPA and self-reported moderate activity (other differences between the groups were all nonsignificant). In addition to the maintenance seen in the group averages, most intervention participants had maintained their behavioral outcomes during the first 6 months of noncontact. Conclusions: The GHSH participants were better off relative to where they were initially, and relative to their counterparts, not receiving extended contact in terms of MVPA. However, based on the between-group difference in bodyweight over the first 6 months of noncontact, GHSH does appear to simply delay the inevitable weight regain. However, this delay in weight regain, coupled with sustained improvements in MVPA, has public health benefits. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12613000949785; https://www.anzctr.org. au/Trial/Registration/TrialReview.aspx?id=364821&isReview=true %M 30860492 %R 10.2196/11070 %U https://mhealth.jmir.org/2019/3/e11070/ %U https://doi.org/10.2196/11070 %U http://www.ncbi.nlm.nih.gov/pubmed/30860492 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e11114 %T Repeated Automated Mobile Text Messaging Reminders for Follow-Up of Positive Fecal Occult Blood Tests: Randomized Controlled Trial %A Azulay,Revital %A Valinsky,Liora %A Hershkowitz,Fabienne %A Magnezi,Racheli %+ Central Laboratory, Meuhedet Health Care, Pesach Lev 5, Lod,, Israel, 972 97289130421, eazulay39@gmail.com %K adherence %K cancer screening %K colonoscopy %K fetal occult blood test %K patient-physician relationship %K positive colorectal cancer screening %K SMS %K text reminder %D 2019 %7 05.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Fecal occult blood tests (FOBTs) are recommended by the US Preventive Services Task Force as a screening method for colorectal cancer (CRC), but they are only effective if positive results are followed by colonoscopy. Surprisingly, a large proportion of patients with a positive result do not follow this recommendation. Objective: The objective of this study was to examine the effectiveness of text messaging (short message service, SMS) in increasing adherence to colonoscopy follow-up after a positive FOBT result. Methods: This randomized controlled trial was conducted with patients who had positive CRC screening results. Randomization was stratified by residential district and socioeconomic status (SES). Subjects in the control group (n=238) received routine care that included an alert to the physician regarding the positive FOBT result. The intervention group (n=232) received routine care and 3 text messaging SMS reminders to visit their primary care physician. Adherence to colonoscopy was measured 120 days from the positive result. All patient information, including test results and colonoscopy completion, were obtained from their electronic medical records. Physicians of study patients completed an attitude survey regarding FOBT as a screening test for CRC. Intervention and control group variables (dependent and independent) were compared using chi-square test. Logistic regression was used to calculate odds ratios (ORs) and 95% CIs for performing colonoscopy within 120 days for the intervention group compared with the control group while adjusting for potential confounders including age, gender, SES, district, ethnicity, and physicians’ attitude. Results: Overall, 163 of the 232 patients in the intervention group and 112 of the 238 patients in the control group underwent colonoscopy within 120 days of the positive FOBT results (70.3% vs 47.1%; OR 2.17, 95% CI 1.49-3.17; P<.001); this association remained significant after adjusting for potential confounders (P=.001). Conclusions: A text message (SMS) reminder is an effective, simple, and inexpensive method for improving adherence among patients with positive colorectal screening results. This type of intervention could also be evaluated for other types of screening tests. Trial Registration: ClinicalTrials.gov NCT03642652; https://clinicaltrials.gov/ct2/show/NCT03642652 (Archived by WebCite at http://www.webcitation.org/74TlICijl) %M 30720439 %R 10.2196/11114 %U http://mhealth.jmir.org/2019/2/e11114/ %U https://doi.org/10.2196/11114 %U http://www.ncbi.nlm.nih.gov/pubmed/30720439 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11954 %T Exploring Community Smokers’ Perspectives for Developing a Chat-Based Smoking Cessation Intervention Delivered Through Mobile Instant Messaging: Qualitative Study %A Luk,Tzu Tsun %A Wong,Sze Wing %A Lee,Jung Jae %A Chan,Sophia Siu-Chee %A Lam,Tai Hing %A Wang,Man Ping %+ School of Nursing, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong,, China (Hong Kong), 852 39176636, mpwang@hku.hk %K chat intervention %K instant messaging %K mHealth %K mobile phone %K social media %K smoking cessation %K tobacco dependence %K WhatsApp %D 2019 %7 31.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Advances in mobile communication technologies provide a promising avenue for the delivery of tobacco dependence treatment. Although mobile instant messaging (IM) apps (eg, WhatsApp, Facebook messenger, and WeChat) are an inexpensive and widely used communication tool, evidence on its use for promoting health behavior, including smoking cessation, is scarce. Objective: This study aims to explore the perception of using mobile IM as a modality to deliver a proposed chat intervention for smoking cessation in community smokers in Hong Kong, where the proportion of smartphone use is among the highest in the world. Methods: We conducted 5 focus group, semistructured qualitative interviews on a purposive sample of 15 male and 6 female current cigarette smokers (age 23-68 years) recruited from the community in Hong Kong. All interviews were audiotaped and transcribed. Two investigators independently analyzed the transcripts using thematic analyses. Results: Participants considered mobile IM as a feasible and acceptable platform for the delivery of a supportive smoking cessation intervention. The ability to provide more personalized and adaptive behavioral support was regarded as the most valued utility of the IM–based intervention. Other perceived utilities included improved perceived psychosocial support and identification of motivator to quit. In addition, participants provided suggestions on the content and design of the intervention, which may improve the acceptability and usability of the IM–based intervention. These include avoiding health warning information, positive messaging, using former smokers as counselors, and adjusting the language style (spoken vs written) according to the recipients’ preference. Conclusions: This qualitative study provides the first evidence that mobile IM may be an alternative mobile health platform for the delivery of a smoking cessation intervention. Furthermore, the findings inform the development of a chat-based, IM smoking cessation program being evaluated in a community trial. %M 30702431 %R 10.2196/11954 %U https://mhealth.jmir.org/2019/1/e11954/ %U https://doi.org/10.2196/11954 %U http://www.ncbi.nlm.nih.gov/pubmed/30702431 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 1 %P e10814 %T Usability and Acceptability of a Text Message-Based Developmental Screening Tool for Young Children: Pilot Study %A Johnson,Pamela Ryden %A Bushar,Jessica %A Dunkle,Margaret %A Leyden,Sharon %A Jordan,Elizabeth T %+ Voxiva, Inc, 1101 Wilson Boulevard, Arlington, VA, 22209, United States, 1 202 251 1423, pamelajohnson999@gmail.com %K developmental screening %K EPSDT %K ITP %K low income %K Medicaid %K mHealth %K mobile health %K Text4baby %K text messaging %K PEDS:DM %K WIC %D 2019 %7 30.01.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Only 30% of parents of children aged 9-35 months report that their child received a developmental screening in the previous year. Screening rates are even lower in low-income households, where the rates of developmental delays are typically higher than those in high-income households. Seeking to evaluate ways to increase developmental screening, Text4baby, a national perinatal texting program, created an interactive text message-based version of a validated developmental screening tool for parents. Objective: This study aimed to assess whether a text message-based developmental screening tool is usable and acceptable by low-income mothers. Methods: Low-income mothers of infants aged 8-10 months were recruited from the Women, Infants and Children Program clinics in Prince George’s County, MD. Once enrolled, participants used text messages to receive and respond to six developmental screening questions from the Parents’ Evaluation of Developmental Status: Developmental Milestones. After confirming their responses, participants received the results and feedback. Project staff conducted a follow-up phone survey and invited a subset of survey respondents to attend focus groups. A representative of the County’s Infants and Toddlers Program met with or called participants whose results indicated that their infants “may be behind.” Results: Eighty-one low-income mothers enrolled in the study, 93% of whom reported that their infants received Medicaid (75/81). In addition, 49% of the mothers were Hispanic/Latina (40/81) and 42% were African American (34/81). A total of 80% participated in follow-up surveys (65/81), and 14 mothers attended focus groups. All participants initiated the screening and responded to all six screening questions. Of the total, 79% immediately confirmed their responses (64/81), and 21% made one or more changes (17/81). Based on the final responses, 63% of participants received a text that the baby was “doing well” in all six developmental domains (51/81); furthermore, 37% received texts listing domains where their baby was “doing well” and one or more domains where their baby “may be behind” (30/81). All participants received a text with resources for follow-up. In a follow-up survey reaching 65 participants, all respondents said that they would like to answer screening questions again when their baby was older. All but one participant would recommend the tool to a friend and rated the experience of answering questions and receiving feedback by text as “very good” or “good.” Conclusions: A mobile text version of a validated developmental screening tool was both usable and acceptable by low-income mothers, including those whose infants “may be behind.” Our results may inform further research on the use of the tool at older ages and options for a scalable, text-based developmental screening tool such as that in Text4baby. %M 31518329 %R 10.2196/10814 %U http://pediatrics.jmir.org/2019/1/e10814/ %U https://doi.org/10.2196/10814 %U http://www.ncbi.nlm.nih.gov/pubmed/31518329 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e9351 %T Better Ask Than Tell: Responses to mHealth Interrogative Reminders and Associations With Colorectal Cancer Screening Subsequent Uptake in a Prospective Cohort Intervention %A Hagoel,Lea %A Stein,Nili %A Rennert,Gad %A Neter,Efrat %+ Department of Behavioral Sciences, Ruppin Academic Center, Beit 3, Emeq Hefer, 4025000, Israel, 972 45 646 2678, neter@ruppin.ac.il %K adherence %K colorectal cancer %K cancer screening %K health behaviors %K interrogative reminders %K short message service text messages %D 2019 %7 21.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Text message (short message service, SMS) interrogative reminders were adopted in population screening for the early detection of colorectal cancer (CRC). Objective: This study aims to examine responses to text message (SMS) reminders and associate responses with senders’ characteristics, message type (interrogative/declarative), and subsequent screening uptake. Methods: We conducted a prospective cohort intervention. Text message (SMS) reminders to undergo CRC screening, randomized into interrogative and declarative phrasing, were sent to nonadherent 40,000 women and men (age 50-74 years) at CRC average risk. We analyzed recipient responses by message phrasing, recipient characteristics, and for content, the latter predicting subsequent CRC screening per program database. Results: While interrogative text message (SMS) reminders elicited 7.67% (1475/19,227) responses, declarative ones elicited 0.76% (146/19,262) responses. Text message (SMS) responses were content analyzed and grouped into attitudes toward CRC screening (1237/1512, 81.8% positive) and intention to screen (1004/1512, 62.6%). Text message (SMS) respondents screened significantly more than nonrespondents after 6 months (415/1621, 25.6% vs 3322/36,868, 9.0%; χ12=487.5, P<.001); 1 year (340/1621, 21.0% vs 4711/36,868; χ12=91.5, P<.001); and 2 years (225/1621, 13.9% vs 3924/36,868; χ12=16.9, P<.001) following the reminders. In a multivariable logistic regression among text message (SMS) respondents, screening after 6 months was significantly predicted by older age, past sporadic screening, attitudes, and intentions. Conclusions: Interrogative text message (SMS) reminders reached previously uninvolved sectors in the CRC target population—men, sporadic-screenees, and the “never-tested” before. This novel application resulted in a population-level, incrementally enhanced screening. Asking patients about their future health behavior may be relevant for enhancing other health behaviors in preventive medicine and clinical settings. %M 30664486 %R 10.2196/mhealth.9351 %U https://mhealth.jmir.org/2019/1/e9351/ %U https://doi.org/10.2196/mhealth.9351 %U http://www.ncbi.nlm.nih.gov/pubmed/30664486 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e9967 %T Predicting Attrition in a Text-Based Nutrition Education Program: Survival Analysis of Text2BHealthy %A Grutzmacher,Stephanie K %A Munger,Ashley L %A Speirs,Katherine E %A Vafai,Yassaman %A Hilberg,Evan %A Braunscheidel Duru,Erin %A Worthington,Laryessa %A Lachenmayr,Lisa %+ School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, 118 Milam Hall, Corvallis, OR, 97331, United States, 1 3019080779, stephanie.grutzmacher@oregonstate.edu %K text messaging %K retention %K diet, food, and nutrition %K food assistance %K parents %K survival analysis %D 2019 %7 21.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Text-based programs have been shown to effectively address a wide variety of health issues. Although little research examines short message service (SMS) text messaging program characteristics that predict participant retention and attrition, features of SMS text message programs, such as program duration and intensity, message content, and the participants’ context, may have an impact. The impact of stop messages—messages with instructions for how to drop out of an SMS text message program—may be particularly important to investigate. Objective: The aim of this study was to describe attrition from Text2BHealthy, a text-based nutrition and physical activity promotion program for parents of low-income elementary school children, and to determine the impact of message content and number of stop messages received on attrition. Methods: Using data from 972 parents enrolled in Text2BHealthy, we created Kaplan-Meier curves to estimate differences in program duration for different SMS text message types, including nutrition, physical activity, stop, and other messages. Covariates, including rurality and number of stop messages received, were included. Results: Retention rates by school ranged from 74% (60/81) to 95.0% (132/139), with an average retention rate of 85.7% (833/972) across all schools. Program duration ranged from 7 to 282 days, with a median program duration of 233 days and an average program duration of 211.7 days. Among those who dropped out, program duration ranged from 7 to 247 days, with a median program duration of 102.5 days. Receiving a stop message increased the probability of attrition compared with receiving messages about nutrition, physical activity, or other topics (hazard ratio=51.5, 95% CI 32.46-81.7; P<.001). Furthermore, each additional stop message received increased the probability of attrition (hazard ratio=10.36, 95% CI 6.14-17.46; P<.001). The degree of rurality also had a significant effect on the probability of attrition, with metropolitan county participants more likely to drop out of the program than rural county participants. The interaction between SMS text message type and total number of stop messages received had a significant effect on attrition, with the effect of the number of stop messages received dependent on the SMS text message type. Conclusions: This study demonstrates the potential of SMS text message programs to retain participants over time. Furthermore, this study suggests that the probability of attrition increases substantially when participants receive messages with instructions for dropping out of the program. Program planners should carefully consider the impact of stop messages and other program content and characteristics on program retention. Additional research is needed to identify participant, programmatic, and contextual predictors of program duration and to explicate the relationship between program duration and program efficacy. %M 30664489 %R 10.2196/mhealth.9967 %U https://mhealth.jmir.org/2019/1/e9967/ %U https://doi.org/10.2196/mhealth.9967 %U http://www.ncbi.nlm.nih.gov/pubmed/30664489 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12199 %T Feasibility and Acceptability of Technology-Based Exercise and Posture Training in Older Adults With Age-Related Hyperkyphosis: Pre-Post Study %A Katzman,Wendy B %A Gladin,Amy %A Lane,Nancy E %A Wong,Shirley %A Liu,Felix %A Jin,Chengshi %A Fukuoka,Yoshimi %+ Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, 1500 Owens Street, Suite 400, San Francisco, CA, 94158, United States, 1 415 514 6776, wendy.katzman@ucsf.edu %K acceptability %K exercise %K feasibility %K hyperkyphosis %K kyphosis %K posture %K spine %K technology-based %D 2019 %7 21.01.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Hyperkyphosis is common among older adults and is associated with multiple adverse health outcomes. Kyphosis-specific exercise and posture training programs improve hyperkyphosis, but in-person programs are expensive to implement and maintain over long periods. It is unclear if a technology-based posture training program disseminated through a mobile phone is a feasible or acceptable alternative to in-person training among older adults with hyperkyphosis. Objective: The primary purpose was to assess the feasibility of subject recruitment, short-term retention and adherence, and acceptability of a technology-based exercise and posture training program disseminated as video clip links and text messaging prompts via a mobile phone. The secondary purpose was to explore the potential efficacy of this program for kyphosis, physical function, and health-related quality of life in older adults with hyperkyphosis. Methods: In this 6-week pre-post design pilot trial, we recruited community-dwelling adults aged ≥65 years with hyperkyphosis ≥40° (±5°) and access to a mobile phone. The intervention had two parts: (1) exercise and posture training via video clips sent to participants daily via text messaging, including 6 weekly video clip links to be viewed on the participant’s mobile phone, and (2) text messaging prompts to practice good posture. We analyzed the subject recruitment, adherence, retention, and acceptability of the intervention. Outcomes included change in kyphometer-measured kyphosis, occiput-to-wall (OTW) distance, Short Physical Performance Battery score, Scoliosis Research Society (SRS-30) score, Center for Epidemiological Studies Depression score, and Physical Activity Scale for the Elderly (PASE) score. Results: A total of 64 potential participants were recruited, 17 were enrolled, and 12 completed postintervention testing at 6 weeks. The average age was 71.6 (SD 4.9) years, and 50% were women. The median adherence to daily video viewing was 100% (range, 14%-100%) and to practicing good posture at least three times per day was 71% (range, 0%-100%). Qualitative evaluation of intervention acceptability revealed that the mobile phone screen was too small for participants to view the videos well and daily prompts to practice posture were too frequent. Kyphosis, OTW distance, and physical activity significantly improved after the 6-week intervention. Kyphosis decreased by 8° (95% CI –12 to –5; P<.001), OTW decreased by 1.9 cm (95% CI –3.3 to –0.7; P=.007), and physical activity measured by PASE increased by 29 points (95% CI 3 to 54; P=.03). The health-related quality of life SRS-30 score increased by 0.11 point (SD 0.19), but this increase was not statistically significant (P=.09). Conclusions: Technology-based exercise and posture training using video clip viewing and text messaging reminders is feasible and acceptable for a small cohort of older adults with hyperkyphosis. Technology-based exercise and posture training warrants further study as a potential self-management program for age-related hyperkyphosis, which may be more easily disseminated than in-person training. %M 31363712 %R 10.2196/12199 %U http://aging.jmir.org/2019/1/e12199/ %U https://doi.org/10.2196/12199 %U http://www.ncbi.nlm.nih.gov/pubmed/31363712 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e12297 %T The Efficacy of Mobile Phone Apps for Lifestyle Modification in Diabetes: Systematic Review and Meta-Analysis %A Wu,Xinghan %A Guo,Xitong %A Zhang,Zhiwei %+ eHealth Research Institute, School of Management, Harbin Institute of Technology, 92 West Dazhi Street, Nangang District, Harbin,, China, 86 451 86414022, xitongguo@gmail.com %K smartphone %K mobile applications %K diabetes mellitus %K lifestyle %K physical activity %K diet %K behavior therapy %D 2019 %7 15.01.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Diabetes and related complications are estimated to cost US $727 billion worldwide annually. Type 1 diabetes, type 2 diabetes, and gestational diabetes are three subtypes of diabetes that share the same behavioral risk factors. Efforts in lifestyle modification, such as daily physical activity and healthy diets, can reduce the risk of prediabetes, improve the health levels of people with diabetes, and prevent complications. Lifestyle modification is commonly performed in a face-to-face interaction, which can prove costly. Mobile phone apps provide a more accessible platform for lifestyle modification in diabetes. Objective: This review aimed to summarize and synthesize the clinical evidence of the efficacy of mobile phone apps for lifestyle modification in different subtypes of diabetes. Methods: In June 2018, we conducted a literature search in 5 databases (Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, and PsycINFO). We evaluated the studies that passed screening using The Cochrane Collaboration’s risk of bias tool. We conducted a meta-analysis for each subtype on the mean difference (between intervention and control groups) at the posttreatment glycated hemoglobin (HbA1c) level. Where possible, we analyzed subgroups for short-term (3-6 months) and long-term (9-12 months) studies. Heterogeneity was assessed using the I2 statistic. Results: We identified total of 2669 articles through database searching. After the screening, we included 26 articles (23 studies) in the systematic review, of which 18 studies (5 type 1 diabetes, 11 type 2 diabetes, and 2 prediabetes studies) were eligible for meta-analysis. For type 1 diabetes, the overall effect on HbA1c was statistically insignificant (P=.46) with acceptable heterogeneity (I2=39%) in the short-term subgroup (4 studies) and significant heterogeneity between the short-term and long-term subgroups (I2=64%). Regarding type 2 diabetes, the overall effect on HbA1c was statistically significant (P<.01) in both subgroups, and when the 2 subgroups were combined, there was virtually no heterogeneity within and between the subgroups (I2 range 0%-2%). The effect remained statistically significant (P<.01) after adjusting for publication bias using the trim and fill method. For the prediabetes condition, the overall effect on HbA1c was statistically insignificant (P=.67) with a large heterogeneity (I2=65%) between the 2 studies. Conclusions: There is strong evidence for the efficacy of mobile phone apps for lifestyle modification in type 2 diabetes. The evidence is inconclusive for the other diabetes subtypes. %M 30664494 %R 10.2196/12297 %U http://mhealth.jmir.org/2019/1/e12297/ %U https://doi.org/10.2196/12297 %U http://www.ncbi.nlm.nih.gov/pubmed/30664494 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e10421 %T Identifying Brief Message Content for Interventions Delivered via Mobile Devices to Improve Medication Adherence in People With Type 2 Diabetes Mellitus: A Rapid Systematic Review %A Long,Hannah %A Bartlett,Yvonne K %A Farmer,Andrew J %A French,David P %+ Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Coupland 1 Building, Coupland Street, Manchester, M13 9PL, United Kingdom, 44 161 275 2605, david.french@manchester.ac.uk %K medication adherence %K diabetes mellitus %K systematic review %K text messaging %K mHealth %K self-management %D 2019 %7 09.01.2019 %9 Review %J J Med Internet Res %G English %X Background: Current interventions to support medication adherence in people with type 2 diabetes are generally resource-intensive and ineffective. Brief messages, such as those delivered via short message service (SMS) systems, are increasingly used in digital health interventions to support adherence because they can be delivered on a wide scale and at low cost. The content of SMS text messages is a crucial intervention feature for promoting behavior change, but it is often unclear what the rationale is for chosen wording or any underlying mechanisms targeted for behavioral change. There is little guidance for developing and optimizing brief message content for use in mobile device–delivered interventions. Objective: This review aimed to (1) identify theoretical constructs (ie, the targets that interventions aim to change) and behavioral strategies (ie, features of intervention content) found to be associated with medication adherence in patients with type 2 diabetes and (2) map these onto a standard taxonomy for behavior change techniques (BCTs, that is, active ingredients of interventions used to promote behavioral change, to produce an evidence-based set of approaches that have shown promise of improving adherence in previous studies and which could be further tested in digital health interventions. Methods: A rapid systematic review of existing relevant systematic reviews was conducted. MEDLINE and PsycINFO databases were searched from inception to April 10, 2017. Inclusion criteria were (1) systematic reviews of quantitative data if the studies reviewed identified predictors of or correlates with medication adherence or evaluated medication adherence–enhancing interventions and included adult participants taking medication to manage a chronic physical health condition, and (2) systematic reviews of qualitative studies of experiences of medication adherence for adult participants with type 2 diabetes. Data were extracted on review characteristics and BCTs, theoretical constructs, or behavioral strategies associated with improved adherence. Constructs and strategies were mapped onto the BCT version 1 taxonomy. Results: A total of 1701 references were identified; 25 systematic reviews (19 quantitative reviews, 3 qualitative reviews, and 3 mixed-method reviews) were included. Moreover, 20 theoretical constructs (eg, self-efficacy) and 19 behavioral strategies (eg, habit analysis) were identified in the included reviews. In total, 46 BCTs were identified as being related to medication adherence in type 2 diabetes (eg, habit formation, prompts or cues, and information about health consequences). Conclusions: We identified 46 promising BCTs related to medication adherence in type 2 diabetes on which the content of brief messages delivered through mobile devices to improve adherence could be based. By using explicit systematic review methods and linking our findings to a standardized taxonomy of BCTs, we have described a novel approach for the development of digital message content. Future brief message interventions that aim to support medication adherence could incorporate the identified BCTs. %M 30626562 %R 10.2196/10421 %U https://www.jmir.org/2019/1/e10421/ %U https://doi.org/10.2196/10421 %U http://www.ncbi.nlm.nih.gov/pubmed/30626562 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11246 %T Text Messaging to Enhance Mindfulness-Based Smoking Cessation Treatment: Program Development Through Qualitative Research %A Spears,Claire A %A Bell,Sharrill A %A Scarlett,Charlayne A %A Anderson,Natalie K %A Cottrell-Daniels,Cherell %A Lotfalian,Sadaf %A Bandlamudi,Maitreyi %A Grant,Amanda %A Sigurdardottir,Anna %A Carter,Brittani P %A Abroms,Lorien C %A Wetter,David W %+ Division of Health Promotion and Behavior, Georgia State University School of Public Health, 140 Decatur Street SE, Suite 612, Atlanta, GA, United States, 1 404 413 9335, cspears@gsu.edu %K mobile phone %K low socioeconomic status %K qualitative %K short message service text messaging %K smoking cessation %D 2019 %7 07.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mindfulness-based programs show promise for promoting smoking cessation in diverse populations. Mobile health strategies could increase treatment engagement and in-the-moment support, thus enhancing the effects of mindfulness-based smoking cessation interventions. However, most mobile health programs have been developed without sufficient input from the target population. Objective: By eliciting input from the target population, predominantly low socioeconomic status (SES) African American adult smokers, throughout the development of an SMS (short message service) text messaging program that teaches mindfulness for smoking cessation, we aimed for the resulting program to be optimally effective and consistent with participants’ needs and preferences. Methods: Two qualitative studies (N=25) were conducted with predominantly low SES, African American adult smokers. In Study 1 (initial qualitative input; n=15), participants engaged in focus groups to provide suggestions for program development. In Study 2 (abbreviated trial; n=10), participants received a 1-week version of the SMS text messaging program and provided feedback through in-depth interviews. Results: In Study 1, participants suggested that the SMS text messaging program should be personalized and interactive (ie, involve two-way messaging); provide strategies for coping with cravings and recovering from smoking lapses; involve relatively short, to-the-point messages; and include pictures. In Study 2, participants were highly engaged with the texts, indicated that the program was useful, and provided additional suggestions for improvement. Conclusions: Eliciting feedback from the target population throughout the intervention development process allowed for iterative revisions to increase feasibility, acceptability, and effectiveness. Overall, SMS text messaging appears to be a feasible, appealing way to provide in-the-moment personalized support and encourage mindfulness among low-income African American smokers. %M 30617043 %R 10.2196/11246 %U https://mhealth.jmir.org/2019/1/e11246/ %U https://doi.org/10.2196/11246 %U http://www.ncbi.nlm.nih.gov/pubmed/30617043 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e203 %T Comparison of mHealth and Face-to-Face Interventions for Smoking Cessation Among People Living With HIV: Meta-Analysis %A Uthman,Olalekan A %A Nduka,Chidozie U %A Abba,Mustapha %A Enriquez,Rocio %A Nordenstedt,Helena %A Nalugoda,Fred %A Kengne,Andre P %A Ekström,Anna M %+ Warwick-Centre for Applied Health Research and Delivery, Division of Health Sciences, University Warwick, Gibbet Hill campus, Coventry, CV4 7AL, United Kingdom, 44 2476573163, olalekan.uthman@warwick.ac.uk %K HIV %K mHealth %K smoking cessation %D 2019 %7 07.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The prevalence of smoking among people living with HIV (PLHIV) is higher than that reported in the general population, and it is a significant risk factor for noncommunicable diseases in this group. Mobile phone interventions to promote healthier behaviors (mobile health, mHealth) have the potential to reach a large number of people at a low cost. It has been hypothesized that mHealth interventions may not be as effective as face-to-face strategies in achieving smoking cessation, but there is no systematic evidence to support this, especially among PLHIV. Objective: This study aimed to compare two modes of intervention delivery (mHealth vs face-to-face) for smoking cessation among PLHIV. Methods: Literature on randomized controlled trials (RCTs) investigating effects of mHealth or face-to-face intervention strategies on short-term (4 weeks to <6 months) and long-term (≥6 months) smoking abstinence among PLHIV was sought. We systematically reviewed relevant RCTs and conducted pairwise meta-analyses to estimate relative treatment effects of mHealth and face-to-face interventions using standard care as comparison. Given the absence of head-to-head trials comparing mHealth with face-to-face interventions, we performed adjusted indirect comparison meta-analyses to compare these interventions. Results: A total of 10 studies involving 1772 PLHIV met the inclusion criteria. The average age of the study population was 45 years, and women comprised about 37%. In the short term, mHealth-delivered interventions were significantly more efficacious in increasing smoking cessation than no intervention control (risk ratio, RR, 2.81, 95% CI 1.44-5.49; n=726) and face-to-face interventions (RR 2.31, 95% CI 1.13-4.72; n=726). In the short term, face-to-face interventions were no more effective than no intervention in increasing smoking cessation (RR 1.22, 95% CI 0.94-1.58; n=1144). In terms of achieving long-term results among PLHIV, there was no significant difference in the rates of smoking cessation between those who received mHealth-delivered interventions, face-to-face interventions, or no intervention. Trial sequential analysis showed that only 15.16% (726/1304) and 5.56% (632/11,364) of the required information sizes were accrued to accept or reject a 25% relative risk reduction for short- and long-term smoking cessation treatment effects. In addition, sequential monitoring boundaries were not crossed, indicating that the cumulative evidence may be unreliable and inconclusive. Conclusions: Compared with face-to-face interventions, mHealth-delivered interventions can better increase smoking cessation rate in the short term. The evidence that mHealth increases smoking cessation rate in the short term is encouraging but not sufficient to allow a definitive conclusion presently. Future research should focus on strategies for sustaining smoking cessation treatment effects among PLHIV in the long term. %M 30617044 %R 10.2196/mhealth.9329 %U https://mhealth.jmir.org/2019/1/e203/ %U https://doi.org/10.2196/mhealth.9329 %U http://www.ncbi.nlm.nih.gov/pubmed/30617044 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11724 %T Mobile-Based Oral Chemotherapy Adherence–Enhancing Interventions: Scoping Review %A Skrabal Ross,Xiomara %A Gunn,Kate M %A Patterson,Pandora %A Olver,Ian %+ Cancer Research Institute, University of South Australia, GPO Box 2471, Adelaide, 5001, Australia, 61 0410900975, xioyen@gmail.com %K medication adherence %K antineoplastic agents %K neoplasms %K cell phone %K text messaging %K mobile apps %K review %K mHealth %D 2018 %7 21.12.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Adherence to oral chemotherapy is crucial to maximize treatment outcomes and avoid health complications in cancer patients. Mobile phones are widely available worldwide, and evidence that this technology can be successfully employed to increase medication adherence for the treatment of other chronic diseases (eg, diabetes) is well established. However, the extent to which there is evidence that mobile phone–based interventions improve adherence to oral chemotherapy is unknown. Objective: This scoping review aims to explore what is known about mobile phone–delivered interventions designed to enhance adherence to oral chemotherapy, to examine the reported findings on the utility of these interventions in increasing oral chemotherapy adherence, and to identify opportunities for development of future interventions. Methods: This study followed Arksey and O’Malley’s scoping review methodological framework. Results: The review search yielded 5 studies reporting on 4 interventions with adults (aged >18 years) diagnosed with diverse cancer types. All interventions were considered acceptable, useful, and feasible. The following themes were evident: text messages and mobile apps were the main methods of delivering these interventions, the 2 most commonly employed oral chemotherapy adherence–enhancing strategies were management and reporting of drug-related symptoms and reminders to take medication, the importance of stakeholders’ engagement in intervention design, and the overall positive perceptions of delivery features. Areas for future research identified by this review include the need for further studies to evaluate the impact of mobile phone–delivered interventions on adherence to oral chemotherapy as well as the relevance for future studies to incorporate design frameworks and economic evaluations and to explore the moderator effect of high anxiety, poor baseline adherence, and longer time taking prescribed drug on adherence to oral chemotherapy. Conclusions: Despite the increasing body of evidence on the use of mobile phones to deliver medication adherence–enhancing interventions in chronic diseases, literature on the oral chemotherapy context is lacking. This review showed that existing interventions are highly acceptable and useful to cancer patients. The engagement of stakeholders as well as the use of a design framework are important elements in the development of mobile phone–delivered interventions that can be translated into oncology settings. %M 30578182 %R 10.2196/11724 %U http://mhealth.jmir.org/2018/12/e11724/ %U https://doi.org/10.2196/11724 %U http://www.ncbi.nlm.nih.gov/pubmed/30578182 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11213 %T The Impact of a Maternal Education Program Through Text Messaging in Rural China: Cluster Randomized Controlled Trial %A Xie,Ri-Hua %A Tan,Hongzhuan %A Taljaard,Monica %A Liao,Yan %A Krewski,Daniel %A Du,Qingfeng %A Wen,Shi Wu %+ Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Road, Ottawa, ON, ON K1H 8L6, Canada, 1 6137378899 ext 73912, swwen@ohri.ca %K maternal education %K text messaging %K maternal health %K infant health %K cluster trial %D 2018 %7 19.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In recent years, attempts have been made to use mobile phone text messaging (short message service, SMS) to achieve positive results for a range of health issues. Reports on the impact of maternal education programs based on this widely available, inexpensive, and instant communication tool are sparse. Objective: This study aimed to explore the impact of a maternal education program through text messaging. Methods: We conducted a cluster randomized trial in a remote region in the Chinese province of Hunan between October 1, 2011, and December 31, 2012. We used county as the unit of randomization (a total of 10 counties), with half of the counties randomly allocated to the intervention arm (with maternal education material adapted from the World Health Organization being delivered by text messaging to village health workers and pregnant women alike) and the other half to the control arm (normal care without text messaging). Data on maternal and infant health outcomes and health behaviors were collected and compared between the 2 arms, with maternal and perinatal mortality as the primary outcomes. Results: A total of 13,937 pregnant women completed the follow-up and were included in the final analysis. Among them, 6771 were allocated to the intervention arm and 6966 were allocated to the control arm. At the county level, the mean (SD) of maternal mortality and perinatal mortality rate were 0.0% (0.1) and 1.3% (0.6), respectively, in the intervention arm and 0.1% (0.2) and 1.5% (0.4), respectively, in the control arm. However, these differences were not statistically significant. At the individual level, there were 3 maternal deaths (0.04%) and 84 perinatal deaths (1.24%) in the intervention arm and 6 maternal deaths (0.09%) and 101 perinatal deaths (1.45%) in the control arm. However, the differences were again not statistically significant. Conclusions: Adequate resources should be secured to launch large-scale cluster randomized trials with smaller cluster units and more intensive implementation to confirm the benefits of the text messaging–based maternal education program suggested by this trial. Trial Registration: ClinicalTrials.gov NCT01775150; https://clinicaltrials.gov/ct2/show/NCT01775150 (Archived by WebCite at http://www.webcitation.org/74cHmUexo) %M 30567693 %R 10.2196/11213 %U http://mhealth.jmir.org/2018/12/e11213/ %U https://doi.org/10.2196/11213 %U http://www.ncbi.nlm.nih.gov/pubmed/30567693 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e10239 %T Text Messages Sent to Household Tuberculosis Contacts in Kampala, Uganda: Process Evaluation %A Meyer,Amanda J %A Babirye,Diana %A Armstrong-Hough,Mari %A Mark,David %A Ayakaka,Irene %A Katamba,Achilles %A Haberer,Jessica E %A Davis,J Lucian %+ Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, 60 College Street, PO Box 208034, New Haven, CT, 06520, United States, 1 203 785 3665, lucian.davis@yale.edu %K Africa %K fidelity %K implementation %K intervention %K short message service %K tuberculosis %D 2018 %7 20.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Previous studies have reported the inconsistent effectiveness of text messaging (short message service, SMS) for improving health outcomes, but few have examined to what degree the quality, or “fidelity,” of implementation may explain study results. Objective: The aim of this study was to determine the fidelity of a one-time text messaging (SMS) intervention to promote the uptake of tuberculosis evaluation services among household contacts of index patients with tuberculosis. Methods: From February to June 2017, we nested a process evaluation of text message (SMS) delivery within the intervention arm of a randomized controlled trial of tuberculosis contact investigation in Kampala, Uganda. Because mobile service providers in Uganda do not provide delivery confirmations, we asked household tuberculosis contacts to confirm the receipt of a one-time tuberculosis-related text message (SMS) by sending a text message (SMS) reply through a toll-free “short code.” Two weeks later, a research officer followed up by telephone to confirm the receipt of the one-time text message (SMS) and administer a survey. We considered participants lost to follow-up after 3 unsuccessful call attempts on 3 separate days over a 1-week period. Results: Of 206 consecutive household contacts, 119 had a text message (SMS) initiated from the server. While 33% (39/119) were children aged 5-14 years, including 20% (24/119) girls and 13% (15/119) boys, 18 % (21/119) were adolescents or young adults, including 12% (14/119) young women and 6% (7/119) young men. 50% (59/119) were adults, including 26% (31/119) women and 24% (28/119) men. Of 107 (90%) participants for whom we could ascertain text message (SMS) receipt status, 67% (72/107) confirmed text message (SMS) receipt, including 22% (24/107) by reply text message (SMS) and 45% (48/107) during the follow-up telephone survey. No significant clinical or demographic differences were observed between those who did and did not report receiving the text message (SMS). Furthermore, 52% (56/107) reported ever reading the SMS. The cumulative likelihood of a text message (SMS) reaching its target and being read and retained by a participant was 19%. Conclusions: The fidelity of a one-time text message (SMS) intervention to increase the uptake of household tuberculosis contact investigation and linkage to care was extremely low, a fact only discoverable through detailed process evaluation. This study suggests the need for systematic process monitoring and reporting of implementation fidelity in both research studies and programmatic interventions using mobile communications to improve health. %M 30459147 %R 10.2196/10239 %U http://mhealth.jmir.org/2018/11/e10239/ %U https://doi.org/10.2196/10239 %U http://www.ncbi.nlm.nih.gov/pubmed/30459147 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 11 %P e11289 %T The Ready to Reduce Risk (3R) Study for a Group Educational Intervention With Telephone and Text Messaging Support to Improve Medication Adherence for the Primary Prevention of Cardiovascular Disease: Protocol for a Randomized Controlled Trial %A Byrne,Jo L %A Dallosso,Helen M %A Rogers,Stephen %A Gray,Laura J %A Waheed,Ghazala %A Patel,Prashanth %A Gupta,Pankaj %A Doherty,Yvonne %A Davies,Melanie %A Khunti,Kamlesh %+ Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, United Kingdom, 44 116 258 4005, kk22@leicester.ac.uk %K medication adherence %K cardiovascular diseases %K primary prevention %K educational intervention %K telephone support %K text messaging support %D 2018 %7 12.11.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Poor adherence to cardiovascular medications is associated with worse clinical outcomes. Evidence for effective education interventions that address medication adherence for the primary prevention of cardiovascular disease is lacking. The Ready to Reduce Risk (3R) study aims to investigate whether a complex intervention, involving group education plus telephone and text messaging follow-up support, can improve medication adherence and reduce cardiovascular risk. Objective: This protocol paper details the design and rationale for the development of the 3R intervention and the study methods used. Methods: This is an open and pragmatic randomized controlled trial with 12 months of follow-up. We recruited participants from primary care and randomly assigned them at a 1:1 frequency, stratified by sex and age, to either a control group (usual care from a general practitioner) or an intervention group involving 2 facilitated group education sessions with telephone and text messaging follow-up support, with a theoretical underpinning and using recognized behavioral change techniques. The primary outcome was medication adherence to statins. The primary measure was an objective, novel, urine-based biochemical measure of medication adherence. We also used the 8-item Morisky Medication Adherence Scale to assess medication adherence. Secondary outcomes were changes in total cholesterol, blood pressure, high-density lipoprotein, total cholesterol to high-density lipoprotein ratio, body mass index, waist to hip ratio, waist circumference, smoking behavior, physical activity, fruit and vegetable intake, patient activation level, quality of life, health status, health and medication beliefs, and overall cardiovascular disease risk score. We also considered process outcomes relating to acceptability and feasibility of the 3R intervention. Results: We recruited 212 participants between May 2015 and March 2017. The 12-month follow-up data collection clinics were completed in April 2018, and data analysis will commence once all study data have been collected and verified. Conclusions: This study will identify a potentially clinically useful and effective educational intervention for the primary prevention of cardiovascular disease. Medication adherence to statins is being assessed using a novel urine assay as an objective measure, in conjunction with other validated measures. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN16863160; http://www.isrctn.com/ISRCTN16863160 (Archived by WebCite at http://www.webcitation.org/734PqfdQw) International Registered Report Identifier (IRRID): DERR1-10.2196/11289 %M 30425027 %R 10.2196/11289 %U http://www.researchprotocols.org/2018/11/e11289/ %U https://doi.org/10.2196/11289 %U http://www.ncbi.nlm.nih.gov/pubmed/30425027 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e10190 %T Insights From a Text Messaging–Based Sexual and Reproductive Health Information Program in Tanzania (m4RH): Retrospective Analysis %A Olsen,Patrick S %A Plourde,Kate F %A Lasway,Christine %A van Praag,Eric %+ Health Services Research, Global Health, Population, and Nutrition, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, United States, 1 919 544 7040 ext 11713, polsen@fhi360.org %K data analysis %K mobile phone %K mHealth %K short message service %K user engagement %D 2018 %7 01.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many mobile health (mHealth) interventions have the potential to generate and store vast amounts of system-generated participant interaction data that could provide insight into user engagement, programmatic strengths, and areas that need improvement to maximize efficacy. However, despite the popularity of mHealth interventions, there is little documentation on how to use these data to monitor and improve programming or to evaluate impact. Objective: This study aimed to better understand how users of the Mobile for Reproductive Health (m4RH) mHealth intervention engaged with the program in Tanzania from September 2013 to August 2016. Methods: We conducted secondary data analysis of longitudinal data captured by system logs of participant interactions with the m4RH program from 127 districts in Tanzania from September 2013 to August 2016. Data cleaning and analysis was conducted using Stata 13. The data were examined for completeness and “correctness.” No missing data was imputed; respondents with missing or incorrect values were dropped from the analyses. Results: The total population for analysis included 3,673,702 queries among 409,768 unique visitors. New users represented roughly 11.15% (409,768/3,673,702) of all queries. Among all system queries for new users, 46.10% (188,904/409,768) users accessed the m4RH main menu. Among these users, 89.58% (169,218/188,904) accessed specific m4RH content on family planning, contraceptive methods, adolescent-specific and youth-specific information, and clinic locations after first accessing the m4RH main menu. The majority of these users (216,422/409,768, 52.82%) requested information on contraceptive methods; fewer users (23,236/409,768, 5.67%) requested information on clinic location. The conversion rate was highest during the first and second years of the program when nearly all users (11,246/11,470, 98.05%, and 33,551/34,830, 96.33%, respectively) who accessed m4RH continued on to query more specific content from the system. The rate of users that accessed m4RH and became active users declined slightly from 98.05% (11,246/11,470) in 2013 to 87.54% (56,696/64,765) in 2016. Overall, slightly more than one-third of all new users accessing m4RH sent queries at least once per month for 2 or more months, and 67.86% (278,088/409,768) of new and returning users requested information multiple times per month. Promotional periods were present for 15 of 36 months during the study period. Conclusions: The analysis of the rich data captured provides a useful framework with which to measure the degree and nature of user engagement utilizing routine system-generated data. It also contributes to knowledge of how users engage with text messaging (short message service)-based health promotion interventions and demonstrates how data generated on user interactions could inform improvements to the design and delivery of a service, thereby enhancing its effectiveness. %M 30389651 %R 10.2196/10190 %U https://mhealth.jmir.org/2018/11/e10190/ %U https://doi.org/10.2196/10190 %U http://www.ncbi.nlm.nih.gov/pubmed/30389651 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 3 %N 4 %P e15 %T Improved Diabetes Care Management Through a Text-Message Intervention for Low-Income Patients: Mixed-Methods Pilot Study %A Watterson,Jessica L %A Rodriguez,Hector P %A Shortell,Stephen M %A Aguilera,Adrian %+ Center for Healthcare Organizational and Innovation Research, School of Public Health, University of California, Berkeley, University Hall, Berkeley, CA, 94720, United States, 1 3602014410, jwatterson@berkeley.edu %K diabetes mellitus, type 2 %K text messaging %K telemedicine %K health education %K qualitative research %K poverty %K Hispanic Americans %D 2018 %7 30.10.2018 %9 Original Paper %J JMIR Diabetes %G English %X Background: Diabetes is a major contributor to global death and disability. Text-messaging interventions hold promise for improving diabetes outcomes through better knowledge and self-management. Objective: The aim of this study was to examine the implementation and impact of a diabetes text-messaging program targeted primarily for low-income Latino patients receiving care at 2 federally qualified health centers (FQHCs). Methods: A mixed-methods, quasi-experimental research design was employed for this pilot study. A total of 50 Spanish or English-speaking adult patients with diabetes attending 2 FQHC sites in Los Angeles from September 2015 to February 2016 were enrolled in a 12-week, bidirectional text-messaging program. A comparison group (n=160) was constructed from unexposed, eligible patients. Demographic data and pre/post clinical indicators were compared for both the groups. Propensity score weighting was used to reduce selection bias, and over-time differences in clinical outcomes between groups were estimated using individual fixed-effects regression models. Population-averaged linear models were estimated to assess differential effects of patient engagement on each clinical indicator among the intervention participants. A sample of intervention patients (n=11) and all implementing staff (n=8) were interviewed about their experiences with the program. Qualitative data were transcribed, translated, and analyzed to identify common themes. Results: The intervention group had a mean glycated hemoglobin (HbA1c) reduction of 0.4 points at follow-up, relative to the comparison group (P=.06). Patients who were more highly engaged with the program (response rate ≥median of 64.5%) experienced a 2.2 point reduction in HbA1c, relative to patients who were less engaged, controlling for demographic characteristics (P<.001). Qualitative analyses revealed that many participants felt supported, as though “someone was worrying about [their] health.” Participants also cited learning new information, setting new goals, and receiving helpful reminders. Staff and patients highlighted strategies to improve the program, including incorporating patient responses into in-person clinical care and tailoring the messages to patient knowledge. Conclusions: A diabetes text-messaging program provided instrumental and emotional support for participants and may have contributed to clinically meaningful improvements in HbA1c. Patients who were more engaged demonstrated greater improvement. Program improvements, such as linkages to clinical care, hold potential for improving patient engagement and ultimately, improving clinical outcomes. %M 30377141 %R 10.2196/diabetes.8645 %U http://diabetes.jmir.org/2018/4/e15/ %U https://doi.org/10.2196/diabetes.8645 %U http://www.ncbi.nlm.nih.gov/pubmed/30377141 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e11039 %T A Short Message Service Intervention for Improving Infant Feeding Practices in Shanghai, China: Planning, Implementation, and Process Evaluation %A Jiang,Hong %A Li,Mu %A Wen,Li Ming %A Baur,Louise A %A He,Gengsheng %A Ma,Xiaoying %A Qian,Xu %+ Global Health Institute, School of Public Health, Fudan University, Mailbox 175, No. 138 Yixueyuan Road, Shanghai, 200032, China, 86 21 64179976, h_jiang@fudan.edu.cn %K mHealth %K short message service %K breastfeeding %K infant feeding practices %K health services %K planning and development %K implementation %K process evaluation %D 2018 %7 29.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although mobile health (mHealth) has been widely applied in health care services, few studies have reported the detailed process of the development and implementation of text messaging (short message service, SMS) interventions. Objective: Our study aims to demonstrate the process and lessons learned from a community-based text messaging (SMS) intervention for improving infant feeding in Shanghai, China. Methods: The intervention included planning and development, implementation, and process evaluation. A 3-phase process was adopted during planning and development: (1) a formative study with expectant and new mothers to explore the barriers of appropriate infant feeding practices; (2) a baseline questionnaire survey to understand potential intervention approaches; and (3) development of the text message bank. The text messaging intervention was delivered via a computer-based platform. A message bank was established before the start of the intervention containing information on the benefits of breastfeeding, preparing for breastfeeding, early initiation of breastfeeding, timely introduction of complementary foods, and establishing appropriate feeding practices, etc. An expert advisory committee oversaw the content and quality of the message bank. Process evaluation was conducted through field records and qualitative interviews with participating mothers. Results: We found that the text messaging intervention was feasible and well received by mothers because of its easy and flexible access. The weekly based message frequency was thought to be appropriate, and the contents were anticipatory and trustworthy. Some mothers had high expectations for timely response to inquiries. Occasionally, the text messages were not delivered due to unstable telecommunication transmission. Mothers suggested that the messages could be more personalized. Conclusions: This study demonstrates the feasibility and value of text messaging intervention in filling gaps in delivering health care services and promoting healthy infant feeding practices in settings where personal contact is limited. %M 30373728 %R 10.2196/11039 %U http://mhealth.jmir.org/2018/10/e11039/ %U https://doi.org/10.2196/11039 %U http://www.ncbi.nlm.nih.gov/pubmed/30373728 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e9 %T Mobile Phone Access and Willingness Among Mothers to Receive a Text-Based mHealth Intervention to Improve Prenatal Care in Northwest Ethiopia: Cross-Sectional Study %A Endehabtu,Berhanu %A Weldeab,Adane %A Were,Martin %A Lester,Richard %A Worku,Abebaw %A Tilahun,Binyam %+ eHealthLab Ethiopia, Department of Health Informatics, University of Gondar, PO Box 196, Gondar,, Ethiopia, 251 913875066, binigcms@gmail.com %K mHealth %K mobile phone %K pregnant women %K SMS %K willingness %K Ethiopia %K antenatal care %K maternal health %D 2018 %7 17.10.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Maternal mortality remains high in many low- and middle-income countries where limited access to health services is linked to low antenatal care utilization. Effective communication and engagement with care providers are vital for the delivery and receipt of sufficient health care services. There is strong evidence that simple text-based interventions can improve the prenatal care utilization, but most mobile health (mHealth) interventions are not implemented on a larger scale owing to the lack of context and preliminary evidence on how to make the transition. Objective: The objective of this study was to determine access to mobile phones by pregnant women attending antenatal care as well as willingness to receive a text message (short message service, SMS)–based mHealth intervention for antenatal care services and identify its associated factors among pregnant women attending an antenatal care clinic in Gondar Town Administration, Northwest Ethiopia, Africa. Methods: A cross-sectional quantitative study was conducted among 422 pregnant women attending antenatal care from March 27 to April 28, 2017. Data were collected using structured questionnaires. Data entry and analysis were performed using Epi-Info version 7 and SPSS version 20, respectively. In addition, descriptive statistics and bivariable and multivariable logistic regression analyses were performed. Furthermore, odds ratio with 95% CI was used to identify factors associated with the willingness to receive a text message–based mHealth intervention. Results: A total of 416 respondents (response rate 98.6%, 416/422) were included in the analysis. About 76.7% (319/416) of respondents owned a mobile phone and 71.2% (296/416) were willing to receive an SMS text message. Among the mobile phone owners, only 37.6% (120/319) were having smartphones. Of all women with mobile phones, 89.7% (286/319) described that they are the primary holders of these phones and among them, 85.0% (271/319) reported having had the same phone number for more than a year. Among the phone owners, 90.0% (287/319) described that they could read and 86.8% (277/416) could send SMS text messages using their mobile phones in their day-to-day activities. Among pregnant women who were willing to receive SMS text messages, about 96.3% (285/296) were willing to receive information regarding activities or things to avoid during pregnancy. Factors associated with willingness were youth age group (adjusted odds ratio [AOR] 2.869, 95% CI 1.451-5.651), having attained secondary and higher educational level (AOR 4.995, 95% CI 1.489-14.773), and the frequency of mobile phone use (AOR 0.319, 95% CI 0.141-0.718). Conclusions: A high proportion of pregnant women in an antenatal care clinic in this remote setting have a mobile phone and are willing to receive an SMS text message–based mHealth intervention. Age, educational status, and the frequency of mobile phone use are significantly associated with the willingness to receive SMS text message–based mHealth interventions. %M 31518334 %R 10.2196/pediatrics.9618 %U http://pediatrics.jmir.org/2018/2/e9/ %U https://doi.org/10.2196/pediatrics.9618 %U http://www.ncbi.nlm.nih.gov/pubmed/31518334 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 10 %P e10977 %T Mobile Phone Text Messaging for Tobacco Risk Communication Among Young Adult Community College Students: Protocol and Baseline Overview for a Randomized Controlled Trial %A Prokhorov,Alexander V %A Khalil,Georges Elias %A Calabro,Karen Sue %A Machado,Tamara Costello %A Russell,Sophia %A Czerniak,Katarzyna W %A Botello,Gabrielle C %A Chen,Minxing %A Perez,Adriana %A Vidrine,Damon J %A Perry,Cheryl L %+ Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, 1155 Pressler Street, Unit 1330, Houston, TX,, United States, 1 713 563 2605, aprokhor@mdanderson.org %K tobacco use %K risk %K perception %K text messaging %K young adult %D 2018 %7 15.10.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Community-college students are at high risk for tobacco use. Because the use of mobile phone text messaging is nearly ubiquitous today, short message service (SMS) may be an effective strategy for tobacco risk communication in this population. Little is known, however, concerning the message structure significantly influencing perceived tobacco risk. Objective: We aim to outline the rationale and design of Project Debunk, a randomized trial comparing the effects of different SMS text message structures. Methods: We conducted a 6-month randomized trial comparing 8 arms, based on the combination of the 3 message structures delivered to young adults in a 2×2×2 study design: framing (gain-framed or loss-framed), depth (simple or complex), and appeal (emotional or rational). Participants were invited to participate from 3 community colleges in Houston from September 2016 to July 2017. Participants were randomized to 1 arm and received text messages in 2 separate campaigns. Each campaign consisted of 2 text messages per day for 30 days. Perceived tobacco risk was assessed at baseline, 2 months after the first campaign, and 2 months after the second campaign. We assessed the perceived risk of using conventional products (eg, combustible cigarettes) and new and emerging products (eg, electronic cigarettes). The validity of message structures was assessed weekly for each campaign. A 1-week follow-up assessment was also conducted to understand immediate reactions from participants. Results: We completed data collection for the baseline survey on a rolling basis during this time and assessed the validity of the message structure after 1 week of SMS text messages. For the entire sample (N=636), the average age was 20.92 years (SD 2.52), about two-thirds were male (430/636, 67.6%), and most were black or African American (259/636, 40.7%) or white (236/636, 37.1%). After 1 week of receiving text messages, the following was noted: (a) loss-framed messages were more likely to be perceived as presenting a loss than gain-framed messages (F7,522=13.13, P<.001), (b) complex messages were perceived to be more complex than simple messages (F7,520=2.04, P=.05), and (c) emotional messages were perceived to be more emotionally involving than rational messages (F7,520=6.46, P<.001). Conclusions: This study confirms that the recruitment, randomization, and message composition have been successfully implemented. Further analyses will identify specific types of messages that are more effective than others in increasing the perceived risk of tobacco use. If our results suggest that any of the 8 specific message structures are more effective for helping young adults understand tobacco risk, this would provide evidence to include such messages as part of a larger technology-based campaign such as mobile phone apps, entertainment-based campaigns, and social media. Trial Registration: ClinicalTrials.gov NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480 (Archived by WebCite at http://www.webcitation.org/6ykd4IIap) Registered Report Identifier: RR1-10.2196/10977 %M 30322833 %R 10.2196/10977 %U http://www.researchprotocols.org/2018/10/e10977/ %U https://doi.org/10.2196/10977 %U http://www.ncbi.nlm.nih.gov/pubmed/30322833 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 9 %P e10799 %T Text Messaging Interventions for Improvement in Physical Activity and Sedentary Behavior in Youth: Systematic Review %A Ludwig,Kim %A Arthur,Rosie %A Sculthorpe,Nicholas %A Fountain,Hollie %A Buchan,Duncan S %+ Institute of Clinical Exercise and Health Science, School of Health and Life Sciences, University of the West of Scotland, Stephenson Place, Hamilton International Technology Park, Blantyre, G72 0LH, United Kingdom, 44 1698 283100 ext 8508, duncan.buchan@uws.ac.uk %K review %K exercise %K sedentary lifestyle %K text messaging %K cell phone %K telemedicine %K adolescent %D 2018 %7 17.09.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The use of text messages (short message service, SMS) to change physical activity and sedentary behavior in youth is of interest due to the need for novel, more effective intervention approaches. Previous reviews have examined a variety of technology-based interventions and their impact on different health behaviors, but evidence regarding the impact of just SMS on physical activity and sedentary behavior is lacking. Objective: The aim of this study was to assess the effectiveness and use of theory of SMS interventions for improving physical activity and sedentary behavior in youth. Methods: Authors systematically searched electronic databases from March to November 2017. Citations were sifted using additional reviewers, and a qualitative synthesis of eligible studies was conducted using piloted data extraction forms. To be eligible for inclusion, studies had to be of a randomized controlled or quasi-experimental design, incorporate SMS, involve adolescents between the ages of 10 and 19 years, and assess at least one physical activity or sedentary behavior outcome. Risk of bias was assessed using the Cochrane Collaboration’s Risk of Bias tool. Results: A total of 13 studies reporting 11 interventions were included in the qualitative analysis. Studies included interventions that were conducted in schools, online, or face-to-face. Studies were of high heterogeneity with regard to study duration, participant characteristics, intervention content, and outcome measures. Findings were equivocal with regard to intervention effectiveness for physical activity and sedentary behavior. Overall, 7 interventions resulted in an improvement for physical activity and 6 for sedentary behavior. All studies were judged to be of high risk of bias for at least 1 item. Conclusions: Some studies in this review showed promising results for using SMS to improve physical activity and sedentary behavior in youth. High heterogeneity of design and outcome measures precluded data pooling and conclusions as to which specific intervention elements are linked to increased effectiveness cannot be drawn. The authors propose incorporating the following elements in future studies: specific focus on desired health behavior; mixed-methods design; include long-term follow-up; include self-monitoring, goal setting, and feedback; combine SMS with a mobile app; and send 3 or more SMS text messages per week. More rigorous studies are needed to explore the relationship between intervention effectiveness and specific intervention components such as content and delivery. %M 30224335 %R 10.2196/10799 %U http://mhealth.jmir.org/2018/9/e10799/ %U https://doi.org/10.2196/10799 %U http://www.ncbi.nlm.nih.gov/pubmed/30224335 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 9 %P e10074 %T A Smartphone App and Personalized Text Messaging Framework (InDEx) to Monitor and Reduce Alcohol Use in Ex-Serving Personnel: Development and Feasibility Study %A Leightley,Daniel %A Puddephatt,Jo-Anne %A Jones,Norman %A Mahmoodi,Toktam %A Chui,Zoe %A Field,Matt %A Drummond,Colin %A Rona,Roberto J %A Fear,Nicola T %A Goodwin,Laura %+ King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Cutcombe Road, London, SE5 9RJ, United Kingdom, 44 78485334, daniel.leightley@kcl.ac.uk %K behavior change techniques %K smartphone %K alcohol misuse %K binge drinking %K text messaging %K ex-serving %K armed forces %K mobile phones %D 2018 %7 11.09.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Self-reported alcohol misuse remains high in armed forces personnel even after they have left service. More than 50% of ex-serving personnel meet the criteria for hazardous alcohol use; however, many fail to acknowledge that they have a problem. Previous research indicates that interventions delivered via smartphone apps are suitable in promoting self-monitoring of alcohol use, have a broad reach, and may be more cost-effective than other types of brief interventions. There is currently no such intervention specifically designed for the armed forces. Objective: This study sought to describe the development of a tailored smartphone app and personalized text messaging (short message service, SMS) framework and to test the usability and feasibility (measured and reported as user engagement) of this app in a hard-to-engage ex-serving population. Methods: App development used Agile methodology (an incremental, iterative approach used in software development) and was informed by behavior change theory, participant feedback, and focus groups. Participants were recruited between May 2017 and June 2017 from an existing United Kingdom longitudinal military health and well-being cohort study, prescreened for eligibility, and directed to download either Android or iOS versions of the ”Information about Drinking for Ex-serving personnel” (InDEx) app. Through the app, participants were asked to record alcohol consumption, complete a range of self-report measures, and set goals using implementation intentions (if-then plans). Alongside the app, participants received daily automated personalized text messages (SMS) corresponding to specific behavior change techniques with content informed by the health action process approach with the intended purpose of promoting the use of the drinks diary, suggesting alternative behaviors, and providing feedback on goals setting. Results: Invitations to take part in the study were sent to ex-serving personnel, 22.6% (31/137) of whom accepted and downloaded the app. Participants opened the InDEx app a median of 15.0 (interquartile range [IQR] 8.5-19.0) times during the 4 week period (28 days), received an average of 36.1 (SD 3.2) text messages (SMS), consumed alcohol on a median of 13.0 (IQR 11.0-15.0) days, and consumed a median of 5.6 (IQR 3.3-11.8) units per drinking day in the first week, which decreased to 4.7 (IQR 2.0-6.9) units by the last week and remained active for 4.0 (IQR 3.0-4.0) weeks. Conclusions: Personnel engaged and used the app regularly as demonstrated by the number of initializations, interactions, and time spent using InDEx. Future research is needed to evaluate the engagement with and efficacy of InDEx for the reduction of alcohol consumption and binge drinking in an armed forces population. %M 30206054 %R 10.2196/10074 %U http://mhealth.jmir.org/2018/9/e10074/ %U https://doi.org/10.2196/10074 %U http://www.ncbi.nlm.nih.gov/pubmed/30206054 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 9 %P e10274 %T Development and Feasibility Testing of an mHealth (Text Message and WeChat) Intervention to Improve the Medication Adherence and Quality of Life of People Living with HIV in China: Pilot Randomized Controlled Trial %A Guo,Yan %A Xu,Zhimeng %A Qiao,Jiaying %A Hong,Y Alicia %A Zhang,Hanxi %A Zeng,Chengbo %A Cai,Weiping %A Li,Linghua %A Liu,Cong %+ Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, 212 Adriance Lab Road, MS 1266, College Station, TX, 77843, United States, 1 979 436 9343, yhong@sph.tamhsc.edu %K mHealth %K social media %K medication adherence %K people living with HIV %K randomized controlled trial %D 2018 %7 04.09.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Most people living with HIV (PLWH) reside in middle- and low-income countries with limited access to health services. Thus, cost-effective interventions that can reach a large number of PLWH are urgently needed. Objective: The objective of our study was to assess the feasibility and acceptability of an mHealth intervention among PLWH in China. Methods: Based on previous formative research, we designed an mHealth intervention program that included sending weekly reminders to participants via text messages (short message service, SMS) and articles on HIV self-management three times a week via a popular social media app WeChat. A total of 62 PLWH recruited from an HIV outpatient clinic were randomly assigned to intervention or control group. The intervention lasted for 3 months, and all participants were assessed for their medication adherence, presence of depression, quality of life (QoL), and CD4 (cluster of differentiation 4) counts. Upon completing the intervention, we interviewed 31 participants to further assess the feasibility and acceptability of the study. Results: At baseline, the intervention and control groups did not differ in terms of demographic characteristics or any of the major outcome measures. About 85% (53/62) of the participants completed the intervention, and they provided valuable feedback on the design and content of the intervention. Participants preferred WeChat as the platform for receiving information and interactive communication for ease of access. Furthermore, they made specific recommendations about building trust, interactive features, and personalized feedback. In the follow-up assessment, the intervention and control groups did not differ in terms of major outcome measures. Conclusions: This pilot study represents one of the first efforts to develop a text messaging (SMS)- and WeChat-based intervention that focused on improving the medication adherence and QoL of PLWH in China. Our data indicates that an mHealth intervention is feasible and acceptable to this population. The data collected through this pilot study will inform the future designs and implementations of mHealth interventions in this vulnerable population. We recommend more innovative mHealth interventions with rigorous designs for the PLWH in middle- and low-income countries. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800017987; http://www.chictr.org.cn/showprojen.aspx?proj=30448 (Archived by WebCite at http://www.webcitation.org/71zC7Pdzs) Registered Report Ientifier: RR1-10.2196/ %M 30181109 %R 10.2196/10274 %U http://mhealth.jmir.org/2018/9/e10274/ %U https://doi.org/10.2196/10274 %U http://www.ncbi.nlm.nih.gov/pubmed/30181109 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e173 %T Assessing the Cross-Cultural Adaptation and Translation of a Text-Based Mobile Smoking Cessation Program in Samoa (TXTTaofiTapaa): Pilot Study %A McCool,Judith %A Tanielu,Helen %A Umali,Elaine %A Whittaker,Robyn %+ Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1141, New Zealand, 64 09 373 7599 ext 82372, j.mccool@auckland.ac.nz %K mHealth %K mobile phone %K Pacific %K Samoa %K tobacco cessation %K text messages %D 2018 %7 31.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Samoa faces a persistently high prevalence of adult tobacco use and few existing cessation support services. Mobile phones are ubiquitous and generally affordable. Objective: This study aimed to adopt a text message (short message service, SMS) smoking cessation program designed in New Zealand (stop smoking with mobile phones, STOMP) for use in Samoa to assist national objectives in reducing the tobacco use. Methods: Using focus groups with smokers and ex-smokers, we explored the context for tobacco use and preferences for SMS text messages. Postintervention focus groups were held after participants received SMS text messages for 1 week. Frequent face-to-face meetings with the primary partner (Ministry of Health Samoa) and key stakeholders contributed to the adaptation process. Participatory feedback and collaboration from stakeholders became an integral part of the cultural adaptation and translation of the program. Furthermore, detailed document analyses were included as part of the formal evaluation of the initiative to explore the core determinants of success in adapting the program to the Samoan cultural context. Results: The SMS text messages evolved remarkably following an iterative process of consultation, in situ testing, revision, and retesting to arrive at an acceptable country-specific version of the mobile smoking cessation program. The SMS text messages retained in the final set were consistent with the theory of behavioral change but reflected both linguistic and cultural nuances appropriate for Samoa. Adapting messages required simultaneous multilevel processes, including complex high-level engagement, between the team and the stakeholders, along with crafting the precise content for (character limited) messages. Conclusions: Receiving cessation support messages through a mobile phone is promising and appears to be an acceptable and accessible mode of delivery for tobacco cessation, particularly in the absence of alternative support. Adapting a text-based program in Samoa requires fastidious attention to the nuances of culture, language, and sociopolitical structures in the country. %M 30170994 %R 10.2196/mhealth.9033 %U http://mhealth.jmir.org/2018/8/e173/ %U https://doi.org/10.2196/mhealth.9033 %U http://www.ncbi.nlm.nih.gov/pubmed/30170994 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 8 %P e10398 %T The Influence of Technology Delivery Mode on Intervention Outcomes: Analysis of a Theory-Based Sexual Health Program %A Levitz,Nicole %A Wood,Erica %A Kantor,Leslie %+ Planned Parenthood Federation of America, 123 William Street, New York, NY, 10038, United States, 1 9142623408, nicole.levitz@ppfa.org %K sexual and reproductive health %K public health %K text messaging %K instant messaging %K behavior theory %K internet %D 2018 %7 29.08.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: There are few studies on the role of technology delivery mode on health intervention outcomes. Furthermore, the opportunity to examine potential mode effects on a program that is theory-based and integrates principles of communication and decision-making science to influence sexual and reproductive health outcomes is a new contribution to the literature. Objective: Planned Parenthood Federation of America’s national Chat/Text program can be accessed via short message service (SMS; more commonly referred to as text messaging), Web-based desktop chatting, and mobile phone chatting. The program has been in existence since 2010 and has conducted over 1,000,000 conversations. In this study, we examined whether the mode used to access the program (SMS text, desktop chat, or mobile phone chat) affected program users’ intention to act on the action plan established in their conversation. Methods: Data were examined for a 6-month period from January 2016 to June 2016. The data were collected as a part of the monitoring and evaluation of an ongoing program. We limited our sample to the program’s priority audience of 15-24 years residing within the United States, which resulted in a sample of 64,939 conversations. Available data items for analysis included user demographics, delivery mode, topic discussed, helpfulness rating (on a 4-point scale), user confidence in following through on the intentions made during the conversation (on a 4-point scale), and educator confidence in whether the user would follow through on the stated intention. Linear and multinomial robust regression analyses were conducted to examine the relationships between conversation delivery mode and confidence. Results: No significant relationships between users’ confidence to carry out their intentions and gender or race were found. None of the 3 modalities (SMS text, desktop chat, or mobile phone chat) were significantly associated with user confidence. All the 3 modalities had significant associations with educator confidence and showed similar effect sizes to those of user confidence. Educator confidence was significantly associated with all the topics discussed. Conclusions: The Planned Parenthood Chat/Text program was designed as a tool to improve access to sexual and reproductive health care among young people. The mode of intervention delivery was not associated with users’ confidence in their ability to carry out their stated intention, suggesting that all modes are legitimate for delivering this intervention. Furthermore, each mode worked across gender and race or ethnicity, indicating that this is a modality that can work across groups. %M 30158100 %R 10.2196/10398 %U http://www.jmir.org/2018/8/e10398/ %U https://doi.org/10.2196/10398 %U http://www.ncbi.nlm.nih.gov/pubmed/30158100 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 8 %P e256 %T A Church-Based Weight Loss Intervention in African American Adults using Text Messages (LEAN Study): Cluster Randomized Controlled Trial %A Newton Jr,Robert L %A Carter,Leah A %A Johnson,William %A Zhang,Dachuan %A Larrivee,Sandra %A Kennedy,Betty M %A Harris,Melissa %A Hsia,Daniel S %+ Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, United States, 1 225 763 3034, Robert.Newton@pbrc.edu %K African Americans %K behavioral strategies %K community health %K mHealth %K mobile phone %K obesity %K text messages %K weight loss %D 2018 %7 24.08.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: African American adults experience a high prevalence of obesity and its associated comorbidities, including diabetes. Church-based interventions have been shown to be effective in decreasing weight in this population. mHealth interventions can address two needs for obesity treatment in this community, including enhancing weight loss and providing wide dissemination. Objective: This study aimed to assess the feasibility and efficacy of a church-based weight loss intervention that incorporates mHealth technology. Methods: In this study, 8 churches (n=97) were randomly assigned to the intervention or delayed intervention condition (control group). We recruited participants through their respective church. Volunteer church members were trained by study staff to deliver the 10-session, 6-month intervention. Participants in the intervention group attended group sessions and received automated short message service (SMS) text messages designed to reinforce behavioral strategies. Conversely, participants in the delayed intervention condition received SMS text messages related to health conditions relevant for African American adults. We obtained measures of body composition, blood pressure, blood glucose, and cholesterol. Results: We successfully recruited 97 African American adults, with a mean age of 56.0 (SE 10.3) years and a mean body mass index of 38.6 (SE 6.4) kg/m2 (89/97, 91.8% females), who attended the churches that were randomized to the intervention (n=68) or control (n=29) condition. Of these, 74.2% (72/97) of the participants (47/68, 69.1% intervention; 25/29, 86.2% delayed intervention) completed the 6-month assessment. The average intervention group attendance was 55%. There was a significant difference in weight loss (P=.04) between participants in the intervention (–1.5 (SE 0.5) kg) and control (0.11 (SE 0.6) kg) groups. Among participants in the intervention group, the correlation between the number of SMS text messages sent and the percent body fat loss was r=.3 with P=.04. The participants reported high satisfaction with the automated SMS text messages. Conclusions: Automated SMS text messages were well-received by participants, suggesting that more enhanced mHealth technologies are a viable option for interventions targeting African American adults. Trial Registration: ClinicalTrials.gov NCT02863887; https://clinicaltrials.gov/ct2/show/NCT02863887 (Archived by WebCite at http://www.webcitation.org/71JiYzizO) %M 30143478 %R 10.2196/jmir.9816 %U http://www.jmir.org/2018/8/e256/ %U https://doi.org/10.2196/jmir.9816 %U http://www.ncbi.nlm.nih.gov/pubmed/30143478 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e169 %T Implementing eHealth Technology to Address Gaps in Early Infant Diagnosis Services: Qualitative Assessment of Kenyan Provider Experiences %A Wexler,Catherine %A Brown,Melinda %A Hurley,Emily A %A Ochieng,Martin %A Goggin,Kathy %A Gautney,Brad %A Maloba,May %A Lwembe,Raphael %A Khamadi,Samoel %A Finocchario-Kessler,Sarah %+ Department of Family Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS,, United States, 1 913 945 7077, cwexler@kumc.edu %K early infant diagnosis (EID) %K HIV/AIDS %K eHealth %K mHealth %K implementation science %K Kenya %D 2018 %7 22.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Literature suggests that electronic health (eHealth) interventions can improve the efficiency and accuracy of health service delivery and improve health outcomes and are generally well received by patients; however, there are limited data on provider experiences using eHealth interventions in resource-limited settings. The HIV Infant Tracking System (HITSystem) is an eHealth intervention designed to improve early infant diagnosis (EID) outcomes among HIV-exposed infants. Objective: We aimed to compare provider experiences with standard EID and HITSystem implementation at 6 Kenyan hospitals and 3 laboratories. The objective of this study was to better understand provider experiences implementing and using the HITSystem in order to assess facilitators and barriers that may impact adoption and sustainability of this eHealth intervention. Methods: As part of a randomized controlled trial to evaluate the HITSystem, we conducted semistructured interviews with 17 EID providers at participating intervention and control hospitals and laboratories. Results: Providers emphasized the perceived usefulness of the HITSystem, including improved efficiency in sample tracking and patient follow-up, strengthened communication networks among key stakeholders, and improved capacity to meet patient needs compared to standard EID. These advantages were realized from an intervention that providers saw as easy to use and largely compatible with workflow. However, supply stock outs and patient psychosocial factors (including fear of HIV status disclosure and poverty) provided ongoing challenges to EID service provision. Furthermore, slow or sporadic internet access and heavy workload prevented real-time HITSystem data entry for some clinicians. Conclusions: Provider experiences with the HITSystem indicate that the usefulness of the HITSystem, along with the ease with which it is able to be incorporated into hospital workflows, contributes to its sustained adoption and use in Kenyan hospitals. To maximize implementation success, care should be taken in intervention design and implementation to ensure that end users see clear advantages to using the technology and to account for variations in workflows, patient populations, and resource levels by allowing flexibility to suit user needs. Trial Registration: ClinicalTrials.gov NCT02072603; https://clinicaltrials.gov/ct2/show/NCT02072603 (Archived by WebCite at http://www.webcitation.org/71NgMCrAm) %M 30135052 %R 10.2196/mhealth.9725 %U http://mhealth.jmir.org/2018/8/e169/ %U https://doi.org/10.2196/mhealth.9725 %U http://www.ncbi.nlm.nih.gov/pubmed/30135052 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 8 %P e169 %T Technologies for Innovative Monitoring to Reduce Blood Pressure and Change Lifestyle Using Mobile Phones in Adult and Elderly Populations (TIM Study): Protocol for a Randomized Controlled Trial %A Fuchs,Sandra C %A Harzheim,Erno %A Iochpe,Cirano %A David,Caroline N de %A Gonçalves,Marcelo R %A Sesin,Guilhermo P %A Costa,Cassio M %A Moreira,Leila B %A Fuchs,Flavio D %+ Postgraduate Studies Program in Cardiology, Hospital de Clinicas de Porto Alegre, School of Medicine, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2350, Centro de Pesquisa Clínica, 5th Floor, Porto Alegre,, Brazil, 55 51 3359 7621, sfuchs@hcpa.edu.br %K blood pressure %K blood pressure monitoring %K hypertension %K weight %K diet %K sodium %K physical activity %K randomized controlled trial %K text messages %D 2018 %7 07.08.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Hypertension is a growing problem worldwide, markedly in low- and middle-income countries, where the rate of control slightly decreased. The overall prevalence of hypertension in Brazil is 28.7% among adult individuals and 68.9% in the population aged 60 years and older, and less than a third of patients have controlled blood pressure (BP). The use of technologies—mobile phones and the internet—to implement interventions to reduce blood pressure can minimize costs and diminish cardiovascular risk. Interventions through text messaging and electronic BP monitoring present divergent results. Objective: This trial evaluates the effectiveness of interventions—personalized messages and telemonitoring of BP—to reduce systolic BP and improve lifestyle compared to the usual care of patients with hypertension (control group). Methods: This factorial randomized controlled trial enrolls individuals aged 30 to 75 years who have a mobile phone and internet access with the diagnosis of hypertension under drug treatment with up to 2 medications and uncontrolled BP. Eligible participants should have both increased office BP and 24-hour BP with ambulatory BP monitoring. Participants with severe hypertension (systolic BP ≥180 or diastolic BP ≥110 mm Hg), life threatening conditions, low life expectancy, recent major cardiovascular event (last 6 months), other indications for the use of antihypertensive medication, diagnosis of secondary hypertension, pregnant or lactating women, or those unable to understand the interventions are excluded. Participants are randomly allocate to 1 of 4 experimental arms: (1) Telemonitoring of blood pressure (TELEM) group: receives an automatic oscillometric device to measure BP, (2) telemonitoring by text message (TELEMEV) group: receives personalized, standardized text messages to stimulate lifestyle changes and adhere with BP-lowering medication, (3) TELEM-TELEMEV group: receives both interventions, and (4) control group: receives usual clinical treatment (UCT). Data collection is performed in a clinical research center located in a referent hospital. The primary outcomes are reduction of systolic BP assessed by 24-hour ambulatory BP monitoring (primary outcome) and change of lifestyle (based on dietary approaches to stop hypertension (DASH)-type diet, sodium restriction, weight loss or control, increase of physical activity). Results: This study was funded by two Brazilian agencies: the National Council for Scientific and Technological Development and Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul. Enrollment was completed at the end of 2017 (N=231), the follow-up is ongoing, and data analysis is expected to begin in early 2019. A reduction of 24-hour systolic BP of approximately 8.8 [SD 13.1] mm Hg for participants in the BP monitoring group versus 3.4 [SD 11.6] mm Hg in the UCT group is expected. A similar reduction in the text messaging group is expected. Conclusions: The use of mobile technologies connected to the internet through mobile phones promotes time optimization, cost reduction, and better use of public health resources. However, it has not been established whether simple interventions such as text messaging are superior to electronic BP monitoring and whether both outperform conventional counseling. Trial Registration: ClinicalTrials.gov NCT03005470; https://clinicaltrials.gov/ct2/show/NCT03005470 (Archived by WebCite at http://www.webcitation.org/70AoANESu). Plataforma Brasil CAAE 31423214.0.0000.5327. Registered Report Identifier: RR1-10.2196/9619 %M 30087093 %R 10.2196/resprot.9619 %U http://www.researchprotocols.org/2018/8/e169/ %U https://doi.org/10.2196/resprot.9619 %U http://www.ncbi.nlm.nih.gov/pubmed/30087093 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 7 %P e10756 %T Developing a Digital Marketplace for Family Planning: Pilot Randomized Encouragement Trial %A Green,Eric P %A Augustine,Arun %A Naanyu,Violet %A Hess,Anna-Karin %A Kiwinda,Lulla %+ Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, United States, 1 9196817289, eric.green@duke.edu %K family planning %K unmet need %K contraception %K digital health %K Kenya %D 2018 %7 31.07.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Family planning is an effective tool for preventing death among women who do not want to become pregnant and has been shown to improve newborn health outcomes, advance women’s empowerment, and bring socioeconomic benefits through reductions in fertility and population growth. Yet among the populations that would benefit the most from family planning, uptake remains too low. The emergence of digital health tools has created new opportunities to strengthen health systems and promote behavior change. In this study, women with an unmet need for family planning in Western Kenya were randomized to receive an encouragement to try an automated investigational digital health intervention that promoted the uptake of family planning. Objective: The objectives of the pilot study were to explore the feasibility of a full-scale trial—in particular, the recruitment, encouragement, and follow-up data collection procedures—and to examine the preliminary effect of the intervention on contraception uptake. Methods: This pilot study tested the procedures for a randomized encouragement trial. We recruited 112 women with an unmet need for family planning from local markets in Western Kenya, conducted an eligibility screening, and randomized half of the women to receive an encouragement to try the investigational intervention. Four months after encouraging the treatment group, we conducted a follow-up survey with enrolled participants via short message service (SMS) text message. Results: The encouragement sent via SMS text messages to the treatment group led to differential rates of intervention uptake between the treatment and control groups; however, uptake by the treatment group was lower than anticipated (19/56, 33.9% vs 1/56, 1.8%, in the control group). Study attrition was also substantial. We obtained follow-up data from 44.6% (50/112) of enrolled participants. Among those in the treatment group who tried the intervention, the instrumental variables estimate of the local average treatment effect was an increase in the probability of contraceptive uptake of 41.0 percentage points (95% uncertainty interval −0.03 to 0.85). Conclusions: This randomized encouragement design and study protocol is feasible but requires modifications to the recruitment, encouragement, and follow-up data collection procedures. Trial Registration: ClinicalTrials.gov NCT03224390; https://clinicaltrials.gov/ct2/show/NCT03224390 (Archived by WebCite at http://www.webcitation.org/70yitdJu8) %M 30064968 %R 10.2196/10756 %U http://www.jmir.org/2018/7/e10756/ %U https://doi.org/10.2196/10756 %U http://www.ncbi.nlm.nih.gov/pubmed/30064968 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e153 %T Forecasting the Value for Money of Mobile Maternal Health Information Messages on Improving Utilization of Maternal and Child Health Services in Gauteng, South Africa: Cost-Effectiveness Analysis %A LeFevre,Amnesty %A Cabrera-Escobar,Maria A %A Mohan,Diwakar %A Eriksen,Jaran %A Rogers,Debbie %A Neo Parsons,Annie %A Barre,Iman %A Jo,Youngji %A Labrique,Alain %A Coleman,Jesse %+ Department of Public Health Sciences, Karolinska Institutet, SE-171 77, Stockholm,, Sweden, 46 852480000, denots@gmail.com %K mHealth %K cost effectiveness %K cost utility analysis %K digital health %D 2018 %7 27.07.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Limited evidence exists on the value for money of mHealth information programs in low resource settings. Objective: This study sought to model the incremental cost-effectiveness of gradually scaling up text messaging services to pregnant women throughout Gauteng province, South Africa from 2012 to 2017. Methods: Data collection occurred as part of a retrospective study in 6 health centers in Gauteng province. Stage-based short message service (SMS) text messages on maternal health were sent to pregnant women twice per week during pregnancy and continued until the infant’s first birthday. Program costs, incremental costs to users, and the health system costs for these women were measured along with changes in the utilization of antenatal care visits and childhood immunizations and compared with those from a control group of pregnant women who received no SMS text messages. Incremental changes in utilization were entered into the Lives Saved Tool and used to forecast lives saved and disability adjusted life years (DALYs) averted by scaling up program activities over 5 years to reach 60% of pregnant women across Gauteng province. Uncertainty was characterized using one-way and probabilistic uncertainty analyses. Results: Five-year program costs were estimated to be US $1.2 million, 17% of which were incurred by costs on program development and 31% on SMS text message delivery costs. Costs to users were US $1.66 to attend clinic-based services, nearly 90% of which was attributed to wages lost. Costs to the health system included provider time costs to register users (US $0.08) and to provide antenatal care (US $4.36) and postnatal care (US $3.08) services. Incremental costs per DALY averted from a societal perspective ranged from US $1985 in the first year of implementation to US $200 in the 5th year. At a willingness-to-pay threshold of US $2000, the project had a 40% probability of being cost-effective in year 1 versus 100% in all years thereafter. Conclusions: Study findings suggest that delivering SMS text messages on maternal health information to pregnant and postpartum women may be a cost-effective strategy for bolstering antenatal care and childhood immunizations, even at very small margins of coverage increases. Primary data obtained prospectively as part of more rigorous study designs are needed to validate modeled results. %M 30054263 %R 10.2196/mhealth.8185 %U http://mhealth.jmir.org/2018/7/e153/ %U https://doi.org/10.2196/mhealth.8185 %U http://www.ncbi.nlm.nih.gov/pubmed/30054263 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e149 %T Mobile Phone-Based Ecological Momentary Intervention to Reduce Young Adults’ Alcohol Use in the Event: A Three-Armed Randomized Controlled Trial %A Wright,Cassandra %A Dietze,Paul M %A Agius,Paul A %A Kuntsche,Emmanuel %A Livingston,Michael %A Black,Oliver C %A Room,Robin %A Hellard,Margaret %A Lim,Megan SC %+ Burnet Institute, 85 Commercial Road, Melbourne, 3004, Australia, 61 392822173, cassandra.wright@burnet.edu.au %K alcohol %K brief intervention %K ecological momentary assessment %K randomized controlled trial %K mHealth %K mobile phone %K young adults %D 2018 %7 20.07.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Real-time ecological momentary interventions have shown promising effects in domains other than alcohol use; however, only few studies regarding ecological momentary interventions for alcohol use have been conducted thus far. The increasing popularity of smartphones offers new avenues for intervention and innovation in data collection. Objective: We aimed to test the efficacy of an ecological momentary intervention, comprising mobile Web-based ecological momentary assessments (EMAs) and text messaging (short message service, SMS) brief interventions, delivered during drinking events using participants’ mobile phones. Methods: We conducted a three-armed randomized controlled trial to assess the effect of a mobile Web-based ecological momentary assessment with texting feedback on self-reported alcohol consumption and alcohol-related harms in young adults. Participants were enrolled from an existing observational cohort study of young adults screened for risky drinking behavior. The intervention group (ecological momentary intervention group) completed repeated ecological momentary assessments during 6 drinking events and received immediate texting-based feedback in response to each ecological momentary assessment. The second group (ecological momentary assessment group) completed ecological momentary assessments without the brief intervention, and the third did not receive any contact during the trial period. Recent peak risky single-occasion drinking was assessed at the baseline and follow-up using telephone interviews. We used a random effects mixed modeling approach using maximum likelihood estimation to provide estimates of differences in mean drinking levels between groups between baseline and 12-week follow-up. Results: A total of 269 participants were randomized into the 3 groups. The ecological momentary intervention group exhibited a small and nonsignificant increase between baseline and follow-up in (geometric) the mean number of standard drinks consumed at the most recent heavy drinking occasion (mean 12.5 vs 12.7). Both ecological momentary assessment and control groups exhibited a nonsignificant decrease (ecological momentary assessment: mean 13.8 vs 11.8; control: mean 12.3 vs 11.6); these changes did not differ significantly between groups (Wald χ22 1.6; P=.437) and the magnitude of the effects of the intervention were markedly small. No other significant differences between groups on measures of alcohol consumption or related harms were observed. The intervention acceptability was high despite the technical problems in delivery. Conclusions: With a small number of participants, this study showed few effects of an SMS-based brief intervention on peak risky single-occasion drinking. Nevertheless, the study highlights areas for further investigation into the effects of EMI on young adults with heavy alcohol consumption. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616001323415; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369534 (Archived by WebCite at http://www.webcitation.org/7074mqwcs) %M 30030211 %R 10.2196/mhealth.9324 %U http://mhealth.jmir.org/2018/7/e149/ %U https://doi.org/10.2196/mhealth.9324 %U http://www.ncbi.nlm.nih.gov/pubmed/30030211 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e10671 %T You Will Know That Despite Being HIV Positive You Are Not Alone: Qualitative Study to Inform Content of a Text Messaging Intervention to Improve Prevention of Mother-to-Child HIV Transmission %A Fairbanks,Jade %A Beima-Sofie,Kristin %A Akinyi,Pamela %A Matemo,Daniel %A Unger,Jennifer A %A Kinuthia,John %A O'Malley,Gabrielle %A Drake,Alison L %A John-Stewart,Grace %A Ronen,Keshet %+ Department of Global Health, University of Washington, 325 9th Avenue, Seattle, WA, 98104, United States, 1 206 685 4363, keshet@uw.edu %K HIV %K ART %K PMTCT %K SMS text messaging %K adherence %K retention %D 2018 %7 19.07.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Prevention of mother-to-child HIV transmission (PMTCT) relies on long-term adherence to antiretroviral therapy (ART). Mobile health approaches, such as text messaging (short message service, SMS), may improve adherence in some clinical contexts, but it is unclear what SMS content is desired to improve PMTCT-ART adherence. Objective: We aimed to explore the SMS content preferences related to engagement in PMTCT care among women, male partners, and health care workers. The message content was used to inform an ongoing randomized trial to enhance the PMTCT-ART adherence. Methods: We conducted 10 focus group discussions with 87 HIV-infected pregnant or postpartum women and semistructured individual interviews with 15 male partners of HIV-infected women and 30 health care workers from HIV and maternal child health clinics in Kenya. All interviews were recorded, translated, and transcribed. We analyzed transcripts using deductive and inductive approaches to characterize women’s, partners’, and health care workers’ perceptions of text message content. Results: All women and male partners, and most health care workers viewed text messages as a useful strategy to improve engagement in PMTCT care. Women desired messages spanning 3 distinct content domains: (1) educational messages on PMTCT and maternal child health, (2) reminder messages regarding clinic visits and adherence, and (3) encouraging messages that provide emotional support. While all groups valued reminder and educational messages, women highlighted emotional support more than the other groups (partners or health care workers). In addition, women felt that encouraging messages would assist with acceptance of their HIV status, support disclosure, improve patient-provider relationship, and provide support for HIV-related challenges. All 3 groups valued not only messages to support PMTCT or HIV care but also messages that addressed general maternal child health topics, stressing that both HIV- and maternal child health–related messages should be part of an SMS system for PMTCT. Conclusions: Women, male partners, and health care workers endorsed SMS text messaging as a strategy to improve PMTCT and maternal child health outcomes. Our results highlight the specific ways in which text messaging can encourage and support HIV-infected women in PMTCT to remain in care, adhere to treatment, and care for themselves and their children. Trial Registration: ClinicalTrials.gov NCT02400671; https://clinicaltrials.gov/ct2/show/NCT02400671 (Archived by WebCite at http://www.webcitation.org/70W7SVIVJ) %M 30026177 %R 10.2196/10671 %U http://mhealth.jmir.org/2018/7/e10671/ %U https://doi.org/10.2196/10671 %U http://www.ncbi.nlm.nih.gov/pubmed/30026177 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 7 %P e166 %T Toward Increasing Engagement in Substance Use Data Collection: Development of the Substance Abuse Research Assistant App and Protocol for a Microrandomized Trial Using Adolescents and Emerging Adults %A Rabbi,Mashfiqui %A Philyaw Kotov,Meredith %A Cunningham,Rebecca %A Bonar,Erin E %A Nahum-Shani,Inbal %A Klasnja,Predrag %A Walton,Maureen %A Murphy,Susan %+ Department of Statistics, Harvard University, 1 Oxford Street, Cambridge, MA, 02138, United States, 1 6036671797, mrabbi@fas.harvard.edu %K engagement %K microrandomized trial %K just-in-time adaptive intervention %D 2018 %7 18.07.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Substance use is an alarming public health issue associated with significant morbidity and mortality. Adolescents and emerging adults are at particularly high risk because substance use typically initiates and peaks during this developmental period. Mobile health apps are a promising data collection and intervention delivery tool for substance-using youth as most teens and young adults own a mobile phone. However, engagement with data collection for most mobile health applications is low, and often, large fractions of users stop providing data after a week of use. Objective: Substance Abuse Research Assistant (SARA) is a mobile application to increase or sustain engagement of substance data collection overtime. SARA provides a variety of engagement strategies to incentivize data collection: a virtual aquarium in the app grows with fish and aquatic resources; occasionally, funny or inspirational contents (eg, memes or text messages) are provided to generate positive emotions. We plan to assess the efficacy of SARA’s engagement strategies over time by conducting a micro-randomized trial, where the engagement strategies will be sequentially manipulated. Methods: We aim to recruit participants (aged 14-24 years), who report any binge drinking or marijuana use in the past month. Participants are instructed to use SARA for 1 month. During this period, participants are asked to complete one survey and two active tasks every day between 6 pm and midnight. Through the survey, we assess participants’ daily mood, stress levels, loneliness, and hopefulness, while through the active tasks, we measure reaction time and spatial memory. To incentivize and support the data collection, a variety of engagement strategies are used. First, predata collection strategies include the following: (1) at 4 pm, a push notification may be issued with an inspirational message from a contemporary celebrity; or (2) at 6 pm, a push notification may be issued reminding about data collection and incentives. Second, postdata collection strategies include various rewards such as points which can be used to grow a virtual aquarium with fishes and other treasures and modest monetary rewards (up to US $12; US $1 for each 3-day streak); also, participants may receive funny or inspirational content as memes or gifs or visualizations of prior data. During the study, the participants will be randomized every day to receive different engagement strategies. In the primary analysis, we will assess whether issuing 4 pm push-notifications or memes or gifs, respectively, increases self-reporting on the current or the following day. Results: The microrandomized trial started on August 21, 2017 and the trial ended on February 28, 2018. Seventy-three participants were recruited. Data analysis is currently underway. Conclusions: To the best of our knowledge, SARA is the first mobile phone app that systematically manipulates engagement strategies in order to identify the best sequence of strategies that keep participants engaged in data collection. Once the optimal strategies to collect data are identified, future versions of SARA will use this data to provide just-in-time adaptive interventions to reduce substance use among youth. Trial Registration: ClinicalTrials.gov NCT03255317; https://clinicaltrials.gov/show/NCT03255317 (Archived by WebCite at http://www.webcitation.org/70raGWV0e) Registered Report Identifier: RR1-10.2196/9850 %M 30021714 %R 10.2196/resprot.9850 %U http://www.researchprotocols.org/2018/7/e166/ %U https://doi.org/10.2196/resprot.9850 %U http://www.ncbi.nlm.nih.gov/pubmed/30021714 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 3 %P e23 %T A Text Message–Based Intervention Targeting Alcohol Consumption Among University Students: User Satisfaction and Acceptability Study %A Müssener,Ulrika %A Thomas,Kristin %A Linderoth,Catharina %A Leijon,Matti %A Bendtsen,Marcus %+ Department of Medical and Health Sciences, Linköping University, Linköping, Sweden, S-58183, Sweden, 46 732702426, ulrika.mussener@liu.se %K students %K text messages %K mobile phones %K SMS %K alcohol consumption intervention %D 2018 %7 10.07.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Heavy consumption of alcohol among university students is a global problem, with excessive drinking being the social norm. Students can be a difficult target group to reach, and only a minority seek alcohol-related support. It is important to develop interventions that can reach university students in a way that does not further stretch the resources of the health services. Text messaging (short message service, SMS)–based interventions can enable continuous, real-time, cost-effective, brief support in a real-world setting, but there is a limited amount of evidence for effective interventions on alcohol consumption among young people based on text messaging. To address this, a text messaging–based alcohol consumption intervention, the Amadeus 3 intervention, was developed. Objective: This study explored self-reported changes in drinking habits in an intervention group and a control group. Additionally, user satisfaction among the intervention group and the experience of being allocated to a control group were explored. Methods: Students allocated to the intervention group (n=460) were asked about their drinking habits and offered the opportunity to give their opinion on the structure and content of the intervention. Students in the control group (n=436) were asked about their drinking habits and their experience in being allocated to the control group. Participants received an email containing an electronic link to a short questionnaire. Descriptive analyses of the distribution of the responses to the 12 questions for the intervention group and 5 questions for the control group were performed. Results: The response rate for the user feedback questionnaire of the intervention group was 38% (176/460) and of the control group was 30% (129/436). The variation in the content of the text messages from facts to motivational and practical advice was appreciated by 77% (135/176) participants, and 55% (97/176) found the number of messages per week to be adequate. Overall, 81% (142/176) participants stated that they had read all or nearly all the messages, and 52% (91/176) participants stated that they were drinking less, and increased awareness regarding negative consequences was expressed as the main reason for reduced alcohol consumption. Among the participants in the control group, 40% (52/129) stated that it did not matter that they had to wait for access to the intervention. Regarding actions taken while waiting for access, 48% (62/129) participants claimed that they continued to drink as before, whereas 35% (45/129) tried to reduce their consumption without any support. Conclusions: Although the main randomized controlled trial was not able to detect a statistically significant effect of the intervention, most participants in this qualitative follow-up study stated that participation in the study helped them reflect upon their consumption, leading to altered drinking habits and reduced alcohol consumption. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN95054707; http://www.isrctn.com/ISRCTN95054707 (Archived by WebCite at http://www.webcitation.org/705putNZT) %M 29991469 %R 10.2196/humanfactors.9641 %U http://humanfactors.jmir.org/2018/3/e23/ %U https://doi.org/10.2196/humanfactors.9641 %U http://www.ncbi.nlm.nih.gov/pubmed/29991469 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e13 %T A Text Messaging Intervention (Txt4HappyKids) to Promote Fruit and Vegetable Intake Among Families With Young Children: Pilot Study %A Power,Julianne Mary %A Bersamin,Andrea %+ Center for Alaska Native Health Research, Institute of Arctic Biology, University of Alaska Fairbanks, 902 N Koyukuk Drive, PO Box 757000, Fairbanks, AK, 99775, United States, 1 907 474 6129, abersamin@alaska.edu %K fruits and vegetables %K nutrition education %K nutrition intervention %K young children %K text messaging %D 2018 %7 06.07.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Increasing fruit and vegetable intake among low-income populations, especially children, is a priority for United States federal food assistance programs. With over 49 million federal food assistance program recipients, cost-effective and efficient methods are needed to effectively deliver nutrition education to such a large population. Objective: The objective of our study was to examine the preliminary efficacy and acceptability of a text messaging intervention, Txt4HappyKids, to promote fruit and vegetable intake among families with young children. Methods: The intervention was evaluated using a pre-post study design. Parents (N=72) in Alaska were recruited from venues that serve a predominantly low-income population to participate in an 11-week intervention based on social cognitive theory. Parents received two texts per week promoting child fruit and vegetable intake. Behaviors, self-efficacy, and attitudes related to fruit and vegetable intake were measured at baseline and postintervention. Perceived changes in behaviors and open-ended feedback were also collected postintervention. Results: Of all participants, 67.3% (72/107) completed the intervention. We found no changes in behavior (P=.26), self-efficacy (P=.43), or attitudes (P=.35) related to fruit and vegetable intake from pre- to postintervention. Completers reported that since their participation in Txt4HappyKids, 92% (66/72) served more fruits and vegetables to their child because they thought fruits and vegetables were beneficial, 86% (62/72) tried to follow a healthier diet, 85% (61/72) tried different ways of preparing fruits and vegetables, and 81% (58/72) were more aware of the foods their child consumes. Additionally, 79% (57/72) of completers thought that Txt4HappyKids was credible, 71% (51/72) found texts useful, and 82% (59/72) would recommend it to a friend. Conclusions: A text messaging intervention was not sufficient to increase fruit and vegetable intake among families with young children. However, parents felt positively impacted by Txt4HappyKids and were receptive to nutrition information, despite the absence of face-to-face contact. High satisfaction among completers indicates that text messaging may be an acceptable complement to budget-constrained nutrition programs. These findings are an important first step in developing larger multi-level interventions utilizing mobile technology; however, a more rigorous evaluation of the Txt4HappyKids intervention is warranted. %M 30684412 %R 10.2196/formative.8544 %U http://formative.jmir.org/2018/2/e13/ %U https://doi.org/10.2196/formative.8544 %U http://www.ncbi.nlm.nih.gov/pubmed/30684412 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e151 %T An mHealth Intervention for Persons with Diabetes Type 2 Based on Acceptance and Commitment Therapy Principles: Examining Treatment Fidelity %A Nes,Andréa Aparecida Gonçalves %A van Dulmen,Sandra %A Brembo,Espen Andreas %A Eide,Hilde %+ Faculty of Nursing, Lovisenberg Diaconal University College, Lovisenberggt 15b, Oslo, 0456, Norway, 47 21981673090, andreanes@msn.com %K diabetes mellitus type 2 %K Acceptance and Commitment Therapy %K mobile phone %K Web-based %K treatment fidelity %K mHealth %D 2018 %7 03.07.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Web-based interventions are becoming an alternative of treatment aimed to support behavioral changes and several advantages over traditional treatments are reported. New ways of delivering an intervention may result in new challenges regarding monitoring of treatment fidelity (TF) which is essential to ensure internal and external validity. Despite the importance of the theme, only a few studies in this field are reported. Objective: To examine TF of a mobile phone delivered intervention based on Acceptance and Commitment Therapy (ACT) with electronic diaries and written situational feedback for persons with diabetes mellitus type 2, the recommendations from the Behavior Change Consortium (BCC) established by The National Institutes of Health (NHI) were applied. To analyze fidelity, they recommend 5 areas to be investigated (1) design of the study, (2) provider training, (3) delivery of treatment, (4) receipt of treatment, and (5) enactment of treatment. In the current study, these areas were examined based on the analysis of therapists’ adherence to the treatment protocol and participants’ and therapists’ experience with the intervention. Methods: To investigate the therapists’ adherence to the treatment protocol, a total of 251 written feedback text messages were divided into text segments. Qualitative thematic analyses were then performed to examine how ACT and other therapeutic processes were used in the feedback by the therapists. For the therapists’ and participants’ experience analysis, participants answered a self-reported questionnaire and participated in 2 interviews. The therapists continuously reported their experiences to the researcher responsible for the project. Results: The results show high adherence to the TF strategies 20/21 (95%) applicable items of the fidelity checklist recommended by NHI BCC were identified in the present study. Measured provider skill acquisition post-training was the only item absent in the fidelity checklist. The results also show high therapists’ adherence to the treatment protocol. All ACT processes (values, committed action, acceptance, contact with the present moment, self as context and cognitive defusion) were found in the coded text segments of the feedback in addition to communication and motivation strategies. For 336/730 (46%) of total possible text segments coded independently by 2 researchers, the interrater reliability measured by Cohen’s kappa was .85. The evaluation of participants’ and therapists’ experience with the intervention was generally positive. Conclusions: Based on the analyses of therapists’ adherence to the treatment protocol grounded by ACT-principles and participants’ and therapists’ experience with the intervention, the 5 areas of TF recommended by NHI BCC were analyzed indicating a high level of TF. These results ensure an appropriate level of internal and external validity of the study and reliable intervention results and facilitate a precise replication of this intervention concept. Web-based psychological interventions to support people with chronic conditions are becoming increasingly more common. This study supports the results from a previous study which indicated that ACT could be reliably delivered in a written web-based format. Trial Registration: ClinicalTrials.gov NCT01297049; https://clinicaltrials.gov/ct2/show/NCT01297049 (Archived by WebCite at http://www.webcitation.org/70WC4Cm4T) %M 29970357 %R 10.2196/mhealth.9942 %U http://mhealth.jmir.org/2018/7/e151/ %U https://doi.org/10.2196/mhealth.9942 %U http://www.ncbi.nlm.nih.gov/pubmed/29970357 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e146 %T Effectiveness of a Text Messaging–Based Intervention Targeting Alcohol Consumption Among University Students: Randomized Controlled Trial %A Thomas,Kristin %A Müssener,Ulrika %A Linderoth,Catharina %A Karlsson,Nadine %A Bendtsen,Preben %A Bendtsen,Marcus %+ Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, 58183, Sweden, 46 733140708, marcus.bendtsen@liu.se %K alcohol consumption intervention %K text message-based intervention %K university students %K brief intervention %D 2018 %7 25.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Excessive drinking among university students is a global challenge, leading to significant health risks. However, heavy drinking among students is widely accepted and socially normalized. Mobile phone interventions have attempted to reach students who engage in excessive drinking. A growing number of studies suggest that text message–based interventions could potentially reach many students and, if effective, such an intervention might help reduce heavy drinking in the student community. Objective: The objective of this study was to test the effectiveness of a behavior change theory–based 6-week text message intervention among university students. Methods: This study was a two-arm, randomized controlled trial with an intervention group receiving a 6-week text message intervention and a control group that was referred to treatment as usual at the local student health care center. Outcome measures were collected at baseline and at 3 months after the initial invitation to participate in the intervention. The primary outcome was total weekly alcohol consumption. Secondary outcomes were frequency of heavy episodic drinking, highest estimated blood alcohol concentration, and number of negative consequences attributable to excessive drinking. Results: A total of 896 students were randomized to either the intervention or control group. The primary outcome analysis included 92.0% of the participants in the intervention group and 90.1% of the control group. At follow-up, total weekly alcohol consumption decreased in both groups, but no significant between-group difference was seen. Data on the secondary outcomes included 49.1% of the participants in the intervention group and 41.3% of the control group. No significant between-group difference was seen for any of the secondary outcomes. Conclusions: The present study was under-powered, which could partly explain the lack of significance. However, the intervention, although theory-based, needs to be re-assessed and refined to better support the target group. Apart from establishing which content forms an effective intervention, the optimal length of an alcohol intervention targeting students also needs to be addressed in future studies. Trial Registration: International Standard Randomised Controlled Trial Number ISRCTN95054707; http://www.isrctn.com/ISRCTN95054707 (Archived by WebCite at http://www.webcitation.org/70Ax4vXhd) %M 29941417 %R 10.2196/mhealth.9642 %U http://mhealth.jmir.org/2018/6/e146/ %U https://doi.org/10.2196/mhealth.9642 %U http://www.ncbi.nlm.nih.gov/pubmed/29941417 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e11 %T Feasibility of a Proactive Text Messaging Intervention for Smokers in Community Health Centers: Pilot Study %A Kruse,Gina %A Kelley,Jennifer HK %A Chase,Karen %A Rigotti,Nancy A %+ Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA, 02114, United States, 1 6177243157, gkruse@partners.org %K smoking cessation %K primary health care %K text messaging %D 2018 %7 31.05.2018 %9 Short Paper %J JMIR Formativ Res %G English %X Background: Few smokers receive evidence-based cessation services during primary care visits. Objective: We aimed to assess the feasibility of a proactive text messaging program for primary care patients who smoke. Methods: We used electronic health records to identify smokers who had a mobile phone number listed from two community health centers in Massachusetts. Between March 2014 and June 2015, patients were screened by their primary care physician and then sent a proactive text message inviting them to enroll by texting back. Patients who opted in were asked about their readiness to quit. The text message program included messages from the QuitNowTXT library and novel content for smokers who were not ready to quit. Results: Among 949 eligible smokers, 88 (9.3%) enrolled after receiving a single proactive text message. Compared with those who did not enroll, enrollees were more often female (54/88, 61% vs 413/861, 48.0%, P=.02), but otherwise did not differ in age, race, insurance status, or comorbidities. In all, 28% (19/67) of enrollees reported they were not ready to quit in the next 30 days, 61% (41/67) were ready to quit, and 11% (7/67) already quit. The median time in the program was 9 days (interquartile range 2-32 days). Of current smokers, 25% (15/60) sent one or more keyword requests to the server. These did not differ by readiness to quit. Conclusions: A proactively delivered text messaging program targeting primary care patients who smoke was feasible and engaged both smokers ready to quit and those not ready to quit. This method shows promise as part of a population health model for addressing tobacco use outside of the primary care office. %R 10.2196/formative.9608 %U http://formative.jmir.org/2018/1/e11/ %U https://doi.org/10.2196/formative.9608 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e10425 %T Mobile Phone Intervention to Reduce Youth Suicide in Rural Communities: Field Test %A Pisani,Anthony R %A Wyman,Peter A %A Gurditta,Kunali %A Schmeelk-Cone,Karen %A Anderson,Carolyn L %A Judd,Emily %+ Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Box PSYC, 300 Crittenden Boulevard, Rochester, NY, 14642, United States, 1 (585) 275 3644, anthony_pisani@urmc.rochester.edu %K suicide prevention %K school-based program %K text messaging %K school health services %D 2018 %7 31.05.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Suicide is a leading cause of death among 10- to 19-year-olds in the United States, with 5% to 8% attempting suicide each year. Suicide risk rises significantly during early adolescence and is higher in rural and underserved communities. School-based universal prevention programs offer a promising way of reducing suicide by providing strategies for emotion regulation and encouraging help-seeking behaviors and youth-adult connectedness. However, such programs frequently run into difficulties in trying to engage a broad range of students. Text messaging is a dominant medium of communication among youths, and studies show both efficacy and uptake in text messaging interventions aimed at adolescents. Text-based interventions may, thus, offer a means for school-based universal prevention programs to engage adolescents who would otherwise be difficult to reach. Objective: We field tested Text4Strength, an automated, interactive text messaging intervention that seeks to reach a broad range of early adolescents in rural communities. Text4Strength extends Sources of Strength, a peer-led school suicide prevention program, by encouraging emotion regulation, help-seeking behaviors, and youth-adult connectedness in adolescents. The study tested the appeal and feasibility of Text4Strength and its potential to extend universal school-based suicide prevention. Methods: We field tested Text4Strength with 42 ninth-grade students. Over 9 weeks, students received 28 interactive message sequences across 9 categories (Sources of Strength introduction, positive friend, mentors, family support, healthy activities, generosity, spirituality, medical access, and emotion regulation strategies). The message sequences included games, requests for advice, questions about students’ own experiences, and peer testimonial videos. We measured baseline mental health characteristics, frequency of replies, completion of sequences and video viewing, appeal to students, and their perception of having benefited from the program. Results: Of the 42 participating students, 38 (91%) responded to at least one sequence and 22 (52%) responded to more than a third of the sequences. The proportion of students who completed multistep sequences they had started ranged from 35% (6/17) to 100% (3/3 to 28/28), with responses dropping off when more than 4 replies were needed. With the exception of spirituality and generosity, each of the content areas generated at least a moderate number of student replies from both boys and girls. Students with higher and lower levels of risk and distress interacted with the sequences at similar rates. Contrary to expectations, few students watched videos. Students viewed the intervention as useful—even those who rarely responded to messages. More than 70% found the texts useful (3 items, n range 29-34) and 90% (36) agreed the program should be repeated. Conclusions: Text4Strength offers a potentially engaging way to extend school-based interventions that promote protective factors for suicide. Text4Strength is ready to be revised, based on findings and student feedback from this field test, and rigorously tested for efficacy. %R 10.2196/10425 %U http://mental.jmir.org/2018/2/e10425/ %U https://doi.org/10.2196/10425 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e122 %T Acceptability and Feasibility of Real-Time Antiretroviral Therapy Adherence Interventions in Rural Uganda: Mixed-Method Pilot Randomized Controlled Trial %A Musiimenta,Angella %A Atukunda,Esther C %A Tumuhimbise,Wilson %A Pisarski,Emily E %A Tam,Melanie %A Wyatt,Monique A %A Ware,Norma C %A Haberer,Jessica E %+ Mbarara University of Science and Technology, Angella Musiimenta, PhD, Mbarara, PO Box 653, Uganda, 256 776820598, amusiimenta@must.ac.ug %K real-time adherence monitoring %K SMS %K mobile health technologies %K antiretroviral therapy %K acceptability %K feasibility study %D 2018 %7 17.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wireless electronic adherence monitors can detect antiretroviral therapy (ART) adherence lapses and trigger interventions in real time, thus potentially avoiding unnecessary HIV viremia. Evidence about the acceptability and feasibility of these monitors and associated interventions, however, is limited. Objective: The aim of this study was to assess the acceptability and feasibility of real-time adherence monitoring linked to text messaging (short message service, SMS) reminders and notifications to support adherence among individuals living with HIV who are taking ART in rural southwestern Uganda. Methods: Individuals living with HIV who were initiating ART were enrolled in a pilot randomized controlled trial and followed up for 9 months. Participants received a real-time adherence monitor and were randomized to one of the following study arms: (1) scheduled SMS, (2) SMS triggered by missed or delayed doses, or (3) no SMS. SMS notifications were also sent to 45 patient-identified social supporters for sustained adherence lapses in the scheduled SMS and triggered SMS arms. Study participants and social supporters participated in qualitative semistructured in-depth interviews on acceptability and feasibility of this technology. An inductive, content analytic approach, framed by the unified theory of acceptance and use of technology model, was used to analyze qualitative data. Quantitative feasibility data, including device functionality and SMS tracking data, were recorded based upon device metrics collected electronically and summarized descriptively. Results: A total of 63 participants participated in the study. Participants reported that real-time monitoring intervention linked to SMS reminders and notifications are generally acceptable; the predominant feedback was perceived utility—the intervention was beneficial in motivating and reminding patients to take medication, as well as enabling provision of social support. The intervention was found to be technically feasible, as data were obtained from most participants as expected most of the time. Potential challenges included the impact of the technology on confidentiality, shared phone ownership, usability skills, and availability of electricity. Conclusions: Real-time adherence monitoring integrated with SMS reminders and social support notifications is a generally acceptable (based primarily on perceived utility) and feasible intervention in a resource-limited country. Future efforts should focus on optimized device design, user training to overcome the challenges we encountered, cost effectiveness studies, as well as studying the monitoring aspect of the device without accompanying interventions. Trial Registration: ClinicalTrials.gov NCT01957865; https://clinicaltrials.gov/ct2/show/NCT01957865 (Archived by WebCite at http://www.webcitation.org/6zFiDlXDa) %M 29773527 %R 10.2196/mhealth.9031 %U http://mhealth.jmir.org/2018/5/e122/ %U https://doi.org/10.2196/mhealth.9031 %U http://www.ncbi.nlm.nih.gov/pubmed/29773527 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e121 %T mActive-Smoke: A Prospective Observational Study Using Mobile Health Tools to Assess the Association of Physical Activity With Smoking Urges %A Silverman-Lloyd,Luke G %A Kianoush,Sina %A Blaha,Michael J %A Sabina,Alyse B %A Graham,Garth N %A Martin,Seth S %+ Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Carnegie 591, 600 North Wolfe Street, Baltimore, MD, 21287, United States, 1 410 502 0469, smart100@jhmi.edu %K activity trackers %K cigarette smoking %K exercise %K fitness trackers %K mobile health %K mHealth %K physical activity %K smartphone %K smoking %K text messaging %K texting %D 2018 %7 11.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Evidence that physical activity can curb smoking urges is limited in scope to acute effects and largely reliant on retrospective self-reported measures. Mobile health technologies offer novel mechanisms for capturing real-time data of behaviors in the natural environment. Objective: This study aimed to explore this in a real-world longitudinal setting by leveraging mobile health tools to assess the association between objectively measured physical activity and concurrent smoking urges in a 12-week prospective observational study. Methods: We enrolled 60 active smokers (≥3 cigarettes per day) and recorded baseline demographics, physical activity, and smoking behaviors using a Web-based questionnaire. Step counts were measured continuously using the Fitbit Charge HR. Participants reported instantaneous smoking urges via text message using a Likert scale ranging from 1 to 9. On study completion, participants reported follow-up smoking behaviors in an online exit survey. Results: A total of 53 participants (aged 40 [SD 12] years, 57% [30/53] women, 49% [26/53] nonwhite) recorded at least 6 weeks of data and were thus included in the analysis. We recorded 15,365 urge messages throughout the study, with a mean of 290 (SD 62) messages per participant. Mean urge over the course of the study was positively associated with daily cigarette consumption at follow-up (Pearson r=.33; P=.02). No association existed between daily steps and mean daily urge (beta=−6.95×10−3 per 1000 steps; P=.30). Regression models of acute effects, however, did reveal modest inverse associations between steps within 30-, 60-, and 120-min time windows of a reported urge (beta=−.0191 per 100 steps, P<.001). Moreover, 6 individuals (approximately 10% of the study population) exhibited a stronger and consistent inverse association between steps and urge at both the day level (mean individualized beta=−.153 per 1000 steps) and 30-min level (mean individualized beta=−1.66 per 1000 steps). Conclusions: Although there was no association between objectively measured daily physical activity and concurrently self-reported smoking urges, there was a modest inverse relationship between recent step counts (30-120 min) and urge. Approximately 10% of the individuals appeared to have a stronger and consistent inverse association between physical activity and urge, a provocative finding warranting further study. %M 29752250 %R 10.2196/mhealth.9292 %U http://mhealth.jmir.org/2018/5/e121/ %U https://doi.org/10.2196/mhealth.9292 %U http://www.ncbi.nlm.nih.gov/pubmed/29752250 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e119 %T Multistakeholder Perspectives on Maternal Text Messaging Intervention in Uganda: Qualitative Study %A Ilozumba,Onaedo %A Dieleman,Marjolein %A Van Belle,Sara %A Mukuru,Moses %A Bardají,Azucena %A Broerse,Jacqueline EW %+ Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, Amsterdam, 1081 HV, Netherlands, 31 205983143, ona.ilozumba@vu.nl %K maternal health %K telemedicine %K community health workers %K Uganda %K evaluation studies %D 2018 %7 10.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite continued interest in the use of mobile health for improving maternal health outcomes, there have been limited attempts to identify relevant program theories. Objectives: This study had two aims: first, to explicate the assumptions of program designers, which we call the program theory and second, to contrast this program theory with empirical data to gain a better understanding of mechanisms, facilitators, and barriers related to the program outcomes. Methods: To achieve the aforementioned objectives, we conducted a retrospective qualitative study of a text messaging (short message service) platform geared at improving individual maternal health outcomes in Uganda. Through interviews with program designers (n=3), we elicited 3 main designers’ assumptions and explored these against data from qualitative interviews with primary beneficiaries (n=26; 15 women and 11 men) and health service providers (n=6), as well as 6 focus group discussions with village health team members (n=50) who were all involved in the program. Results: Our study results highlighted that while the program designers’ assumptions were appropriate, additional mechanisms and contextual factors, such as the importance of incentives for village health team members, mobile phone ownership, and health system factors should have been considered. Conclusions: Our results indicate that text messages could be an effective part of a more comprehensive maternal health program when context and system barriers are identified and addressed in the program theories. %M 29748159 %R 10.2196/mhealth.9565 %U http://mhealth.jmir.org/2018/5/e119/ %U https://doi.org/10.2196/mhealth.9565 %U http://www.ncbi.nlm.nih.gov/pubmed/29748159 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e146 %T Uptake of Tailored Text Message Smoking Cessation Support in Pregnancy When Advertised on the Internet (MiQuit): Observational Study %A Emery,Joanne L %A Coleman,Tim %A Sutton,Stephen %A Cooper,Sue %A Leonardi-Bee,Jo %A Jones,Matthew %A Naughton,Felix %+ Behavioral Science Group, Institute of Public Health, University of Cambridge, Forvie Site, Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom, 44 0 1223 330355, jle40@medschl.cam.ac.uk %K smoking cessation %K pregnancy %K internet %K telemedicine %K public health %K social media %D 2018 %7 19.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Smoking in pregnancy is a major public health concern. Pregnant smokers are particularly difficult to reach, with low uptake of support options and few effective interventions. Text message–based self-help is a promising, low-cost intervention for this population, but its real-world uptake is largely unknown. Objective: The objective of this study was to explore the uptake and cost-effectiveness of a tailored, theory-guided, text message intervention for pregnant smokers (“MiQuit”) when advertised on the internet. Methods: Links to a website providing MiQuit initiation information (texting a short code) were advertised on a cost-per-click basis on 2 websites (Google Search and Facebook; £1000 budget each) and free of charge within smoking-in-pregnancy webpages on 2 noncommercial websites (National Childbirth Trust and NHS Choices). Daily budgets were capped to allow the Google and Facebook adverts to run for 1 and 3 months, respectively. We recorded the number of times adverts were shown and clicked on, the number of MiQuit initiations, the characteristics of those initiating MiQuit, and whether support was discontinued prematurely. For the commercial adverts, we calculated the cost per initiation and, using quit rates obtained from an earlier clinical trial, estimated the cost per additional quitter. Results: With equal capped budgets, there were 812 and 1889 advert clicks to the MiQuit website from Google (search-based) and Facebook (banner) adverts, respectively. MiQuit was initiated by 5.2% (42/812) of those clicking via Google (95% CI 3.9%-6.9%) and 2.22% (42/1889) of those clicking via Facebook (95% CI 1.65%-2.99%). Adverts on noncommercial webpages generated 53 clicks over 6 months, with 9 initiations (9/53, 17%; 95% CI 9%-30%). For the commercial websites combined, mean cost per initiation was £24.73; estimated cost per additional quitter, including text delivery costs, was £735.86 (95% CI £227.66-£5223.93). Those initiating MiQuit via Google were typically very early in pregnancy (median gestation 5 weeks, interquartile range 10 weeks); those initiating via Facebook were distributed more evenly across pregnancy (median gestation 16 weeks, interquartile range 14 weeks). Conclusions: Commercial online adverts are a feasible, likely cost-effective method for engaging pregnant smokers in digital cessation support and may generate uptake at a faster rate than noncommercial websites. As a strategy for implementing MiQuit, online advertising has large reach potential and can offer support to a hard-to-reach population of smokers. %M 29674308 %R 10.2196/jmir.8525 %U http://www.jmir.org/2018/4/e146/ %U https://doi.org/10.2196/jmir.8525 %U http://www.ncbi.nlm.nih.gov/pubmed/29674308 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 4 %P e91 %T Evaluating the Effectiveness of Text Messaging and Phone Call Reminders to Minimize No Show at Pediatric Outpatient Clinics in Pakistan: Protocol for a Mixed-Methods Study %A Saeed,Sana %A Somani,Noureen %A Sharif,Fatima %A Kazi,Abdul Momin %+ Department of Paediatrics and Child Health, Aga Khan University, Faculty Office Building, Stadium Road, Karachi,, Pakistan, 92 2134864232, momin.kazi@aku.edu %K text messaging %K mobile phone %K mhealth %K appointments and schedules %K outpatient services %K pediatrics %D 2018 %7 10.04.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Missing health care appointments without canceling in advance results in a no show, a vacant appointment slot that cannot be offered to others. No show can be reduced by reminding patients about their appointment in advance. In this regard, mobile health (mHealth) strategy is to use text messaging (short message service, SMS), which is available on all cellular phones, including cheap low-end handsets. Nonattendance for appointments in health care results in wasted resources and disturbs the planned work schedules. Objectives: The purpose of this study is to evaluate the efficacy of the current text messaging (SMS) and call-based reminder system and further explore how to improve the attendance at the pediatric outpatient clinics. The primary objectives are to (1) determine the efficacy of the current clinic appointment reminder service at pediatric outpatient clinics at Aga Khan University Hospital, (2) assess the mobile phone access and usage among caregivers visiting pediatrics consultant clinics, and (3) explore the perception and barriers of parents regarding the current clinic appointment reminder service at the pediatric outpatient clinics at Aga Khan University Hospital. Methods: The study uses a mixed-method design that consists of 3 components: (1) retrospective study (component A) which aims to determine the efficacy of text messaging (SMS) and phone call–based reminder service on patient’s clinic attendance during January to June 2017 (N=58,517); (2) quantitative (component B) in which a baseline survey will be conducted to assess the mobile phone access and usage among parents/caregivers of children visiting pediatrics consultant clinics (n=300); and (3) qualitative (component C) includes in-depth interviews and focus group discussion with parents/caregivers of children visiting the pediatric consultancy clinic and with health care providers and administrative staff. Main constructs will be to explore perceptions and barriers related to existing clinic appointment reminder service. Ethics approval has been obtained from the Ethical Review Committee, Aga Khan University, Pakistan (4770-Ped-ERC-17). Results: Results will be disseminated to pediatric quality public health and mHealth communities through scientific meetings and through publications, nationally and internationally. Conclusions: This study will provide insight regarding efficacy of using mHealth-based reminder services for patient’s appointments in low- and middle-income countries setup. The finding of this study will be used to recommend further enhanced mHealth-based solutions to improve patient appointments and decrease no show. %M 29636321 %R 10.2196/resprot.9294 %U http://www.researchprotocols.org/2018/4/e91/ %U https://doi.org/10.2196/resprot.9294 %U http://www.ncbi.nlm.nih.gov/pubmed/29636321 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e5 %T A Spiritually-Based Text Messaging Program to Increase Cervical Cancer Awareness Among African American Women: Design and Development of the CervixCheck Pilot Study %A Le,Daisy %A Aldoory,Linda %A Garza,Mary A %A Fryer,Craig S %A Sawyer,Robin %A Holt,Cheryl L %+ Department of Behavioral and Community Health, School of Public Health, University of Maryland, 1101H School of Public Health Building (255), College Park, MD, 20742, United States, 1 415 385 7330, drdaisyle@gmail.com %K short message service %K text messaging %K African Americans %K women’s health %K cervical cancer %K health status disparities %K pap test %K cancer screening %K health information technology %K spirituality %K community-based participatory research %D 2018 %7 29.03.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Although Hispanic women have the highest cervical cancer incidence rate, African American women account for a disproportionate burden of cervical cancer incidence and mortality when compared with non-Hispanic white women. Given that religion occupies an essential place in African American lives, delivering health messages through a popular communication delivery channel and framing them with important spiritual themes may allow for a more accessible and culturally appropriate approach to promoting cervical cancer educational content to African American women. Objective: The aim of this paper was to describe the design and development of the CervixCheck project, a spiritually based short message service (SMS) text messaging pilot intervention to increase cervical cancer awareness and Papanicolaou test screening intention among church-attending African American women aged 21 to 65 years. Methods: Through focus group interviews (n=15), formative research was conducted to explore facilitators, motivators, and barriers to cervical cancer screening. The interviews were also used to identify logistical factors that should be considered when developing the CervixCheck intervention. Culturally appropriate and spiritually grounded SMS text messages were developed based on the analysis of focus group data and the review of previous studies that incorporated technology into health behavior change interventions. After the CervixCheck intervention was developed, cognitive response interviews (n=8) were used to review the content of the SMS text messaging library, to ensure that the content was acceptable and understandable, particularly for church-attending African American women aged 21 to 65 years. Results: Design and development of the SMS text messages involved consideration of the content of the messages and technological specifications. Focus group participants overwhelmingly reported cell phone use and an interest in receiving spiritually based SMS text messages on cervical cancer prevention and early detection. Findings from the cognitive response interviews revealed that the content of the SMS text messaging library was acceptable and understandable with the target population. The revised SMS text messaging library currently includes 22 messages for delivery over 16 days, averaging 11 texts per week, with no more than two messages delivered per day. Initial usability testing also showed early feasibility. Conclusions: The design and development of the CervixCheck intervention provides important insight into what may be considered an overlooked minority population and missed opportunity in health information technology research. With increased internet penetration through the use of mobile phones, it is appropriate to investigate the viability of technology as a means to reach minority communities and to reduce health disparities. %M 30684433 %R 10.2196/formative.8112 %U http://formative.jmir.org/2018/1/e5/ %U https://doi.org/10.2196/formative.8112 %U http://www.ncbi.nlm.nih.gov/pubmed/30684433 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e100 %T Integration of a Technology-Based Mental Health Screening Program Into Routine Practices of Primary Health Care Services in Peru (The Allillanchu Project): Development and Implementation %A Diez-Canseco,Francisco %A Toyama,Mauricio %A Ipince,Alessandra %A Perez-Leon,Silvana %A Cavero,Victoria %A Araya,Ricardo %A Miranda,J Jaime %+ CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 497, Miraflores, Lima, Peru, 51 12416978, fdiezcanseco@gmail.com %K mental health %K mHealth %K SMS %K textmessaging %K screening %K mobile health %K health services research %D 2018 %7 15.3.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite their high prevalence and significant burden, mental disorders such as depression remain largely underdiagnosed and undertreated. Objective: The aim of the Allillanchu Project was to design, develop, and test an intervention to promote early detection, opportune referral, and access to treatment of patients with mental disorders attending public primary health care (PHC) services in Lima, Peru. Methods: The project had a multiphase design: formative study, development of intervention components, and implementation. The intervention combined three strategies: training of PHC providers (PHCPs), task shifting the detection and referral of mental disorders, and a mobile health (mHealth) component comprising a screening app followed by motivational and reminder short message service (SMS) to identify at-risk patients. The intervention was implemented by 22 PHCPs from five health centers, working in antenatal care, tuberculosis, chronic diseases, and HIV or AIDS services. Results: Over a period of 9 weeks, from September 2015 to November 2015, 733 patients were screened by the 22 PHCPs during routine consultations, and 762 screening were completed in total. The chronic diseases (49.9%, 380/762) and antenatal care services (36.7%, 380/762) had the higher number of screenings. Time constraints and workload were the main barriers to implementing the screening, whereas the use of technology, training, and supervision of the PHCPs by the research team were identified as facilitators. Of the 733 patients, 21.7% (159/733) screened positively and were advised to seek specialized care. Out of the 159 patients with a positive screening result, 127 had a follow-up interview, 72.4% (92/127) reported seeking specialized care, and 55.1% (70/127) stated seeing a specialist. Both patients and PHCPs recognized the utility of the screening and identified some key challenges to its wider implementation. Conclusions: The use of a screening app supported by training and supervision is feasible and uncovers a high prevalence of unidentified psychological symptoms in primary care. To increase its sustainability and utility, this procedure can be incorporated into the routine practices of existing health care services, following tailoring to the resources and features of each service. The early detection of psychological symptoms by a PHCP within a regular consultation, followed by adequate advice and support, can lead to a significant percentage of patients accessing specialized care and reducing the treatment gap of mental disorders. %M 29588272 %R 10.2196/jmir.9208 %U http://www.jmir.org/2018/3/e100/ %U https://doi.org/10.2196/jmir.9208 %U http://www.ncbi.nlm.nih.gov/pubmed/29588272 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e93 %T Transition of a Text-Based Insulin Titration Program From a Randomized Controlled Trial Into Real-World Settings: Implementation Study %A Levy,Natalie Koch %A Orzeck-Byrnes,Natasha A %A Aidasani,Sneha R %A Moloney,Dana N %A Nguyen,Lisa H %A Park,Agnes %A Hu,Lu %A Langford,Aisha T %A Wang,Binhuan %A Sevick,Mary Ann %A Rogers,Erin S %+ Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, OBVA 616, 462 First Avenue, New York, NY, 10016, United States, 1 212 263 8924, natalie.levy@nyumc.org %K insulin/long-acting/administration & dosage %K diabetes mellitus, type 2/drug therapy %K medically underserved area %K telemedicine %K healthcare disparities %D 2018 %7 19.03.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The Mobile Insulin Titration Intervention (MITI) program helps patients with type 2 diabetes find their correct basal insulin dose without in-person care. Requiring only basic cell phone technology (text messages and phone calls), MITI is highly accessible to patients receiving care in safety-net settings. MITI was shown in a randomized controlled trial (RCT) to be efficacious at a New York City (NYC) safety-net clinic where patients often have challenges coming for in-person care. In 2016, MITI was implemented as usual care at Bellevue Hospital (the site of the original RCT) and at Gouverneur Health (a second NYC safety-net clinic) under 2 different staffing models. Objective: This implementation study examined MITI’s transition into real-world settings. To understand MITI’s flexibility, generalizability, and acceptability among patients and providers, we evaluated whether MITI continued to produce positive outcomes in expanded underserved populations, outside of an RCT setting. Methods: Patients enrolled in MITI received weekday text messages asking for their fasting blood glucose (FBG) values and a weekly titration call. The goal was for patients to reach their optimal insulin dose (OID), defined either as the dose of once-daily basal insulin required to achieve either an FBG of 80-130 mg/dL (4.4-7.2 mmol/L) or as the reaching of the maximum dose of 50 units. After 12 weeks, if OID was not reached, the patients were asked to return to the clinic for in-person care and titration. MITI program outcomes, clinical outcomes, process outcomes, and patient satisfaction were assessed. Results: MITI was successful at both sites, each with a different staffing model. Providers referred 170 patients to the program—129 of whom (75.9%, 129/170) were eligible. Of these, 113 (87.6%, 113/129) enrolled. Moreover, 84.1% (95/113) of patients reached their OID, and they did so in an average of 24 days. Clinical outcomes show that mean FBG levels fell from 209 mg/dL (11.6 mmol/L) to 141 mg/dL (7.8 mmol/L), P<.001. HbA1c levels fell from 11.4% (101 mmol/mol) to 10.0% (86 mmol/mol), P<.001. Process outcomes show that 90.1% of MITI’s text message prompts received a response, nurses connected with patients 81.9% of weeks to provide titration instructions, and 85% of attending physicians made at least one referral to the MITI program. Satisfaction surveys showed that most patients felt comfortable sharing information over text and felt the texts reminded them to take their insulin, check their sugar, and make healthy food choices. Conclusions: This implementation study showed MITI to have continued success after transitioning from an RCT program into real-world settings. MITI showed itself to be flexible and generalizable as it easily fits into a second site staffed by general medical clinic–registered nurses and remained acceptable to patients and staff who had high levels of engagement with the program. %M 29555621 %R 10.2196/jmir.9515 %U http://www.jmir.org/2018/3/e93/ %U https://doi.org/10.2196/jmir.9515 %U http://www.ncbi.nlm.nih.gov/pubmed/29555621 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 1 %P e20 %T Effect of Mobile Phone Text Message Reminders on Routine Immunization Uptake in Pakistan: Randomized Controlled Trial %A Kazi,Abdul Momin %A Ali,Murtaza %A Zubair,Khurram %A Kalimuddin,Hussain %A Kazi,Abdul Nafey %A Iqbal,Saleem Perwaiz %A Collet,Jean-Paul %A Ali,Syed Asad %+ Department of Paediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan, 92 34864232, momin.kazi@aku.edu %K SMS %K mobile phone %K reminders %K low- and middle-income countries %K routine immunization %K children %D 2018 %7 07.03.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Improved routine immunization (RI) coverage is recommended as the priority public health strategy to decrease vaccine-preventable diseases and eradicate polio in Pakistan and worldwide. Objective: The objective of this study was to ascertain whether customized, automated, one-way text messaging (short message service, SMS) reminders delivered to caregivers via mobile phones when a child is due for an RI visit can improve vaccination uptake and timelines in Pakistan. Methods: This was a randomized controlled trial, conducted in an urban squatter settlement area of Karachi, Pakistan. Infants less than 2 weeks of age with at least one family member who had a valid mobile phone connection and was comfortable receiving and reading SMS text messages were included. Participants were randomized to the intervention (standard care + one-way SMS reminder) or control (standard care) groups. The primary outcome was to compare the proportion of children immunized up to date at 18 weeks of age. Vaccine given at 6, 10, and 14 weeks schedule includes DPT-Hep-B-Hib vaccine (ie, diphtheria, pertussis, and tetanus; hepatitis B; and Haemophilus influenza type b) and oral poliovirus vaccine (OPV). Data were analyzed using chi-square tests of independence and tested for both per protocol (PP) and intention-to-treat (ITT) analyses. Results: Out of those approached, 84.3% (300/356) of the participants were eligible for enrollment and 94.1% (318/338) of the participants had a working mobile phone. Only children in the PP analyses, who received an SMS reminder for vaccine uptake at 6 weeks visit, showed a statistically significant difference (96.0%, 86/90 vs 86.4%, 102/118; P=.03).The immunization coverage was consistently higher in the intervention group according to ITT analyses at the 6 weeks scheduled visit (76.0% vs 71.3%, P=.36). The 10 weeks scheduled visit (58.7% vs 52.7%, P=.30) and the 14 weeks scheduled visit (31.3% vs 26.0%, P=.31), however, were not statistically significant. Conclusions: Automated simple one-way SMS reminders in local languages might be feasible for improving routine vaccination coverage. Whether one-way SMS reminders alone can have a strong impact on parental attitudes and behavior for improvement of RI coverage and timeliness needs to be further evaluated by better-powered studies and by comparing different types and content of text messages in low-and middle-income countries (LMICs). Trial Registration: ClinicalTrials.gov NCT01859546; https://clinicaltrials.gov/ct2/show/NCT01859546 (Archived by WebCite at http://www.webcitation.org/6xFr57AOc) %M 29514773 %R 10.2196/publichealth.7026 %U http://publichealth.jmir.org/2018/1/e20/ %U https://doi.org/10.2196/publichealth.7026 %U http://www.ncbi.nlm.nih.gov/pubmed/29514773 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 1 %P e13 %T Experiences of Indian Health Workers Using WhatsApp for Improving Aseptic Practices With Newborns: Exploratory Qualitative Study %A Pahwa,Parika %A Lunsford,Sarah %A Livesley,Nigel %+ EnCompass LLC, 5404 Wisconsin Ave, Chevy Chase, MD, 20815, United States, 1 6177849008, ssmith@urc-chs.com %K quality improvement %K mobile apps %K communication %K patient care team %D 2018 %7 01.03.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: Quality improvement (QI) involves the following 4 steps: (1) forming a team to work on a specific aim, (2) analyzing the reasons for current underperformance, (3) developing changes that could improve care and testing these changes using plan-do-study-act cycles (PDSA), and (4) implementing successful interventions to sustain improvements. Teamwork and group discussion are key for effective QI, but convening in-person meetings with all staff can be challenging due to workload and shift changes. Mobile technologies can support communication within a team when face-to-face meetings are not possible. WhatsApp, a mobile messaging platform, was implemented as a communication tool by a neonatal intensive care unit (NICU) team in an Indian tertiary hospital seeking to reduce nosocomial infections in newborns. Objective: This exploratory qualitative study aimed to examine experiences with WhatsApp as a communication tool among improvement team members and an external coach to improve adherence to aseptic protocols. Methods: Ten QI team members and the external coach were interviewed on communication processes and approaches and thematically analyzed. The WhatsApp transcript for the implementation period was also included in the analysis. Results: WhatsApp was effective for disseminating information, including guidance on QI and clinical practice, and data on performance indicators. It was not effective as a platform for group discussion to generate change ideas or analyze the performance indicator data. The decision of who to include in the WhatsApp group and how members engaged in the group may have reinforced existing hierarchies. Using WhatsApp created a work environment in which members were accessible all the time, breaking down barriers between personal and professional time. The continual influx of messages was distracting to some respondents, and how respondents managed these messages (eg, using the silent function) may have influenced their perceptions of WhatsApp. The coach used WhatsApp to share information, schedule site visits, and prompt action on behalf of the team. Conclusions: WhatsApp is a productive communication tool that can be used by teams and coaches to disseminate information and prompt action to improve the quality of care, but cannot replace in-person meetings. %M 29496651 %R 10.2196/medinform.8154 %U http://medinform.jmir.org/2018/1/e13/ %U https://doi.org/10.2196/medinform.8154 %U http://www.ncbi.nlm.nih.gov/pubmed/29496651 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e35 %T A Text Message Intervention with Adaptive Goal Support to Reduce Alcohol Consumption Among Non-Treatment-Seeking Young Adults: Non-Randomized Clinical Trial with Voluntary Length of Enrollment %A Suffoletto,Brian %A Chung,Tammy %A Muench,Frederick %A Monti,Peter %A Clark,Duncan B %+ Department of Emergency Medicine, University of Pittsburgh, Suite 400, Iroquois Building, 3600 Forbes Avenue, Pittsburgh, PA, 15261, United States, 1 412 901 6892, suffbp@upmc.edu %K binge drinking %K young adult %K text messaging %D 2018 %7 16.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Stand-alone text message–based interventions can reduce binge drinking episodes (≥4 drinks for women and ≥5 drinks for men) among nontreatment-seeking young adults, but may not be optimized. Adaptive text message support could enhance effectiveness by assisting context-specific goal setting and striving, but it remains unknown how to best integrate it into text message interventions. Objective: The objective of this study was to evaluate young adults’ engagement with a text message intervention, Texting to Reduce Alcohol Consumption 2 (TRAC2), which focuses on reducing weekend alcohol consumption. TRAC2 incorporated preweekend drinking-limit goal-commitment ecological momentary assessments (EMA) tailored to past 2-week alcohol consumption, intraweekend goal reminders, self-efficacy EMA with support tailored to goal confidence, and maximum weekend alcohol consumption EMA with drinking limit goal feedback. Methods: We enrolled 38 nontreatment-seeking young adults (aged 18 to 25 years) who screened positive for hazardous drinking in an urban emergency department. Following a 2-week text message assessment-only run-in, subjects were given the opportunity to enroll in 4-week intervention blocks. We examined patterns of EMA responses and voluntary re-enrollment. We then examined how goal commitment and goal self-efficacy related to event-level alcohol consumption. Finally, we examined the association of length of TRAC2 exposure with alcohol-related outcomes from baseline to 3-month follow-up. Results: Among a diverse sample of young adults (56% [28/50] female, 54% [27/50] black, 32% [12/50] college enrolled), response rates to EMA queries were, on average, 82% for the first 4-week intervention block, 75% for the second 4-week block, and 73% for the third 4-week block. In the first 4 weeks of the intervention, drinking limit goal commitment was made 68/71 times it was prompted (96%). The percentage of subjects being prompted to commit to a drinking limit goal above the binge threshold was 52% (15/29) in week 1 and decreased to 0% (0/15) by week 4. Subjects met their goal 130/146 of the times a goal was committed to (89.0%). There were lower rates of goal success when subjects reported lower confidence (score <4) in meeting the goal (76% [32/42 weekends]) compared with that when subjects reported high confidence (98% [56/57 weekends]; P=.001). There were reductions in alcohol consumption from baseline to 3 months, but reductions were not different by length of intervention exposure. Conclusions: Preliminary evidence suggests that nontreatment-seeking young adults will engage with a text message intervention incorporating self-regulation support features, resulting in high rates of weekend drinking limit goal commitment and goal success. %M 29453191 %R 10.2196/mhealth.8530 %U http://mhealth.jmir.org/2018/2/e35/ %U https://doi.org/10.2196/mhealth.8530 %U http://www.ncbi.nlm.nih.gov/pubmed/29453191 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e39 %T Feasibility and Efficacy of a Parent-Focused, Text Message–Delivered Intervention to Reduce Sedentary Behavior in 2- to 4-Year-Old Children (Mini Movers): Pilot Randomized Controlled Trial %A Downing,Katherine L %A Salmon,Jo %A Hinkley,Trina %A Hnatiuk,Jill A %A Hesketh,Kylie D %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, 3125, Australia, 61 392446088, k.downing@deakin.edu.au %K child behavior %K children %K mHealth %D 2018 %7 09.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite public health guidelines to limit sedentary behavior, many young children spend large amounts of time sedentary (eg, screen and sitting time) during waking hours. Objective: The objective of this study was to test the feasibility and efficacy of a parent-focused, predominantly text message–delivered intervention to support parents to reduce the amount of time their children spend in sedentary behavior. Methods: Mini Movers was a pilot randomized controlled trial delivered to parents of 2- to 4-year-old children in Melbourne, Australia. Participants were recruited through playgroups, social media, and snowball sampling. Eligibility criteria were having an ambulatory child (2-4 years), English literacy, and smartphone ownership. Participants were randomized to intervention or wait-list control on a 1:1 ratio after baseline data collection. The 6-week intervention was predominantly delivered via text messages, using a Web-based bulk text message platform managed by the interventionist. Intervention strategies focused on increasing parental knowledge, building self-efficacy, setting goals, and providing reinforcement, and were underpinned by the Coventry, Aberdeen & London-Refined taxonomy of behavior change techniques and social cognitive theory. The primary outcome was intervention feasibility, measured by recruitment, retention, intervention delivery, and fidelity; process evaluation questionnaires; and qualitative interviews with a subsample of participants. Secondary outcomes were children’s screen and restraint time (parent report), sitting time (parent report, activPAL), and potential mediators (parent report). Linear regression models were used to determine intervention effects on secondary outcomes, controlling for the child’s sex and age and clustering by playgroup; effect sizes (Cohen's d) were calculated. Results: A total of 57 participants (30 intervention; 27 wait-list control) were recruited, and retention was high (93%). Process evaluation results showed that the intervention was highly acceptable to parents. The majority of intervention components were reported to be useful and relevant. Compared with children in the control group, children in the intervention group had significantly less screen time postintervention (adjusted difference [95% CI]=−35.0 [−64.1 to −5.9] min/day; Cohen's d=0.82). All other measures of sedentary behavior were in the expected direction, with small to moderate effect sizes. Conclusions: Mini Movers was shown to be a feasible, acceptable, and efficacious pilot intervention for parents of young children, warranting a larger-scale randomized control trial. Trial Registration: Australian New Zealand Clinical Trials registry: ACTRN12616000628448; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?ACTRN=12616000628448p (Archived by WebCite at http://www.webcitation.org/ 6wZcA3cYM) %M 29426816 %R 10.2196/mhealth.8573 %U http://mhealth.jmir.org/2018/2/e39/ %U https://doi.org/10.2196/mhealth.8573 %U http://www.ncbi.nlm.nih.gov/pubmed/29426816 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 1 %P e9 %T The Use of Communication Apps by Medical Staff in the Australian Health Care System: Survey Study on Prevalence and Use %A Nikolic,Amanda %A Wickramasinghe,Nilmini %A Claydon-Platt,Damian %A Balakrishnan,Vikram %A Smart,Philip %+ General Surgery and Gastroenterology Clinical Institute, Epworth Healthcare, 89 Bridge Road, Richmond, 3121, Australia, 61 294266666, nikolicamanda@gmail.com %K mobile phone %K information science %K communications media %K privacy %K interdisciplinary communication %K hospital communication systems %K communication %D 2018 %7 09.02.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: The use of communication apps on mobile phones offers an efficient, unobtrusive, and portable mode of communication for medical staff. The potential enhancements in patient care and education appear significant, with clinical details able to be shared quickly within multidisciplinary teams, supporting rapid integration of disparate information, and more efficient patient care. However, sharing patient data in this way also raises legal and ethical issues. No data is currently available demonstrating how widespread the use of these apps are, doctor’s attitudes towards them, or what guides clinician choice of app. Objective: The objective of this study was to quantify and qualify the use of communication apps among medical staff in clinical situations, their role in patient care, and knowledge and attitudes towards safety, key benefits, potential disadvantages, and policy implications. Methods: Medical staff in hospitals across Victoria (Australia) were invited to participate in an anonymous 33-question survey. The survey collected data on respondent’s demographics, their use of communication apps in clinical settings, attitudes towards communication apps, perceptions of data “safety,” and why one communication app was chosen over others. Results: Communication apps in Victorian hospitals are in widespread use from students to consultants, with WhatsApp being the primary app used. The median number of messages shared per day was 12, encompassing a range of patient information. All respondents viewed these apps positively in quickly communicating patient information in a clinical setting; however, all had concerns about the privacy implications arising from sharing patient information in this way. In total, 67% (60/90) considered patient data “moderately safe” on these apps, and 50% (46/90) were concerned the use of these apps was inconsistent with current legislation and policy. Apps were more likely to be used if they were fast, easy to use, had an easy login process, and were already in widespread use. Conclusions: Communication app use by medical personnel in Victorian hospitals is pervasive. These apps contribute to enhanced communication between medical staff, but their use raises compliance issues, most notably with Australian privacy legislation. Development of privacy-compliant apps such as MedX needs to prioritize a user-friendly interface and market the product as a privacy-compliant comparator to apps previously adapted to health care settings. %M 29426813 %R 10.2196/medinform.9526 %U http://medinform.jmir.org/2018/1/e9/ %U https://doi.org/10.2196/medinform.9526 %U http://www.ncbi.nlm.nih.gov/pubmed/29426813 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 2 %P e37 %T Text-Based Program Addressing the Mental Health of Soon-to-be and New Fathers (SMS4dads): Protocol for a Randomized Controlled Trial %A Fletcher,Richard %A May,Chris %A Attia,John %A Garfield,Craig Franklin %A Skinner,Geoff %+ Family Action Centre, Faculty of Health and Medicine, University of Newcastle, Academic Office Block, University Drive, Callaghan, 2308, Australia, 61 0429152405, richard.fletcher@newcastle.edu.au %K perinatal %K fathers %K online intervention %K randomized controlled trial %K mental health %D 2018 %7 06.02.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Recent estimates indicating that approximately 10% of fathers experience Paternal Perinatal Depression (PPND) and the increasing evidence of the impact of PPND on child development suggest that identifying and assisting distressed fathers is justified on public health grounds. However, addressing new fathers’ mental health needs requires overcoming men’s infrequent contact with perinatal health services and their reluctance to seek help. Text-based interventions delivering information and support have the potential to reach such groups in order to reduce the impact of paternal perinatal distress and to improve the wellbeing of their children. While programs utilising mobile phone technology have been developed for mothers, fathers have not been targeted. Since text messages can be delivered to individual mobile phones to be accessed at a time that is convenient, it may provide a novel channel for engaging with “hard-to-reach” fathers in a critical period of their parenting. Objective: The study will test the efficacy of SMS4dads, a text messaging program designed specifically for fathers including embedded links to online information and regular invitations (Mood Tracker) to monitor their mood, in order to reduce self-reported depression, anxiety and stress over the perinatal period. Methods: A total of 800 fathers-to-be or new fathers from within Australia will be recruited via the SMS4dads website and randomized to the intervention or control arm. The intervention arm will receive 14 texts per month addressing fathers’ physical and mental health, their relationship with their child, and coparenting with their partner. The control, SMS4health, delivers generic health promotion messages twice per month. Messages are timed according to the babies’ expected or actual date of birth and fathers can enroll from 16 weeks into the pregnancy until their infant is 12 weeks of age. Participants complete questionnaires assessing depression, anxiety, stress, and alcohol at baseline and 24 weeks postenrolment. Measures of coparenting and parenting confidence are also completed at baseline and 24 weeks for postbirth enrolments. Results: Participant were recruited between October 2016 and September 2017. Follow-up data collection has commenced and will be completed in March 2018 with results expected in June 2018. Conclusions: This study’s findings will assess the efficacy of a novel text-based program specifically targeting fathers in the perinatal period to improve their depression, anxiety and distress symptoms, coparenting quality, and parenting self-confidence. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000261415; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=370085 (Archived by WebCite at http://www.webcitation.org/6wav55wII). %M 29410387 %R 10.2196/resprot.8368 %U http://www.researchprotocols.org/2018/2/e37/ %U https://doi.org/10.2196/resprot.8368 %U http://www.ncbi.nlm.nih.gov/pubmed/29410387 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e30 %T Improving Refill Adherence in Medicare Patients With Tailored and Interactive Mobile Text Messaging: Pilot Study %A Brar Prayaga,Rena %A Jeong,Erwin W %A Feger,Erin %A Noble,Harmony K %A Kmiec,Magdalen %A Prayaga,Ram S %+ mPulse Mobile, Inc, 16530 Ventura Blvd. Suite 500, Encino, CA,, United States, 1 888 678 5735, rena@mpulsemobile.com %K patient activation %K patient engagement %K medication adherence %K refill management %K text messaging %K interactive %K NLP %K Medicare %K disease management %K technology acceptability model %D 2018 %7 30.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nonadherence is a major concern in the management of chronic conditions such as hypertension, cardiovascular disease, and diabetes where patients may discontinue or interrupt their medication for a variety of reasons. Text message reminders have been used to improve adherence. However, few programs or studies have explored the benefits of text messaging with older populations and at scale. In this paper, we present a program design using tailored and interactive text messaging to improve refill rates of partially adherent or nonadherent Medicare members of a large integrated health plan. Objective: The aim of this 3-month program was to gain an understanding of whether tailored interactive text message dialogues could be used to improve medication refills in Medicare patients with one or more chronic diseases. Methods: We used the mPulse Mobile interactive text messaging solution with partially adherent and nonadherent Medicare patients (ie, over age 65 years or younger with disabilities) of Kaiser Permanente Southern California (KP), a large integrated health plan, and compared refill rates of the text messaging group (n=12,272) to a group of partially adherent or nonadherent Medicare patients at KP who did not receive text messages (nontext messaging group, n=76,068). Both groups were exposed to other forms of refill and adherence outreach including phone calls, secure emails, and robo-calls from December 2016 to February 2017. Results: The text messaging group and nontext messaging group were compared using an independent samples t test to test difference in group average of refill rates. There was a significant difference in medication refill rates between the 2 groups, with a 14.07 percentage points higher refill rate in the text messaging group (P<.001). Conclusions: The results showed a strong benefit of using this text messaging solution to improve medication refill rates among Medicare patients. These findings also support using interactive text messaging as a cost-effective, convenient, and user-friendly solution for patient engagement. Program outcomes and insights can be used to enhance the design of future text-based solutions to improve health outcomes and promote adherence and long-term behavior change. %M 29382623 %R 10.2196/mhealth.8930 %U http://mhealth.jmir.org/2018/1/e30/ %U https://doi.org/10.2196/mhealth.8930 %U http://www.ncbi.nlm.nih.gov/pubmed/29382623 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 1 %N 1 %P e1 %T Accessible Communication Tools for Surgical Site Infection Monitoring and Prevention in Joint Reconstruction: Feasibility Study %A Lu,Keyin %A Chermside-Scabbo,Christopher J %A Marino,Nikolas Evan %A Concepcion,Angela %A Yugawa,Craig %A Aladegbami,Bola %A Paar,Theodora %A St John,Theresa A %A Ross,Will %A Clohisy,John C %A Kirby,John P %+ Department of Surgery, Washington University in Saint Louis, 4901 Forest Park Avenue, St Louis, MO, 63108, United States, 1 (314) 362 1272, kirbyj@wudosis.wustl.edu %K communication tool %K decolonization %K mobile health %K surgical site infection %K automated %K messaging %D 2018 %7 17.01.2018 %9 Original Paper %J JMIR Perioper Med %G English %X Background: The National Surgical Quality Improvement Program logs surgical site infections (SSIs) as the most common cause of unplanned postoperative readmission for a variety of surgical interventions. Hospitals are making significant efforts preoperatively and postoperatively to reduce SSIs and improve care. Telemedicine, defined as using remote technology to implement health care, has the potential to improve outcomes across a wide range of parameters, including reducing SSIs. Objective: The purpose of this study was to assess the feasibility and user satisfaction of two automated messaging systems, EpxDecolonization and EpxWound, to improve perioperative care in a quality improvement project for patients undergoing total joint replacement. Methods: We designed two automated text messaging and calling systems named EpxDecolonization, which reminded patients of their preoperative decolonization protocol, and EpxWound, which monitored pain, wound, and fever status postoperatively. Daily patient responses were recorded and a post-usage survey was sent out to participants to assess satisfaction with the systems. Results: Over the 40-week study period, 638 and 642 patients were enrolled in EpxDecolonization (a preoperative decolonization reminder) and EpxWound (a postoperative surgical site infection telemonitoring system), respectively. Patients could be enrolled in either or both EpxDecolonization and EpxWound, with the default option being dual enrollment. The proportion of sessions responded to was 85.2% for EpxDecolonization and 78.4% for EpxWound. Of the 1280 patients prescribed EpxWound and EpxDecolonization, 821 (64.14%) fully completed the postoperative system satisfaction survey. The median survey score (scale 1-9) was 9 for patient-rated overall care and 8 for whether the telemonitoring systems improved patient communication with providers. The majority of patients (69.0%, 566/821) indicated that the systems sent out an ideal number of messages (not too many, not too few). Conclusions: EpxDecolonization and EpxWound demonstrated high response rates and improved patient-rated communication with providers. These preliminary data suggest that these systems are well tolerated and potentially beneficial to both patients and providers. The systems have the potential to improve both patient satisfaction scores and compliance with preoperative protocols and postoperative wound monitoring. Future efforts will focus on testing the sensitivity and specificity of alerts generated by each system and on demonstrating the ability of these systems to improve clinical quality metrics with more authoritative data. %M 33401369 %R 10.2196/periop.7874 %U http://periop.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/periop.7874 %U http://www.ncbi.nlm.nih.gov/pubmed/33401369 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e8 %T Toward mHealth Brief Contact Interventions in Suicide Prevention: Case Series From the Suicide Intervention Assisted by Messages (SIAM) Randomized Controlled Trial %A Berrouiguet,Sofian %A Larsen,Mark Erik %A Mesmeur,Catherine %A Gravey,Michel %A Billot,Romain %A Walter,Michel %A , %A Lemey,Christophe %A Lenca,Philippe %+ IMT Atlantique, Lab-STICC, Université Bretagne Loire F-29238 Brest, Brest Medical University Hospital at Bohars, Adult Psychiatry, Route de Ploudalmezeau, Brest, 29820, France, 33 668204178, sofian.berrouiguet@gmail.com %K Suicide %K Text Messaging %K Electronic Health Records %K Cell Phone %K Secondary Prevention %K Tertiary Prevention %D 2018 %7 10.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Research indicates that maintaining contact either via letter or postcard with at-risk adults following discharge from care services after a suicide attempt (SA) can reduce reattempt risk. Pilot studies have demonstrated that interventions using mobile health (mHealth) technologies are feasible in a suicide prevention setting. Objective: The aim of this study was to report three cases of patients recruited in the Suicide Intervention Assisted by Messages (SIAM) study to describe how a mobile intervention may influence follow-up. Methods: SIAM is a 2-year, multicenter randomized controlled trial conducted by the Brest University Hospital, France. Participants in the intervention group receive SIAM text messages 48 hours after discharge, then at day 8 and day 15, and months 1, 2, 3, 4, 5, and 6. The study includes participants aged 18 years or older, who have attended a participating hospital for an SA, and have been discharged from the emergency department (ED) or a psychiatric unit (PU) for a stay of less than 7 days. Eligible participants are randomized between the SIAM intervention messages and a control group. In this study, we present three cases from the ongoing SIAM study that demonstrate the capability of a mobile-based brief contact intervention for triggering patient-initiated contact with a crisis support team at various time points throughout the mobile-based follow-up period. Results: Out of the 244 patients recruited in the SIAM randomized controlled trial, three cases were selected to illustrate the impact of mHealth on suicide risk management. Participants initiated contact with the emergency crisis support service after receiving text messages up to 6 months following discharge from the hospital. Contact was initiated immediately following receipt of a text message or up to 6 days following a message. Conclusions: This text message–based brief contact intervention has demonstrated the potential to reconnect suicidal individuals with crisis support services while they are experiencing suicidal ideation as well as in a period after receiving messages. As follow-up phone calls over an extended period of time may not be feasible, this intervention has the potential to offer simple technological support for individuals following discharge from the ED. Trial Registration: ClinicalTrials.gov NCT02106949; https://clinicaltrials.gov/ct2/show/NCT02106949 (Archived by WebCite at http://www.webcitation.org/6wMtAFL49) %M 29321126 %R 10.2196/mhealth.7780 %U http://mhealth.jmir.org/2018/1/e8/ %U https://doi.org/10.2196/mhealth.7780 %U http://www.ncbi.nlm.nih.gov/pubmed/29321126 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e202 %T Medication Adherence and Technology-Based Interventions for Adolescents With Chronic Health Conditions: A Few Key Considerations %A Badawy,Sherif M %A Thompson,Alexis A %A Kuhns,Lisa M %+ Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H Lurie Children's Hospital of Chicago, 225 E Chicago Ave., Box 30, Chicago, IL, 60611, United States, 1 3122274090, sbadawy@luriechildrens.org %K adolescents %K adherence %K compliance %K technology interventions %K mobile apps %K text messaging %D 2017 %7 22.12.2017 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X The number of children and adolescents with chronic health conditions (CHCs) has doubled over the past two decades. Medication adherence is a key component of disease management within these groups. Low adherence to prescribed medications is a known problem in adolescents with CHCs and is related to health outcomes, including quality of life, disease complications, and mortality. Adolescence is a critical time to create routines and health behaviors that optimize disease self-management and transition to adult care. The mounting interest in the development and use of mobile health tools provides novel opportunities to connect patients, particularly adolescents, with their providers outside of the clinic and to improve health outcomes. There is growing evidence to support the efficacy of technology-based approaches, in particular text-messaging and mobile apps, to improve adherence behavior in adolescents, although cost-effectiveness and long-term health benefits remain unclear. In this short viewpoint article, we review some important considerations for promoting medication adherence in adolescents with CHCs using technology-based approaches. %M 29273573 %R 10.2196/mhealth.8310 %U http://mhealth.jmir.org/2017/12/e202/ %U https://doi.org/10.2196/mhealth.8310 %U http://www.ncbi.nlm.nih.gov/pubmed/29273573 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e174 %T Developing mHealth Messages to Promote Postmenstrual Regulation Contraceptive Use in Bangladesh: Participatory Interview Study %A Eckersberger,Elisabeth %A Pearson,Erin %A Andersen,Kathryn %A Hossain,Altaf %A Footman,Katharine %A Biswas,Kamal Kanti %A Nuremowla,Sadid %A Reiss,Kate %+ Ipas, PO Box 9990, Chapel Hill, NC, 27515, United States, 1 9199677052, eckersbergere@ipas.org %K abortion %K reproductive health services %K contraception %K family planning %K mHealth %K Bangladesh %D 2017 %7 14.12.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Abortions are restricted in Bangladesh, but menstrual regulation is an approved alternative, defined as a procedure of regulating the menstrual cycle when menstruation is absent for a short duration. Use of contraception after menstrual regulation can reduce subsequent unintended pregnancy, but in Bangladesh, the contraceptive method mix is dominated by short-term methods, which have higher discontinuation and failure rates. Mobile phones are a channel via which menstrual regulation clients could be offered contraceptive support after leaving the clinic. Objective: This study aimed to support the development of a mobile phone intervention to support postmenstrual regulation family planning use in Bangladesh. It explored what family planning information women want to receive after having a menstrual regulation procedure, whether they would like to receive this information via their mobile phone, and if so, what their preferences are for the way in which it is delivered. Methods: We conducted participatory interviews with 24 menstrual regulation clients in Dhaka and Sylhet divisions in Bangladesh. Women were recruited from facilities in urban and peri-urban areas, which included public sector clinics supported by Ipas, an international nongovernmental organization (NGO), and NGO clinics run by Marie Stopes. Main themes covered in the interviews were factors affecting the use of contraception, what information and support women want after their menstrual regulation procedure, how respondents would prefer to receive information about contraception, and other key issues for mobile health (mHealth) interventions, such as language and privacy. As part of the in-depth interviews, women were shown and played 6 different messages about contraception on the research assistant’s phone, which they were given to operate, and were then asked to give feedback. Results: Women were open to both receiving messages about family planning methods on their mobile phones and talking to a counselor about family planning methods over the phone after their menstrual regulation. Women most commonly wanted information about the contraceptive method they were currently using and wanted this information to be tailored to their particular needs. Women preferred voice messages to text and liked the interactive voice message format. When asked to repeat and identify the main points of the messages, women demonstrated good understanding of the content. Women did not seem too concerned with privacy or with others reading the messages and welcomed including their husbands in speaking to a counselor. Conclusions: This study found that menstrual regulation clients are very interested in receiving information on their phones to support family planning use and wanted more information about the method of contraception they were using. Participatory voicemail was the preferred modality. %M 29242175 %R 10.2196/mhealth.6969 %U http://mhealth.jmir.org/2017/12/e174/ %U https://doi.org/10.2196/mhealth.6969 %U http://www.ncbi.nlm.nih.gov/pubmed/29242175 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 4 %P e56 %T A Mobile Text Message Intervention to Reduce Repeat Suicidal Episodes: Design and Development of Reconnecting After a Suicide Attempt (RAFT) %A Larsen,Mark Erik %A Shand,Fiona %A Morley,Kirsten %A Batterham,Philip J %A Petrie,Katherine %A Reda,Bill %A Berrouiguet,Sofian %A Haber,Paul S %A Carter,Gregory %A Christensen,Helen %+ Black Dog Institute, University of New South Wales, Hospital Road, Sydney, 2031, Australia, 61 293828508, mark.larsen@blackdog.org.au %K suicide, attempted %K emergency service, hospital %K continuity of patient care %K text messaging %K Internet %D 2017 %7 13.12.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Suicide is a leading cause of death, particularly among young people. Continuity of care following discharge from hospital is critical, yet this is a time when individuals often lose contact with health care services. Offline brief contact interventions following a suicide attempt can reduce the number of repeat attempts, and text message (short message service, SMS) interventions are currently being evaluated. Objective: The aim of this study was to extend postattempt caring contacts by designing a brief Web-based intervention targeting proximal risk factors and the needs of this population during the postattempt period. This paper details the development process and describes the realized system. Methods: To inform the design of the intervention, a lived experience design group was established. Participants were asked about their experiences of support following their suicide attempt, their needs during this time, and how these could be addressed in a brief contact eHealth intervention. The intervention design was also informed by consultation with lived experience panels external to the project and a clinical design group. Results: Prompt outreach following discharge, initial distraction activities with low cognitive demands, and ongoing support over an extended period were identified as structural requirements of the intervention. Key content areas identified included coping with distressing feelings, safety planning, emotional regulation and acceptance, coping with suicidal thoughts, connecting with others and interpersonal relationships, and managing alcohol consumption. Conclusions: The RAFT (Reconnecting AFTer a suicide attempt) text message brief contact intervention combines SMS contacts with additional Web-based brief therapeutic content targeting key risk factors. It has the potential to reduce the number of repeat suicidal episodes and to provide accessible, acceptable, and cost-effective support for individuals who may not otherwise seek face-to-face treatment. A pilot study to test the feasibility and acceptability of the RAFT intervention is underway. %M 29237584 %R 10.2196/mental.7500 %U http://mental.jmir.org/2017/4/e56/ %U https://doi.org/10.2196/mental.7500 %U http://www.ncbi.nlm.nih.gov/pubmed/29237584 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 12 %P e247 %T MyVoice National Text Message Survey of Youth Aged 14 to 24 Years: Study Protocol %A DeJonckheere,Melissa %A Nichols,Lauren P %A Moniz,Michelle H %A Sonneville,Kendrin R %A Vydiswaran,VG Vinod %A Zhao,Xinyan %A Guetterman,Timothy C %A Chang,Tammy %+ Department of Family Medicine, University of Michigan, 1018 Fuller St., Ann Arbor, MI, 48104, United States, 1 (734) 998 7120, mdejonck@med.umich.edu %K adolescents %K text messaging %K longitudinal study %K mixed methods %K health policy %D 2017 %7 11.12.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: There has been little progress in adolescent health outcomes in recent decades. Researchers and youth-serving organizations struggle to accurately elicit youth voice and translate youth perspectives into health care policy. Objective: Our aim is to describe the protocol of the MyVoice Project, a longitudinal mixed methods study designed to engage youth, particularly those not typically included in research. Text messaging surveys are collected, analyzed, and disseminated in real time to leverage youth perspectives to impact policy. Methods: Youth aged 14 to 24 years are recruited to receive weekly text message surveys on a variety of policy and health topics. The research team, including academic researchers, methodologists, and youth, develop questions through an iterative writing and piloting process. Question topics are elicited from community organizations, researchers, and policy makers to inform salient policies. A youth-centered interactive platform has been developed that automatically sends confidential weekly surveys and incentives to participants. Parental consent is not required because the survey is of minimal risk to participants. Recruitment occurs online (eg, Facebook, Instagram, university health research website) and in person at community events. Weekly surveys collect both quantitative and qualitative data. Quantitative data are analyzed using descriptive statistics. Qualitative data are quickly analyzed using natural language processing and traditional qualitative methods. Mixed methods integration and analysis supports a more in-depth understanding of the research questions. Results: We are currently recruiting and enrolling participants through in-person and online strategies. Question development, weekly data collection, data analysis, and dissemination are in progress. Conclusions: MyVoice quickly ascertains the thoughts and opinions of youth in real time using a widespread, readily available technology—text messaging. Results are disseminated to researchers, policy makers, and youth-serving organizations through a variety of methods. Policy makers and organizations also share their priority areas with the research team to develop additional question sets to inform important policy decisions. Youth-serving organizations can use results to make decisions to promote youth well-being. %M 29229587 %R 10.2196/resprot.8502 %U http://www.researchprotocols.org/2017/12/e247/ %U https://doi.org/10.2196/resprot.8502 %U http://www.ncbi.nlm.nih.gov/pubmed/29229587 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e176 %T Texting Condolences: Adapting mHealth Programs After Unexpected Pregnancy and Infant Outcomes %A Unger,Jennifer A %A Kinuthia,John %A John-Stewart,Grace %+ Global Center for Integrated Health of Women, Adolescents and Children, Department of Global Health, University of Washington, Harborview Medical Center, Seattle, WA,, United States, 1 206 388 8141, junger@uw.edu %K mHealth %K infant loss %K miscarriage %D 2017 %7 08.12.2017 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Mobile health (mHealth) short message system (SMS) interventions for maternal and child health (MCH) are being implemented globally. In many low- and middle-income settings in which these mHealth interventions are being rolled out, stillbirths and neonatal and infant deaths are common. It is important that mHealth solutions do not exacerbate emotional stress and pain by continuing with routine messaging for pregnancy or infant care when someone has experienced loss. In this brief viewpoint paper, we argue that SMS programs for maternal and child health need to adapt and make available messaging for miscarriage, stillbirth, and infant loss. %M 29222078 %R 10.2196/mhealth.8303 %U http://mhealth.jmir.org/2017/12/e176/ %U https://doi.org/10.2196/mhealth.8303 %U http://www.ncbi.nlm.nih.gov/pubmed/29222078 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 4 %P e89 %T Check and Report Ebola (CARE) Hotline: The User Perspective of an Innovative Tool for Postarrival Monitoring of Ebola in the United States %A McCarthy,Ilana Olin %A Wojno,Abbey E %A Joseph,Heather A %A Teesdale,Scott %+ Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, 1600 Clifton Road, Mail Stop E-07, Atlanta, GA, 30333, United States, +1 4046616153, yyr6@cdc.gov %K Ebola %K postarrival monitoring %K interactive voice recognition %D 2017 %7 14.11.2017 %9 Short Paper %J JMIR Public Health Surveill %G English %X Background: The response to the 2014-2016 Ebola epidemic included an unprecedented effort from federal, state, and local public health authorities to monitor the health of travelers entering the United States from countries with Ebola outbreaks. The Check and Report Ebola (CARE) Hotline, a novel approach to monitoring, was designed to enable travelers to report their health status daily to an interactive voice recognition (IVR) system. The system was tested with 70 Centers for Disease Control and Prevention (CDC) federal employees returning from deployments in outbreak countries. Objective: The objective of this study was to describe the development of the CARE Hotline as a tool for postarrival monitoring and examine the usage characteristics and user experience of the tool during a public health emergency. Methods: Data were obtained from two sources. First, the CARE Hotline system produced a call log which summarized the usage characteristics of all 70 users’ daily health reports. Second, we surveyed federal employees (n=70) who used the CARE Hotline to engage in monitoring. A total of 21 (21/70, 30%) respondents were included in the survey analytic sample. Results: While the CARE Hotline was used for monitoring, 70 users completed a total of 1313 calls. We found that 94.06% (1235/1313) of calls were successful, and the average call time significantly decreased from the beginning of the monitoring period to the end by 32 seconds (Z score=−6.52, P<.001). CARE Hotline call log data were confirmed by user feedback; survey results indicated that users became more familiar with the system and found the system easier to use, from the beginning to the end of their monitoring period. The majority of the users were highly satisfied (90%, 19/21) with the system, indicating ease of use and convenience as primary reasons, and would recommend it for future monitoring efforts (90%, 19/21). Conclusions: The CARE Hotline garnered high user satisfaction, required minimal reporting time from users, and was an easily learned tool for monitoring. This phone-based technology can be modified for future public health emergencies. %M 29138130 %R 10.2196/publichealth.7817 %U http://publichealth.jmir.org/2017/4/e89/ %U https://doi.org/10.2196/publichealth.7817 %U http://www.ncbi.nlm.nih.gov/pubmed/29138130 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 11 %P e172 %T Electronic Brief Intervention and Text Messaging for Marijuana Use During Pregnancy: Initial Acceptability of Patients and Providers %A Gray,Justin %A Beatty,Jessica R %A Svikis,Dace S %A Puder,Karoline S %A Resnicow,Ken %A Konkel,Janine %A Rice,Shetoya %A McGoron,Lucy %A Ondersma,Steven J %+ Merrill Palmer Skillman Institute, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, 71 East Ferry, Detroit, MI, 48202, United States, 1 3136642518, jbeatty@wayne.edu %K pregnancy %K marijuana %K intervention study %K text messaging %D 2017 %7 08.11.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Marijuana is the most widely used illicit substance during pregnancy. Technology-delivered brief interventions and text messaging have shown promise in general and pregnant samples but have not yet been applied to marijuana use in pregnancy. Objective: The objective of the study was to evaluate, among pregnant women and prenatal care providers, the acceptability of an electronic brief intervention and text messaging plan for marijuana use in pregnancy. Methods: Participants included patients (n=10) and medical staff (n=12) from an urban prenatal clinic. Patient-participants were recruited directly during a prenatal care visit. Those who were eligible reviewed the interventions individually and provided quantitative and qualitative feedback regarding software acceptability and helpfulness during a one-on-one interview with research staff. Provider-participants took part in focus groups in which the intervention materials were reviewed and discussed. Qualitative and focus group feedback was transcribed, coded manually, and classified by category and theme. Results: Patient-participants provided high ratings for satisfaction, with mean ratings for respectfulness, interest, ease of use, and helpfulness ranging between 4.4 and 4.7 on a 5-point Likert scale. Of the 10 participants, 5 reported that they preferred working with the program versus their doctor, and 9 of 10 said the intervention made them more likely to reduce their marijuana use. Provider-participants received the program favorably, stating the information presented was both relevant and important for their patient population. Conclusions: The findings support the acceptability of electronic brief intervention and text messaging for marijuana use during pregnancy. This, combined with their ease of use and low barrier to initiation, suggests that further evaluation in a randomized trial is appropriate. %M 29117931 %R 10.2196/mhealth.7927 %U http://mhealth.jmir.org/2017/11/e172/ %U https://doi.org/10.2196/mhealth.7927 %U http://www.ncbi.nlm.nih.gov/pubmed/29117931 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 1 %N 1 %P e4 %T Using mHealth to Support Postabortion Contraceptive Use: Results From a Feasibility Study in Urban Bangladesh %A Biswas,Kamal Kanti %A Hossain,Altaf %A Chowdhury,Rezwana %A Andersen,Kathryn %A Sultana,Sharmin %A Shahidullah,S M %A Pearson,Erin %+ Ipas, P.O. Box 9990, Chapel Hill, NC, 27515, United States, 919 967 7052, andersenk@Ipas.org %K mHealth %K Bangladesh %K contraceptive usage %K postabortion contraception %D 2017 %7 27.10.2017 %9 Original Paper %J JMIR Formativ Res %G English %X Background: As access to mobile technology improves in low- and middle-income countries, it becomes easier to provide information about sensitive issues, such as contraception and abortion. In Bangladesh, 97% of the population has access to a mobile signal, and the equity gap is closing in mobile phone ownership. Bangladesh has a high pregnancy termination rate and improving effective use of contraception after abortion is essential to reducing subsequent unwanted pregnancies. Objective: This study examines the feasibility and acceptability of implementing a short message service (SMS) text message-based mHealth intervention to support postabortion contraceptive use among abortion clients in Bangladesh, including women’s interest in the intervention, intervention preferences, and privacy concerns. Methods: This feasibility study was conducted in four urban, high abortion caseload facilities. Women enrolled in the study were randomized into an intervention (n=60) or control group (n=60) using block randomization. Women completed a baseline interview on the day of their abortion procedure and a follow-up interview 4 months later (retention rate: 89.1%, 107/120). Women in the intervention group received text message reminders to use their selected postabortion contraceptive methods and reminders to contact the facility if they had problems or concerns with their method. Women who did not select a method received weekly messages that they could visit the clinic if they would like to start a method. Women in the control group did not receive any messages. Results: Almost all women in the feasibility study reported using their mobile phones at least once per day (98.3%, 118/120) and 77.5% (93/120) used their phones for text messaging. In the intervention group, 87% (48/55) of women were using modern contraception at the 4-month follow-up, whereas 90% (47/52) were using contraception in the control group (P=.61). The intervention was not effective in increasing modern contraceptive use at follow-up, but 93% (51/55) of women reported at follow-up that the text reminders helped them use their method correctly and 76% (42/55) said they would sign up for this service again. Approximately half of the participants (53%, 29/55) said that someone they did not want to know about the text message reminders found out, mostly their husbands or children. Conclusions: In this small-scale feasibility study, text reminders did not increase postabortion contraceptive use. Despite the ineffectiveness of the text reminder intervention, implementation of a mHealth intervention among abortion clients in urban Bangladesh was feasible in that women were interested in receiving follow-up messages after their abortion and mobile phone use was common. Text messages may not be the best modality for a mHealth intervention due to relatively low baseline SMS text message use and privacy concerns. %M 30684398 %R 10.2196/formative.5151 %U http://formative.jmir.org/2017/1/e4/ %U https://doi.org/10.2196/formative.5151 %U http://www.ncbi.nlm.nih.gov/pubmed/30684398 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 4 %P e46 %T Techniques for Improving Communication of Emotional Content in Text-Only Web-Based Therapeutic Communications: Systematic Review %A Paul,Christine Louise %A Cox,Martine Elizabeth %A Small,Hannah Julie %A Boyes,Allison W %A O'Brien,Lorna %A Rose,Shiho Karina %A Baker,Amanda L %A Henskens,Frans A %A Kirkwood,Hannah Naomi %A Roach,Della M %+ Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 2 4042 0659, chris.paul@newcastle.edu.au %K nonverbal communication %K Internet %K computer-assisted therapy %D 2017 %7 24.10.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Web-based typed exchanges are increasingly used by professionals to provide emotional support to patients. Although some empirical evidence exists to suggest that various strategies may be used to convey emotion during Web-based text communication, there has been no critical review of these data in patients with chronic conditions. Objectives: The objective of this review was to identify the techniques used to convey emotion in written or typed Web-based communication and assess the empirical evidence regarding impact on communication and psychological outcomes. Methods: An electronic search of databases, including MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Library was conducted to identify literature published from 1990 to 2016. Searches were also conducted using Google Scholar, manual searching of reference lists of identified papers and manual searching of tables of contents for selected relevant journals. Data extraction and coding were completed by 2 reviewers (10.00% [573/5731] of screened papers, at abstract/title screening stage; 10.0% of screened [69/694] papers, at full-text screening stage). Publications were assessed against the eligibility criteria and excluded if they were duplicates, were not published in English, were published before 1990, referenced animal or nonhuman subjects, did not describe original research, were not journal papers, or did not empirically test the effect of one or more nonverbal communication techniques (for eg, smileys, emoticons, emotional bracketing, voice accentuation, trailers [ellipsis], and pseudowords) as part of Web-based or typed communication on communication-related variables, including message interpretation, social presence, the nature of the interaction (eg, therapeutic alliance), patient perceptions of the interaction (eg, participant satisfaction), or psychological outcomes, including depression, anxiety, and distress. Results: A total of 6902 unique publications were identified. Of these, six publications met the eligibility criteria and were included in a narrative synthesis. All six studies addressed the effect of smileys or emoticons on participant responses, message interpretation, or social presence of the writer. None of these studies specifically targeted chronic conditions. It was found that emoticons were more effective in influencing the emotional impact of a message than no cue and that smileys and emoticons were able to convey a limited amount of emotion. No studies addressed other techniques for conveying emotion in written communication. No studies addressed the effects of any techniques on the nature of the interaction (eg, therapeutic alliance), patient perceptions of the interaction (eg, participant satisfaction), or psychological outcomes (depression, anxiety, or distress). Conclusions: There is a need for greater empirical attention to the effects of the various proposed techniques for conveying emotion in Web-based typed communications to inform health service providers regarding best-practice communication skills in this setting. %M 29066426 %R 10.2196/mental.6707 %U http://mental.jmir.org/2017/4/e46/ %U https://doi.org/10.2196/mental.6707 %U http://www.ncbi.nlm.nih.gov/pubmed/29066426 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e357 %T Social Media–Promoted Weight Loss Among an Occupational Population: Cohort Study Using a WeChat Mobile Phone App-Based Campaign %A He,Chao %A Wu,Shiyan %A Zhao,Yingying %A Li,Zheng %A Zhang,Yanyan %A Le,Jia %A Wang,Lei %A Wan,Siyang %A Li,Changqing %A Li,Yindong %A Sun,Xinying %+ Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, No.38, Xueyuan Road Haidian District Beijing 100191, P.R.China, Beijing, 100191, China, 86 13691212050, xysun@bjmu.edu.cn %K WeChat %K weight loss %K social media %K health %K intervention %D 2017 %7 23.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Being overweight and obese are major risk factors for noncommunicable diseases such as cardiovascular diseases. The prevalence of overweight and obesity is high throughout the world and these issues are very serious in the Shunyi District in China. As mobile technologies have rapidly developed, mobile apps such as WeChat are well accepted and have the potential to improve health behaviors. Objective: This study aims to evaluate the effectiveness of a mobile app (WeChat) as an intervention on weight loss behavior. Methods: This study was conducted among an occupational population from August 2015 to February 2016 in the Shunyi District of Beijing. Before the intervention, the Shunyi District Government released an official document for weight loss to all 134 government agencies and enterprises in Shunyi District. Participants willing to use our official WeChat account were enrolled in a WeChat group and received 6 months of interventions for weight loss; those who were not willing to use the account were in a control group given routine publicity on weight loss. Results: In total, 15,310 occupational participants including 3467 participants (22.65%) in the control group and 11,843 participants (77.35%) in the WeChat group were enrolled. Participants in the WeChat group lost more weight (mean 2.09, SD 3.43 kg) than people in the control group (mean 1.78, SD 2.96 kg), and the difference in mean weight loss between the two groups for males was significant based on the stratification of age and educational level. To control for confounding factors and to explore the effects of WeChat on weight loss, the propensity score method with a multinominal logistic regression was utilized. For males, this showed that the WeChat group (with both active and inactive subgroups) had a higher probability of maintaining weight, weight loss from 1 to 2 kg, or weight loss more than 2 kg than the control group. However, the control group had higher probability of weight loss from 0 to 1 kg. Being active in WeChat was likely to be associated with weight loss. The more active participants were in the weight loss program via WeChat, the more weight they lost. Conclusions: The weight loss intervention campaign based on an official WeChat account focused on an occupation-based population in Shunyi District was effective for males. The more active male participants were in using WeChat, the more weight they lost. There might be no effect or there may even be a negative effect on weight loss for females. Future research should focus on how to improve adherence to the WeChat weight loss interventions, to improve and refine the WeChat content such as developing a variety of materials to attract interest, and to protect personal privacy, especially for females. %M 29061555 %R 10.2196/jmir.7861 %U http://www.jmir.org/2017/10/e357/ %U https://doi.org/10.2196/jmir.7861 %U http://www.ncbi.nlm.nih.gov/pubmed/29061555 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e333 %T Assessing the National Cancer Institute’s SmokefreeMOM Text-Messaging Program for Pregnant Smokers: Pilot Randomized Trial %A Abroms,Lorien C %A Chiang,Shawn %A Macherelli,Laura %A Leavitt,Leah %A Montgomery,Margaret %+ Milken Insitute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Washington, DC,, United States, 1 202 994 3518, lorien@gwu.edu %K mHealth %K text messaging %K SMS %K mobile phone %K pregnant %K smoking %K quit %D 2017 %7 03.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Automated text messages on mobile phones have been found to be effective for smoking cessation in adult smokers. Objective: This study aims to test the acceptability and feasibility of SmokefreeMOM, a national smoking cessation text-messaging program for pregnant smokers. Methods: Participants were recruited from prenatal care and randomized to receive SmokefreeMOM (n=55), an automated smoking cessation text-messaging program, or a control text message quitline referral (n=44). Participants were surveyed by phone at baseline and at 1 month and 3 months after enrollment. Results: Results indicate that the SmokefreeMOM program was highly rated overall and rated more favorably than the control condition in its helpfulness at 3-month follow-up (P<.01) and in its frequency of messaging at both 1-month and 3-month follow-ups (P<.001, P<.01, respectively). Despite the presence of technical problems, the vast majority of intervention participants read all program messages, and few participants unsubscribed from the program. There were no significant differences between groups on the use of extra treatment resources or on smoking-related outcomes. However, at the 3-month follow-up, some outcomes favored the intervention group. Conclusions: SmokefreeMOM is acceptable for pregnant smokers. It is recommended that SmokefreeMOM be further refined and evaluated. Trial Registration: Clinicaltrials.gov NCT02412956; https://clinicaltrials.gov/ct2/show/NCT02412956 (Archived by WebCite at http://www.webcitation.org/6tcmeRnbC) %M 28974483 %R 10.2196/jmir.8411 %U http://www.jmir.org/2017/10/e333/ %U https://doi.org/10.2196/jmir.8411 %U http://www.ncbi.nlm.nih.gov/pubmed/28974483 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 3 %P e20 %T Perceptions of Patients With Chronic Obstructive Pulmonary Disease and Their Physiotherapists Regarding the Use of an eHealth Intervention %A Vorrink,Sigrid %A Huisman,Chantal %A Kort,Helianthe %A Troosters,Thierry %A Lammers,Jan-Willem %+ Faculty Chair Demand Driven Care, Research Centre for Innovations in Health Care, University of Applied Sciences Utrecht, Lectoraat vraaggestuurde zorg, Heidelberglaan 7, Utrecht, PO Box 12011 – 350, Netherlands, 31 88 481 5384, sigrid.vorrink@hu.nl %K telemedicine %K self care %K physical therapists %K pulmonary disease, chronic obstructive %D 2017 %7 19.09.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: If eHealth interventions are not used (properly), their potential benefits cannot be fulfilled. User perceptions of eHealth are an important determinant of its successful implementation. This study examined how patients with chronic obstructive pulmonary disease (COPD) and their physiotherapists (PHTs) value an eHealth self-management intervention following a period of use. Objective: The study aimed to evaluate the perceptions of COPD patients and their PHTs as eHealth users. Methods: In this study, an eHealth self-management intervention (website and mobile phone app) aimed at stimulating physical activity (PA) in COPD patients was evaluated by its users (patients and PHTs). As participants in a randomized controlled trial (RCT), they were asked how they valued the eHealth intervention after 6 months’ use. Interview requests were made to 33 PHTs from 26 participating practices, and a questionnaire was sent to 76 patients. The questionnaire was analyzed in Excel (Microsoft). The interviews with the PHTs and text messages (short message service, SMS) sent between patients and PHTs were transcribed and independently coded in MAXQDA 10 for Windows (VERBI GmbH). Results: A total of 60 patients with COPD filled out the questionnaire, and 24 PHTs were interviewed. The mobile phone app was used 89.0% (160.2/180 days) (standard deviation [SD] 18.5) of the time by patients; 53% (13/24) of PHTs reported low or no use. Patients scored the ease of use of the app 5.09 (SD 1.14) (on a 7-point scale). They found the presentation of the PA information in the app to be clear, insightful, and stimulating. All PHTs judged the website as explicit and user-friendly but had trouble devising a new PA goal for their patients. Patients mostly sent informative, neutral messages concerning the PA goal, and PHTs sent mostly motivating, positive messages concerning the PA goal. Messages were not perceived as supportive in reaching the PA goal according to the patients. Perceived usefulness of the intervention for the PHTs was the objective measurement of PA, the ability to see PA patterns over time, and the ability to use the intervention as a tool to give their patients insight into their PA. For patients, it was that the intervention supported them in increasing their PA and that it made them feel fitter. Barriers to use of the intervention according to the PHTs were time constraints and financial reasons. Seventy-nine percent (19/24) of the PHTs and 58% (35/60) of the patients mentioned they would be interested in using the intervention in the future. Conclusions: PHTs and COPD patients had positive feelings regarding the functionality and potential of the eHealth self-management intervention. This paper addresses a number of topics that may aid in the successful development and implementation of these types of eHealth interventions in the future. %M 28928110 %R 10.2196/humanfactors.7196 %U http://humanfactors.jmir.org/2017/3/e20/ %U https://doi.org/10.2196/humanfactors.7196 %U http://www.ncbi.nlm.nih.gov/pubmed/28928110 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 1 %N 1 %P e2 %T A Novel Patient Engagement Platform Using Accessible Text Messages and Calls (Epharmix): Feasibility Study %A Som,Avik %A Patel,Kunjan %A Sink,Eric %A Peters,Robert Mattson %A Javaherian,Kavon %A Groenendyk,Jacob %A An,Tonya %A Xu,Zhuchen %A Polites,Gregory M %A Blanchard,Melvin %A Ross,Will %+ Department of Internal Medicine, Renal Division, Washington University School of Medicine, Box 8023, 660 South Euclid Avenue, St. Louis, MO,, United States, 1 314 362 6861, rossw@wustl.edu %K telemedicine %K mobile health %K eHealth %K telehealth %K mHealth innovations %K bioinformatics %K multiple chronic conditions %D 2017 %7 18.09.2017 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Patient noncompliance with therapy, treatments, and appointments represents a significant barrier to improving health care delivery and reducing the cost of care. One method to improve therapeutic adherence is to improve feedback loops in getting clinically acute events and issues to the relevant clinical providers as necessary (ranging from detecting hypoglycemic events for patients with diabetes to notifying the provider when patients are out of medications). Patients often don’t know which information should prompt a call to their physician and proactive checks by the clinics themselves can be very resource intensive. We hypothesized that a two-way SMS system combined with a platform web service for providers would enable both high patient engagement but also the ability to detect relevant clinical alerts. Objective: The objectives of this study are to develop a feasible two-way automated SMS/phone call + web service platform for patient-provider communication, and then study the feasibility and acceptability of the Epharmix platform. First, we report utilization rates over the course of the first 18 months of operation including total identified clinically significant events, and second, review results of patient user-satisfaction surveys for interventions for patients with diabetes, COPD, congestive heart failure, hypertension, surgical site infections, and breastfeeding difficulties. Methods: To test this question, we developed a web service + SMS/phone infrastructure (“Epharmix”). Utilization results were measured based on the total number of text messages or calls sent and received, with percentage engagement defined as a patient responding to a text message at least once in a given week, including the number of clinically significant alerts generated. User satisfaction surveys were sent once per month over the 18 months to measure satisfaction with the system, frequency and degree of communication. Descriptive statistics were used to describe the above information. Results: In total, 28,386 text messages and 24,017 calls were sent to 929 patients over 9 months. Patients responded to 80% to 90% of messages allowing the system to detect 1164 clinically significant events. Patients reported increased satisfaction and communication with their provider. Epharmix increased the number of patient-provider interactions to over 10 on average in any given month for patients with diabetes, COPD, congestive heart failure, hypertension, surgical site infections, and breastfeeding difficulties. Conclusions: Engaging high-risk patients remains a difficult process that may be improved through novel, digital health interventions. The Epharmix platform enables increased patient engagement with very low risk to improve clinical outcomes. We demonstrated that engagement among high-risk populations is possible when health care comes conveniently to where they are. %M 30684401 %R 10.2196/formative.7211 %U http://formative.jmir.org/2017/1/e2/ %U https://doi.org/10.2196/formative.7211 %U http://www.ncbi.nlm.nih.gov/pubmed/30684401 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 8 %P e295 %T The Use of Mobile Apps and SMS Messaging as Physical and Mental Health Interventions: Systematic Review %A Rathbone,Amy Leigh %A Prescott,Julie %+ School of Education and Psychology, University of Bolton, Deane Road, Bolton, BL3 5AB, United Kingdom, 44 01204903676, alr3wss@bolton.ac.uk %K mHealth %K smartphone %K health %K review %K systematic %K short message service %K treatment efficacy %K portable electronic applications %K intervention study %D 2017 %7 24.08.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The initial introduction of the World Wide Web in 1990 brought around the biggest change in information acquisition. Due to the abundance of devices and ease of access they subsequently allow, the utility of mobile health (mHealth) has never been more endemic. A substantial amount of interactive and psychoeducational apps are readily available to download concerning a wide range of health issues. mHealth has the potential to reduce waiting times for appointments; eradicate the need to meet in person with a clinician, successively diminishing the workload of mental health professionals; be more cost effective to practices; and encourage self-care tactics. Previous research has given valid evidence with empirical studies proving the effectiveness of physical and mental health interventions using mobile apps. Alongside apps, there is evidence to show that receiving short message service (SMS) messages, which entail psychoeducation, medication reminders, and links to useful informative Web pages can also be advantageous to a patient’s mental and physical well-being. Available mHealth apps and SMS services and their ever improving quality necessitates a systematic review in the area in reference to reduction of symptomology, adherence to intervention, and usability. Objective: The aim of this review was to study the efficacy, usability, and feasibility of mobile apps and SMS messages as mHealth interventions for self-guided care. Methods: A systematic literature search was carried out in JMIR, PubMed, PsychINFO, PsychARTICLES, Google Scholar, MEDLINE, and SAGE. The search spanned from January 2008 to January 2017. The primary outcome measures consisted of weight management, (pregnancy) smoking cessation, medication adherence, depression, anxiety and stress. Where possible, adherence, feasibility, and usability outcomes of the apps or SMS services were evaluated. Between-group and within-group effect sizes (Cohen d) for the mHealth intervention method group were determined. Results: A total of 27 studies, inclusive of 4658 participants were reviewed. The papers included randomized controlled trials (RCTs) (n=19), within-group studies (n=7), and 1 within-group study with qualitative aspect. Studies show improvement in physical health and significant reductions of anxiety, stress, and depression. Within-group and between-group effect sizes ranged from 0.05-3.37 (immediately posttest), 0.05-3.25 (1-month follow-up), 0.08-3.08 (2-month follow-up), 0.00-3.10 (3-month follow-up), and 0.02-0.27 (6-month follow-up). Usability and feasibility of mHealth interventions, where reported, also gave promising, significant results. Conclusions: The review shows the promising and emerging efficacy of using mobile apps and SMS text messaging as mHealth interventions. %M 28838887 %R 10.2196/jmir.7740 %U http://www.jmir.org/2017/8/e295/ %U https://doi.org/10.2196/jmir.7740 %U http://www.ncbi.nlm.nih.gov/pubmed/28838887 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 8 %P e296 %T Text Messaging Interventions on Cancer Screening Rates: A Systematic Review %A Uy,Catherine %A Lopez,Jennifer %A Trinh-Shevrin,Chau %A Kwon,Simona C %A Sherman,Scott E %A Liang,Peter S %+ Department of Medicine, VA New York Harbor Manhattan Medical Center, 11N, Gastroenterology, 423 E 23rd St, New York, NY, 10010, United States, 1 212 686 7500 ext 5745, Peter.Liang@nyumc.org %K text messaging %K early detection of cancer %K breast neoplasms %K colorectal neoplasms %K lung neoplasms %K mHealth %K uterine cervical neoplasms %D 2017 %7 24.08.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite high-quality evidence demonstrating that screening reduces mortality from breast, cervical, colorectal, and lung cancers, a substantial portion of the population remains inadequately screened. There is a critical need to identify interventions that increase the uptake and adoption of evidence-based screening guidelines for preventable cancers at the community practice level. Text messaging (short message service, SMS) has been effective in promoting behavioral change in various clinical settings, but the overall impact and reach of text messaging interventions on cancer screening are unknown. Objective: The objective of this systematic review was to assess the effect of text messaging interventions on screening for breast, cervical, colorectal, and lung cancers. Methods: We searched multiple databases for studies published between the years 2000 and 2017, including PubMed, EMBASE, and the Cochrane Library, to identify controlled trials that measured the effect of text messaging on screening for breast, cervical, colorectal, or lung cancers. Study quality was evaluated using the Cochrane risk of bias tool. Results: Our search yielded 2238 citations, of which 31 underwent full review and 9 met inclusion criteria. Five studies examined screening for breast cancer, one for cervical cancer, and three for colorectal cancer. No studies were found for lung cancer screening. Absolute screening rates for individuals who received text message interventions were 0.6% to 15.0% higher than for controls. Unadjusted relative screening rates for text message recipients were 4% to 63% higher compared with controls. Conclusions: Text messaging interventions appear to moderately increase screening rates for breast and cervical cancer and may have a small effect on colorectal cancer screening. Benefit was observed in various countries, including resource-poor and non-English-speaking populations. Given the paucity of data, additional research is needed to better quantify the effectiveness of this promising intervention. %M 28838885 %R 10.2196/jmir.7893 %U http://www.jmir.org/2017/8/e296/ %U https://doi.org/10.2196/jmir.7893 %U http://www.ncbi.nlm.nih.gov/pubmed/28838885 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 6 %N 2 %P e14 %T Promoting Engagement With a Digital Health Intervention (HeLP-Diabetes) Using Email and Text Message Prompts: Mixed-Methods Study %A Alkhaldi,Ghadah %A Modrow,Kerstin %A Hamilton,Fiona %A Pal,Kingshuk %A Ross,Jamie %A Murray,Elizabeth %+ eHealth Unit, Research Department of Primary Care and Population Health, University College London, Upper Third Floor, UCL Medical School (Royal Free Campus), Rowland Hill Street,, London, NW3 2PF, United Kingdom, 44 020 7794 0500 ext 38826, elizabeth.murray@ucl.ac.uk %K mHealth %K eHealth %K email %K text messages %D 2017 %7 22.08.2017 %9 Original Paper %J Interact J Med Res %G English %X Background: Engagement with digital health interventions (DHIs) may be regarded as a prerequisite for the intervention to achieve positive health or behavior change outcomes. One method employed to promote engagement is the use of prompts such as emails and text messages. However, little is known about the characteristics of prompts that promote engagement. This study explored the association between the content and delivery mode of prompts and the users’ engagement with HeLP-Diabetes (Healthy Living for People with type 2 Diabetes), a DHI that aimed to promote self-management in adults with type 2 diabetes. Objective: The objective of this study was to identify the characteristics of prompts, specifically the content and delivery mode, which were associated with increased engagement. Methods: This was a mixed-methods study. Email and text message prompts were sent to the registered users of HeLP-Diabetes. Use of the intervention was recorded and examined to identify which email and text message prompts were associated with subsequent visits to the DHI. Characteristics of prompts that were identified as particularly effective or ineffective were explored through think-aloud interviews with the participants. Results: Of a total of 39 email prompts, 49% (19/39) prompts showed a significant association with subsequent visits to the DHI. However, none of the text message prompts were associated with subsequent visits to the DHI. Furthermore, think-aloud interviews were carried out with 6 experienced participants with type 2 diabetes. The findings suggest that these participants preferred email prompts that were clear, relatively short, and empowering; used nondirective advice; included health professional references; were visually appealing; and contained news and updates. Conclusions: The findings of this study contribute to the existing evidence supporting the role of email prompts in promoting and maintaining engagement with DHIs. This study described the content of prompts that may be engaging. However, the results should be interpreted with caution, as prompts may be context-specific interventions and the results may not be generalizable across other DHIs or other types of interventions targeting self-management of type 2 diabetes. %M 28829328 %R 10.2196/ijmr.6952 %U http://www.i-jmr.org/2017/2/e14/ %U https://doi.org/10.2196/ijmr.6952 %U http://www.ncbi.nlm.nih.gov/pubmed/28829328 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 2 %N 2 %P e19 %T Diabetes App-Related Text Messages From Health Care Professionals in Conjunction With a New Wireless Glucose Meter With a Color Range Indicator Improves Glycemic Control in Patients With Type 1 and Type 2 Diabetes: Randomized Controlled Trial %A Grady,Mike %A Katz,Laurence Barry %A Cameron,Hilary %A Levy,Brian Leonard %+ LifeScan Scotland Ltd, Beechwood Park North, Inverness, IV2 5DL, United Kingdom, 44 01463 ext 721889, mgrady@its.jnj.com %K diabetes app %K text message %K color range indicator %K blood glucose monitor, wireless %D 2017 %7 07.08.2017 %9 Original Paper %J JMIR Diabetes %G English %X Background: Mobile diabetes apps enable health care professionals (HCPs) to monitor patient progress, offer remote consultations, and allow more effective and informed treatment decisions between patients and HCPs. The OneTouch Reveal app aggregates data from a blood glucose meter and provides analytics to help patients and HCPs visualize glycemic trends and patterns, enabling more informed treatment and lifestyle decisions. The app also allows patients and HCPs to keep connected by exchanging text messages (short message service [SMS]) or progress reports via email. Objective: The primary objective of our study was to assess changes in glycemic control and overall experiences of patients and HCPs using the app in conjunction with the wireless OneTouch Verio Flex blood glucose meter. Methods: We randomly assigned 137 adults with type 1 (T1DM) or type 2 diabetes mellitus (T2DM) and a glycated hemoglobin (HbA1c) level of ≥7.5% and ≤11.0% to use the glucose meter alone or glucose meter plus the app for 24 weeks. The meter + app group were scheduled to receive diabetes-related text messages from their HCP every 2 weeks (total of 12 texts). Clinical measures and self-reported outcomes were assessed during face-to-face clinic visits between the participant and a diabetes nurse at baseline, week 12, and week 24. Results: In 128 completed participants, HbA1c decreased after 12 and 24 weeks in both the meter-only (n=66) (0.56% and 0.55%, respectively) and meter + app groups (n=62) (0.78% and 0.67%, respectively) compared with baseline (each P<.001). The difference in HbA1c reduction between the 2 groups was not statistically significant at 12 or 24 weeks (P=.12 and P=.45, respectively). However, the decrease in HbA1c was greater in T2DM participants using the meter + app after 12 weeks (1.04%) than in T2DM participants using the meter alone (0.58%; P=.09). In addition, decrease in HbA1c in participants using the meter + app who received at least 10 diabetes-related text messages (1.05%) was significantly greater than in meter-only participants (P<.01). Conclusions: Use of the OneTouch Verio Flex glucose meter alone or in combination with the OneTouch Reveal diabetes app was associated with significant improvements in glycemic control after 12 and 24 weeks. Improvements using the app were greatest in participants with T2DM and those participants who received the highest number of HCP text messages. This study suggests that real-time availability of patient data and the ability to send personalized diabetes-related text messages can assist HCPs to improve glycemic control in patients between scheduled visits. Trial Registration: Clinicaltrials.gov NCT02429024; https://clinicaltrials.gov/ct2/show/NCT02429024 (Archived by WebCite at http://www.webcitation.org/6sCTDRa1l) %M 30291092 %R 10.2196/diabetes.7454 %U http://diabetes.jmir.org/2017/2/e19/ %U https://doi.org/10.2196/diabetes.7454 %U http://www.ncbi.nlm.nih.gov/pubmed/30291092 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 8 %P e267 %T Application of Synchronous Text-Based Dialogue Systems in Mental Health Interventions: Systematic Review %A Hoermann,Simon %A McCabe,Kathryn L %A Milne,David N %A Calvo,Rafael A %+ Positive Computing Laboratory, School of Electrical and Information Engineering, The University of Sydney, Building J03, Maze Crescent, Sydney, 2008, Australia, 61 2 9351 8171, rafael.calvo@sydney.edu.au %K chat %K dialog system %K remote psychotherapy %D 2017 %7 21.7.2017 %9 Review %J J Med Internet Res %G English %X Background: Synchronous written conversations (or “chats”) are becoming increasingly popular as Web-based mental health interventions. Therefore, it is of utmost importance to evaluate and summarize the quality of these interventions. Objective: The aim of this study was to review the current evidence for the feasibility and effectiveness of online one-on-one mental health interventions that use text-based synchronous chat. Methods: A systematic search was conducted of the databases relevant to this area of research (Medical Literature Analysis and Retrieval System Online [MEDLINE], PsycINFO, Central, Scopus, EMBASE, Web of Science, IEEE, and ACM). There were no specific selection criteria relating to the participant group. Studies were included if they reported interventions with individual text-based synchronous conversations (ie, chat or text messaging) and a psychological outcome measure. Results: A total of 24 articles were included in this review. Interventions included a wide range of mental health targets (eg, anxiety, distress, depression, eating disorders, and addiction) and intervention design. Overall, compared with the waitlist (WL) condition, studies showed significant and sustained improvements in mental health outcomes following synchronous text-based intervention, and post treatment improvement equivalent but not superior to treatment as usual (TAU) (eg, face-to-face and telephone counseling). Conclusions: Feasibility studies indicate substantial innovation in this area of mental health intervention with studies utilizing trained volunteers and chatbot technologies to deliver interventions. While studies of efficacy show positive post-intervention gains, further research is needed to determine whether time requirements for this mode of intervention are feasible in clinical practice. %M 28784594 %R 10.2196/jmir.7023 %U http://www.jmir.org/2017/8/e267/ %U https://doi.org/10.2196/jmir.7023 %U http://www.ncbi.nlm.nih.gov/pubmed/28784594 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 8 %P e116 %T Feasibility and Acceptability of a Text Message-Based Smoking Cessation Program for Young Adults in Lima, Peru: Pilot Study %A Blitchtein-Winicki,Dora %A Zevallos,Karine %A Samolski,M Reuven %A Requena,David %A Velarde,Chaska %A Briceño,Patricia %A Piazza,Marina %A Ybarra,Michele L %+ Executive Office of Research, Peruvian National Institute of Health, Cápac Yupanqui 1400, Jesus María, Lima, CP 11, Peru, 51 999 090917, dblit2007@gmail.com %K Pilot Projects, Text Messaging, Smoking Cessation, Young Adult, Cognitive Therapy, Feasibility Studies, Latinos %D 2017 %7 04.08.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In Peru’s urban communities, tobacco smoking generally starts during adolescence and smoking prevalence is highest among young adults. Each year, many attempt to quit, but access to smoking cessation programs is limited. Evidence-based text messaging smoking cessation programs are an alternative that has been successfully implemented in high-income countries, but not yet in middle- and low-income countries with limited tobacco control policies. Objective: The objective was to assess the feasibility and acceptability of an short message service (SMS) text message-based cognitive behavioral smoking cessation program for young adults in Lima, Peru. Methods: Recruitment included using flyers and social media ads to direct young adults interested in quitting smoking to a website where interested participants completed a Google Drive survey. Inclusion criteria were being between ages 18 and 25 years, smoking at least four cigarettes per day at least 6 days per week, willing to quit in the next 30 days, owning a mobile phone, using SMS text messaging at least once in past year, and residing in Lima. Participants joined one of three phases: (1) focus groups and in-depth interviews whose feedback was used to develop the SMS text messages, (2) validating the SMS text messages, and (3) a pilot of the SMS text message-based smoking cessation program to test its feasibility and acceptability among young adults in Lima. The outcome measures included adherence to the SMS text message-based program, acceptability of content, and smoking abstinence self-report on days 2, 7, and 30 after quitting. Results: Of 639 participants who completed initial online surveys, 42 met the inclusion criteria and 35 agreed to participate (focus groups and interviews: n=12; validate SMS text messages: n=8; program pilot: n=15). Common quit practices and beliefs emerged from participants in the focus groups and interviews informed the content, tone, and delivery schedule of the messages used in the SMS text message smoking cessation program. A small randomized controlled pilot trial was performed to test the program’s feasibility and acceptability; nine smokers were assigned to the SMS text message smoking cessation program and six to a SMS text message nutrition program. Participant retention was high: 93% (14/15) remained until day 30 after quit day. In all, 56% of participants (5/9) in the SMS text message smoking cessation program reported remaining smoke-free until day 30 after quit day and 17% of participants (1/6) in the SMS text message nutrition program reported remaining smoke-free during the entire program. The 14 participants who completed the pilot reported that they received valuable health information and approved the delivery schedule of the SMS text messages. Conclusions: This study provides initial evidence that a SMS text message smoking cessation program is feasible and acceptable for young adults residing in Lima. %M 28778850 %R 10.2196/mhealth.7532 %U http://mhealth.jmir.org/2017/8/e116/ %U https://doi.org/10.2196/mhealth.7532 %U http://www.ncbi.nlm.nih.gov/pubmed/28778850 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 8 %P e110 %T The Impact of Text Messaging on Medication Adherence and Exercise Among Postmyocardial Infarction Patients: Randomized Controlled Pilot Trial %A Pandey,Avinash %A Krumme,Alexis A %A Patel,Tejal %A Choudhry,Niteesh K %+ Brigham and Women’s Hospital and Harvard Medical School, 1620 Tremont St Suite 3030, Boston, MA, 02120, United States, 1 617 278 0930, nkchoudhry@bwh.harvard.edu %K medication adherence %K cardiac rehabilitation %K exercise %K randomized controlled trial %D 2017 %7 03.08.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adherence to evidence-based therapies such as medications and exercise remains poor among patients after a myocardial infarction (MI). Text message reminders have been shown to improve rates of adherence to medication and exercise, but the existing studies have been of short duration. Objective: Two single-center randomized controlled pilot trials were conducted to evaluate the impact of text message reminders over 12 months on adherence to cardiac medications and exercise among patients receiving cardiac rehabilitation after hospitalization for MI. Methods: In the medication adherence trial, 34 patients were randomized to receive usual care alone or usual care plus daily text message reminders delivered at the time of day at which medications were to be taken. In the exercise adherence trial, 50 patients were randomized to receive usual care alone or usual care plus 4 daily text messages reminding them to exercise as directed. Results: The text message reminders led to a mean 14.2 percentage point improvement in self-reported medication adherence over usual care (P<.001, 95% CI 7-21). In the exercise trial, text message reminders resulted in an additional 4.2 days (P=.001, 95% CI 1.9-6.4) and 4.0 hours (P<.001, 95% CI 2.4-5.6) of exercise per month over usual care and a nonsignificant increase of 1.2 metabolic equivalents (METS; P=.06) in exercise capacity as assessed by a BRUCE protocol at 12 months. Conclusions: Text message reminders significantly increased adherence to medication and exercise among post-MI patients receiving care in a structured cardiac rehabilitation program. This technology represents a simple and scalable method to ensure consistent use of evidence-based cardiovascular therapies. Trial Registration: Clinicaltrials.gov NCT02783287; https://clinicaltrials.gov/ct2/show/NCT02783287 (Archived by WebCite at http://www.webcitation.org/6sBnvNb05) %M 28778843 %R 10.2196/mhealth.7144 %U http://mhealth.jmir.org/2017/8/e110/ %U https://doi.org/10.2196/mhealth.7144 %U http://www.ncbi.nlm.nih.gov/pubmed/28778843 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 1 %N 2 %P e2 %T Assessing the Utility of a Novel SMS- and Phone-Based System for Blood Pressure Control in Hypertensive Patients: Feasibility Study %A Peters,Robert Mattson %A Shivakumar,Nishkala %A Xu,Ran %A Javaherian,Kavon %A Sink,Eric %A Patel,Kunjan %A Brown,Angela %A Huynh,Justin %A Blanchard,Melvin %A Ross,Will %A Byrd,Jonathan %+ Washington University in St. Louis School of Medicine, Grant Medical Clinic, 114 North Taylor Avenue., St. Louis, MO, 63108, United States, 1 314 534 8600, byrdj@wustl.edu %K telemedicine %K hypertension %K quality improvement %K text messaging %K primary care %K eHealth %K mHealth %K disease management %D 2017 %7 27.07.2017 %9 Original Paper %J JMIR Cardio %G English %X Background: Although hypertension (HTN) is a major modifiable risk factor for arterial damage, blood pressure (BP) remains poorly controlled in the hypertensive population. Telemedicine is a promising adjunct intervention that may complement traditional therapies and improve adherence rates; however, current approaches have multiple barriers to entry, including the use of relatively expensive Bluetooth devices or the dependence on smart phone utilization, which tend to exclude low-income and more elderly populations. Objective: The aim of this study was to design and implement a new phone call- and short message service text messaging-based intervention, Epharmix’s EpxHypertension, in a quality improvement project that demonstrates the feasibility of this system for BP control in a family medicine setting. Methods: We recruited 174 patients from a community clinic in St Louis from a database of patients diagnosed with HTN. An automated call or text messaging system was used to monitor patient-reported BPs. If determined to be elevated, physicians were notified by an email, text, or electronic medical record alert. Mean systolic BPs (SBPs) and diastolic BPs (DBPs) were compared at the beginning and end of 12 weeks. Results: After 12 weeks on the system, patients with a baseline SBP of 140 mm Hg or higher reduced SBP by 10.8 mm Hg (95% CI −14.5 to −7.2, P<.001) and DBP by 6.6 mm Hg (95% CI −9.9 to −3.4, P=.002), but no significant changes were observed in overall BPs and BPs in the group with baseline SBP less than 140 mm Hg. Conclusions: EpxHypertension provides a viable means to control HTN in patients with high baseline BPs despite previous therapy. This community implementation study demonstrates the feasibility of implementing EpxHypertension across a primary care setting without the need for smartphones or Bluetooth-linked BP cuffs. Future studies should evaluate its effectiveness in a randomized control trial compared with standard of care. %M 31758763 %R 10.2196/cardio.7915 %U http://cardio.jmir.org/2017/2/e2/ %U https://doi.org/10.2196/cardio.7915 %U http://www.ncbi.nlm.nih.gov/pubmed/31758763 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 2 %N 2 %P e15 %T Improving Glycemic Control With a Standardized Text-Message and Phone-Based Intervention: A Community Implementation %A Peters,Robert Mattson %A Lui,Matt %A Patel,Kunjan %A Tian,Lewis %A Javaherian,Kavon %A Sink,Eric %A Xu,Ran %A Xu,Zhuchen %A Aung,Wint %A Zhou,Li %A Huynh,Justin %A Polites,Gregory %A Blanchard,Melvin %A Som,Avik %A Ross,Will %A Bernal-Mizrachi,Carlos %+ Division of Endocrinology, Metabolism and Lipid Research, Washington University in St. Louis School of Medicine, Campus Box 8127, 660 South Euclid Ave, St. Louis, MO, 63110, United States, 1 314 362 0947, cbernal@wustl.edu %K diabetes mellitus %K glycemic control %K telemedicine %K electronic health (eHealth) %K mobile health (mHealth) %K telehealth %K SMS %K diabetes management %D 2017 %7 25.07.2017 %9 Original Paper %J JMIR Diabetes %G English %X Background: Type II diabetes mellitus (T2DM) presents a major disease burden in the United States. Outpatient glycemic control among patients with T2DM remains difficult. Telemedicine shows great potential as an adjunct therapy to aid in glycemic control in real-world settings. Objective: We aimed to explore the effectiveness of EpxDiabetes, a novel digital health intervention, in improving hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) among patients with uncontrolled diabetes. Methods: We recruited 396 patients from a community clinic in St. Louis, Missouri, from a database of patients diagnosed with T2DM and with a most recent HbA1c >7% as part of a quality improvement project. An automated call or text-messaging system was used to monitor patient-reported FBG. If determined to be elevated, care managers were notified by email, text, or electronic medical record alert. Participants self-reported their FBG data by replying to EpxDiabetes automated phone calls or text messages. Data were subsequently analyzed, triaged, and shared with providers to enable appropriate follow-up and care plan adjustments. Absolute HbA1c reduction, patient engagement, and absolute patient-reported FBG reduction were examined at approximately 6 months post implementation. Results: EpxDiabetes had an average 95.6% patient response rate to messages at least once per month and an average 71.1% response rate to messages at least once per week. Subsequent HbA1c drop with EpxDiabetes use over 4 months was -1.15% (95% CI -1.58 to -0.71) for patients with HbA1c >8% at baseline compared to the change in HbA1c over 4 months prior to the implementation of EpxDiabetes of only -0.005 points (95% CI -0.28 to 0.27), P=.0018. Conclusions: EpxDiabetes may help reduce HbA1c in patients with high HbA1c baselines (>8%). The intervention demonstrates high patient engagement sustainable for at least 6 months. %M 30291063 %R 10.2196/diabetes.7910 %U http://diabetes.jmir.org/2017/2/e15/ %U https://doi.org/10.2196/diabetes.7910 %U http://www.ncbi.nlm.nih.gov/pubmed/30291063 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e245 %T Short Text Messages to Encourage Adherence to Medication and Follow-up for People With Psychosis (Mobile.Net): Randomized Controlled Trial in Finland %A Välimäki,Maritta %A Kannisto,Kati Anneli %A Vahlberg,Tero %A Hätönen,Heli %A Adams,Clive E %+ Department of Nursing Science, Joukahaisenkatu 3-5, University of Turku, 20014, Turku,, Finland, 358 40 5599235, mava@utu.fi %K text messaging %K psychotic disorders %K randomized controlled trial %K medication adherence %D 2017 %7 12.07.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: A text messaging service (short message service [SMS]) has the potential to target large groups of people with long-term illnesses such as serious mental disorders, who may have difficulty with treatment adherence. Robust research on the impact of mobile technology interventions for these patients remains scarce. Objective: The main objective of our study was to investigate the impact of individually tailored short text messages on the rate of psychiatric hospital readmissions, health care service use, and clinical outcomes. In addition, we analyzed treatment costs. Methods: Between September 2011 and November 2012, we randomly assigned 1139 people to a tailored text message intervention (n=569) or usual care (n=570). Participants received semiautomated text messages for up to 12 months or usual care. The primary outcome, based on routinely collected health register data, was patient readmission into a psychiatric hospital during a 12-month follow-up period. Secondary outcomes were related to other service use, coercion, medication, adverse events, satisfaction, social functioning, quality of life, and economic factors (cost analysis). Results: There was 98.24% (1119/1139) follow-up at 12 months. Tailored mobile telephone text messages did not reduce the rate of hospital admissions (242/563, 43.0% of the SMS group vs 216/556, 38.8% of the control group; relative risk 1.11; 95% CI 0.92-1.33; P=.28), time between hospitalizations (mean difference 7.0 days 95% CI –8.0 to 24.0; P=.37), time spent in a psychiatric hospital during the year (mean difference 2.0 days 95% CI –2.0 to 7.0; P=.35), or other service outcomes. People who received text messages were less disabled, based on Global Assessment Scale scores at the time of their readmission, than those who did not receive text messages (odds ratio 0.68; 95% CI 0.47-0.97; P=.04). The costs of treatment were higher for people in the SMS group than in the control group (mean €10,103 vs €9210, respectively, P<.001). Conclusions: High-grade routinely collected data can provide clear outcomes for pragmatic randomized trials. SMS messaging tailored with the input of each individual patient did not decrease the rate of psychiatric hospital visits after the 12 months of follow-up. Although there may have been other, more subtle effects, the results of these were not evident in outcomes of agreed importance to clinicians, policymakers, and patients and their families. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 27704027; http://www.isrctn.com/ISRCTN27704027 (Archived by WebCite at http://www.webcitation.org/6rVzZrbuz). %M 28701292 %R 10.2196/jmir.7028 %U http://www.jmir.org/2017/7/e245/ %U https://doi.org/10.2196/jmir.7028 %U http://www.ncbi.nlm.nih.gov/pubmed/28701292 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 6 %P e126 %T Mobile Phone Short Messages to Improve Exclusive Breastfeeding and Reduce Adverse Infant Feeding Practices: Protocol for a Randomized Controlled Trial in Yangon, Myanmar %A Hmone,Myat Pan %A Li,Mu %A Alam,Ashraful %A Dibley,Michael J %+ Sydney Medical School, School of Public Health, The University of Sydney, A27, Edward Ford Building, Sydney,, Australia, 61 4 2470 8124, myat.panhmone@sydney.edu.au %K randomized controlled trial %K mHealth %K text messaging (SMS) %K intervention studies %K exclusive breastfeeding %K infant and young child feeding %K nutrition %K Myanmar %K pregnant women %K child health %D 2017 %7 28.06.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Myanmar has a high burden of mortality for children aged younger than 5 years in which undernutrition plays a major role. Despite current efforts, the exclusive breastfeeding rate for children under 6 months is only 24%. To date there have been no interventions using mobile phones to improve breastfeeding and other feeding practices in Myanmar. Objective: This study aims to implement a breastfeeding promotion intervention using mobile phone text messages in Yangon, Myanmar, and evaluate its impact on breastfeeding practices. Methods: M528 is a 2-group parallel-arm randomized controlled trial with 9 months follow-up from recruitment until 6 months post-delivery. A total of 353 pregnant women between 28 and 34 weeks’ gestation who had access to a mobile phone and were able to read and write have been recruited from the Central Women’s Hospital, Yangon, and allocated randomly to an intervention or control group in a 1:1 ratio. The intervention group received breastfeeding promotional SMS messages 3 times a week while the control group received maternal and child health care messages (excluding breastfeeding-related messages) once a week. The SMS messages were tailored for the women’s stage of gestation or the child’s age. A formative qualitative study was conducted prior to the trial to inform the study design and text message content. We hypothesize that the exclusive breastfeeding rate in the intervention group will be double that in the control group. The primary outcome is exclusive breastfeeding from birth to 6 months and secondary outcomes are median durations of exclusive breastfeeding and other infant feeding practices. Both primary and secondary outcomes were assessed by monthly phone calls at 1 to 6 months postdelivery in both groups. Participants’ delivery status was tracked through text messages, phone calls, and hospital records, and delivery characteristics were assessed 1 month after delivery. Child morbidity and breastfeeding self-efficacy scores were assessed at 1, 3, and 5 months postdelivery. Social desirability was measured at 5 months, and text messages expressing delivery success and user experience were assessed at the end of the study. Results: The targeted 353 pregnant women were recruited between January and March 2015. Baseline data have been collected; SMS messages have been developed and pretested and sent to the women from both groups. Follow-up data collection via phone calls has been completed. Data analysis is being done and results are expected soon. This is the first RCT study examining the effects of mobile text messaging for promoting exclusive breastfeeding. Conclusions: This trial is timely in Myanmar following the telecommunications market opening in 2014. Our results will help determine whether text messaging is an effective and feasible method for promoting appropriate feeding practices and will inform further research to assess how this model could be replicated in the broader community. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12615000063516; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367704 (Archived by WebCite at http://www.webcitation.org/ 6rGif3l81) %M 28659252 %R 10.2196/resprot.7679 %U http://www.researchprotocols.org/2017/6/e126/ %U https://doi.org/10.2196/resprot.7679 %U http://www.ncbi.nlm.nih.gov/pubmed/28659252 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 6 %P e79 %T Beyond Basic Feedback in Mobile Brief Interventions: Designing SMS Message Content for Delivery to Young Adults During Risky Drinking Events %A Wright,Cassandra J C %A Dietze,Paul M %A Lim,Megan S C %+ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne,, Australia, 61 392822173, cassandra.wright@burnet.edu.au %K alcohol drinking %K young adult %K mHealth %K text messaging %K motivational interviewing %K community-based participatory research %D 2017 %7 20.06.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Brief interventions can reduce alcohol consumption in young people through screening and delivery of personally relevant feedback. Recently, Web and mobile platforms have been harnessed to increase the reach of brief interventions. Existing literature on mobile-based alcohol brief interventions indicates mixed use of theory in developing interventions. There is no research available to guide the development of SMS text messaging (short message service, SMS) interventions delivered during risky drinking events. Objective: The aim of this study was to develop and pilot an alcohol-related risk-reduction brief intervention delivered by SMS to Australian young adults during drinking events. This paper describes the development of intervention message content, with specific focus on the context of delivery during drinking events. Methods: A sample of 42 young adults attended 4 workshops; these comprised focus-group style discussion on drinking habits and motivations, discussion of intervention design, analysis of existing alcohol media campaigns, and participant development of message content. Data were analyzed thematically. Results: Participants described a focus on having fun and blocking out any incongruent negative influences during drinking episodes. For content to be acceptable, nonjudgmental and non-authoritative language was deemed essential. A preference for short, actionable messages was observed, including suggestions for reminders around drinking water, organizing transport home, checking on friends, and plans the next day. Participants were excited about the potential for messages to be tailored to individuals, as previous alcohol-related campaigns were deemed too generic and often irrelevant. Normative-based messages were also perceived as largely irrelevant as participants felt that they understood the drinking-related norms of their immediate peers already. Conclusions: Findings from this study offer insights into young adults’ drinking events and practical advice for designing alcohol-related brief interventions. During our formative development process, we demonstrated a neat correspondence between young people’s preferences for alcohol harm reduction interventions and the theoretical principles of brief interventions, including acceptable topics and message style. %M 28634153 %R 10.2196/mhealth.6497 %U http://mhealth.jmir.org/2017/6/e79/ %U https://doi.org/10.2196/mhealth.6497 %U http://www.ncbi.nlm.nih.gov/pubmed/28634153 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 6 %P e114 %T Phone-Based Interventions in Adolescent Psychiatry: A Perspective and Proof of Concept Pilot Study With a Focus on Depression and Autism %A Chen,Robert Yuzen %A Feltes,Jordan Robert %A Tzeng,William Shun %A Lu,Zoe Yunzhu %A Pan,Michael %A Zhao,Nan %A Talkin,Rebecca %A Javaherian,Kavon %A Glowinski,Anne %A Ross,Will %+ Washington University School of Medicine, Farrell Learning and Teaching Center, 660 S Euclid Avenue, St. Louis, MO, 63110, United States, 1 425 753 4101, robert.chen@wustl.edu %K telemedicine %K depression %K autistic disorder %K mobile applications %K text messaging %K child %K mental health %D 2017 %7 16.06.2017 %9 Viewpoint %J JMIR Res Protoc %G English %X Background: Telemedicine has emerged as an innovative platform to diagnose and treat psychiatric disorders in a cost-effective fashion. Previous studies have laid the functional framework for monitoring and treating child psychiatric disorders electronically using videoconferencing, mobile phones (smartphones), and Web-based apps. However, phone call and text message (short message service, SMS) interventions in adolescent psychiatry are less studied than other electronic platforms. Further investigations on the development of these interventions are needed. Objective: The aim of this paper was to explore the utility of text message interventions in adolescent psychiatry and describe a user feedback-driven iterative design process for text message systems. Methods: We developed automated text message interventions using a platform for both depression (EpxDepression) and autism spectrum disorder (ASD; EpxAutism) and conducted 2 pilot studies for each intervention (N=3 and N=6, respectively). The interventions were prescribed by and accessible to the patients’ healthcare providers. EpxDepression and EpxAutism utilized an automated system to triage patients into 1 of 3 risk categories based on their text responses and alerted providers directly via phone and an online interface when patients met provider-specified risk criteria. Rapid text-based feedback from participants and interviews with providers allowed for quick iterative cycles to improve interventions. Results: Patients using EpxDepression had high weekly response rates (100% over 2 to 4 months), but exhibited message fatigue with daily prompts with mean (SD) overall response rates of 66.3% (21.6%) and 64.7% (8.2%) for mood and sleep questionnaires, respectively. In contrast, parents using EpxAutism displayed both high weekly and overall response rates (100% and 85%, respectively, over 1 to 4 months) that did not decay significantly with time. Monthly participant feedback surveys for EpxDepression (7 surveys) and EpxAutism (18 surveys) preliminarily indicated that for both interventions, daily messages constituted the “perfect amount” of contact and that EpxAutism, but not EpxDepression, improved patient communication with providers. Notably, EpxDepression detected thoughts of self-harm in patients before their case managers or caregivers were aware of such ideation. Conclusions: Text-message interventions in adolescent psychiatry can provide a cost-effective and engaging method to track symptoms, behavior, and ideation over time. Following the collection of pilot data and feedback from providers and patients, larger studies are already underway to validate the clinical utility of EpxDepression and EpxAutism. Trial Registration: Clinicaltrials.gov NCT03002311; https://clinicaltrials.gov/ct2/show/NCT03002311 (Archived by WebCite at http://www.webcitation.org/6qQtlCIS0) %M 28623183 %R 10.2196/resprot.7245 %U http://www.researchprotocols.org/2017/6/e114/ %U https://doi.org/10.2196/resprot.7245 %U http://www.ncbi.nlm.nih.gov/pubmed/28623183 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 2 %P e19 %T Delivering Cognitive Behavior Therapy to Young Adults With Symptoms of Depression and Anxiety Using a Fully Automated Conversational Agent (Woebot): A Randomized Controlled Trial %A Fitzpatrick,Kathleen Kara %A Darcy,Alison %A Vierhile,Molly %+ Woebot Labs Inc., 55 Fair Avenue, San Francisco, CA, 94110, United States, alison@woebot.io %K conversational agents %K mobile mental health %K mental health %K chatbots %K depression %K anxiety %K college students %K digital health %D 2017 %7 06.06.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Web-based cognitive-behavioral therapeutic (CBT) apps have demonstrated efficacy but are characterized by poor adherence. Conversational agents may offer a convenient, engaging way of getting support at any time. Objective: The objective of the study was to determine the feasibility, acceptability, and preliminary efficacy of a fully automated conversational agent to deliver a self-help program for college students who self-identify as having symptoms of anxiety and depression. Methods: In an unblinded trial, 70 individuals age 18-28 years were recruited online from a university community social media site and were randomized to receive either 2 weeks (up to 20 sessions) of self-help content derived from CBT principles in a conversational format with a text-based conversational agent (Woebot) (n=34) or were directed to the National Institute of Mental Health ebook, “Depression in College Students,” as an information-only control group (n=36). All participants completed Web-based versions of the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder scale (GAD-7), and the Positive and Negative Affect Scale at baseline and 2-3 weeks later (T2). Results: Participants were on average 22.2 years old (SD 2.33), 67% female (47/70), mostly non-Hispanic (93%, 54/58), and Caucasian (79%, 46/58). Participants in the Woebot group engaged with the conversational agent an average of 12.14 (SD 2.23) times over the study period. No significant differences existed between the groups at baseline, and 83% (58/70) of participants provided data at T2 (17% attrition). Intent-to-treat univariate analysis of covariance revealed a significant group difference on depression such that those in the Woebot group significantly reduced their symptoms of depression over the study period as measured by the PHQ-9 (F=6.47; P=.01) while those in the information control group did not. In an analysis of completers, participants in both groups significantly reduced anxiety as measured by the GAD-7 (F1,54= 9.24; P=.004). Participants’ comments suggest that process factors were more influential on their acceptability of the program than content factors mirroring traditional therapy. Conclusions: Conversational agents appear to be a feasible, engaging, and effective way to deliver CBT. %M 28588005 %R 10.2196/mental.7785 %U http://mental.jmir.org/2017/2/e19/ %U https://doi.org/10.2196/mental.7785 %U http://www.ncbi.nlm.nih.gov/pubmed/28588005 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 2 %N 1 %P e8 %T Phone Messaging to Prompt Physical Activity and Social Support Among Low-Income Latino Patients With Type 2 Diabetes: A Randomized Pilot Study %A Ramirez,Magaly %A Wu,Shinyi %+ Fielding School of Public Health, Department of Health Policy and Management, University of California, Los Angeles, 650 Charles Young Dr S, 31-293A, Los Angeles, CA, 90095-1772, United States, 1 310 825 2594, ramirezma@ucla.edu %K short message service %K reminder system %K pilot project %K exercise %K Hispanic Americans %K type 2 diabetes mellitus %K self-care %K social support %D 2017 %7 06.06.2017 %9 Original Paper %J JMIR Diabetes %G English %X Background: Given disparities in diabetes prevalence, receipt of diabetes education, diabetes knowledge, and self-management behaviors among Latinos, there is a need to provide education and ongoing support to this population. Phone-based interventions have the potential to reach and engage both patients and their family members and friends. Objective: The aim of this study was to investigate the feasibility, perceived usefulness, and potential effectiveness of a short text or voice message (STVM) intervention to activate (1) physical activity (PA) behavior change among urban, low-income Latino adults with type 2 diabetes and (2) supportive behaviors by their family members and friends. Methods: A 12-week pilot study randomized 42 participants recruited in person from a safety-net ambulatory care clinic in Los Angeles into one of the 3 study arms: control, phone messaging (PM), and phone messaging plus social support from family members and friends (PM+FF). All participants were prompted to set PA goals and to self-monitor PA behavior using pedometers and walking logs. PM and PM+FF participants received STVMs with reminders to review goals and self-monitor, PA behavior change education, and feedback on performance. Participants in the PM+FF arm also had their family members and friends receiving STVMs with suggestions for how they could support the participant’s PA behavior change efforts. Participants completed semistructured assessments in person at baseline, 6 weeks, and 12 weeks. Outcomes were PA (steps/day) and perceived social support from family members and friends. Results: Among PM and PM+FF participants, those who opted to receive text messages (short message service, SMS) responded to 62.7% (128/204) of SMS text messages requiring a response while those who opted to receive voice messages responded 30% (12/40) of the time. Participants perceived guidance in self-regulation as useful, particularly self-monitoring, goal setting, self-instruction, feedback, and social support. All participants increased PA at 6 weeks, but only the PM and PM+FF arms increased PA at 12 weeks. All study arms experienced an increase in perceived social support from family members and friends at 6 weeks, but only those in the PM+FF arm had an increase in the perception of social support at 12 weeks. Conclusion: Designing an STVM intervention based on self-regulation techniques is feasible and perceived as useful by participants. The STVM intervention has the potential to improve PA in terms of daily steps and perceived social support from family members and friends. Trial Registration: Clinicaltrials.gov NCT02850770; https://clinicaltrials.gov/ct2/show/NCT02850770 (Archived by WebCite at http://www.webcitation.org/query?id=1495567756845570) %M 30291094 %R 10.2196/diabetes.7063 %U http://diabetes.jmir.org/2017/1/e8/ %U https://doi.org/10.2196/diabetes.7063 %U http://www.ncbi.nlm.nih.gov/pubmed/30291094 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e190 %T Mobile Text Messaging to Improve Medication Adherence and Viral Load in a Vulnerable Canadian Population Living With Human Immunodeficiency Virus: A Repeated Measures Study %A King,Elizabeth %A Kinvig,Karen %A Steif,Jonathan %A Qiu,Annie Q %A Maan,Evelyn J %A Albert,Arianne YK %A Pick,Neora %A Alimenti,Ariane %A Kestler,Mary H %A Money,Deborah M %A Lester,Richard T %A Murray,Melanie Caroline Margaret %+ Division of Infectious Diseases, Department of Medicine, University of British Columbia, E600B, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada, 1 604 875 2212, melanie.murray@cw.bc.ca %K mHealth %K HIV %K medication adherence %K vulnerable %K female %K viral load %K mobile phone %K engagement %D 2017 %7 01.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Combination antiretroviral therapy (cART) as treatment for human immunodeficiency virus (HIV) infection is effective and available, but poor medication adherence limits benefits, particularly in vulnerable populations. In a Kenyan randomized controlled trial, a weekly text-messaging intervention (WelTel) improved cART adherence and HIV viral load (VL). Despite growing evidence for short message service (SMS) text-message interventions in HIV care, there is a paucity of data utilizing these interventions in marginalized or female cohorts. Objective: This study was undertaken to assess whether the standardized WelTel SMS text-message intervention applied to a vulnerable, predominantly female, population improved cART adherence and VL. Methods: We conducted a repeated measures study of the WelTel intervention in high-risk HIV-positive persons by measuring change in VL, CD4 count, and self-reported adherence 12 months before and 12 months after the WelTel intervention was introduced. Inclusion criteria included VL ≥200 copies/mL, indication for treatment, and meeting vulnerability criteria. Participants were given a mobile phone with unlimited texting (where required), and weekly check-in text messages were sent for one year from the WelTel computer platform. Clinical data were collected for control and intervention years. Participants were followed by a multidisciplinary team in a clinical setting. Outcomes were assessed using Wilcoxon signed ranks tests for change in CD4 and VL from control year to study end and mixed-effects logistic regressions for change in cART adherence and appointment attendance. A secondary analysis was conducted to assess the effect of response rate on the outcome by modeling final log10 VL by number of responses while controlling for mean log10 VL in the control year. Results: Eighty-five participants enrolled in the study, but 5 withdrew (final N=80). Participants were predominantly female (90%, 72/80) with a variety of vulnerabilities. Mean VL decreased from 1098 copies/mL in the control year to 439 copies/mL at study end (P=.004). Adherence to cART significantly improved (OR 1.14, IQR 1.10-1.18; P<.001), whereas appointment attendance decreased slightly with the intervention (OR 0.81, IQR 0.67-0.99; P=.03). A response was received for 46.57% (1753/3764) of messages sent and 9.62% (362/3764) of text messages sent were replied to with a problem. An outcome analysis examining relationship between reply rate and VL did not meet statistical significance (P=.07), but may be worthy of investigating further in a larger study. Conclusions: WelTel may be an effective tool for improving cART adherence and reducing VLs among high-risk, vulnerable HIV-positive persons. Trial Registration: Clinicaltrials.gov NCT02603536; https://clinicaltrials.gov/ct2/show/NCT02603536 (Archived by WebCite at http://www.webcitation.org/6qK57zCwv) %M 28572079 %R 10.2196/jmir.6631 %U http://www.jmir.org/2017/6/e190/ %U https://doi.org/10.2196/jmir.6631 %U http://www.ncbi.nlm.nih.gov/pubmed/28572079 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 5 %P e84 %T Comparison of Ecological Momentary Assessment Versus Direct Measurement of E-Cigarette Use With a Bluetooth-Enabled E-Cigarette: A Pilot Study %A Pearson,Jennifer L %A Elmasry,Hoda %A Das,Babita %A Smiley,Sabrina L %A Rubin,Leslie F %A DeAtley,Teresa %A Harvey,Emily %A Zhou,Yitong %A Niaura,Raymond %A Abrams,David B %+ Truth Initiative, Schroeder Institute for Tobacco Research and Policy Studies, 900 G St NW, Fourth Floor, Washington, DC,, United States, 1 202 454 5768, jpearson@truthinitiative.org %K smoking %K humans %K tobacco products/utilization %K electronic cigarettes %K observational study %K United States %D 2017 %7 29.05.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Assessing the frequency and intensity of e-cigarette use presents special challenges beyond those posed by cigarette use. Accurate measurement of e-cigarette consumption, puff duration, and the stability of these measures over time will be informative for estimating the behavioral and health effects of e-cigarette use. Objective: The purpose of this pilot study was to compare the accuracy of self-reported e-cigarette puff counts collected via ecological momentary assessment (EMA) to objective puff count data collected by a Bluetooth-enabled e-cigarette device and to examine the feasibility and acceptability of using a second-generation e-cigarette among adult smokers. Methods: A total of 5 adult smokers were enrolled in a longitudinal parent study assessing how e-cigarette use affects cigarette use among e-cigarette–naïve smokers. Using a text message–based EMA system, participants reported e-cigarette puffs for 2 weeks. Participants were also given a Bluetooth-enabled e-cigarette (Smokio) that passively collected puff counts and puff duration. Comparisons between mean reports of Smokio (device-report) and EMA (self-report) use were evaluated using paired t tests. Correlation and agreement between device- and self-reports were evaluated using Pearson correlation and the concordance correlation coefficient (CCC), respectively. A linear mixed effect model was used to determine the fixed effect of timing and Smokio-reported daily puffs on report accuracy. We examined the relationship between time of day and reporting accuracy using Tukey's test for multiple pairwise comparisons. Results: A total of 5 African American participants, 4 men and 1 woman, who ranged in age from 24 to 59 years completed the study, resulting in 5180 observations (device-report) of e-cigarette use. At baseline, participants reported smoking for 5 to 25 years and consumed a mean of 7 to 13 cigarettes per day (CPD); 4 smoked within 30 minutes of waking. At the 30-day follow-up, CPD range decreased to 1 to 3 cigarettes; 4 participants reported past 7-day e-cigarette use, and 1 participant reported no cigarette smoking in the past 7 days. Over 2 weeks of e-cigarette use, participants took an average of 1074 e-cigarette (SD 779.0) puffs per person as captured by the device reports. Each participant took a mean of 75.0 (SD 58.8) puffs per day, with each puff lasting an average of 3.6 (SD 2.4) seconds. Device reports captured an average of 33.3 (SD 47.8) more puffs per person per day than the self-reported e-cigarette puffs. In 87% of days, participants underestimated the number of puffs they had taken on the Smokio. There was significant moderate correlation (r=.47, P<.001) but poor agreement (pc=0.31, 95% CI 0.15-0.46) between the device- and self-reported data. Reporting accuracy was affected by amount and timing of e-cigarette use. Conclusions: Compared to self-reported e-cigarette use, the Bluetooth-enabled device captured significantly more e-cigarette use and allowed for examination of puff duration in addition to puff counts. A Bluetooth-enabled e-cigarette is a powerful and feasible tool for objective collection of e-cigarette use behavior in the real world. %M 28554877 %R 10.2196/resprot.6501 %U http://www.researchprotocols.org/2017/5/e84/ %U https://doi.org/10.2196/resprot.6501 %U http://www.ncbi.nlm.nih.gov/pubmed/28554877 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e147 %T More Than a Text Message: Dismantling Digital Triggers to Curate Behavior Change in Patient-Centered Health Interventions %A Muench,Frederick %A Baumel,Amit %+ Psychiatry, Northwell Health, 311, 1010 Northern Blvd, Great Neck, NY, 11021, United States, 1 191 532 0623, fmuench@northwell.edu %K alerts %K digital triggers %K text messaging %K haptic triggers %K reminder systems %K push alerts %K mHealth %K mobile health %K engagement %K marketing %K behavior change %K behavioral medicine %D 2017 %7 26.05.2017 %9 Viewpoint %J J Med Internet Res %G English %X Digital triggers such as text messages, emails, and push alerts are designed to focus an individual on a desired goal by prompting an internal or external reaction at the appropriate time. Triggers therefore have an essential role in engaging individuals with digital interventions delivered outside of traditional health care settings, where other events in daily lives and fluctuating motivation to engage in effortful behavior exist. There is an emerging body of literature examining the use of digital triggers for short-term action and longer-term behavior change. However, little attention has been given to understanding the components of digital triggers. Using tailoring as an overarching framework, we separated digital triggers into 5 primary components: (1) who (sender), (2) how (stimulus type, delivery medium, heterogeneity), (3) when (delivered), (4) how much (frequency, intensity), and (5) what (trigger’s target, trigger’s structure, trigger’s narrative). We highlighted key considerations when tailoring each component and the pitfalls of ignoring common mistakes, such as alert fatigue and habituation. As evidenced throughout the paper, there is a broad literature base from which to draw when tailoring triggers to curate behavior change in health interventions. More research is needed, however, to examine differences in efficacy based on component tailoring, to best use triggers to facilitate behavior change over time, and to keep individuals engaged in physical and mental health behavior change efforts. Dismantling digital triggers into their component parts and reassembling them according to the gestalt of one’s change goals is the first step in this development work. %M 28550001 %R 10.2196/jmir.7463 %U http://www.jmir.org/2017/5/e147/ %U https://doi.org/10.2196/jmir.7463 %U http://www.ncbi.nlm.nih.gov/pubmed/28550001 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 5 %P e95 %T An Ecological Momentary Intervention to Reduce Alcohol Consumption in Young Adults Delivered During Drinking Events: Protocol for a Pilot Randomized Controlled Trial %A Wright,Cassandra JC %A Dietze,Paul M %A Agius,Paul A %A Kuntsche,Emmanuel %A Room,Robin %A Livingston,Michael %A Hellard,Margaret %A Lim,Megan SC %+ School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne,, Australia, 61 3 9282 2173, cassandra.wright@burnet.edu.au %K alcohol drinking %K young adult %K mHealth %K text messaging %K ecological momentary intervention %D 2017 %7 25.05.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Risky drinking is a significant public health issue in young Australian adults. Brief interventions are one of few effective methods of reducing risky drinking but are time and cost intensive; innovative methods of delivery are therefore of interest. Mobile phones offer new opportunities to collect data and intervene during risky drinking events. Mobile phones have successfully been used for delivery of alcohol-related brief interventions and data collection but not in combination with or during drinking events. Objective: This pilot study will investigate the efficacy of an ecological momentary intervention (EMI), with combined ecological momentary assessment (EMA) and brief intervention delivered by mobile phones to young adults during risky drinking events. Methods: We will use a 3-armed randomized controlled trial to investigate the efficacy of the intervention for reducing peak single occasion drinking. Our sample is recruited from an observational cohort study of young, risky drinkers. Participants will be randomized into 1 of 3 intervention arms. On 6 nights across a 12-week study period, EMI and EMA groups will complete hourly EMA surveys on their mobile phone. EMI participants will receive tailored feedback short message service (SMS) texts corresponding to their EMA survey responses. The EMI participants will not receive feedback SMS. A third group will have no contact (no-contact control). All groups will then be contacted for a follow-up interview within 4 weeks of the 12-week study period ending. Results: The primary outcome is mean reduction in standard drinks consumed during their most recent heavy drinking occasion as measured at follow-up. Secondary outcomes include alcohol consumption over the previous 6 months, experiences of alcohol-related harms, attitudes toward drinking and drunkenness, hazardous drinking and use of tobacco and illicit drugs. A random effects mixed modelling approach using maximum likelihood estimation will be used to provide estimates of differences in mean drinking levels between those receiving the intervention and control participants. Conclusions: This study is novel in that, unlike previous work, it will intervene repeatedly during single occasion drinking events. Further, it extends previous research in this area, which has applied limited tailoring of message content for SMS-based brief interventions. The findings of this study will contribute to the growing body of evidence to inform the use of mobile health interventions for reducing alcohol consumption and harms. Trial Registration: Australian New Zealand Clinical Trials ACTRN12616001323415; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=369534 (Archived by WebCite at http://www.webcitation.org/ 6qDqBZV9b) %M 28546136 %R 10.2196/resprot.6760 %U http://www.researchprotocols.org/2017/5/e95/ %U https://doi.org/10.2196/resprot.6760 %U http://www.ncbi.nlm.nih.gov/pubmed/28546136 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 5 %P e91 %T The Use of Text Messaging to Improve the Hospital-to-Community Transition in Acute Coronary Syndrome Patients (Txt2Prevent): Intervention Development and Pilot Randomized Controlled Trial Protocol %A Ross,Emily S %A Sakakibara,Brodie M %A Mackay,Martha H %A Whitehurst,David GT %A Singer,Joel %A Toma,Mustafa %A Corbett,Kitty K %A Van Spall,Harriette GC %A Rutherford,Kimberly %A Gheorghiu,Bobby %A Code,Jillianne %A Lear,Scott A %+ Division of Cardiology, Providence Health Care, Healthy Heart Program St. Paul's Hospital, B180-1081 Burrard Street, Vancouver, BC,, Canada, 1 604 682 2344 ext 62778, slear@providencehealth.bc.ca %K acute coronary syndrome %K cardiovascular diseases %K heart diseases %K mobile health %K text messaging %K mobile phone %K SMS %D 2017 %7 23.05.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Acute coronary syndrome, including acute myocardial infarction (AMI), is one of the leading causes for hospitalization, with AMI 30-day readmission rates around 20%. Supporting patient information needs and increasing adherence to recommended self-management behaviors during transition from hospital to home has the potential to improve patient outcomes. Text messages have been effective in other interventions and may be suitable to provide support to patients during this transition period. Objective: The goal of this study is to pilot test a text messaging intervention program (Txt2Prevent) that supports acute coronary syndrome patients for 60 days postdischarge. The primary objective is to compare self-management, as measured by the Health Education Impact Questionnaire, between patients receiving only usual care versus those who receive usual care plus the Txt2Prevent intervention. The secondary objectives are to compare medication adherence, health-related quality of life, self-efficacy, health care resource use (and associated costs), all-cause and cardiovascular disease (CVD) readmission, and all-cause and CVD mortality rates between the 2 groups. The third objective is to assess acceptability of the text messaging intervention and feasibility of the study protocol. Methods: This is a randomized controlled trial with blinding of outcome assessors. The Txt2Prevent program includes automated text messages to patients about standard follow-up care, general self-management, and healthy living. The content of the text messages was informed by and developed based on interviews with patients, discharge materials, theoretical domains of behavior, and a clinical advisory group composed of patients, clinicians, and researchers. We will recruit 76 consecutive cardiac in-patients with acute coronary syndrome who are treated with either medical management or percutaneous coronary intervention from a hospital in Vancouver, Canada. Results: Assessments at baseline will include measures for demographic information, self-management, health-related quality of life, and self-efficacy. Assessments at follow-up will include medication adherence, readmissions, health care resource use, and mortality in addition to the reassessment of baseline measures. Baseline assessments are done in-person while follow-up assessments are completed through a combination of mailed packages and phone calls. Semistructured interviews with participants will also be performed to better understand participant experiences managing their condition and with the text messages. Conclusions: This study will determine preliminary efficacy, feasibility, and acceptability of the Txt2Prevent program to support acute coronary syndrome patients in the transition to home following hospital discharge. The results of this study will be used to inform a larger trial. Trial Registration: ClinicalTrials.gov NCT02336919; https://clinicaltrials.gov/ct2/show/NCT02336919 (Archived by WebCite at http://www.webcitation.org/6qMjEqo6O) %M 28536088 %R 10.2196/resprot.6968 %U http://www.researchprotocols.org/2017/5/e91/ %U https://doi.org/10.2196/resprot.6968 %U http://www.ncbi.nlm.nih.gov/pubmed/28536088 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e67 %T Effect of a Counseling Session Bolstered by Text Messaging on Self-Selected Health Behaviors in College Students: A Preliminary Randomized Controlled Trial %A Sandrick,Janice %A Tracy,Doreen %A Eliasson,Arn %A Roth,Ashley %A Bartel,Jeffrey %A Simko,Melanie %A Bowman,Tracy %A Harouse-Bell,Karen %A Kashani,Mariam %A Vernalis,Marina %+ Integrative Cardiac Health Project, Department of Medicine, Walter Reed Military Medical Center, Bldg 17A, 8901 Wisconsin Avenue, Bethesda, MD, 20889, United States, 1 301 400 1111, aheliasson@aol.com %K health behaviors %K diet habits %K exercise %K sleep %K text telecommunications %K universities %D 2017 %7 17.05.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The college experience is often the first time when young adults live independently and make their own lifestyle choices. These choices affect dietary behaviors, exercise habits, techniques to deal with stress, and decisions on sleep time, all of which direct the trajectory of future health. There is a need for effective strategies that will encourage healthy lifestyle choices in young adults attending college. Objective: This preliminary randomized controlled trial tested the effect of coaching and text messages (short message service, SMS) on self-selected health behaviors in the domains of diet, exercise, stress, and sleep. A second analysis measured the ripple effect of the intervention on health behaviors not specifically selected as a goal by participants. Methods: Full-time students aged 18-30 years were recruited by word of mouth and campuswide advertisements (flyers, posters, mailings, university website) at a small university in western Pennsylvania from January to May 2015. Exclusions included pregnancy, eating disorders, chronic medical diagnoses, and prescription medications other than birth control. Of 60 participants, 30 were randomized to receive a single face-to-face meeting with a health coach to review results of behavioral questionnaires and to set a health behavior goal for the 8-week study period. The face-to-face meeting was followed by SMS text messages designed to encourage achievement of the behavioral goal. A total of 30 control subjects underwent the same health and behavioral assessments at intake and program end but did not receive coaching or SMS text messages. Results: The texting app showed that 87.31% (2187/2505) of messages were viewed by intervention participants. Furthermore, 28 of the 30 intervention participants and all 30 control participants provided outcome data. Among intervention participants, 22 of 30 (73%) showed improvement in health behavior goal attainment, with the whole group (n=30) showing a mean improvement of 88% (95% CI 39-136). Mean improvement in any behavioral domains was not seen in the control group. Intervention participants also increased their exercise significantly compared with controls, regardless of their self-selected goal category. The increased exercise was paralleled by significantly lower fasting glucose levels. Conclusions: The health coaching session plus tailored SMS text messages improved self-selected health behaviors with a modest ripple effect to include unselected health behaviors. Trial Registration: Clinicaltrials.gov NCT02476604; https://clinicaltrials.gov/ct2/show/NCT02476604 (Archived by WebCite at http://www.webcitation.org/6qAAryS5t) %M 28526664 %R 10.2196/mhealth.6638 %U http://mhealth.jmir.org/2017/5/e67/ %U https://doi.org/10.2196/mhealth.6638 %U http://www.ncbi.nlm.nih.gov/pubmed/28526664 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 5 %P e88 %T Using Text Messaging in Long-Term Arthroplasty Follow-Up: A Pilot Study %A Blocker,Oliver %A Bullock,Alison %A Morgan-Jones,Rhidian %A Ghandour,Adel %A Richardson,James %+ Department of Trauma and Orthopaedics, University Hospital of Wales, Cardiff and Vale University Health Board, Heath Park, Cardiff,, United Kingdom, 44 292 074 8044, drblocker@gmail.com %K texting %K text messages %K short message service %K patient outcome assessment %K follow-up studies %K arthroplasty %D 2017 %7 16.05.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Patient-reported outcome measures (PROMs) and mobile technology have the potential to change the way patients are monitored following joint replacement surgery. Objective: The aim of this study was to determine the feasibility of text messaging to record PROMs in long-term follow-up of hip and knee arthroplasty. Our participants were 17 patients 2-years-plus post hip or knee arthroplasty attending clinic with a mobile telephone number on record. Methods: A simple PROM (Oswestry Very Short Form) was texted to the patient. Responses were compared to clinical, radiographic, and existing PROM findings. Patients were interviewed to discover their opinions on this use of texting. Results: A total of 11 patients engaged with the text messaging. Reasons for not engaging included wrong numbers, physical barriers, and lack of understanding. A total of 8 patients attending clinic allowed comparison of text messaging with clinical findings. The average age was 70 years. A total of 4 patient text messaging responses matched clinical and radiographic findings; 3 also matched PROM scores collected in clinic. The 3 patients with mixed responses had abnormal clinical, radiographic, or PROM findings. One patient’s text responses conflicted with clinical outcome. Analysis of patients’ views showed a generally positive opinion: patients were happy to communicate with surgeons by text. Practical problems, PROM limitations, and trustworthiness of texting were highlighted. Conclusions: Engaging with changing technology creates challenges for patients and health care professionals. Despite this, our results suggest text messaging is a promising way to communicate with arthroplasty patients. Earlier integration of text communication in the patient pathway may be important and needs further research. %M 28512080 %R 10.2196/resprot.6047 %U http://www.researchprotocols.org/2017/5/e88/ %U https://doi.org/10.2196/resprot.6047 %U http://www.ncbi.nlm.nih.gov/pubmed/28512080 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e66 %T Text Messaging and Mobile Phone Apps as Interventions to Improve Adherence in Adolescents With Chronic Health Conditions: A Systematic Review %A Badawy,Sherif M %A Barrera,Leonardo %A Sinno,Mohamad G %A Kaviany,Saara %A O’Dwyer,Linda C %A Kuhns,Lisa M %+ Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Division of Hematology, Oncology and Stem Cell Transplant, Northwestern University Feinberg School of Medicine, 225 E Chicago Ave, Box 30, Chicago, IL, 60611, United States, 1 3122274836, sbadawy@luriechildrens.org %K adolescents %K medication adherence %K chronic health conditions %K chronic medical conditions %K text messaging %K mobile phone apps %K smartphone apps %K smartphone applications %D 2017 %7 15.05.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The number of adolescents with chronic health conditions (CHCs) continues to increase. Medication nonadherence is a global challenge among adolescents across chronic conditions and is associated with poor health outcomes. While there has been growing interest in the use of mHealth technology to improve medication adherence among adolescents with CHCs, particularly text messaging and mobile phone apps, there has been no prior systematic review of their efficacy. Objective: The purpose of this review was to systematically evaluate the most recent evidence for the efficacy of text messaging and mobile phone apps as interventions to promote medication adherence among adolescents with CHCs. Methods: PubMed, Embase, CENTRAL, PsycINFO, Web of Science, Google Scholar, and additional databases were searched from 1995 until November 2015. An additional hand search of related themes in the Journal of Medical Internet Research was also conducted. The Preferred Reporting Results of Systematic Reviews and Meta-Analyses guidelines were followed. Two reviewers independently screened titles/abstracts, assessed full-text articles, extracted data from included articles, and assessed their quality using Grades of Recommendation, Assessment, Development, and Evaluation criteria. Included studies were described in original research articles that targeted adherence in adolescents with CHCs (12-24 years-old). Results: Of the 1423 records examined, 15 met predefined criteria: text messaging (n=12) and mobile phone apps (n=3). Most studies were performed in the United States (11/15, 73%), were randomized-controlled trials (8/15, 53%), had a sample size <50 (11/15, 73%), and included adherence self-report and/or biomarkers (9/15, 60%). Only four studies were designed based on a theoretical framework. Approaches for text messaging and mobile phone app interventions varied across studies. Seven articles (7/15, 47%) reported significant improvement in adherence with moderate to large standardized mean differences. Most of the included studies were of low or moderate quality. Studies varied in sample size, methods of adherence assessment, and definition of adherence, which prohibited performing a meta-analysis. Conclusions: The use of text messaging and mobile phone app interventions to improve medication adherence among adolescents with CHCs has shown promising feasibility and acceptability, and there is modest evidence to support the efficacy of these interventions. Further evaluation of short- and long-term efficacy and cost-effectiveness of these interventions is warranted given the early and evolving state of the science. %M 28506955 %R 10.2196/mhealth.7798 %U http://mhealth.jmir.org/2017/5/e66/ %U https://doi.org/10.2196/mhealth.7798 %U http://www.ncbi.nlm.nih.gov/pubmed/28506955 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 5 %P e87 %T EpxMedTracking: Feasibility Evaluation of an SMS-Based Medication Adherence Tracking System in Community Practice %A Tricarico,Christopher %A Peters,Robert %A Som,Avik %A Javaherian,Kavon %A Ross,Will %+ Washington University in St. Louis School of Medicine, Washington University School of Medicine, Campus Box 8023, St. Louis, MO,, United States, 1 314 362 6854, rossw@wustl.edu %K medication adherence %K eHealth %K text messaging %D 2017 %7 15.05.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Medication adherence remains a difficult problem to both assess and improve in patients. It is a multifactorial problem that goes beyond the commonly cited reason of forgetfulness. To date, eHealth (also known as mHealth and telehealth) interventions to improve medication adherence have largely been successful in improving adherence. However, interventions to date have used time- and cost-intensive strategies or focused solely on medication reminding, leaving much room for improvement in using a modality as flexible as eHealth. Objective: Our objective was to develop and implement a fully automated short message service (SMS)-based medication adherence system, EpxMedTracking, that reminds patients to take their medications, explores reasons for missed doses, and alerts providers to help address problems of medication adherence in real time. Methods: EpxMedTracking is a fully automated bidirectional SMS-based messaging system with provider involvement that was developed and implemented through Epharmix, Inc. Researchers analyzed 11 weeks of de-identified data from patients cared for by multiple provider groups in routine community practice for feasibility and functionality. Patients included were those in the care of a provider purchasing the EpxMedTracking tool from Epharmix and were enrolled from a clinic by their providers. The primary outcomes assessed were the rate of engagement with the system, reasons for missing doses, and self-reported medication adherence. Results: Of the 25 patients studied over the 11 weeks, 3 never responded and subsequently opted out or were deleted by their provider. No other patients opted out or were deleted during the study period. Across the 11 weeks of the study period, the overall weekly engagement rate was 85.9%. There were 109 total reported missed doses including “I forgot” at 33 events (30.3%), “I felt better” at 29 events (26.6%), “out of meds” at 20 events (18.4%), “I felt sick” at 19 events (17.4%), and “other” at 3 events (2.8%). We also noted an increase in self-reported medication adherence in patients using the EpxMedTracking system. Conclusions: EpxMedTracking is an effective tool for tracking self-reported medication adherence over time. It uniquely identifies actionable reasons for missing doses for subsequent provider intervention in real time based on patient feedback. Patients enrolled on EpxMedTracking also self-report higher rates of medication adherence over time while on the system. %M 28506954 %R 10.2196/resprot.7223 %U http://www.researchprotocols.org/2017/5/e87/ %U https://doi.org/10.2196/resprot.7223 %U http://www.ncbi.nlm.nih.gov/pubmed/28506954 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e148 %T Automated Text Messaging as an Adjunct to Cognitive Behavioral Therapy for Depression: A Clinical Trial %A Aguilera,Adrian %A Bruehlman-Senecal,Emma %A Demasi,Orianna %A Avila,Patricia %+ School of Social Welfare, University of California, Berkeley, 120 Haviland Hall, MC 7400, Berkeley, CA, 94720, United States, 1 5106428564, aguila@berkeley.edu %K depression %K text messaging %K cognitive behavioral therapy %K mhealth %K mental health %K Latinos %D 2017 %7 08.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive Behavioral Therapy (CBT) for depression is efficacious, but effectiveness is limited when implemented in low-income settings due to engagement difficulties including nonadherence with skill-building homework and early discontinuation of treatment. Automated messaging can be used in clinical settings to increase dosage of depression treatment and encourage sustained engagement with psychotherapy. Objectives: The aim of this study was to test whether a text messaging adjunct (mood monitoring text messages, treatment-related text messages, and a clinician dashboard to display patient data) increases engagement and improves clinical outcomes in a group CBT treatment for depression. Specifically, we aim to assess whether the text messaging adjunct led to an increase in group therapy sessions attended, an increase in duration of therapy attended, and reductions in Patient Health Questionnaire-9 item (PHQ-9) symptoms compared with the control condition of standard group CBT in a sample of low-income Spanish speaking Latino patients. Methods: Patients in an outpatient behavioral health clinic were assigned to standard group CBT for depression (control condition; n=40) or the same treatment with the addition of a text messaging adjunct (n=45). The adjunct consisted of a daily mood monitoring message, a daily message reiterating the theme of that week’s content, and medication and appointment reminders. Mood data and qualitative responses were sent to a Web-based platform (HealthySMS) for review by the therapist and displayed in session as a tool for teaching CBT skills. Results: Intent-to-treat analyses on therapy attendance during 16 sessions of weekly therapy found that patients assigned to the text messaging adjunct stayed in therapy significantly longer (median of 13.5 weeks before dropping out) than patients assigned to the control condition (median of 3 weeks before dropping out; Wilcoxon-Mann-Whitney z=−2.21, P=.03). Patients assigned to the text messaging adjunct also generally attended more sessions (median=6 sessions) during this period than patients assigned to the control condition (median =2.5 sessions), but the effect was not significant (Wilcoxon-Mann-Whitney z=−1.65, P=.10). Both patients assigned to the text messaging adjunct (B=−.29, 95% CI −0.38 to −0.19, z=−5.80, P<.001) and patients assigned to the control conditions (B=−.20, 95% CI −0.32 to −0.07, z=−3.12, P=.002) experienced significant decreases in depressive symptom severity over the course of treatment; however, the conditions did not significantly differ in their degree of symptom reduction. Conclusions: This study provides support for automated text messaging as a tool to sustain engagement in CBT for depression over time. There were no differences in depression outcomes between conditions, but this may be influenced by low follow-up rates of patients who dropped out of treatment. %M 28483742 %R 10.2196/jmir.6914 %U http://www.jmir.org/2017/5/e148/ %U https://doi.org/10.2196/jmir.6914 %U http://www.ncbi.nlm.nih.gov/pubmed/28483742 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e59 %T Text Message Feedback to Support Mindfulness Practice in People With Depressive Symptoms: A Pilot Randomized Controlled Trial %A Kraft,Susanne %A Wolf,Markus %A Klein,Thomas %A Becker,Thomas %A Bauer,Stephanie %A Puschner,Bernd %+ Section Process-Outcome Research, Department of Psychiatry II, Ulm University, 3rd floor, Ludwig-Heilmeyer-Str 2, Günzburg, 89312, Germany, 49 8221 982866, bernd.puschner@bkh-guenzburg.de %K mindfulness %K text messaging %K pilot study %K randomized controlled trial %D 2017 %7 02.05.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: It has been shown that mindfulness practice can be helpful in preventing relapse from depression. However, practicing mindfulness regularly at home is often a challenge for people with depression. Mobile phone text messaging (short message service, SMS) may be a feasible approach to assist regular mindfulness home practice. Objective: The aim of this study was to evaluate the feasibility of text message–based feedback to support mindfulness practice in people with depressive symptoms after inpatient psychiatric treatment. Methods: Participants received a manualized group introduction to three mindfulness exercises during inpatient treatment and were randomized at hospital discharge. All participants were asked to practice the exercises daily during the 4-month follow-up period. Only participants allocated to the intervention group received reinforcing feedback via mobile phone text messages after reporting their mindfulness practice via text message. Participation rates and satisfaction with the interventions were evaluated, and effects on relevant outcomes were explored. Results: Of the 176 eligible inpatients invited to participate, 65.9% (116/176) attended the introductory mindfulness group at least once, 33.0% (58/176) were willing to participate in the study, and 41 were randomized. The majority 85% (35/41) of these participants completed the study. Among the participants allocated to the intervention group (n=21), 81% (17/21) used the text message support at least once. The average number of text messages sent during the intervention period was 14 (SD 21, range 0-91). Satisfaction rates were high. Preliminary analyses of the effects of the intervention yielded mixed results. Conclusions: Findings indicate that text messaging following inpatient treatment is feasible for some, but not for all people with depressive symptoms. Modest use of the text messaging intervention and its mixed effects imply that dose and ingredients of the intervention should be increased for this group of patients in a future full-size RCT. Such a larger study should also include a process evaluation to investigate moderators of the effect of mindfulness practice and text message feedback on clinical outcome. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 58808893; http://www.controlled-trials.com/ISRCTN58808893 (Archived by Webcite at http://www.webcitation.org/6pmrDRnGt) %M 28465278 %R 10.2196/mhealth.7095 %U http://mhealth.jmir.org/2017/5/e59/ %U https://doi.org/10.2196/mhealth.7095 %U http://www.ncbi.nlm.nih.gov/pubmed/28465278 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 4 %P e61 %T Using Mobile Phones to Collect Patient Data: Lessons Learned From the SIMPle Study %A Duane,Sinead %A Tandan,Meera %A Murphy,Andrew W %A Vellinga,Akke %+ Discipline of General Practice, National University of Ireland Galway, 1 Distillery Road, Galway,, Ireland, 353 91493855, sinead.duane@nuigalway.ie %K mobile phone apps %K mobile survey %K antimicrobial resistance %K primary care %K quantitative %K prescribing %K urinary tract infection %D 2017 %7 25.04.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Mobile phones offer new opportunities to efficiently and interactively collect real-time data from patients with acute illnesses, such as urinary tract infections (UTIs). One of the main benefits of using mobile data collection methods is automated data upload, which can reduce the chance of data loss, an issue when using other data collection methods such as paper-based surveys. Objective: The aim was to explore differences in collecting data from patients with UTI using text messaging, a mobile phone app (UTI diary), and an online survey. This paper provides lessons learned from integrating mobile data collection into a randomized controlled trial. Methods: Participants included UTI patients consulting in general practices that were participating in the Supporting the Improvement and Management of UTI (SIMPle) study. SIMPle was designed to improve prescribing antimicrobial therapies for UTI in the community. Patients were invited to reply to questions regarding their UTI either via a prospective text message survey, a mobile phone app (UTI diary), or a retrospective online survey. Data were collected from 329 patients who opted in to the text message survey, 71 UTI patients through the mobile phone UTI symptom diary app, and 91 online survey participants. Results: The age profile of UTI diary app users was younger than that of the text message and online survey users. The largest dropout for both the text message survey respondents and UTI diary app users was after the initial opt-in message; once the participants completed question 1 of the text message survey or day 2 in the UTI diary app, they were more likely to respond to the remaining questions/days. Conclusions: This feasibility study highlights the potential of using mobile data collection methods to capture patient data. As well as improving the efficiency of data collection, these novel approaches highlight the advantage of collecting data in real time across multiple time points. There was little variation in the number of patients responding between text message survey, UTI diary, and online survey, but more patients participated in the text message survey than the UTI diary app. The choice between designing a text message survey or UTI diary app will depend on the age profile of patients and the type of information the researchers’ desire. Trial Registration: ClinicalTrials.gov NCT01913860; https://clinicaltrials.gov/ct2/show/NCT01913860 (Archived by WebCite at http://www.webcitation.org/6pfgCztgT). %M 28442451 %R 10.2196/resprot.6389 %U http://www.researchprotocols.org/2017/4/e61/ %U https://doi.org/10.2196/resprot.6389 %U http://www.ncbi.nlm.nih.gov/pubmed/28442451 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e54 %T Designing Patient-Centered Text Messaging Interventions for Increasing Physical Activity Among Participants With Type 2 Diabetes: Qualitative Results From the Text to Move Intervention %A Horner,Gabrielle N %A Agboola,Stephen %A Jethwani,Kamal %A Tan-McGrory,Aswita %A Lopez,Lenny %+ Division of Hospital Medicine, University of California San Francisco, 4150 Clement St, 1A-69, San Francisco, CA, 94121, United States, 1 6176276600, lenny.lopez@ucsf.edu %K diabetes mellitus, type 2 %K text messaging %K exercise %K qualitative research %D 2017 %7 24.04.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Type 2 diabetes mellitus (T2DM) is a disease affecting approximately 29.1 million people in the United States, and an additional 86 million adults have prediabetes. Diabetes self-management education, a complex health intervention composed of 7 behaviors, is effective at improving self-care behaviors and glycemic control. Studies have employed text messages for education, reminders, and motivational messaging that can serve as “cues to action,” aiming to improve glucose monitoring, self-care behaviors, appointment attendance, and medication adherence. Objectives: The Text to Move (TTM) study was a 6-month 2-parallel group randomized controlled trial of individuals with T2DM to increase physical activity, measured by a pedometer. The intervention arm received text messages twice daily for 6 months that were tailored to the participant’s stage of behavior change as defined by the transtheoretical model of behavior change. Methods: We assessed participants’ attitudes regarding their experience with text messaging, focusing on perceived barriers and facilitators, through two focus groups and telephone interviews. All interviews were audiorecorded, transcribed verbatim, coded, and analyzed using a grounded theory approach. Results: The response rate was 67% (31/46 participants). The average age was 51.4 years and 61% (19/31 participants) were male. The majority of individuals were English speakers and married, had completed at least 12th grade and approximately half of the participants were employed full-time. Overall, participants were satisfied with the TTM program and recalled the text messages as educational, informational, and motivational. Program involvement increased the sense of connection with their health care center. The wearing of pedometers and daily step count information served as motivational reminders and created a sense of accountability through the sentinel effect. However, there was frustration concerning the automation of the text message program, including the repetitiveness, predictability of text time delivery, and lack of customization and interactivity of text message content. Participants recommended personalization of texting frequency as well as more contact time with personnel for a stronger sense of support, including greater surveillance and feedback based on their own results and comparison to other participants. Conclusions: Participants in a theory-based text messaging intervention identified key facilitators and barriers to program efficacy that should be incorporated into future texting interventions to optimize participant satisfaction and outcomes. Trial Registration: Clinicaltrials.gov NCT01569243; http://clinicaltrials.gov/ct2/show/NCT01569243 (Archived by Webcite at http://www.webcitation.org/6pfH6yXag) %M 28438728 %R 10.2196/mhealth.6666 %U http://mhealth.jmir.org/2017/4/e54/ %U https://doi.org/10.2196/mhealth.6666 %U http://www.ncbi.nlm.nih.gov/pubmed/28438728 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e49 %T Development of a Culturally Tailored Text Message Maternal Health Program: TextMATCH %A Dobson,Rosie %A Whittaker,Robyn %A Bartley,Hannah %A Connor,Augusta %A Chen,Ruyan %A Ross,Mairead %A McCool,Judith %+ National Institute for Health Innovation, School of Population Health, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand, 64 93737599 ext 88908, r.dobson@auckland.ac.nz %K mHealth %K short message service %K maternal health %K culture %K text messages %D 2017 %7 20.04.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phones are increasingly being used to deliver health information and health services globally. Mobile health (mHealth) interventions may be well-suited for minority groups with greater barriers to accessing traditional health services. However, little has been written about the process of culturally adapting interventions for multiple ethnic and cultural minorities within a population. Objective: This study describes the process of developing a culturally tailored text message-based maternal health program (TextMATCH: Text for MATernal and Child Health) for Māori, Pacific, Asian, and South Asian families living in New Zealand. We report on engagement and acceptability of the TextMATCH program. Methods: Program data was examined to describe engagement with the program 18 months after implementation. Telephone interviews were conducted with a sample of participants who consented to provide feedback on acceptability and relevance of the program. Results: A total of 1404 participants enrolled in TextMATCH over 18 months, with 18.52% (260) actively opting out at some point (after 0 to 17 months of messages). It was found that 356 (70.9%) of the 502 eligible participants actively switched from the initial pregnancy program to the baby program after delivery. Phone interviews were conducted with 29 participants including 6 who had withdrawn (duration of program from 3 to 16 months). Only 2 participants reported that the program was not useful, with the remainder rating the usefulness of messages positively (average 4.24 out of 5). All participants stated that the messages were relevant, culturally appropriate, and easy to understand. Most were happy with the specific advice and the language options provided. Conclusions: We have demonstrated the importance of an intensive approach to the development of a culturally adapted and tailored mHealth program for multiple different cultural minority groups within our population. %M 28428159 %R 10.2196/mhealth.7205 %U http://mhealth.jmir.org/2017/4/e49/ %U https://doi.org/10.2196/mhealth.7205 %U http://www.ncbi.nlm.nih.gov/pubmed/28428159 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e47 %T A Framework for the Study of Complex mHealth Interventions in Diverse Cultural Settings %A Maar,Marion A %A Yeates,Karen %A Perkins,Nancy %A Boesch,Lisa %A Hua-Stewart,Diane %A Liu,Peter %A Sleeth,Jessica %A Tobe,Sheldon W %+ Faculty of Medicine, Northern Ontario School of Medicine, Laurentian University, 935 Ramsey Lake Rd, Sudbury, ON, P3E 2C6, Canada, 1 705 662 7233, mmaar@nosm.ca %K mobile health %K health care texting %K SMS %K protocol %K process evaluation %K process assessment (health care) %K health services, Indigenous %K Tanzania %K community-based participatory research %K DREAM-GLOBAL %D 2017 %7 20.04.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To facilitate decision-making capacity between options of care under real-life service conditions, clinical trials must be pragmatic to evaluate mobile health (mHealth) interventions under the variable conditions of health care settings with a wide range of participants. The mHealth interventions require changes in the behavior of patients and providers, creating considerable complexity and ambiguity related to causal chains. Process evaluations of the implementation are necessary to shed light on the range of unanticipated effects an intervention may have, what the active ingredients in everyday practice are, how they exert their effect, and how these may vary among recipients or between sites. Objective: Building on the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth) statement and participatory evaluation theory, we present a framework for the process evaluations for mHealth interventions in multiple cultural settings. We also describe the application of this evaluation framework to the implementation of DREAM-GLOBAL (Diagnosing hypertension—Engaging Action and Management in Getting Lower BP in Indigenous and LMIC [low- and middle-income countries]), a pragmatic randomized controlled trial (RCT), and mHealth intervention designed to improve hypertension management in low-resource environments. We describe the evaluation questions and the data collection processes developed by us. Methods: Our literature review revealed that there is a significant knowledge gap related to the development of a process evaluation framework for mHealth interventions. We used community-based participatory research (CBPR) methods and formative research data to develop a process evaluation framework nested within a pragmatic RCT. Results: Four human organizational levels of participants impacted by the mHealth intervention were identified that included patients, providers, community and organizations actors, and health systems and settings. These four levels represent evaluation domains and became the core focus of the evaluation. In addition, primary implementation themes to explore in each of the domains were identified as follows: (1) the major active components of the intervention, (2) technology of the intervention, (3) cultural congruence, (4) task shifting, and (5) unintended consequences. Using the four organizational domains and their interaction with primary implementation themes, we developed detailed evaluation research questions and identified the data or information sources to best answer our questions. Conclusions: Using DREAM-GLOBAL to illustrate our approach, we succeeded in developing an uncomplicated process evaluation framework for mHealth interventions that provide key information to stakeholders, which can optimize implementation of a pragmatic trial as well as inform scale up. The human organizational level domains used to focus the primary implementation themes in the DREAM-GLOBAL process evaluation framework are sufficiently supported in our research, and the literature and can serve as a valuable tool for other mHealth process evaluations. Trial Registration: ClinicalTrials.gov NCT02111226; https://clinicaltrials.gov/ct2/show/NCT02111226 (Archived by WebCite at http://www.webcitation.org/6oxfHXege) %M 28428165 %R 10.2196/mhealth.7044 %U http://mhealth.jmir.org/2017/4/e47/ %U https://doi.org/10.2196/mhealth.7044 %U http://www.ncbi.nlm.nih.gov/pubmed/28428165 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e50 %T Texting and Mobile Phone App Interventions for Improving Adherence to Preventive Behavior in Adolescents: A Systematic Review %A Badawy,Sherif M %A Kuhns,Lisa M %+ Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Division of Hematology, Oncology, and Stem Cell Transplant, Northwestern University Feinberg School of Medicine, 225 E, Chicago Ave, Box #30, Chicago, IL, 60611, United States, 1 312 227 4836, sbadawy@luriechildrens.org %K adolescent %K text messaging %K smartphone %K mobile phone %K mobile applications %K medication adherence %K behavior %K prevention %D 2017 %7 19.04.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many preventable behaviors contribute to adolescent mortality and morbidity. Non-adherence to preventive measures represents a challenge and has been associated with worse health outcomes in this population. The widespread use of electronic communication technologies by adolescents, particularly the use of text messaging (short message service, SMS) and mobile phones, presents new opportunities to intervene on risk and preventive risk behavior, but little is known about their efficacy. Objective: This study aimed to systematically evaluate evidence for the efficacy of text messaging and mobile phone app interventions to improve adherence to preventive behavior among adolescents and describe intervention approaches to inform intervention development. Methods: This review covers literature published between 1995 and 2015. Searches included PubMed, Embase, CENTRAL, PsycINFO, CINAHL, INSPEC, Web of Science, Google Scholar, and additional databases. The search strategy sought articles on text messaging and mobile phone apps combined with adherence or compliance, and adolescents and youth. An additional hand search of related themes in the Journal of Medical Internet Research was also conducted. Two reviewers independently screened titles and abstracts, assessed full-text articles, and extracted data from articles that met inclusion criteria. Included studies reflect original research—experimental or preexperimental designs with text messaging or mobile phone app interventions—targeting adherence to preventive behavior among adolescents (12-24 years old). The preferred reporting items of systematic reviews and meta-analyses (PRISMA) guidelines were followed for reporting results, and findings were critically appraised against the Oxford Centre for Evidence-based Medicine criteria. Results: Of 1454 records, 19 met inclusion criteria, including text messaging (n=15) and mobile phone apps (n=4). Studies targeted clinic attendance, contraceptive use, oral health, physical activity and weight management, sun protection, human papillomavirus (HPV) vaccination, smoking cessation, and sexual health. Most studies were performed in the United States (47%, 9/19), included younger adolescents (63%, 12/19), and had sample size <100 (63%, 12/19). Although most studies were randomized controlled trials (RCTs; 58%, 11/19), only 5 followed an intent-to-treat analysis. Only 6 of 19 studies (32%) incorporated a theoretical framework in their design. Most studies reported good feasibility with high acceptability and satisfaction. About half of the included studies (42%, 8/19) demonstrated significant improvement in preventive behavior with moderate standardized mean differences. As early efforts in this field to establish feasibility and initial efficacy, most studies were low to moderate in quality. Studies varied in sample size and methods of preventive behavior adherence or outcome assessment, which prohibited performing a meta-analysis. Conclusions: Despite the promising feasibility and acceptability of text messaging and mobile phone apps in improving preventive behavior among adolescents, overall findings were modest in terms of efficacy. Further research evaluating the efficacy, effectiveness, and cost-effectiveness of these intervention approaches in promoting preventive behavior among adolescents is needed. %M 28428157 %R 10.2196/mhealth.6837 %U http://mhealth.jmir.org/2017/4/e50/ %U https://doi.org/10.2196/mhealth.6837 %U http://www.ncbi.nlm.nih.gov/pubmed/28428157 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e102 %T Timely Digital Patient-Clinician Communication in Specialist Clinical Services for Young People: A Mixed-Methods Study (The LYNC Study) %A Griffiths,Frances %A Bryce,Carol %A Cave,Jonathan %A Dritsaki,Melina %A Fraser,Joseph %A Hamilton,Kathryn %A Huxley,Caroline %A Ignatowicz,Agnieszka %A Kim,Sung Wook %A Kimani,Peter K %A Madan,Jason %A Slowther,Anne-Marie %A Sujan,Mark %A Sturt,Jackie %+ Division of Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom, 44 24765 ext 22534, f.e.griffiths@warwick.ac.uk %K digital communication %K long-term conditions %K young people %K digital health care %K patient communication %K NHS %K National Health Service %D 2017 %7 10.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Young people (aged 16-24 years) with long-term health conditions can disengage from health services, resulting in poor health outcomes, but clinicians in the UK National Health Service (NHS) are using digital communication to try to improve engagement. Evidence of effectiveness of this digital communication is equivocal. There are gaps in evidence as to how it might work, its cost, and ethical and safety issues. Objective: Our objective was to understand how the use of digital communication between young people with long-term conditions and their NHS specialist clinicians changes engagement of the young people with their health care; and to identify costs and necessary safeguards. Methods: We conducted mixed-methods case studies of 20 NHS specialist clinical teams from across England and Wales and their practice providing care for 13 different long-term physical or mental health conditions. We observed 79 clinical team members and interviewed 165 young people aged 16-24 years with a long-term health condition recruited via case study clinical teams, 173 clinical team members, and 16 information governance specialists from study NHS Trusts. We conducted a thematic analysis of how digital communication works, and analyzed ethics, safety and governance, and annual direct costs. Results: Young people and their clinical teams variously used mobile phone calls, text messages, email, and voice over Internet protocol. Length of clinician use of digital communication varied from 1 to 13 years in 17 case studies, and was being considered in 3. Digital communication enables timely access for young people to the right clinician at the time when it can make a difference to how they manage their health condition. This is valued as an addition to traditional clinic appointments and can engage those otherwise disengaged, particularly at times of change for young people. It can enhance patient autonomy, empowerment and activation. It challenges the nature and boundaries of therapeutic relationships but can improve trust. The clinical teams studied had not themselves formally evaluated the impact of their intervention. Staff time is the main cost driver, but offsetting savings are likely elsewhere in the health service. Risks include increased dependence on clinicians, inadvertent disclosure of confidential information, and communication failures, which are mostly mitigated by young people and clinicians using common-sense approaches. Conclusions: As NHS policy prompts more widespread use of digital communication to improve the health care experience, our findings suggest that benefit is most likely, and harms are mitigated, when digital communication is used with patients who already have a relationship of trust with the clinical team, and where there is identifiable need for patients to have flexible access, such as when transitioning between services, treatments, or lived context. Clinical teams need a proactive approach to ethics, governance, and patient safety. %M 28396301 %R 10.2196/jmir.7154 %U http://www.jmir.org/2017/4/e102/ %U https://doi.org/10.2196/jmir.7154 %U http://www.ncbi.nlm.nih.gov/pubmed/28396301 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 3 %P e39 %T Experiences of Older Adults With Mobile Phone Text Messaging as Reminders of Home Exercises After Specialized Manual Therapy for Recurrent Low Back Pain: A Qualitative Study %A Lilje,Stina Charlotta %A Olander,Ewy %A Berglund,Johan %A Skillgate,Eva %A Anderberg,Peter %+ Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm, SE-171 77, Sweden, 46 708233332, titti.lilje@gmail.com %K text messages %K older adults %K recurrent low back pain %K manual therapy %D 2017 %7 30.03.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Clinical experience of manual therapy for musculoskeletal pain is that patients often suffer from recurrent pain and disorders, but that they do not continue to perform their physical home exercises when they are free from symptoms. The chance of positive long-term effects of manual therapy would probably increase if patients were reminded that they are to continue to perform their exercises. Mobile phone text messaging (short messaging service, SMS) is increasingly used as an innovative intervention to remind patient to exercise. However, there are only a few studies on such interventions in the field of low back pain (LBP). Qualitative studies of patients’ experiences of receiving text messages as reminders of home exercises after manual treatment for recurrent LBP have to the best of our knowledge never been published. Objectives: The aim of this study was to explore older persons’ common experiences of receiving reminders of home exercises through mobile phone text messaging after specialized manual therapy for recurrent LBP. Methods: A total of 7 men and 8 women (67-86 years), who had sought specialized manual therapy (Naprapathic manual therapy) for recurrent LBP were included in the study. Individual one-way text messages as reminders of home exercises (to be performed on a daily basis) were sent to each patient every third day for 3 weeks, then once a week for another 2 weeks. Semistructured interviews with 2 broad, open-ended questions were held and data were analyzed with systematic text condensation, based on Giorgi’s principles of psychological phenomenological analysis. Results: The participants appreciated the messages, which were perceived as timely and usable, and also stimulated memorizing. The messages made the participants reflect on the aim of the exercise, value of being reminded, and on their improvement in pain. During the interviews, the participants created their own routines for continued adherence to the exercises. Conclusions: It seems plausible that mobile phone text messaging may serve as a useful tool for patient empowerment with regard to recurrent LBP in older persons. Further studies are needed to explore whether future compliance with the exercises will be as large if the participants are not being interviewed. %M 28360026 %R 10.2196/mhealth.7184 %U http://mhealth.jmir.org/2017/3/e39/ %U https://doi.org/10.2196/mhealth.7184 %U http://www.ncbi.nlm.nih.gov/pubmed/28360026 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 3 %P e48 %T Automated Adherence Reminders for High Risk Children With Asthma: A Research Protocol %A Adams,Sarah A %A Leach,Michelle Chan %A Feudtner,Chris %A Miller,Victoria A %A Kenyon,Chén Collin %+ The Children's Hospital of Philadelphia, PolicyLab and Center for Pediatric Clinical Effectiveness, 15th floor, Rm 1509, 3401 Civic Center Blvd, CHOP North, Philadelphia, PA, 19104, United States, 1 (267) 426 6339, kenyonc@email.chop.edu %K asthma %K pediatrics %K child %K child, preschool %K adolescent %K metered dose inhalers %K medication adherence %K text messaging %K pilot projects %K randomized controlled trial %K clinical protocols %D 2017 %7 27.03.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: The use of inhaled corticosteroid (ICS) medications has been shown to improve asthma control and reduce asthma-related morbidity and mortality. Two recent randomized trials demonstrated dramatic improvements in ICS adherence by monitoring adherence with electronic sensors and providing automated reminders to participants to take their ICS medications. Given their lower levels of adherence and higher levels of asthma-related emergency department (ED) visits, hospitalizations, and death, urban minority populations could potentially benefit greatly from these types of interventions. Objective: The principal objective of this study will be to evaluate the feasibility, acceptability, and limited efficacy of a text message (short message service, SMS) reminder intervention to enhance ICS adherence in an urban minority population of children with asthma. We will also assess trajectories of ICS adherence in the 2 months following asthma hospitalization. Methods: Participants will include 40 children aged 2-13 years, who are currently admitted to the Children’s Hospital of Philadelphia (CHOP) for asthma, and their parent or legal guardian. Participants will be assigned to intervention and control arms using a 1:1 randomization scheme. The intervention arm will receive daily text message reminders for a 30-day intervention phase following hospitalization. This will be followed by a 30-day follow-up phase, in which all participants may choose whether or not to receive the text messages. Feasibility will be assessed by measuring (1) retention of the participants through the study phases and (2) perceived usefulness, acceptability, and preferences regarding the intervention components. Limited efficacy outcomes will include percent adherence to prescribed ICS regimen measured using Propeller Health sensors and change in parent-reported asthma control. We will perform an exploratory analysis to assess for discrete trajectories of adherence using group-based trajectory modeling (GBTM). Results: Study enrollment began in December 2015 and the intervention and follow-up phases are ongoing. Results of the data analysis are expected to be available by December 2016. Conclusions: This study will add to the literature by providing foundational feasibility data on which elements of a mobile health text-message reminder intervention may need to be modified to suit the needs and constraints of high-risk urban minority populations. Trial Registration: Clinicaltrials.gov NCT02615743; https://www.clinicaltrials.gov/ct2/show/study/NCT02615743 (Archived with WebCite at http://www.webcitation.org/6ji59rAXN) %M 28347975 %R 10.2196/resprot.6674 %U http://www.researchprotocols.org/2017/3/e48/ %U https://doi.org/10.2196/resprot.6674 %U http://www.ncbi.nlm.nih.gov/pubmed/28347975 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 3 %P e36 %T Investigating the Perceptions of Care Coordinators on Using Behavior Theory-Based Mobile Health Technology With Medicaid Populations: A Grounded Theory Study %A Sigler,Brittany Erika %+ Wellpass (formerly Sense Health), 821 Broadway, floor 5, New York, NY,, United States, 1 917 359 7114, bs2897@caa.columbia.edu %K communication %K health behavior %K Medicaid %K mHealth %K patient engagement %K safety-net providers %K text messaging %D 2017 %7 21.03.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Medicaid populations are less engaged in their health care than the rest of the population, translating to worse health outcomes and increased health care costs. Since theory-based mobile health (mHealth) interventions have been shown to increase patient engagement, mobile phones may be an optimal strategy to reach this population. With increased development of theory-based mHealth technology, these interventions must now be evaluated with these medically underserved populations in a real-world setting. Objective: The aim of our study was to investigate care coordinators’ perceived value of using a health behavior theory-based mHealth platform with Medicaid clients. In particular, attention was paid to the perceived impact on patient engagement. This research was conducted using the patient-provider text messaging (short message service, SMS) platform, Sense Health (now Wellpass), which integrates the transtheoretical model (TTM), also called the stages of change model; social cognitive theory (SCT); supportive accountability; and motivational interviewing (MI). Methods: Interviews based in grounded theory methodology were conducted with 10 care managers to understand perceptions of the relationship between mHealth and patient engagement. Results: The interviews with care managers yielded a foundation for a grounded theory model, presenting themes that suggested 4 intertwined correlative relationships revolving around patient engagement: (1) A text messaging (short message service, SMS) platform supplements the client-care manager dynamic, which is grounded in high quality, reciprocal-communication to increase patient engagement; (2) Texting enhances the relationship between literacy and access to care for Medicaid patients, increasing low-literacy patients’ agency to access services; (3) Texting enhances communication, providing care managers with a new means to support their clients; and (4) Reminders augment client accountability, leading to both increased motivation and readiness to change behaviors, as well as an improved client-care manager relationship. Conclusions: Messaging platform features tied to health behavior theory appear to be effective in improving patient engagement. Two-way communication (supportive accountability), trusted relationships (supportive accountability, SCT), personalized messages (TTM), and patient input (TTM, SCT, MI) appeared as the most relevant components in achieving desired outcomes. Additionally, reminder messages were noted as especially useful in making Medicaid patients accountable and in turn engaging them in their health and health care. These findings convey suggested elements for inclusion in other mHealth interventions aiming to improve patient engagement in Medicaid populations. %M 28325711 %R 10.2196/mhealth.5892 %U http://mhealth.jmir.org/2017/3/e36/ %U https://doi.org/10.2196/mhealth.5892 %U http://www.ncbi.nlm.nih.gov/pubmed/28325711 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 2 %P e21 %T Women’s Perceptions of Participation in an Extended Contact Text Message–Based Weight Loss Intervention: An Explorative Study %A Job,Jennifer R %A Spark,Lauren C %A Fjeldsoe,Brianna S %A Eakin,Elizabeth G %A Reeves,Marina M %+ Cancer Prevention Research Centre, School of Public Health, The University of Queensland, Level 4, Public Health Building, Herston Road, Herston, Brisbane, 4006, Australia, 61 7 3345 5163, j.job@uq.edu.au %K exercise %K diet %K text messaging %K qualitative research %K overweight %K obesity %K weight loss %D 2017 %7 27.02.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Extending contact with participants after the end of an initial weight loss intervention has been shown to lead to maintained weight loss and related behavioral change. Mobile phone text messaging (short message service, SMS) offers a low-cost and efficacious method to deliver extended contact. In this rapidly developing area, formative work is required to understand user perspectives of text message technology. An extended contact intervention delivered by text messages following an initial telephone-delivered weight loss intervention in breast cancer survivors provided this opportunity. Objective: The aim of this study was to qualitatively explore women’s perceptions of participation in an extended contact intervention using text messaging to support long-term weight loss, physical activity, and dietary behavioral change. Methods: Following the end of an initial 6-month randomized controlled trial of a telephone-delivered weight loss intervention (versus usual care), participants received a 6-month extended contact intervention via tailored text messages. Participant perceptions of the different types of text messages, the content, tailoring, timing, and frequency of the text messages, and the length of the intervention were assessed through semistructured interviews conducted after the extended contact intervention. The interviews were transcribed verbatim and analyzed with key themes identified. Results: Participants (n=27) were a mean age of 56.0 years (SD 7.8) and mean body mass index of 30.4 kg/m2 (SD 4.2) and were at a mean of 16.1 months (SD 3.1) postdiagnosis at study baseline. Participants perceived the text messages to be useful behavioral prompts and felt the messages kept them accountable to their behavioral change goals. The individual tailoring of the text message content and schedules was a key to the acceptability of the messages; however, some women preferred the support and real-time discussion via telephone calls (during the initial intervention) compared with the text messages (during the extended contact intervention). Conclusions: Text message support was perceived as acceptable for the majority of women as a way of extending intervention contact for weight loss and behavioral maintenance. Text messages supported the maintenance of healthy behaviors established in the intervention phase and kept the women accountable to their goals. A combination of telephone calls and text message support was suggested as a more acceptable option for some of the women for an extended contact intervention. %M 28242595 %R 10.2196/mhealth.6325 %U http://mhealth.jmir.org/2017/2/e21/ %U https://doi.org/10.2196/mhealth.6325 %U http://www.ncbi.nlm.nih.gov/pubmed/28242595 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 2 %N 1 %P e4 %T The Use of Mobile Health to Deliver Self-Management Support to Young People With Type 1 Diabetes: A Cross-Sectional Survey %A Dobson,Rosie %A Whittaker,Robyn %A Murphy,Rinki %A Khanolkar,Manish %A Miller,Steven %A Naylor,Joanna %A Maddison,Ralph %+ National Institute for Health Innovation, School of Population Health, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand, 64 93737599 ext 88908, r.dobson@auckland.ac.nz %K mHealth %K diabetes mellitus %K mobile phone %K mobile applications %K text messages %D 2017 %7 15.02.2017 %9 Original Paper %J JMIR Diabetes %G English %X Background: Young people living with type 1 diabetes face not only the challenges typical of adolescence, but also the challenges of daily management of their health and evolving understanding of the impact of their diagnosis on their future. Adolescence is a critical time for diabetes self-management, with a typical decline in glycemic control increasing risk for microvascular diabetes complications. To improve glycemic control, there is a need for evidence-based self-management support interventions that address the issues pertinent to this population, utilizing platforms that engage them. Increasingly, mobile health (mHealth) interventions are being developed and evaluated for this purpose with some evidence supporting improved glycemic control. A necessary step to enhance effectiveness of such approaches is to understand young people’s preferences for this mode of delivery. Objective: A cross-sectional survey was conducted to investigate the current and perceived roles of mHealth in supporting young people to manage their diabetes. Methods: Young adults (16-24 years) with type 1 diabetes in Auckland, New Zealand, were invited to take part in a survey via letter from their diabetes specialist. Results: A total of 115 young adults completed the survey (mean age 19.5 years; male 52/115, 45%; European 89/115, 77%), with all reporting they owned a mobile phone and 96% (110/115) of those were smartphones. However, smartphone apps for diabetes management had been used by only 33% (38/115) of respondents. The most commonly reported reason for not using apps was a lack of awareness that they existed. Although the majority felt they managed their diabetes well, 63% (72/115) reported wanting to learn more about diabetes and how to manage it. A total of 64% (74/115) respondents reported that they would be interested in receiving diabetes self-management support via text message (short message service, SMS). Conclusions: Current engagement with mHealth in this population appears low, although the findings from this study provide support for the use of mHealth in this group because of the ubiquity and convenience of mobile devices. mHealth has potential to provide information and support to this population, utilizing mediums commonplace for this group and with greater reach than traditional methods. %M 30291057 %R 10.2196/diabetes.7221 %U http://diabetes.jmir.org/2017/1/e4/ %U https://doi.org/10.2196/diabetes.7221 %U http://www.ncbi.nlm.nih.gov/pubmed/30291057 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 1 %P e7 %T SmartMom Text Messaging for Prenatal Education: A Qualitative Focus Group Study to Explore Canadian Women’s Perceptions %A Munro,Sarah %A Hui,Amber %A Salmons,Vanessa %A Solomon,Carolyn %A Gemmell,Emily %A Torabi,Nahal %A Janssen,Patricia A %+ School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada, 1 604 827 4026, patti.janssen@ubc.ca %K pregnancy %K text messaging %K prenatal education %K health behavior %D 2017 %7 07.02.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: We engaged Canadian women in the development of a prenatal education program delivered via one-way text messaging called SmartMom. SmartMom is the first peer-reviewed, evidence-based mHealth program for prenatal education in Canada and the first to be endorsed by the Society of Obstetricians and Gynaecologists of Canada. Objective: To explore women’s preferences for a prenatal education program by text messaging. Methods: We conducted a qualitative focus group study in three Canadian communities in the Northern Health Authority. Women completed a demographic questionnaire, participated in a guided discussion about their pregnancy information-seeking behavior, reviewed a printed copy of the SmartMom text messages, and then engaged in a moderated discussion about their perceptions of the usability of the SmartMom program. Open-ended questions explored women’s perceptions regarding the message content, acceptability of receiving information by text message, positive health behaviors they might engage in after receiving a message, modifiable program factors, and intention to use the program. Thematic analysis of transcribed audio recordings was undertaken and modifications were made to the SmartMom program based on these findings. Results: A total of 40 women participated in seven focus groups in three rural northern communities. The vast majority had a mobile phone (39/40, 98%), used text messages “all the time” (28/40, 70%), and surfed the Internet on their phone (37/40, 93%). Participants perceived SmartMom to be highly acceptable and relevant. The text message modality reflected how participants currently sought pregnancy-related information and provided them with local information tailored to their gestational age, which they had not received through other pregnancy resources. Women recommended adding the opportunity to receive supplemental streams of messages tailored to their individual needs, for example, depression, pregnancy after previous cesarean, >35 years of age, new immigrants, and harm reduction for smoking and alcohol. Conclusions: This formative qualitative evaluation provides evidence that a prenatal education program by text messaging, SmartMom, is acceptable to the end users. These findings support the usability of the SmartMom program at a population level and the development of an evaluation program exploring the effects of the text messages on adoption of health-promoting behaviors and maternal-child health outcomes. %M 28174149 %R 10.2196/publichealth.6949 %U http://publichealth.jmir.org/2017/1/e7/ %U https://doi.org/10.2196/publichealth.6949 %U http://www.ncbi.nlm.nih.gov/pubmed/28174149 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 2 %P e9 %T Text Messaging to Improve Hypertension Medication Adherence in African Americans From Primary Care and Emergency Department Settings: Results From Two Randomized Feasibility Studies %A Buis,Lorraine %A Hirzel,Lindsey %A Dawood,Rachelle M %A Dawood,Katee L %A Nichols,Lauren P %A Artinian,Nancy T %A Schwiebert,Loren %A Yarandi,Hossein N %A Roberson,Dana N %A Plegue,Melissa A %A Mango,LynnMarie C %A Levy,Phillip D %+ Department of Family Medicine, University of Michigan, 1018 Fuller St, Ann Arbor, MI, 48104, United States, 1 734 998 7120 ext 312, buisl@umich.edu %K cell phone %K text messaging %K hypertension %K blood pressure %K African Americans %K medication adherence %K telemedicine %D 2017 %7 01.02.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hypertension (HTN) is an important problem in the United States, with an estimated 78 million Americans aged 20 years and older suffering from this condition. Health disparities related to HTN are common in the United States, with African Americans suffering from greater prevalence of the condition than whites, as well as greater severity, earlier onset, and more complications. Medication adherence is an important component of HTN management, but adherence is often poor, and simply forgetting to take medications is often cited as a reason. Mobile health (mHealth) strategies have the potential to be a low-cost and effective method for improving medication adherence that also has broad reach. Objective: Our goal was to determine the feasibility, acceptability, and preliminary clinical effectiveness of BPMED, an intervention designed to improve medication adherence among African Americans with uncontrolled HTN, through fully automated text messaging support. Methods: We conducted two parallel, unblinded randomized controlled pilot trials with African-American patients who had uncontrolled HTN, recruited from primary care and emergency department (ED) settings. In each trial, participants were randomized to receive either usual care or the BPMED intervention for one month. Data were collected in-person at baseline and one-month follow-up, assessing the effect on medication adherence, systolic and diastolic blood pressure (SBP and DBP), medication adherence self-efficacy, and participant satisfaction. Data for both randomized controlled pilot trials were analyzed separately and combined. Results: A total of 58 primary care and 65 ED participants were recruited with retention rates of 91% (53/58) and 88% (57/65), respectively. BPMED participants consistently showed numerically greater, yet nonsignificant, improvements in measures of medication adherence (mean change 0.9, SD 2.0 vs mean change 0.5, SD 1.5, P=.26), SBP (mean change –12.6, SD 24.0 vs mean change –11.3, SD 25.5 mm Hg, P=.78), and DBP (mean change –4.9, SD 13.1 mm Hg vs mean change –3.3, SD 14.3 mm Hg, P=.54). Control and BPMED participants had slight improvements to medication adherence self-efficacy (mean change 0.8, SD 9.8 vs mean change 0.7, SD 7.0) with no significant differences found between groups (P=.92). On linear regression analysis, baseline SBP was the only predictor of SBP change; participants with higher SBP at enrollment exhibited significantly greater improvements at one-month follow-up (β=–0.63, P<.001). In total, 94% (51/54) of BPMED participants agreed/strongly agreed that they were satisfied with the program, regardless of pilot setting. Conclusions: Use of text message reminders to improve medication adherence is a feasible and acceptable approach among African Americans with uncontrolled HTN. Although differences in actual medication adherence and blood pressure between BPMED and usual care controls were not significant, patterns of improvement in the BPMED condition suggest that text message medication reminders may have an effect and fully powered investigations with longer-term follow-up are warranted. Trial Registration: Clinicaltrials.gov NCT01465217; https://clinicaltrials.gov/ct2/show/NCT01465217 (Archived by WebCite at http://www.webcitation.org/6V0tto0lZ). %M 28148474 %R 10.2196/mhealth.6630 %U http://mhealth.jmir.org/2017/2/e9/ %U https://doi.org/10.2196/mhealth.6630 %U http://www.ncbi.nlm.nih.gov/pubmed/28148474 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 1 %P e5 %T Assessing Mobile Phone Access and Perceptions for Texting-Based mHealth Interventions Among Expectant Mothers and Child Caregivers in Remote Regions of Northern Kenya: A Survey-Based Descriptive Study %A Kazi,Abdul Momin %A Carmichael,Jason-Louis %A Hapanna,Galgallo Waqo %A Wangoo,Patrick Gikaria %A Karanja,Sarah %A Wanyama,Denis %A Muhula,Samuel Opondo %A Kyomuhangi,Lennie Bazira %A Loolpapit,Mores %A Wangalwa,Gilbert Bwire %A Kinagwi,Koki %A Lester,Richard Todd %+ Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver General Hospital site, Department of Medicine, 10th Floor, Gordon and Leslie Diamond Health Care Centre, room #10127 – 2775, Laurel Street, Vancouver, BC, V5Z 1M9, Canada, 1 604 875 4111 ext 63140, mominkazi@gmail.com %K mobile health %K text messaging %K prenatal care %K immunization %K Kenya %D 2017 %7 30.01.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: With a dramatic increase in mobile phone use in low- and middle-income countries, mobile health (mHealth) has great potential to connect health care services directly to participants enrolled and improve engagement of care. Rural and remote global settings may pose both significant challenges and opportunities. Objective: The objective of our study was to understand the demographics, phone usage and ownership characteristics, and feasibility among patients in rural and remote areas of Kenya of having text messaging (short messaging service, SMS)-based mHealth intervention for improvements in antenatal care attendance and routine immunization among children in Northern Kenya. Methods: A survey-based descriptive study was conducted between October 2014 and February 2015 at 8 health facilities in Northern Kenya as part of a program to scale up an mHealth service in rural and remote regions. The study was conducted at 6 government health facilities in Isiolo, Marsabit, and Samburu counties in remote and northern arid lands (NAL). Two less remote health facilities in Laikipia and Meru counties in more populated central highlands were included as comparison sites. Results: A total of 284 participants were surveyed; 63.4% (180/284) were from NAL clinics, whereas 36.6% (104/284) were from adjacent central highland clinics. In the NAL, almost half (48.8%, 88/180) reported no formal education and 24.4% (44/180) self-identified as nomads. The majority of participants from both regions had access to mobile phone: 99.0% (103/104) of participants from central highlands and 82.1% (147/180) of participants from NAL. Among those who had access to a phone, there were significant differences in network challenges and technology literacy between the 2 regions. However, there was no significant difference in the proportion of participants from NAL and central highlands who indicated that they would like to receive a weekly SMS text message from their health care provider (90.0% vs 95.0%; P=.52). Overall, 92.0% (230/250) of participants who had access to a telephone said that they would like to receive a weekly SMS text message from their health care provider. Most phone users already spent the equivalent of 626 SMS text messages on mobile credit for personal use. Conclusions: Despite the remoteness of northern Kenya’s NAL, the results indicate that the majority of pregnant women or care givers attending the maternal, newborn, and child health clinics have access to mobile phone and would like to receive text messages from their health care provider. mHealth programs, if designed appropriately for these settings, may be an innovative way for engaging women in care for improved maternal and newborn child health outcomes in order to achieve sustainable development goals. %M 28137702 %R 10.2196/publichealth.5386 %U http://publichealth.jmir.org/2017/1/e5/ %U https://doi.org/10.2196/publichealth.5386 %U http://www.ncbi.nlm.nih.gov/pubmed/28137702 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 2 %N 1 %P e29 %T Health eRide: Outcomes of a Pilot Program Leveraging Principles of Gamification and SMS Messaging to Help Veterans Self-Manage Chronic Pain %A Johnson,Sara %A Levesque,Deborah %A Broderick,Lynne %+ Pro-Change Behavior Systems, Inc, 1174 Kingstown Road, Suite 101, South Kingstown, RI, 02879, United States, 1 401 360 2978, lbroderick@prochange.com %K gamification %K intervention %K veterans %K serious games %K pain management %D 2016 %7 29.12.2016 %9 Poster %J iproc %G English %X Background: Chronic pain creates a significant public health burden and disproportionately affects veterans. Over 56% of Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), and Operation New Dawn (OND) veterans have a diagnosis of chronic pain. The frequency and extent of pain, posttraumatic stress disorder (PTSD), traumatic brain injury, and the co-occurrence of all three conditions (post-deployment multi-symptom disorder, PMD) can complicate and reduce the effectiveness of traditional treatments for pain. Taken in combination with the opioid crisis in the United States, there is an urgent need for innovative and integrative approaches to non-medical pain management. However, readiness to engage in pain self-management varies. Objective: The objective of this Phase I pilot was to design, develop, and establish the feasibility of a theoretically-grounded, mobile-optimized, interactive pain self-management intervention for veterans that leverages principles of gamification. Methods: The development of Health eRide: Your Journey to Managing Pain included extensive end-user input including a veteran advisory panel (n=5), formative focus groups (n=20), and iterative usability testing (n=20). Health eRide is tailored not only to veterans’ preference for pain self-management strategies but also their readiness to adopt those strategies as measured by a Transtheoretical Model-based stage of change assessment. The program incorporates core components of promising treatments for PMD by intervening on sleep hygiene and stress management. Health eRide includes (1) an online computer-tailored intervention that provides tailored behavior change guidance and (2) an individually tailored subway-themed “map” of their pain management journey. Stops along the map include stage-based interactive activities designed to further users along in their journey to self-managing pain. The program also included optional text messaging and a Facebook page. A pilot study with a 30-day follow-up was conducted with 69 veterans (81% male, 58% Caucasian, average age=50) to examine the acceptability and preliminary effectiveness of Health eRide. Users completed stage of change algorithms and pain rating scales at baseline and follow-up and completed a measure of acceptability and the System Usability Scale (SUS) at follow-up. Results: A total of 44 veterans (64%) completed the follow-up assessment (no significant differences on baseline demographics between those who completed the follow-up assessment and those who did not). The mean rating of acceptability for Health eRide was 3.20 on a 4 point scale, indicating that users found the program useful, informative, reliable, and easy to navigate. Likewise, the mean score on the SUS was 65.4, indicating the program meets standards for usability. The results show significant changes in movement to readiness to adopt strategies to self-manage pain (54.5% at baseline vs 79.5% at follow-up, P=.007) and effectively manage stress (50% vs 88.6%, P<.001). While there was movement to readiness to adopt healthy sleep habits (25% vs 38.6%), the change was not significant. There were significant improvements in ratings of pain: “How would you rate your pain right now?” (partial η2=.205, P=.002) and “How would you rate your usual pain in the last week?” (partial η2=.378, P<.001). Conclusions: Findings provide encouraging evidence of the acceptability and effectiveness of incorporating principles of gamification into a theoretically grounded intervention for veterans at all levels of readiness for self-managing chronic pain. %R 10.2196/iproc.6155 %U http://www.iproc.org/2016/1/e29/ %U https://doi.org/10.2196/iproc.6155 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 12 %P e333 %T The Role of Online Social Support in Supporting and Educating Parents of Young Children With Special Health Care Needs in the United States: A Scoping Review %A DeHoff,Beth A %A Staten,Lisa K %A Rodgers,Rylin Christine %A Denne,Scott C %+ Neonatology, Department of Pediatrics, Indiana University Health Physicians, 699 Riley Hospital Dr S, RR208, Indianapolis, IN, 46202, United States, 1 3179441528, badehoff@iu.edu %K health communication %K child %K social media %K health education %K health resources %K early childhood %K disability %K neonatal intensive care unit %K family %K maternal-child health services %D 2016 %7 22.12.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: When parents of young children with special health care needs (CSHCN) receive their child’s diagnosis, they encounter information they may not understand, emotions they may not know how to cope with, and questions about their child’s immediate and long-term future that frequently lack answers. The challenge of health care providers is how to prepare parents for caring for their CSHCN, for coping with any resulting challenges, and for accessing the systems and services that can assist them. Objective: The purpose of this work was to review evidence of the information and support needs of parents of young CSHCN and to determine whether online social support can serve as an avenue for learning and empowerment for these parents. Methods: A scoping review identified the challenges, coping mechanisms, and support needs among parents of CSHCN, and the reach and effectiveness of digital technologies with these families and health care providers. We also conducted interviews with professionals serving parents of CSHCN. Results: The literature review and interviews suggested that parents best learn the information they need, and cope with the emotional challenges of raising a CSHCN, with support from other parents of CSHCN, and that young parents in recent years have most often been finding this parent-to-parent support through digital media, particularly social media, consistent with the theory of online social support. Evidence also shows that social media, particularly Facebook, is used by nearly all women aged 18-29 years across racial and socioeconomic lines in the United States. Conclusions: Parents of young CSHCN experience significant stress but gain understanding, receive support, and develop the ability to care for and be advocates for their child through parent-to-parent emotional and informational social support. Online social support is most effective with young adults of childbearing age, with social media and apps being the most useful within the theoretical framework of social support. This opens new opportunities to effectively educate and support parents of young CSHCN. Providers seeking to inform, educate, and support families of CSHCN should develop strategies to help parents find and use social support through digital resources to facilitate their emotional adjustment and practical abilities to care for and access services for their child. %M 28007689 %R 10.2196/jmir.6722 %U http://www.jmir.org/2016/12/e333/ %U https://doi.org/10.2196/jmir.6722 %U http://www.ncbi.nlm.nih.gov/pubmed/28007689 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e137 %T Design and Feasibility of a Text Messaging Intervention to Prevent Indoor Tanning Among Young Adult Women: A Pilot Study %A Evans,William D %A Mays,Darren %+ Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, Washington, DC, 20052, United States, 1 202 994 3632, wdevans@gwu.edu %K indoor tanning %K risk perceptions %K text messaging %K feasibility testing %D 2016 %7 22.12.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although skin cancer is largely preventable, it affects nearly 1 of 5 US adults. There is a need for research on how to optimally design persuasive public health indoor tanning prevention messages. Objective: The objective of our study was to examine whether framed messages on indoor tanning behavioral intentions delivered through short message service (SMS) text messaging would produce (1) positive responses to the messages, including message receptivity and emotional response; (2) indoor tanning efficacy beliefs, including response efficacy and self-efficacy; and (3) indoor tanning risk beliefs. Methods: We conducted a pilot study of indoor tanning prevention messages delivered via mobile phone text messaging in a sample of 21 young adult women who indoor tan. Participants completed baseline measures, were randomly assigned to receive gain-, loss-, or balanced-framed text messages, and completed postexposure outcome measures on indoor tanning cognitions and behaviors. Participants received daily mobile phone indoor tanning prevention text messages for 1 week and completed the same postexposure measures as at baseline. Results: Over the 1-week period there were trends or significant changes after receipt of the text messages, including increased perceived susceptibility (P<.001), response efficacy beliefs (P<.001), and message receptivity (P=.03). Ordinary least squares stepwise linear regression models showed an effect of text message exposure on self-efficacy to quit indoor tanning (t6=–2.475, P<.02). Ordinary least squares linear regression including all measured scales showed a marginal effect of SMS texts on self-efficacy (t20=1.905, P=.08). Participants endorsed highly favorable views toward the text messaging protocol. Conclusions: This study supports this use of mobile text messaging as an indoor tanning prevention strategy. Given the nature of skin cancer risk perceptions, the addition of multimedia messaging service is another area of potential innovation for disseminating indoor tanning prevention messages. %M 28007691 %R 10.2196/mhealth.6493 %U http://mhealth.jmir.org/2016/4/e137/ %U https://doi.org/10.2196/mhealth.6493 %U http://www.ncbi.nlm.nih.gov/pubmed/28007691 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 11 %P e311 %T Survey Email Scheduling and Monitoring in eRCTs (SESAMe): A Digital Tool to Improve Data Collection in Randomized Controlled Clinical Trials %A Skonnord,Trygve %A Steen,Finn %A Skjeie,Holgeir %A Fetveit,Arne %A Brekke,Mette %A Klovning,Atle %+ Institute of Health and Society, Department of General Practice, University of Oslo, Postbox 1130 Blindern, Oslo, N-0318, Norway, 47 41323232, trygve.skonnord@medisin.uio.no %K randomized controlled trials %K data collection %K surveys and questionnaires %K quality improvement %K sample size %K Internet %K email %K text messaging %D 2016 %7 22.11.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic questionnaires can ease data collection in randomized controlled trials (RCTs) in clinical practice. We found no existing software that could automate the sending of emails to participants enrolled into an RCT at different study participant inclusion time points. Objective: Our aim was to develop suitable software to facilitate data collection in an ongoing multicenter RCT of low back pain (the Acuback study). For the Acuback study, we determined that we would need to send a total of 5130 emails to 270 patients recruited at different centers and at 19 different time points. Methods: The first version of the software was tested in a pilot study in November 2013 but was unable to deliver multiuser or Web-based access. We resolved these shortcomings in the next version, which we tested on the Web in February 2014. Our new version was able to schedule and send the required emails in the full-scale Acuback trial that started in March 2014. The system architecture evolved through an iterative, inductive process between the project study leader and the software programmer. The program was tested and updated when errors occurred. To evaluate the development of the software, we used a logbook, a research assistant dialogue, and Acuback trial participant queries. Results: We have developed a Web-based app, Survey Email Scheduling and Monitoring in eRCTs (SESAMe), that monitors responses in electronic surveys and sends reminders by emails or text messages (short message service, SMS) to participants. The overall response rate for the 19 surveys in the Acuback study increased from 76.4% (655/857) before we introduced reminders to 93.11% (1149/1234) after the new function (P<.001). Further development will aim at securing encryption and data storage. Conclusions: The SESAMe software facilitates consecutive patient data collection in RCTs and can be used to increase response rates and quality of research, both in general practice and in other clinical trial settings. %M 27876689 %R 10.2196/jmir.6560 %U http://www.jmir.org/2016/11/e311/ %U https://doi.org/10.2196/jmir.6560 %U http://www.ncbi.nlm.nih.gov/pubmed/27876689 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 11 %P e307 %T Text to Move: A Randomized Controlled Trial of a Text-Messaging Program to Improve Physical Activity Behaviors in Patients With Type 2 Diabetes Mellitus %A Agboola,Stephen %A Jethwani,Kamal %A Lopez,Lenny %A Searl,Meghan %A O’Keefe,Sandra %A Kvedar,Joseph %+ Partners Connected Health, Suite 300, 25 New Chardon St, Boston, MA, 02114, United States, 1 617 643 0291, sagboola@partners.org %K type 2 diabetes %K text messaging %K mobile phones %K physical activity %K engagement %K pedometers %D 2016 %7 18.11.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Text messages are increasingly being used because of the low cost and the ubiquitous nature of mobile phones to engage patients in self-care behaviors. Self-care is particularly important in achieving treatment outcomes in type 2 diabetes mellitus (T2DM). Objective: This study examined the effect of personalized text messages on physical activity, as measured by a pedometer, and clinical outcomes in a diverse population of patients with T2DM. Methods: Text to Move (TTM) incorporates physical activity monitoring and coaching to provide automated and personalized text messages to help patients with T2DM achieve their physical activity goals. A total of 126 English- or Spanish-speaking patients with glycated hemoglobin A1c (HbA1c) >7 were enrolled in-person to participate in the study for 6 months and were randomized into either the intervention arm that received the full complement of the intervention or a control arm that received only pedometers. The primary outcome was change in physical activity. We also assessed the effect of the intervention on HbA1c, weight, and participant engagement. Results: All participants (intervention: n=64; control: n=62) were included in the analyses. The intervention group had significantly higher monthly step counts in the third (risk ratio [RR] 4.89, 95% CI 1.20 to 19.92, P=.03) and fourth (RR 6.88, 95% CI 1.21 to 39.00, P=.03) months of the study compared to the control group. However, over the 6-month follow-up period, monthly step counts did not differ statistically by group (intervention group: 9092 steps; control group: 3722 steps; RR 2.44, 95% CI 0.68 to 8.74, P=.17). HbA1c decreased by 0.07% (95% CI –0.47 to 0.34, P=.75) in the TTM group compared to the control group. Within groups, HbA1c decreased significantly from baseline in the TTM group by –0.43% (95% CI –0.75 to –0.12, P=.01), but nonsignificantly in the control group by –0.21% (95% CI –0.49 to 0.06, P=.13). Similar changes were observed for other secondary outcomes. Conclusion: Personalized text messaging can be used to improve outcomes in patients with T2DM by employing optimal patient engagement measures. %M 27864165 %R 10.2196/jmir.6439 %U http://www.jmir.org/2016/11/e307/ %U https://doi.org/10.2196/jmir.6439 %U http://www.ncbi.nlm.nih.gov/pubmed/27864165 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e127 %T Design Considerations in Development of a Mobile Health Intervention Program: The TEXT ME and TEXTMEDS Experience %A Thakkar,Jay %A Barry,Tony %A Thiagalingam,Aravinda %A Redfern,Julie %A McEwan,Alistair L %A Rodgers,Anthony %A Chow,Clara K %+ The George Institute for Global Health, Level 10, King George V Building, Missenden Road, Camperdown, 2050, Australia, 61 2 9993 4500, cchow@georgeinstitute.org.au %K text message %K mobile phone %K coronary artery disease %K mHealth %D 2016 %7 15.11.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) has huge potential to deliver preventative health services. However, there is paucity of literature on theoretical constructs, technical, practical, and regulatory considerations that enable delivery of such services. Objectives: The objective of this study was to outline the key considerations in the development of a text message-based mHealth program; thus providing broad recommendations and guidance to future researchers designing similar programs. Methods: We describe the key considerations in designing the intervention with respect to functionality, technical infrastructure, data management, software components, regulatory requirements, and operationalization. We also illustrate some of the potential issues and decision points utilizing our experience of developing text message (short message service, SMS) management systems to support 2 large randomized controlled trials: TEXT messages to improve MEDication adherence & Secondary prevention (TEXTMEDS) and Tobacco, EXercise and dieT MEssages (TEXT ME). Results: The steps identified in the development process were: (1) background research and development of the text message bank based on scientific evidence and disease-specific guidelines, (2) pilot testing with target audience and incorporating feedback, (3) software-hardware customization to enable delivery of complex personalized programs using prespecified algorithms, and (4) legal and regulatory considerations. Additional considerations in developing text message management systems include: balancing the use of customized versus preexisting software systems, the level of automation versus need for human inputs, monitoring, ensuring data security, interface flexibility, and the ability for upscaling. Conclusions: A merging of expertise in clinical and behavioral sciences, health and research data management systems, software engineering, and mobile phone regulatory requirements is essential to develop a platform to deliver and manage support programs to hundreds of participants simultaneously as in TEXT ME and TEXTMEDS trials. This research provides broad principles that may assist other researchers in developing mHealth programs. %M 27847350 %R 10.2196/mhealth.5996 %U http://mhealth.jmir.org/2016/4/e127/ %U https://doi.org/10.2196/mhealth.5996 %U http://www.ncbi.nlm.nih.gov/pubmed/27847350 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 2 %P e164 %T Efficacy of Web-Based Collection of Strength-Based Testimonials for Text Message Extension of Youth Suicide Prevention Program: Randomized Controlled Experiment %A Thiha,Phyo %A Pisani,Anthony R %A Gurditta,Kunali %A Cherry,Erin %A Peterson,Derick R %A Kautz,Henry %A Wyman,Peter A %+ Department of Psychiatry, University of Rochester School of Medicine and Dentistry, 300 Crittenden Blvd., Box PSYC, Rochester, NY, 14642, United States, 1 585 275 3644, anthony_pisani@urmc.rochester.edu %K mental health %K adolescent health %K user interface design %K suicide %K text messaging %D 2016 %7 09.11.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Equipping members of a target population to deliver effective public health messaging to peers is an established approach in health promotion. The Sources of Strength program has demonstrated the promise of this approach for “upstream” youth suicide prevention. Text messaging is a well-established medium for promoting behavior change and is the dominant communication medium for youth. In order for peer ‘opinion leader’ programs like Sources of Strength to use scalable, wide-reaching media such as text messaging to spread peer-to-peer messages, they need techniques for assisting peer opinion leaders in creating effective testimonials to engage peers and match program goals. We developed a Web interface, called Stories of Personal Resilience in Managing Emotions (StoryPRIME), which helps peer opinion leaders write effective, short-form messages that can be delivered to the target population in youth suicide prevention program like Sources of Strength. Objective: To determine the efficacy of StoryPRIME, a Web-based interface for remotely eliciting high school peer leaders, and helping them produce high-quality, personal testimonials for use in a text messaging extension of an evidence-based, peer-led suicide prevention program. Methods: In a double-blind randomized controlled experiment, 36 high school students wrote testimonials with or without eliciting from the StoryPRIME interface. The interface was created in the context of Sources of Strength–an evidence-based youth suicide prevention program–and 24 ninth graders rated these testimonials on relatability, usefulness/relevance, intrigue, and likability. Results: Testimonials written with the StoryPRIME interface were rated as more relatable, useful/relevant, intriguing, and likable than testimonials written without StoryPRIME, P=.054. Conclusions: StoryPRIME is a promising way to elicit high-quality, personal testimonials from youth for prevention programs that draw on members of a target population to spread public health messages. %M 27829575 %R 10.2196/publichealth.6207 %U http://publichealth.jmir.org/2016/2/e164/ %U https://doi.org/10.2196/publichealth.6207 %U http://www.ncbi.nlm.nih.gov/pubmed/27829575 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e121 %T Economic Evaluation of Text-Messaging and Smartphone-Based Interventions to Improve Medication Adherence in Adolescents with Chronic Health Conditions: A Systematic Review %A Badawy,Sherif M %A Kuhns,Lisa M %+ Ann and Robert H Lurie Children's Hospital of Chicago, Department of Pediatrics, Division of Hematology, Oncology, and Stem Cell Transplant, Northwestern University Feinberg School of Medicine, 225 E Chicago Ave, Box 30, Chicago, IL,, United States, 1 312 227 4836, sbadawy@luriechildrens.org %K adolescent %K text messaging %K smartphone %K medication adherence %K chronic disease %K cost-benefit analysis %D 2016 %7 25.10.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The rate of chronic health conditions (CHCs) in children and adolescents has doubled in the past 20 years, with increased health care costs. Technology-based interventions have demonstrated efficacy to improving medication adherence. However, data to support the cost effectiveness of these interventions are lacking. Objective: The objective of this study is to conduct an economic evaluation of text-messaging and smartphone-based interventions that focus on improving medication adherence in adolescents with CHCs. Methods: Searches included PubMed MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science, and Inspec. Eligibility criteria included age (12-24 years old), original articles, outcomes for medication adherence, and economic outcomes. Results: Our search identified 1118 unique articles that were independently screened. A total of 156 articles met inclusion criteria and were then examined independently with full-text review. A total of 15 articles met most criteria but lacked economic outcomes such as cost effectiveness or cost-utility data. No articles met all predefined criteria to be included for final review. Only 4 articles (text messaging [n=3], electronic directly observed therapy [n=1]) described interventions with possible future cost-saving but no formal economic evaluation. Conclusions: The evidence to support the cost effectiveness of text-messaging and smartphone-based interventions in improving medication adherence in adolescents with CHCs is insufficient. This lack of research highlights the need for comprehensive economic evaluation of such interventions to better understand their role in cost-savings while improving medication adherence and health outcomes. Economic evaluation of technology-based interventions can contribute to more evidence-based assessment of the scalability, sustainability, and benefits of broader investment of such technology tools in adolescents with CHCs. %M 27780795 %R 10.2196/mhealth.6425 %U http://mhealth.jmir.org/2016/4/e121/ %U https://doi.org/10.2196/mhealth.6425 %U http://www.ncbi.nlm.nih.gov/pubmed/27780795 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e119 %T Text Message-Based Intervention Targeting Alcohol Consumption Among University Students: Findings From a Formative Development Study %A Thomas,Kristin %A Linderoth,Catharina %A Bendtsen,Marcus %A Bendtsen,Preben %A Müssener,Ulrika %+ Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, 58183, Linköping,, Sweden, 46 13282546, kristin.thomas@liu.se %K SMS intervention %K university student drinking %K formative research %D 2016 %7 20.10.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Drinking of alcohol among university students is a global phenomenon; heavy episodic drinking is accepted despite several potential negative consequences. There is emerging evidence that short message service (SMS) text messaging interventions are effective to promote behavior change among students. However, it is still unclear how effectiveness can be optimized through intervention design or how user interest and adherence can be maximized. Objective: The objective of this study was to develop an SMS text message-based intervention targeting alcohol drinking among university students using formative research. Methods: A formative research design was used including an iterative revision process based on input from end users and experts. Data were collected via seven focus groups with students and a panel evaluation involving students (n=15) and experts (n=5). Student participants were recruited from five universities in Sweden. A semistructured interview guide was used in the focus groups and included questions on alcohol culture, message content, and intervention format. The panel evaluation asked participants to rate to what degree preliminary messages were understandable, usable, and had a good tone on a scale from 1 (very low degree) to 4 (very high degree). Participants could also write their own comments for each message. Qualitative data were analyzed using qualitative descriptive analysis. Quantitative data were analyzed using descriptive statistics. The SMS text messages and the intervention format were revised continuously in parallel with data collection. A behavior change technique (BCT) analysis was conducted on the final version of the program. Results: Overall, students were positive toward the SMS text message intervention. Messages that were neutral, motivated, clear, and tangible engaged students. Students expressed that they preferred short, concise messages and confirmed that a 6-week intervention was an appropriate duration. However, there was limited consensus regarding SMS text message frequency, personalization of messages, and timing. Overall, messages scored high on understanding (mean 3.86, SD 0.43), usability (mean 3.70, SD 0.61), and tone (mean 3.78, SD 0.53). Participants added comments to 67 of 70 messages, including suggestions for change in wording, order of messages, and feedback on why a message was unclear or needed major revision. Comments also included positive feedback that confirmed the value of the messages. Twenty-three BCTs aimed at addressing self-regulatory skills, for example, were identified in the final program. Conclusions: The formative research design was valuable and resulted in significant changes to the intervention. All the original SMS text messages were changed and new messages were added. Overall, the findings showed that students were positive toward receiving support through SMS text message and that neutral, motivated, clear, and tangible messages promoted engagement. However, limited consensus was found on the timing, frequency, and tailoring of messages. %M 27765732 %R 10.2196/mhealth.5863 %U http://mhealth.jmir.org/2016/4/e119/ %U https://doi.org/10.2196/mhealth.5863 %U http://www.ncbi.nlm.nih.gov/pubmed/27765732 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 9 %P e261 %T Adolescent Female Text Messaging Preferences to Prevent Pregnancy After an Emergency Department Visit: A Qualitative Analysis %A Chernick,Lauren Stephanie %A Schnall,Rebecca %A Stockwell,Melissa S %A Castaño,Paula M %A Higgins,Tracy %A Westhoff,Carolyn %A Santelli,John %A Dayan,Peter S %+ Division of Pediatric Emergency Medicine, Department of Pediatrics, Columbia University Medical Center, 3959 Broadway, CHN 1-116, New York, NY, 10032, United States, 1 212 305 9825, lc2243@columbia.edu %K pregnancy in adolescence %K emergency medicine %K text messaging %K reproductive health %K contraception %K preventive medicine %D 2016 %7 29.09.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Over 15 million adolescents use the emergency department (ED) each year in the United States. Adolescent females who use the ED for medical care have been found to be at high risk for unintended pregnancy. Given that adolescents represent the largest users of text messaging and are receptive to receiving text messages related to their sexual health, the ED visit represents an opportunity for intervention. Objective: The aim of this qualitative study was to explore interest in and preferences for the content, frequency, and timing of an ED-based text message intervention to prevent pregnancy for adolescent females. Methods: We conducted semistructured, open-ended interviews in one urban ED in the United States with adolescent females aged 14-19 years. Eligible subjects were adolescents who were sexually active in the past 3 months, presented to the ED for a reproductive health complaint, owned a mobile phone, and did not use effective contraception. Using an interview guide, enrollment continued until saturation of key themes. The investigators designed sample text messages using the Health Beliefs Model and participants viewed these on a mobile phone. The team recorded, transcribed, and coded interviews based on thematic analysis using the qualitative analysis software NVivo and Excel. Results: Participants (n=14) were predominantly Hispanic (13/14; 93%), insured (13/14; 93%), ED users in the past year (12/14; 86%), and frequent text users (10/14; 71% had sent or received >30 texts per day). All were interested in receiving text messages from the ED about pregnancy prevention, favoring messages that were “brief,” “professional,” and “nonaccusatory.” Respondents favored texts with links to websites, repeated information regarding places to receive “confidential” care, and focused information on contraception options and misconceptions. Preferences for text message frequency varied from daily to monthly, with random hours of delivery to maintain “surprise.” No participant feared that text messages would violate her privacy. Conclusions: Adolescent female patients at high pregnancy risk are interested in ED-based pregnancy prevention provided by texting. Understanding preferences for the content, frequency, and timing of messages can guide in designing future interventions in the ED. %M 27687855 %R 10.2196/jmir.6324 %U http://www.jmir.org/2016/9/e261/ %U https://doi.org/10.2196/jmir.6324 %U http://www.ncbi.nlm.nih.gov/pubmed/27687855 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e114 %T Baseline Motivation Type as a Predictor of Dropout in a Healthy Eating Text Messaging Program %A Coa,Kisha %A Patrick,Heather %+ ICF International, 530 Gaither Rd, Rockville, MD, 20850, United States, 1 3015720458, kisha.coa@icfi.com %K mHealth %K behavior change %K diet %K engagement %K motivation %K Self-Determination Theory %D 2016 %7 29.09.2016 %9 Short Paper %J JMIR Mhealth Uhealth %G English %X Background: Growing evidence suggests that text messaging programs are effective in facilitating health behavior change. However, high dropout rates limit the potential effectiveness of these programs. Objective: This paper describes patterns of early dropout in the HealthyYou text (HYTxt) program, with a focus on the impact of baseline motivation quality on dropout, as characterized by Self-Determination Theory (SDT). Methods: This analysis included 193 users of HYTxt, a diet and physical activity text messaging intervention developed by the US National Cancer Institute. Descriptive statistics were computed, and logistic regression models were run to examine the association between baseline motivation type and early program dropout. Results: Overall, 43.0% (83/193) of users dropped out of the program; of these, 65.1% (54/83; 28.0% of all users) did so within the first 2 weeks. Users with higher autonomous motivation had significantly lower odds of dropping out within the first 2 weeks. A one unit increase in autonomous motivation was associated with lower odds (odds ratio 0.44, 95% CI 0.24–0.81) of early dropout, which persisted after adjusting for level of controlled motivation. Conclusions: Applying SDT-based strategies to enhance autonomous motivation might reduce early dropout rates, which can improve program exposure and effectiveness. %M 27688034 %R 10.2196/mhealth.5992 %U http://mhealth.jmir.org/2016/3/e114/ %U https://doi.org/10.2196/mhealth.5992 %U http://www.ncbi.nlm.nih.gov/pubmed/27688034 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e99 %T Increasing Nonsedentary Behaviors in University Students Using Text Messages: Randomized Controlled Trial %A Cotten,Emma %A Prapavessis,Harry %+ Exercise and Health Psychology Laboratory, School of Kinesiology, Western University, Room 408, Arthur and Sonia Labatt Health Sciences Building, London, ON, N6A 5B9, Canada, 1 519 902 9136, ecotten@uwo.ca %K sedentary behaviour %K prolonged sitting %K text messages %K self-efficacy %K university students %K breaks from sitting %K light intensity physical activity %K moderate intensity physical activity %D 2016 %7 19.08.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Sedentary behavior (SB) has been linked to many health problems such as type 2 diabetes and heart disease. Increasing the length and frequency of breaks from sitting and increasing the time spent standing and engaged in light and moderate physical activity are ways to decrease SB. Text message-based interventions have succeeded in aiding smoking cessation and increase both physical activity and healthy eating, but they have not been shown to reduce SB. Objective: The primary purpose of this pilot study was to determine the effectiveness of a text message-based intervention in increasing nonsedentary behaviors in university students. A secondary purpose was to (1) determine whether the intervention could enhance self-efficacy beliefs for decreasing SB and (2) whether these efficacious beliefs could predict actual SB. Methods: Eighty-two university students were recruited via mass emails and randomized into intervention (SB-related text messages) or control (text messages unrelated to SB) groups. Participants received daily text messages scheduled by the researcher encouraging breaks from sitting, standing, light- and moderate-intensity physical activity (PA). They then reported various SBs via Web-based questionnaires at four time points (baseline, 2, 4, and 6 weeks). Self-efficacious beliefs toward taking breaks from sitting and decreasing the amount of time spent sitting were assessed at the same time points. Results: Last observation carried forward (LOCF) method was used for incomplete data as an intent-to-treat (ITT) analysis (intervention group n=15, control group n=11). Small-to-moderate effects favoring the text intervention group were found at 6 weeks for break frequency -14.64 minutes, break length +.59 minutes, standing +24.30 min/day, light-intensity +74.34 min/day, and moderate-intensity + 9.97 min/day PA. Only light-intensity PA approached significance (P=.07). Self-efficacy beliefs also favored the text intervention group and reached significance (P=.032) for sitting less. Significant (P<.05) relations were found between the self-efficacy constructs and breaks, standing, and light or moderate PA. Conclusions: Text messages have the potential to increase nonsedentary behaviors in university students. These messages can increase self-efficacy beliefs to take more breaks and reduce sitting time. Efficacious beliefs can predict actual SB and to a lesser extent light- and moderate-intensity PA. Trial Registration: ClinicalTrials.gov NCT02562937; https://clinicaltrials.gov/ct2/show/NCT02562937 (Archived by WebCite at http://www.webcitation.org/6jVLwXE5M) %M 27543317 %R 10.2196/mhealth.5411 %U http://mhealth.jmir.org/2016/3/e99/ %U https://doi.org/10.2196/mhealth.5411 %U http://www.ncbi.nlm.nih.gov/pubmed/27543317 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 3 %P e170 %T Protocol for a Randomized Controlled Trial Evaluating Mobile Text Messaging to Promote Retention and Adherence to Antiretroviral Therapy for People Living With HIV in Burkina Faso %A Wagner,Natascha %A Ouedraogo,Denis %A Artavia-Mora,Luis %A Bedi,Arjun %A Thiombiano,Boundia Alexandre %+ International Institute of Social Studies, Erasmus University Rotterdam, Kortenaerkade 12, The Hage, 2518AX, Netherlands, 31 0704260 ext 574, wagner@iss.nl %K HIV %K PLHIV %K mHealth %K SMS %K RCT %K developing countries %D 2016 %7 17.08.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Retention in care and adherence to antiretroviral therapy (ART) among people living with human immunodeficiency virus (PLHIV) is a critical challenge in many African countries including Burkina Faso. Delivering text messaging (short message service, SMS) interventions through mobile phones may help facilitate health service delivery and improve patient health. Despite this potential, no evaluations have been delivered for national scale settings to demonstrate the impact of mobile health (mHealth) for PLHIV. Objectives: This study aims to test the impact of SMS text messaging reminders for PLHIV in Burkina Faso, who are under ART. The evaluation identifies whether patients who receive SMS text messages are more likely to (1) retain in care (measured as a dichotomous variable), (2) adhere to antiretroviral regimens (measured as the number of doses missed in the past 7 days), and (3) experience slower disease progression (measured with T-lymphocytes cells). The second objective is to assess its effects on the frequency of health center visits, physical and psychosocial health, nutrition and whether the type of message (text vs image) and frequency (weekly vs semiweekly) have differential impacts including the possibility of message fatigue over time. Methods: This 24-month, wide-scale intervention implements a randomized controlled trial (RCT) to evaluate the impact of four variants of a mHealth intervention versus a control group. Our sample comprises adult patients (>15 years of age) undergoing antiretroviral therapy with access to mobile phone services. Multivariate regression analysis will be used to analyze the effect of the intervention on the study population. Data collection is done at baseline and three follow-up waves 6, 12, and 24 months after the intervention starts. Results: The targeted 3800 patients were recruited between February 2015 and May 2015. But political uncertainty delayed the launch of the intervention until October 2015. Data analysis has not yet started. The first follow-up data collection started in April 2016. To the best of our knowledge, this is the first research that explores the effects of mobile message reminders using a wide-spread sample across an entire nation over a 2-year horizon, especially in a Francophone African country. Conclusions: We hypothesize that the interventions have a positive impact on retention in care and adherence to ART schemes and that a more sluggish disease progression will be observed in the short run. However, these benefits may fade out in the long run. The study expects to advance the research on how long mHealth interventions remain effective and when fatigue sets in the context of wide-scale interventions. This information will be useful in designing future wide-scale mHealth interventions in developing countries. %M 27535717 %R 10.2196/resprot.5823 %U http://www.researchprotocols.org/2016/3/e170/ %U https://doi.org/10.2196/resprot.5823 %U http://www.ncbi.nlm.nih.gov/pubmed/27535717 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 8 %P e200 %T Reaching Adolescent Gay, Bisexual, and Queer Men Online: Development and Refinement of a National Recruitment Strategy %A Prescott,Tonya L %A Phillips II,Gregory %A DuBois,L. Zachary %A Bull,Sheana S %A Mustanski,Brian %A Ybarra,Michele L %+ Center for Innovative Public Health Research, 555 N. El Camino Real #A347, San Clemente, CA, 92672, United States, 1 877 302 6858 ext 801, michele@innovativepublichealth.org %K Facebook %K mHealth %K recruitment methods %K intervention development %K HIV %K adolescent %K AGBM %K sexual minority %D 2016 %7 04.08.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Using social networking websites to recruit research participants is increasingly documented in the literature, although few studies have leveraged these sites to reach those younger than 18 years. Objective: To discuss the development and refinement of a recruitment protocol to reach and engage adolescent gay, bisexual, and other teenaged men who have sex with men (AGBM). Participants were recruited for development and evaluation activities related to Guy2Guy, a text messaging–based human immunodeficiency virus infection prevention program. Methods: Eligibility criteria included being between 14 to 18 years old; being a cisgender male; self-identifying as gay, bisexual, and/or queer; being literate in English, exclusively owning a cell phone, enrolled in an unlimited text messaging plan, intending to keep their current phone number over the next 6 months, and having used text messaging for at least the past 6 months. Recruitment experiences and subsequent steps to refine the Internet-based recruitment strategy are discussed for 4 research activities: online focus groups, content advisory team, beta test, and randomized controlled trial (RCT). Recruitment relied primarily on Facebook advertising. To a lesser extent, Google AdWords and promotion through partner organizations working with AGBM youth were also utilized. Results: Facebook advertising strategies were regularly adjusted based on preidentified recruitment targets for race, ethnicity, urban-rural residence, and sexual experience. The result was a diverse sample of participants, of whom 30% belonged to a racial minority and 20% were Hispanic. Facebook advertising was the most cost-effective method, and it was also able to reach diverse recruitment goals: recruitment for the first focus group cost an average of US $2.50 per enrolled participant, and it took 9 days to enroll 40 participants; the second focus group cost an average of US $6.96 per enrolled participant, and it took 11 days to enroll 40 participants. Recruitment for the first content advisory team cost an average of US $32.52 per enrolled participant; the second cost US $29.52 per participant. Both recruitment drives required 10 days to enroll 24 participants. For the beta test, recruitment cost an average of US $17.19 per enrolled participant, and it took 16 days to complete enrollment of 20 participants. For the RCT, recruitment cost an average of US $12.54 per enrolled participant, and it took 148 days to enroll 302 participants. Google AdWords campaigns did not result in any enrolled participants of whom the research staff members were aware. Conclusions: Internet-based strategies can be a cost-efficient means to recruit and retain hard-to-reach populations from across the country. With real-time monitoring of participant demographic characteristics, diverse samples can be achieved. Although Facebook advertising was particularly successful in this study, alternative social media strategies can be explored in future research as these media are ever-changing. %M 27492781 %R 10.2196/jmir.5602 %U http://www.jmir.org/2016/8/e200/ %U https://doi.org/10.2196/jmir.5602 %U http://www.ncbi.nlm.nih.gov/pubmed/27492781 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 7 %P e209 %T A Mobile Ecological Momentary Assessment Tool (devilSPARC) for Nutrition and Physical Activity Behaviors in College Students: A Validation Study %A Bruening,Meg %A van Woerden,Irene %A Todd,Michael %A Brennhofer,Stephanie %A Laska,Melissa N %A Dunton,Genevieve %+ Arizona State University, 550 N 5th Street, Phoenix, AZ, 85004, United States, 1 602 827 2266, meg.bruening@asu.edu %K validation study %K ecological momentary assessment %K nutritional status %K physical activity %K sedentary activity %K emerging adults %D 2016 %7 27.07.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The majority of nutrition and physical activity assessments methods commonly used in scientific research are subject to recall and social desirability biases, which result in over- or under-reporting of behaviors. Real-time mobile-based ecological momentary assessments (mEMAs) may result in decreased measurement biases and minimize participant burden. Objective: The aim was to examine the validity of a mEMA methodology to assess dietary and physical activity levels compared to 24-hour dietary recalls and accelerometers. Methods: This study was a pilot test of the SPARC (Social impact of Physical Activity and nutRition in College) study, which aimed to determine the mechanism by which friendship networks impact weight-related behaviors among young people. An mEMA app, devilSPARC, was developed to assess weight-related behaviors in real time. A diverse sample of 109 freshmen and community mentors attending a large southwestern university downloaded the devilSPARC mEMA app onto their personal mobile phones. Participants were prompted randomly eight times per day over the course of 4 days to complete mEMAs. During the same 4-day period, participants completed up to three 24-hour dietary recalls and/or 4 days of accelerometry. Self-reported mEMA responses were compared to 24-hour dietary recalls and accelerometry measures using comparison statistics, such as match rate, sensitivity and specificity, and mixed model odds ratios, adjusted for within-person correlation among repeated measurements. Results: At the day level, total dietary intake data reported through the mEMA app reflected eating choices also captured by the 24-hour recall. Entrées had the lowest match rate, and fruits and vegetables had the highest match rate. Widening the window of aggregation of 24-hour dietary recall data on either side of the mEMA response resulted in increased specificity and decreased sensitivity. For physical activity behaviors, levels of activity reported through mEMA differed for sedentary versus non-sedentary activity at the day level as measured by accelerometers. Conclusions: The devilSPARC mEMA app is valid for assessing eating behaviors and the presence of sedentary activity at the day level. This mEMA may be useful in studies examining real-time weight-related behaviors. %M 27465701 %R 10.2196/jmir.5969 %U http://www.jmir.org/2016/7/e209/ %U https://doi.org/10.2196/jmir.5969 %U http://www.ncbi.nlm.nih.gov/pubmed/27465701 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 2 %P e133 %T A Research Protocol to Test the Effectiveness of Text Messaging and Reminder Calls to Increase Service Use Referrals in a Community Engagement Program %A Varma,Deepthi Satheesa %A Hart,Mark %A McIntyre,Denise Sonya %A Kwiatkowski,Evan %A Cottler,Linda Bauer %+ College of Public Health and Health Professions and College of Medicine, Department of Epidemiology, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610, United States, 1 352 294 5941, dvarma@ufl.edu %K text messaging %K reminder calls %K community engagement %K referral use %K mHealth %D 2016 %7 28.06.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mobile phoned–based interventions have been increasingly used in clinical populations to improve health and health care delivery. The literature has shown that mobile phone–based text messages (short message service, SMS) are instantaneous, cost effective, and have less chance of being misplaced. Studies using mobile phone based–text messages have reported text messages as effective reminders that have resulted in increased appointment attendance, adherence to treatment, and better self-management. There have been no reports of adverse events when using text messaging in terms of misreading or misinterpreting data, transmitting inaccurate data, losing verbal or nonverbal communication cues, privacy issues, or failure or delay in message delivery. However, the literature has cited a need for personalized messages that are more responsive to individual needs. In addition, there has been a dearth of information on the use of reminders in nonclinical populations. Objective: The goal of this study is to assess the effectiveness of adding reminders in the form of text messaging versus reminder calls versus text messages and reminder calls to increase use of service referrals provided through community outreach. Methods: A total of 300 participants will be recruited for the study. Each participant will be randomized to one of three arms: a group that receives only reminder calls (CALLSONLY); a group that receives only text message reminders (TEXTONLY); and a group that receives both reminder calls and text messages (CALLS+TEXT). All groups will receive their reminder intervention on the 15th and 45th day after baseline when they receive medical and social service referrals from the community health workers (CHWs). A standard script will be used to administer the call and text reminders and a 15-item telephone-based satisfaction survey will be administered to assess the participant satisfaction with the process of receiving periodic reminders. Results: The study is in the recruitment and follow-up phase. The authors anticipate completion of recruitment, interventions, and data entry by July 2016. Preliminary results are expected to be available by September 2016. Conclusions: This study will provide an opportunity to test the effectiveness of mobile-based interventions on nonclinical, community-recruited populations. In particular, such a protocol would increase the effectiveness of a community-based engagement program by instating a formal reminder system for all program members who receive social and/or medical service referrals during outreach in the community. Findings from this study would guide the development and implementation of reminder protocols for community-based engagement programs nationwide. %M 27353040 %R 10.2196/resprot.5854 %U http://www.researchprotocols.org/2016/2/e133/ %U https://doi.org/10.2196/resprot.5854 %U http://www.ncbi.nlm.nih.gov/pubmed/27353040 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e176 %T How a Fully Automated eHealth Program Simulates Three Therapeutic Processes: A Case Study %A Holter,Marianne T. S %A Johansen,Ayna %A Brendryen,Håvar %+ The Norwegian Centre for Addiction Research, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postboks 1039 Blindern, Oslo, 0315, Norway, 47 93 62 30 61, m.t.s.holter@medisin.uio.no %K Internet %K eHealth %K telemedicine %K behavior therapy %K motivational interviewing %K working alliance %K intervention mapping %K smoking cessation %K cell phones %K text messaging %D 2016 %7 28.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth programs may be better understood by breaking down the components of one particular program and discussing its potential for interactivity and tailoring in regard to concepts from face-to-face counseling. In the search for the efficacious elements within eHealth programs, it is important to understand how a program using lapse management may simultaneously support working alliance, internalization of motivation, and behavior maintenance. These processes have been applied to fully automated eHealth programs individually. However, given their significance in face-to-face counseling, it may be important to simulate the processes simultaneously in interactive, tailored programs. Objective: We propose a theoretical model for how fully automated behavior change eHealth programs may be more effective by simulating a therapist’s support of a working alliance, internalization of motivation, and managing lapses. Methods: We show how the model is derived from theory and its application to Endre, a fully automated smoking cessation program that engages the user in several “counseling sessions” about quitting. A descriptive case study based on tools from the intervention mapping protocol shows how each therapeutic process is simulated. Results: The program supports the user’s working alliance through alliance factors, the nonembodied relational agent Endre and computerized motivational interviewing. Computerized motivational interviewing also supports internalized motivation to quit, whereas a lapse management component responds to lapses. The description operationalizes working alliance, internalization of motivation, and managing lapses, in terms of eHealth support of smoking cessation. Conclusions: A program may simulate working alliance, internalization of motivation, and lapse management through interactivity and individual tailoring, potentially making fully automated eHealth behavior change programs more effective. %M 27354373 %R 10.2196/jmir.5415 %U http://www.jmir.org/2016/6/e176/ %U https://doi.org/10.2196/jmir.5415 %U http://www.ncbi.nlm.nih.gov/pubmed/27354373 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 2 %P e131 %T A Cognitive Behavioral Therapy–Based Text Messaging Intervention Versus Medical Management for HIV-Infected Substance Users: Study Protocol for a Pilot Randomized Trial %A Glasner-Edwards,Suzette %A Patrick,Kevin %A Ybarra,Michele L %A Reback,Cathy J %A Rawson,Richard A %A Chokron Garneau,Helene %A Chavez,Kathryn %A Venegas,Alexandra %+ Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 11075 Santa Monica Blvd, Suite 200, Los Angeles, CA,, United States, 1 310 267 5206, sglasner@ucla.edu %K SMS %K medication adherence %K HIV %K relapse prevention %K text messaging %K CBT %K ART %D 2016 %7 24.06.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Evidence-based psychosocial interventions for addictions and related conditions such as cognitive behavioral therapy (CBT) are underutilized. Obstacles to implementation of CBT in clinical settings include limited availability of quality training, supervision, and certification in CBT for clinicians; high rates of clinician turnover and high caseloads; and limited qualifications of the workforce to facilitate CBT expertise. Objective: Mobile phone–based delivery of CBT, if demonstrated to be feasible and effective, could be transformative in broadening its application and improving the quality of addiction treatment. No experimental interventions that deliver CBT targeting both drug use and medication adherence using text messaging have been previously reported; as such, the objective of this study is to develop and test an SMS-based treatment program for HIV-positive adults with comorbid substance use disorders. Methods: With user input, we developed a 12-week CBT-based text messaging intervention (TXT-CBT) targeting antiretroviral (ART) adherence, risk behaviors, and drug use in a population of HIV-infected substance users. Results: The intervention has been developed and is presently being tested in a pilot randomized clinical trial. Results will be reported later this year. Conclusions: This investigation will yield valuable knowledge about the utility of a cost-effective, readily deployable text messaging behavioral intervention for HIV-infected drug users. %M 27341852 %R 10.2196/resprot.5407 %U http://www.researchprotocols.org/2016/2/e131/ %U https://doi.org/10.2196/resprot.5407 %U http://www.ncbi.nlm.nih.gov/pubmed/27341852 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e73 %T Optimizing a Text Message Intervention to Reduce Heavy Drinking in Young Adults: Focus Group Findings %A Suffoletto,Brian %A Kristan,Jeffrey %A Person Mecca,Laurel %A Chung,Tammy %A Clark,Duncan B %+ University of Pittsburgh, Department of Emergency Medicine, Iroquois Building, Suite 400A, 3600 Forbes Avenue, Pittsburgh, PA, 15261, United States, 1 412 901 6892, suffbp@upmc.edu %K alcohol %K young adult %K text messages %K qualitative %D 2016 %7 22.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Recent trial results show that an interactive short message service (SMS) text message intervention, Texting to Reduce Alcohol Consumption (TRAC), is effective in reducing heavy drinking in non-treatment-seeking young adults, but may not be optimized. Objective: To assess the usability of the TRAC intervention among young adults in an effort to optimize future intervention design. Methods: We conducted five focus groups with 18 young adults, aged 18-25 years, who had a history of heavy drinking and had been randomized to 12 weeks of the TRAC intervention as part of a clinical trial. A trained moderator followed a semistructured interview guide. Focus groups were audiotaped, transcribed, and analyzed to identify themes. Results: We identified four themes regarding user experiences with the TRAC intervention: (1) ease of use, (2) comfort and confidentiality, (3) increased awareness of drinking behavior, and (4) accountability for drinking behavior. Participants’ comments supported the existing features of the TRAC intervention, as well as the addition of other features to increase personalization and continuing engagement with the intervention. Conclusions: Young adults perceived the TRAC intervention as a useful way to help them reduce heavy drinking on weekends. Components that promote ease of use, ensure confidentiality, increase awareness of alcohol consumption, and increase accountability were seen as important. %M 27335099 %R 10.2196/mhealth.5330 %U http://mhealth.jmir.org/2016/2/e73/ %U https://doi.org/10.2196/mhealth.5330 %U http://www.ncbi.nlm.nih.gov/pubmed/27335099 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e78 %T A Mobile Health Lifestyle Program for Prevention of Weight Gain in Young Adults (TXT2BFiT): Nine-Month Outcomes of a Randomized Controlled Trial %A Allman-Farinelli,Margaret %A Partridge,Stephanie Ruth %A McGeechan,Kevin %A Balestracci,Kate %A Hebden,Lana %A Wong,Annette %A Phongsavan,Philayrath %A Denney-Wilson,Elizabeth %A Harris,Mark F %A Bauman,Adrian %+ School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, Building D17, University of Sydney, 2006, Australia, 61 90367045, margaret.allmanfarinelli@sydney.edu.au %K young adult %K weight gain prevention %K mHealth %K telehealth %K fruit %K vegetables %K take-out foods %K sugar-sweetened beverages %K physical activity %D 2016 %7 22.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The unprecedented rise in obesity among young adults, who have limited interaction with health services, has not been successfully abated. Objective: The objective of this study was to assess the maintenance outcomes of a 12-week mHealth intervention on prevention of weight gain in young adults and lifestyle behaviors at 9 months from baseline. Methods: A two-arm, parallel, randomized controlled trial (RCT) with subjects allocated to intervention or control 1:1 was conducted in a community setting in Greater Sydney, Australia. From November 2012 to July 2014, 18- to 35-year-old overweight individuals with a body mass index (BMI) of 25-31.99 kg/m2 and those with a BMI ≥ 23 kg/m2 and a self-reported weight gain of ≥ 2 kg in the past 12 months were recruited. A 12-week mHealth program “TXT2BFiT” was administered to the intervention arm. This included 5 coaching calls, 96 text messages, 12 emails, apps, and downloadable resources from the study website. Lifestyle behaviors addressed were intake of fruits, vegetables, sugar-sweetened beverages (SSBs), take-out meals, and physical activity. The control group received 1 phone call to introduce them to study procedures and 4 text messages over 12 weeks. After 12 weeks, the intervention arm received 2 further coaching calls, 6 text messages, and 6 emails with continued access to the study website during 6-month follow-up. Control arm received no further contact. The primary outcome was weight change (kg) with weight measured at baseline and at 12 weeks and self-report at baseline, 12 weeks, and 9 months. Secondary outcomes were change in physical activity (metabolic equivalent of task, MET-mins) and categories of intake for fruits, vegetables, SSBs, and take-out meals. These were assessed via Web-based surveys. Results: Two hundred and fifty young adults enrolled in the RCT. Intervention participants weighed less at 12 weeks compared with controls (model β=−3.7, 95% CI −6.1 to −1.3) and after 9 months (model β=− 4.3, 95% CI − 6.9 to − 1.8). No differences in physical activity were found but all diet behaviors showed that the intervention group, compared with controls at 9 months, had greater odds of meeting recommendations for fruits (OR 3.83, 95% CI 2.10-6.99); for vegetables (OR 2.42, 95% CI 1.32-4.44); for SSB (OR 3.11, 95% CI 1.47-6.59); and for take-out meals (OR 1.88, 95% CI 1.07-3.30). Conclusions: Delivery of an mHealth intervention for prevention of weight gain resulted in modest weight loss at 12 weeks with further loss at 9 months in 18- to 35-year-olds. Although there was no evidence of change in physical activity, improvements in dietary behaviors occurred, and were maintained at 9 months. Owing to its scalable potential for widespread adoption, replication trials should be conducted in diverse populations of overweight young adults. Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000924853; (Archived by WebCite at http://www.webcitation.org/6i6iRag55) %M 27335237 %R 10.2196/mhealth.5768 %U http://mhealth.jmir.org/2016/2/e78/ %U https://doi.org/10.2196/mhealth.5768 %U http://www.ncbi.nlm.nih.gov/pubmed/27335237 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e75 %T Development and Testing of an Automated 4-Day Text Messaging Guidance as an Aid for Improving Colonoscopy Preparation %A Walter,Benjamin Michael %A Klare,Peter %A Neu,Bruno %A Schmid,Roland M %A von Delius,Stefan %+ II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, TU München, Ismaningerstr.22, 81675, München,, Germany, 49 4140 2223, Benjamin.walter@lrz.tum.de %K short message service %K patient education %K colonoscopy %K colonoscopy preparation %D 2016 %7 21.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In gastroenterology a sufficient colon cleansing improves adenoma detection rate and prevents the need for preterm repeat colonoscopies due to invalid preparation. It has been shown that patient education is of major importance for improvement of colon cleansing. Objective: Objective of this study was to assess the function of an automated text messaging (short message service, SMS)–supported colonoscopy preparation starting 4 days before colonoscopy appointment. Methods: After preevaluation to assess mobile phone usage in the patient population for relevance of this approach, a Web-based, automated SMS text messaging system was developed, following which a single-center feasibility study at a tertiary care center was performed. Patients scheduled for outpatient colonoscopy were invited to participate. Patients enrolled in the study group received automated information about dietary recommendations and bowel cleansing during colonoscopy preparation. Data of outpatient colonoscopies with regular preparation procedure were used for pair matching and served as control. Primary end point was feasibility of SMS text messaging support in colonoscopy preparation assessed as stable and satisfactory function of the system. Secondary end points were quality of bowel preparation according to the Boston Bowel Preparation Scale (BBPS) and patient satisfaction with SMS text messaging–provided information assessed by a questionnaire. Results: Web-based SMS text messaging–supported colonoscopy preparation was successful and feasible in 19 of 20 patients. Mean (standard error of the mean, SEM) total BBPS score was slightly higher in the SMS group than in the control group (7.3, SEM 0.3 vs 6.4, SEM 0.2) and for each colonic region (left, transverse, and right colon). Patient satisfaction regarding SMS text messaging–based information was high. Conclusions: Using SMS for colonoscopy preparation with 4 days’ guidance including dietary recommendation is a new approach to improve colonoscopy preparation. Quality of colonoscopy preparation was sufficient and patients were highly satisfied with the system during colonoscopy preparation. %M 27329204 %R 10.2196/mhealth.5289 %U http://mhealth.jmir.org/2016/2/e75/ %U https://doi.org/10.2196/mhealth.5289 %U http://www.ncbi.nlm.nih.gov/pubmed/27329204 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e60 %T Stepwise Development of a Text Messaging-Based Bullying Prevention Program for Middle School Students (BullyDown) %A Ybarra,Michele L %A Prescott,Tonya L %A Espelage,Dorothy L %+ Center for Innovative Public Health Research, 555 N El Camino Real A347, San Clemente, CA, 92672, United States, 1 8773026858, Michele@InnovativePublicHealth.org %K bullying %K mhealth %K text messaging %K youth %K prevention %D 2016 %7 13.06.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Bullying is a significant public health issue among middle school-aged youth. Current prevention programs have only a moderate impact. Cell phone text messaging technology (mHealth) can potentially overcome existing challenges, particularly those that are structural (e.g., limited time that teachers can devote to non-educational topics). To date, the description of the development of empirically-based mHealth-delivered bullying prevention programs are lacking in the literature. Objective: To describe the development of BullyDown, a text messaging-based bullying prevention program for middle school students, guided by the Social-Emotional Learning model. Methods: We implemented five activities over a 12-month period: (1) national focus groups (n=37 youth) to gather acceptability of program components; (2) development of content; (3) a national Content Advisory Team (n=9 youth) to confirm content tone; and (4) an internal team test of software functionality followed by a beta test (n=22 youth) to confirm the enrollment protocol and the feasibility and acceptability of the program. Results: Recruitment experiences suggested that Facebook advertising was less efficient than using a recruitment firm to recruit youth nationally, and recruiting within schools for the pilot test was feasible. Feedback from the Content Advisory Team suggests a preference for 2-4 brief text messages per day. Beta test findings suggest that BullyDown is both feasible and acceptable: 100% of youth completed the follow-up survey, 86% of whom liked the program. Conclusions: Text messaging appears to be a feasible and acceptable delivery method for bullying prevention programming delivered to middle school students. %M 27296471 %R 10.2196/mhealth.4936 %U http://mhealth.jmir.org/2016/2/e60/ %U https://doi.org/10.2196/mhealth.4936 %U http://www.ncbi.nlm.nih.gov/pubmed/27296471 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e135 %T Fundamentals for Future Mobile-Health (mHealth): A Systematic Review of Mobile Phone and Web-Based Text Messaging in Mental Health %A Berrouiguet,Sofian %A Baca-García,Enrique %A Brandt,Sara %A Walter,Michel %A Courtet,Philippe %+ Brest Medical University Hospital at Bohars, Adult Psychiatry, Hôpital de la Cavale Blanche-Bd Tanguy Prigent, Brest, 29200, France, 33 668204178, sofian.berrouiguet@gmail.com %K text messaging %K cell phones %K mental health %K Internet %K medical informatics %D 2016 %7 10.06.2016 %9 Review %J J Med Internet Res %G English %X Background: Mobile phone text messages (short message service, SMS) are used pervasively as a form of communication. Almost 100% of the population uses text messaging worldwide and this technology is being suggested as a promising tool in psychiatry. Text messages can be sent either from a classic mobile phone or a web-based application. Reviews are needed to better understand how text messaging can be used in mental health care and other fields of medicine. Objective: The objective of the study was to review the literature regarding the use of mobile phone text messaging in mental health care. Methods: We conducted a thorough literature review of studies involving text messaging in health care management. Searches included PubMed, PsycINFO, Cochrane, Scopus, Embase and Web of Science databases on May 25, 2015. Studies reporting the use of text messaging as a tool in managing patients with mental health disorders were included. Given the heterogeneity of studies, this review was summarized using a descriptive approach. Results: From 677 initial citations, 36 studies were included in the review. Text messaging was used in a wide range of mental health situations, notably substance abuse (31%), schizophrenia (22%), and affective disorders (17%). We identified four ways in which text messages were used: reminders (14%), information (17%), supportive messages (42%), and self-monitoring procedures (42%). Applications were sometimes combined. Conclusions: We report growing interest in text messaging since 2006. Text messages have been proposed as a health care tool in a wide spectrum of psychiatric disorders including substance abuse, schizophrenia, affective disorders, and suicide prevention. Most papers described pilot studies, while some randomized clinical trials (RCTs) were also reported. Overall, a positive attitude toward text messages was reported. RCTs reported improved treatment adherence and symptom surveillance. Other positive points included an increase in appointment attendance and in satisfaction with management and health care services. Insight into message content, preventative strategies, and innovative approaches derived from the mental health field may be applicable in other medical specialties. %M 27287668 %R 10.2196/jmir.5066 %U http://www.jmir.org/2016/6/e135/ %U https://doi.org/10.2196/jmir.5066 %U http://www.ncbi.nlm.nih.gov/pubmed/27287668 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e71 %T A Pilot Test of Self-Affirmations to Promote Smoking Cessation in a National Smoking Cessation Text Messaging Program %A Taber,Jennifer M %A Klein,William M.P %A Ferrer,Rebecca A %A Augustson,Erik %A Patrick,Heather %+ Kent State University, Department of Psychological Sciences, 309 Kent Hall Annex, Kent, OH, 44242, United States, 1 1 330 672 8783, jtaber1@kent.edu %K self-affirmation %K smoking cessation %K mHealth %K text messaging %K theoretical study %K self concept %K motivation %D 2016 %7 08.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although effective smoking cessation treatments, including mHealth interventions, have been empirically validated and are widely available, smoking relapse is likely. Self-affirmation, a process through which individuals focus on their strengths and behaviors, has been shown to reduce negative effects of self-threats and to promote engagement in healthier behavior. Objective: To assess the feasibility of incorporating self-affirmations into an existing text messaging-based smoking cessation program (Smokefree TXT) and to determine whether self-affirmation led to greater engagement and higher cessation rates than the standard intervention. Methods: Data were collected from smokers (n=1261) who subscribed to a free smoking cessation program and met eligibility criteria. The intervention lasted 42 days. The original design was a 2 (Baseline affirmation: 5-item questionnaire present vs absent) × 2 (Integrated affirmation: texts present vs absent) factorial design. Only 17 eligible users completed all baseline affirmation questions and these conditions did not influence any outcomes, so we collapsed across baseline affirmation conditions in analysis. In the integrated affirmation conditions, affirmations replaced approximately 20% of texts delivering motivational content. Results: In all, 687 users remained enrolled throughout the 42-day intervention and 81 reported smoking status at day 42. Among initiators (n=1261), self-affirmation did not significantly improve (1) intervention completion, (2) days enrolled, (3) 1-week smoking status, or (4) 6-week smoking status (all Ps>.10); and among the 687 completers, there were no significant effects of affirmation on cessation (Ps>.25). However, among the 81 responders, those who received affirmations were more likely to report cessation at 6 weeks (97.5%; 39 of 40) than those not given affirmations (78.1%; 32 of 41; χ2(1)=7.08, P=.008). Conclusion: This proof-of-concept study provides preliminary evidence that self-affirmation can be integrated into existing text-based cessation programs, as the affirmations did not lead to any adverse effects (ie, less engagement or lower rates of cessation). Among those who reported smoking status at the end of the intervention period (6.4% of eligible respondents), affirmations facilitated cessation. This study provides a “proof-of-concept” that brief, low-touch interventions may be integrated into a text messaging program with potential benefits, minimal disruption to the program or users, and little cost. Many questions remain regarding how self-affirmation and similar approaches can promote engagement in population interventions. %M 27278108 %R 10.2196/mhealth.5635 %U http://mhealth.jmir.org/2016/2/e71/ %U https://doi.org/10.2196/mhealth.5635 %U http://www.ncbi.nlm.nih.gov/pubmed/27278108 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e68 %T Bilingual Text4Walking Food Service Employee Intervention Pilot Study %A Buchholz,Susan Weber %A Ingram,Diana %A Wilbur,JoEllen %A Fogg,Louis %A Sandi,Giselle %A Moss,Angela %A Ocampo,Edith V %+ Rush University, College of Nursing, 600 S. Paulina Street 1030D, Chicago, IL,, United States, 1 312 563 3590, susan_buchholz@rush.edu %K text messaging %K physical activity %K workplace %K employee %K Spanish %K feasibility %K food service %D 2016 %7 01.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Half of all adults in the United States do not meet the level of recommended aerobic physical activity. Physical activity interventions are now being conducted in the workplace. Accessible technology, in the form of widespread usage of cell phones and text messaging, is available for promoting physical activity. Objective: The purposes of this study, which was conducted in the workplace, were to determine (1) the feasibility of implementing a bilingual 12-week Text4Walking intervention and (2) the effect of the Text4Walking intervention on change in physical activity and health status in a food service employee population. Methods: Before conducting the study reported here, the Text4Walking research team developed a database of motivational physical activity text messages in English. Because Hispanic or Latino adults compose one-quarter of all adults employed in the food service industry, the Text4Walking team translated the physical activity text messages into Spanish. This pilot study was guided by the Physical Activity Health Promotion Framework and used a 1-group 12-week pre- and posttest design with food service employees who self-reported as being sedentary. The aim of the study was to increase the number of daily steps over the baseline by 3000 steps. Three physical activity text messages were delivered weekly. In addition, participants received 3 motivational calls during the study. Results: SPSS version 19.0 and R 3.0 were used to perform the data analysis. There were 33 employees who participated in the study (57.6% female), with a mean age of 43.7 years (SD 8.4). The study included 11 Hispanic or Latino participants, 8 of whom requested that the study be delivered in Spanish. There was a 100% retention rate in the study. At baseline, the participants walked 102 (SD 138) minutes/day (per self-report). This rate increased significantly (P=.008) to 182 (SD 219) minutes/day over the course of the study. The participants had a baseline mean of 10,416 (SD 5097) steps, which also increased significantly (P=.017) to 12,540 (SD 5149). They significantly improved their performance on their aerobic fitness test (P<.001). The participants had a baseline mean systolic blood pressure of 120 mm Hg and diastolic blood pressure of 76 mm Hg, a mean body mass index of 29.29 kg/m2, and a mean waist circumference of 36.95 inches, without significant changes seen at 12 weeks. Conclusions: We were able to conduct a motivational physical activity text messaging intervention within the workplace setting. Both physical activity and aerobic fitness improved. However, at baseline, participants were more active than they perceived themselves to be. Although there is insufficient evidence to draw strong conclusions about the study findings, it would be useful to test this physical activity text messaging intervention in a sedentary sample within a larger workplace intervention study trial conducted over a longer time frame. %M 27251878 %R 10.2196/mhealth.5328 %U http://mhealth.jmir.org/2016/2/e68/ %U https://doi.org/10.2196/mhealth.5328 %U http://www.ncbi.nlm.nih.gov/pubmed/27251878 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 2 %P e23 %T Mobile Phone and Web-based Cognitive Behavior Therapy for Depressive Symptoms and Mental Health Comorbidities in People Living With Diabetes: Results of a Feasibility Study %A Clarke,Janine %A Proudfoot,Judith %A Ma,Howard %+ Black Dog Institute, Hospital Road, Randwick, 2031, Australia, 61 2 9382 3767, janine.clarke@unsw.edu.au %K diabetes %K depression %K Internet interventions %K eHealth %K CBT %D 2016 %7 31.05.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: Depression is often comorbid with diabetes; however, undertreatment of depressive symptoms in people affected is common. Objective: We studied preliminary acceptability and effectiveness of a fully automated, mobile phone, and web-based public health intervention, myCompass, for reducing depressive symptoms and improving mental health comorbidities in people with diabetes. Methods: In this single-group feasibility study, 89 volunteers with type 1 (n=34) or type 2 (n=55) diabetes and at least mild depressive symptoms used myCompass for 7 weeks. Web-based measures of depressive and anxious symptoms, functional impairment, diabetes-specific variables, and user satisfaction were completed at baseline, postintervention, and 3-month follow-up. Results: Retention rates were 54% (n=48) at postintervention and 36% (n=32) at follow-up. Depressive symptoms were significantly improved at postintervention (P<.001; within-group effect size d=1.05), with gains persisting at follow-up. Mental health comorbidities, including anxiety (P<.001), functioning (P<.001), and diabetes-specific distress (P<.001), also showed significant and sustained improvement. Satisfaction with myCompass was high, with convenience and ease of program use, and relevance of program content rated positively by participants. Conclusions: The myCompass program shows promise as an acceptable and effective treatment for depression and comorbid mental health problems in people with diabetes. The program is broadly available, free to use, and may benefit patients with diabetes who do not access services and/or wish to manage their mental health themselves. Replication of these findings in a controlled study is warranted. %M 27245948 %R 10.2196/mental.5131 %U http://mental.jmir.org/2016/2/e23/ %U https://doi.org/10.2196/mental.5131 %U http://www.ncbi.nlm.nih.gov/pubmed/27245948 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e44 %T Concordance of Text Message Ecological Momentary Assessment and Retrospective Survey Data Among Substance-Using Men Who Have Sex With Men: A Secondary Analysis of a Randomized Controlled Trial %A Rowe,Christopher %A Hern,Jaclyn %A DeMartini,Anna %A Jennings,Danielle %A Sommers,Mathew %A Walker,John %A Santos,Glenn-Milo %+ San Francisco Department of Public Health, 25 Van Ness, Suite 500, San Francisco, CA, 94102, United States, 1 415 437 6283, chris.rowe@sfdph.org %K data collection %K cell phones %K drug users %K drinking behavior %K homosexuality, male %D 2016 %7 26.05.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Alcohol and illicit drug use is more prevalent among men who have sex with men (MSM) compared to the general population and has been linked to HIV transmission in this population. Research assessing individual patterns of substance use often utilizes questionnaires or interviews that rely on retrospective self-reported information, which can be subject to recall bias. Ecological momentary assessment (EMA) is a set of methods developed to mitigate recall bias by collecting data about subjects’ mental states and behaviors on a near real-time basis. EMA remains underutilized in substance use and HIV research. Objective: To assess the concordance between daily reports of substance use collected by EMA text messages (short message service, SMS) and retrospective questionnaires and identify predictors of daily concordance in a sample of MSM. Methods: We conducted a secondary analysis of EMA text responses (regarding behavior on the previous day) and audio computer-assisted self-interview (ACASI) survey data (14-day recall) from June 2013 to September 2014 as part of a randomized controlled trial assessing a pharmacologic intervention to reduce methamphetamine and alcohol use among nondependent MSM in San Francisco, California. Reports of daily methamphetamine use, alcohol use, and binge alcohol use (5 or more drinks on one occasion) were collected via EMA and ACASI and compared using McNemar’s tests. Demographic and behavioral correlates of daily concordance between EMA and ACASI were assessed for each substance, using separate multivariable logistic regression models, fit with generalized estimating equations. Results: Among 30 MSM, a total of 994 days were included in the analysis for methamphetamine use, 987 for alcohol use, and 981 for binge alcohol use. Methamphetamine (EMA 20%, ACASI 11%, P<.001) and alcohol use (EMA 40%, ACASI 35%, P=.001) were reported significantly more frequently via EMA versus ACASI. In multivariable analysis, text reporting of methamphetamine (adjusted odds ratio 0.06, 95% CI 0.04-0.10), alcohol (0.48, 0.33-0.69), and binge alcohol use (0.27, 0.17-0.42) was negatively associated with daily concordance in the reporting of each respective substance. Compared to white participants, African American participants were less likely to have daily concordance in methamphetamine (0.15, 0.05-0.43) and alcohol (0.2, 0.05-0.54) reporting, and other participants of color (ie, Asian, Hispanic, multi-racial) were less likely to have daily concordance in methamphetamine reporting (0.34, 0.12-1.00). College graduates were more likely to have daily concordance in methamphetamine reporting (6.79, 1.84-25.04) compared to those with no college experience. Conclusions: We found that methamphetamine and alcohol use were reported more frequently with daily EMA texts compared to retrospective ACASI, concordance varied among different racial/ethnic subgroups and education levels, and reported substance use by EMA text was associated with lower daily concordance with retrospective ACASI. These findings suggest that EMA methods may provide more complete reporting of frequent, discrete behaviors such as substance use. %M 27230545 %R 10.2196/mhealth.5368 %U http://mhealth.jmir.org/2016/2/e44/ %U https://doi.org/10.2196/mhealth.5368 %U http://www.ncbi.nlm.nih.gov/pubmed/27230545 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e65 %T Perceptions of the Feasibility and Practicalities of Text Messaging-Based Infectious Disease Surveillance: A Questionnaire Survey %A Dang,Linh Thuy %A Vu,Nguyen Cong %A Vu,Thiem Dinh %A James,Spencer L %A Katona,Peter %A Katona,Lindsay %A Rosen,Joseph M %A Nguyen,Cuong Kieu %+ Institute of Population, Health and Development, 18 Lane 132, Hoa Bang Street, Hanoi, 122667, Vietnam, 84 437822388 ext 822, cuong.kieu.nguyen@phad.org %K SMS %K SMS-based %K infectious diseases %K text messaging %K surveillance %K Vietnam %D 2016 %7 25.05.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: In Vietnam, infectious disease surveillance data are collected via a paper-based system through four government tiers leading to a large delay. Meanwhile, mobile phones are abundant and very popular in the country, and known to be a useful tool in health care worldwide. Therefore, there is a great potential for the development of a timely disease surveillance system through the use of mobile phone short message service (SMS) text messages. Objective: This study aims to explore insights about the feasibility and practicalities of the utilization of SMS text messaging-based interventions in disease-reporting systems by identifying potential challenges and barriers in the text messaging process and looking at lessons learned. Methods: An SMS text messaging-based disease tracking system was set up in Vietnam with patient reports texted by clinic staff. Two 6-month trials utilizing this disease tracking system were designed and implemented in two northern provinces of Vietnam to report two infectious diseases: diarrhea and influenza-like illness. A structured self-reported questionnaire was developed to measure the feasibility and practicalities of the system from the participants. On the completion of the second trial in 2013, participating health staff from 40 commune health centers in the two pilot provinces were asked to complete the survey (N=80). Results: Most participants were female (61%, 49/80) and nearly half (44%, 35/80) were heads of a commune health center. Approximately two-thirds (63%, 50/80) of participants retained the basic structure of the SMS text message report and there was a strong influence (OR 28.2, 95% CI 5.3-151.2) of those people on the time they spent texting the information. The majority (88%, 70/80) felt the information conveyed in the SMS text message report was not difficult to understand. Most (86%, 69/80) believed that they could report all 28 infectious diseases asked for by the Ministry of Health by using SMS text messaging. Conclusions: From a health center staff perspective, a disease-reporting system utilizing text messaging technology is easy to use and has great potential to be implemented and expanded nationwide. The survey showed positive perceptions and feedback from the participants and contributed to a promising practical solution to improve the surveillance system of infectious disease in Vietnam. %M 27226418 %R 10.2196/mhealth.4509 %U http://mhealth.jmir.org/2016/2/e65/ %U https://doi.org/10.2196/mhealth.4509 %U http://www.ncbi.nlm.nih.gov/pubmed/27226418 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e49 %T Text Messaging-Based Interventions for Smoking Cessation: A Systematic Review and Meta-Analysis %A Scott-Sheldon,Lori A. J %A Lantini,Ryan %A Jennings,Ernestine G %A Thind,Herpreet %A Rosen,Rochelle K %A Salmoirago-Blotcher,Elena %A Bock,Beth C %+ Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, United States, 1 401 793 8714, lori_scott-sheldon@brown.edu %K text messaging %K smoking cessation %K intervention %K cigarette smoking %K meta-analysis %D 2016 %7 20.05.2016 %9 Review %J JMIR mHealth uHealth %G English %X Background: Tobacco use is one of the leading preventable global health problems producing nearly 6 million smoking-related deaths per year. Interventions delivered via text messaging (short message service, SMS) may increase access to educational and support services that promote smoking cessation across diverse populations. Objective: The purpose of this meta-analysis is to (1) evaluate the efficacy of text messaging interventions on smoking outcomes, (2) determine the robustness of the evidence, and (3) identify moderators of intervention efficacy. Methods: Electronic bibliographic databases were searched for records with relevant key terms. Studies were included if they used a randomized controlled trial (RCT) to examine a text messaging intervention focusing on smoking cessation. Raters coded sample and design characteristics, and intervention content. Summary effect sizes, using random-effects models, were calculated and potential moderators were examined. Results: The meta-analysis included 20 manuscripts with 22 interventions (N=15,593; 8128 (54%) women; mean age=29) from 10 countries. Smokers who received a text messaging intervention were more likely to abstain from smoking relative to controls across a number of measures of smoking abstinence including 7-day point prevalence (odds ratio (OR)=1.38, 95% confidence interval (CI)=1.22, 1.55, k=16) and continuous abstinence (OR=1.63, 95% CI=1.19, 2.24, k=7). Text messaging interventions were also more successful in reducing cigarette consumption relative to controls (d+=0.14, 95% CI=0.05, 0.23, k=9). The effect size estimates were biased when participants who were lost to follow-up were excluded from the analyses. Cumulative meta-analysis using the 18 studies (k=19) measuring abstinence revealed that the benefits of using text message interventions were established only after only five RCTs (k=5) involving 8383 smokers (OR=1.39, 95% CI=1.15, 1.67, P<.001). The inclusion of the subsequent 13 RCTs (k=14) with 6870 smokers did not change the established efficacy of text message interventions for smoking abstinence (OR=1.37, 95% CI=1.25, 1.51, P<.001). Smoking abstinence rates were stronger when text messaging interventions (1) were conducted in Asia, North America, or Europe, (2) sampled fewer women, and (3) recruited participants via the Internet. Conclusions: The evidence for the efficacy of text messaging interventions to reduce smoking behavior is well-established. Using text messaging to support quitting behavior, and ultimately long-term smoking abstinence, should be a public health priority. %M 27207211 %R 10.2196/mhealth.5436 %U http://mhealth.jmir.org/2016/2/e49/ %U https://doi.org/10.2196/mhealth.5436 %U http://www.ncbi.nlm.nih.gov/pubmed/27207211 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e42 %T Evaluating the Maintenance of Lifestyle Changes in a Randomized Controlled Trial of the ‘Get Healthy, Stay Healthy’ Program %A Fjeldsoe,Brianna S %A Goode,Ana D %A Phongsavan,Philayrath %A Bauman,Adrian %A Maher,Genevieve %A Winkler,Elisabeth %A Eakin,Elizabeth G %+ School of Public Health, Cancer Prevention Research Centre, The University of Queensland, Public Health Building, Herston Rd, Herston, Brisbane, 4502, Australia, 61 73365 5435, b.fjeldsoe@sph.uq.edu.au %K maintenance %K mHealth %K physical activity %K exercise %K diet %K nutrition %K text message %K behavior change %D 2016 %7 10.05.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Extending contact with participants after initial, intensive intervention may support maintenance of weight loss and related behaviors. Objective: This community-wide trial evaluated a text message (short message service, SMS)-delivered, extended contact intervention (‘Get Healthy, Stay Healthy’ (GHSH)), which followed on from a population-level, behavioral telephone coaching program. Methods: This study employed a parallel, randomized controlled trial: GHSH compared with no continued contact (standard practice). Participants (n=228) were recruited after completing a 6-month lifestyle telephone coaching program: mean age = 53.4 (standard deviation (SD)=12.3) years; 66.7% (152/228) female; mean body mass index (BMI) upon entering GHSH=29.5 kg/m2 (SD = 6.0). Participants received tailored text messages over a 6-month period. The message frequency, timing, and content of the messages was based on participant preference, ascertained during two tailoring telephone calls. Primary outcomes of body weight, waist circumference, physical activity (walking, moderate, and vigorous sessions/week), and dietary behaviors (fruit and vegetable serves/day, cups of sweetened drinks per day, takeaway meals per week; fat, fiber and total indices from the Fat and Fiber Behavior Questionnaire) were assessed via self-report before (baseline) and after (6-months) extended contact (with moderate-vigorous physical activity (MVPA) also assessed via accelerometry). Results: Significant intervention effects, all favoring the intervention group, were observed at 6-months for change in weight (-1.35 kg, 95% confidence interval (CI): -2.24, -0.46, P=.003), weekly moderate physical activity sessions (0.56 sessions/week, 95% CI: 0.15, 0.96, P=.008) and accelerometer-assessed MVPA (24.16 minutes/week, 95% CI: 5.07, 43.25, P=.007). Waist circumference, other physical activity outcomes and dietary outcomes, did not differ significantly between groups. Conclusions: The GHSH extended care intervention led to significantly better anthropometric and physical activity outcomes than standard practice (no contact). This evidence is useful for scaling up the delivery of GHSH as standard practice following the population-level telephone coaching program. %M 27166643 %R 10.2196/mhealth.5280 %U http://mhealth.jmir.org/2016/2/e42/ %U https://doi.org/10.2196/mhealth.5280 %U http://www.ncbi.nlm.nih.gov/pubmed/27166643 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 2 %P e77 %T Feasibility of PRIME: A Cognitive Neuroscience-Informed Mobile App Intervention to Enhance Motivated Behavior and Improve Quality of Life in Recent Onset Schizophrenia %A Schlosser,Danielle %A Campellone,Timothy %A Kim,Daniel %A Truong,Brandy %A Vergani,Silvia %A Ward,Charlie %A Vinogradov,Sophia %+ University of California, San Francisco, Department of Psychiatry, 401 Parnassus Ave, San Francisco, CA, 94134, United States, 1 415 476 8721, danielle.schlosser@ucsf.edu %K schizophrenia %K mobile app %K smartphone %K motivation %K technology-based intervention %K social networking %K coaching %K negative symptoms %K quality of life %D 2016 %7 28.04.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Despite improvements in treating psychosis, schizophrenia remains a chronic and debilitating disorder that affects approximately 1% of the US population and costs society more than depression, dementia, and other medical illnesses across most of the lifespan. Improving functioning early in the course of illness could have significant implications for long-term outcome of individuals with schizophrenia. Yet, current gold-standard treatments do not lead to clinically meaningful improvements in outcome, partly due to the inherent challenges of treating a population with significant cognitive and motivational impairments. The rise of technology presents an opportunity to develop novel treatments that may circumvent the motivational and cognitive challenges observed in schizophrenia. Objective: The purpose of this study was two-fold: (1) to evaluate the feasibility and acceptability of implementing a Personalized Real-Time Intervention for Motivation Enhancement (PRIME), a mobile app intervention designed to target reward-processing impairments, enhance motivation, and thereby improve quality of life in recent onset schizophrenia, and (2) evaluate the empirical benefits of using an iterative, user-centered design (UCD) process. Methods: We conducted two design workshops with 15 key stakeholders, followed by a series of in-depth interviews in collaboration with IDEO, a design and innovation firm. The UCD approach ultimately resulted in the first iteration of PRIME, which was evaluated by 10 RO participants. Results from the Stage 1 participants were then used to guide the next iteration that is currently being evaluated in an ongoing RCT. Participants in both phases were encouraged to use the app daily with a minimum frequency of 1/week over a 12-week period. Results: The UCD process resulted in the following feature set: (1) delivery of text message (short message service, SMS)-based motivational coaching from trained therapists, (2) individualized goal setting in prognostically important psychosocial domains, (3) social networking via direct peer-to-peer messaging, and (4) community “moments feed” to capture and reinforce rewarding experiences and goal achievements. Users preferred an experience that highlighted several of the principles of self-determination theory, including the desire for more control of their future (autonomy and competence) and an approach that helps them improve existing relationships (relatedness). IDEO, also recommended an approach that was casual, friendly, and nonstigmatizing, which is in line with the recovery model of psychosis. After 12-weeks of using PRIME, participants used the app, on average, every other day, were actively engaged with its various features each time they logged in and retention and satisfaction was high (20/20, 100% retention, high satisfaction ratings). The iterative design process lead to a 2- to 3-fold increase in engagement from Stage 1 to Stage 2 in almost each aspect of the platform. Conclusions: These results indicate that the neuroscience-informed mobile app, PRIME, is a feasible and acceptable intervention for young people with schizophrenia. %M 27125771 %R 10.2196/resprot.5450 %U http://www.researchprotocols.org/2016/2/e77/ %U https://doi.org/10.2196/resprot.5450 %U http://www.ncbi.nlm.nih.gov/pubmed/27125771 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 4 %P e86 %T The Impact of Automated Brief Messages Promoting Lifestyle Changes Delivered Via Mobile Devices to People with Type 2 Diabetes: A Systematic Literature Review and Meta-Analysis of Controlled Trials %A Arambepola,Carukshi %A Ricci-Cabello,Ignacio %A Manikavasagam,Pavithra %A Roberts,Nia %A French,David P %A Farmer,Andrew %+ University of Oxford, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford., Oxford, OX2 6GG, United Kingdom, 44 01865 617190, ignacio.riccicabello@phc.ox.ac.uk %K Diabetes mellitus, type 2 %K mobile health %K text messaging %K systematic review %K diet %K physical activity %K self-care %D 2016 %7 19.04.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Brief automated messages have the potential to support self-management in people with type 2 diabetes, but their effect compared with usual care is unclear. Objective: To examine the effectiveness of interventions to change lifestyle behavior delivered via automated brief messaging in patients with type 2 diabetes. Methods: A systematic literature review of controlled trials examined the impact of interventions, delivered by brief messaging, and intended to promote lifestyle change in people with type 2 diabetes, on behavioral and clinical outcomes. Bibliographic databases searched included Medline, Embase, CINAHL, PsycINFO, and ISI WoK. Two reviewers independently screened citations. We extracted information on study risk of bias, setting (high versus low- and middle-income countries) and intervention characteristics (including use of theory and behavior-change techniques). Outcome measures included acceptability of the interventions and their impact on 1) determinants of lifestyle behavior (knowledge about diabetes, self-efficacy, attitudes towards self-management), 2) lifestyle behavior (diet, physical activity), and 3) clinical and patient-reported outcomes. Where possible, we pooled data using random-effects meta-analyses to obtain estimates of effect size of intervention compared to usual care. Results: We identified 15 trials (15 interventions) meeting our inclusion criteria. Most interventions were delivered via short message service text messaging (n=12) and simultaneously targeted diet and physical activity (n=11). Nine interventions consisted of unidirectional messages, whereas six consisted of bidirectional messages, with patients receiving automated tailored feedback based on self-reported data. The acceptability of the interventions, and their impact on lifestyle behavior and its determinants, were examined in a low proportion of trials, with heterogeneous results being observed. In 13 trials (1155 patients) where data were available, there was a difference in glycated hemoglobin of -0.53% (95% CI -0.59% to -0.47%) between intervention groups compared to usual care. In five trials (406 patients) there was a non-significant difference in body mass index of -0.25 kg/m2 (95% CI -1.02 to 0.52). Interventions based on unidirectional messages produced similar effects in the outcomes examined, compared to those based on bidirectional messages. Interventions conducted in low- and middle-income countries showed a greater impact than those conducted in high-income countries. In general, trials were not free of bias and did not use explicit theory. Conclusions: Automated brief messages strategies can improve health outcomes in people with type 2 diabetes. Larger, methodologically robust trials are needed to confirm these positive results. %M 27095386 %R 10.2196/jmir.5425 %U http://www.jmir.org/2016/4/e86/ %U https://doi.org/10.2196/jmir.5425 %U http://www.ncbi.nlm.nih.gov/pubmed/27095386 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e26 %T Young People’s Views and Experiences of a Mobile Phone Texting Intervention to Promote Safer Sex Behavior %A French,Rebecca Sophia %A McCarthy,Ona %A Baraitser,Paula %A Wellings,Kaye %A Bailey,Julia V %A Free,Caroline %+ London School of Hygiene & Tropical Medicine, Department of Social & Environmental Health Research, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom, 44 (0)20 7927 2047, Rebecca.French@lshtm.ac.uk %K text messaging %K young people %K sexual health %K intervention %K qualitative interviews %K sexual behavior %K behavior change %D 2016 %7 15.04.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The risk of poor sexual health, including unplanned pregnancy and sexually transmitted infections (STIs), is greatest amongst young people. Innovative and acceptable interventions to improve sexual health are required. Mobile phone text messaging (short message service, SMS) interventions have the potential to reach large numbers of people at relatively low cost, but greater understanding is needed on how these interventions should be developed and how they work. Objectives: The aim of this paper is to explore young people’s views of and experiences with a mobile phone text messaging intervention to promote safer sex behavior. Methods: We undertook qualitative interviews with young people aged 16 to 24 years as part of a pilot trial of a sexual health intervention delivered by text message in the United Kingdom. Study participants received sexual health promotion text messages based on behavior-change techniques. The message content, tailored by gender and STI status, included support for correct STI treatment and promotion of safer sex behaviors. Young people were eligible if they had received a positive chlamydia test or had more than one partner and at least one episode of unprotected sex in the last year. Telephone interviews were conducted 2 to 3 weeks after initiation of the intervention. A semi-structured topic guide was followed to explore participant experiences and a thematic analysis was conducted. Results: We conducted 16 telephone interviews with participants who had received the text intervention and an additional four interviews with those in the control group (13 women and 7 men). Intervention participants found text messages easy to understand and appearing to come from a friendly and trustworthy source. They considered the frequency and timing of messages to be appropriate, and delivery via mobile phones convenient. Receipt of support by text message allowed recipients to assimilate information at their own pace, and prompted reflection on and sharing of messages with friends, family members, and partners, thus providing opportunities for education and discussion. For some recipients, the messages had increased their knowledge of how to correctly use condoms. Some described how the messages had increased their confidence and reduced stigma, enabling them to disclose infection to a partner and/or to do so sooner and more calmly. Discussing the messages with a partner reportedly enabled some women to negotiate condom use. Conclusion: From the perspective of the recipients, the tone, frequency, and content of the text messaging-based sexual health intervention was acceptable and appropriate. Their accounts indicated that the intervention increased knowledge, confidence, and safer sex behaviors. A large-scale randomized controlled trial (RCT) is needed to assess effectiveness. %M 27083784 %R 10.2196/mhealth.4302 %U http://mhealth.jmir.org/2016/2/e26/ %U https://doi.org/10.2196/mhealth.4302 %U http://www.ncbi.nlm.nih.gov/pubmed/27083784 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e21 %T Automated Behavioral Text Messaging and Face-to-Face Intervention for Parents of Overweight or Obese Preschool Children: Results From a Pilot Study %A Militello,Lisa %A Melnyk,Bernadette Mazurek %A Hekler,Eric B %A Small,Leigh %A Jacobson,Diana %+ The Ohio State University, College of Nursing, 145 Newton Hall, 1585 Neil Ave, Columbus, OH, 43210, United States, 1 614 292 4844, militello.14@osu.edu %K Child %K Obesity %K Overweight %K Health Behavior %K Text Messaging/SMS %K Mobile Health %K Parents %K Psychology %K Behavior Therapy %K Telemedicine %D 2016 %7 14.03.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Children are 5 times more likely to be overweight at the age of 12 years if they are overweight during the preschool period. Objective: The purpose of this study was to establish the feasibility, acceptability, and preliminary effects of a cognitive behavioral intervention (TEXT2COPE) synergized with tailored mobile technology (mHealth) on the healthy lifestyle behaviors of parents of overweight and obese preschoolers delivered in a primary care setting. Methods: Fifteen preschooler-parent dyads recruited through primary care clinics completed a manualized 7-week cognitive behavioral skills building intervention. Beck’s Cognitive Theory guided the TEXT2COPE intervention content and Fogg’s Behavior Model guided the implementation. The intervention employed a combination of face-to-face clinic visits and ecological momentary interventions using text messaging (short message service, SMS). To enhance the intervention’s relevance to the family’s needs, parents dictated the wording of the text messages and also were able to adapt the frequency and timing of delivery throughout program implementation. Results: Self-reported findings indicate that the program is feasible and acceptable in this population. The intervention showed preliminary effects with significant improvements on parental knowledge about nutrition (P=.001) and physical activity (P=.012) for their children, parental beliefs (P=.001) toward healthy lifestyles, and parental behaviors (P=.040) toward engaging in healthy lifestyle choices for their children. Effect sizes were medium to large for all variables. The timing, frequency, and wording of the text messages were tailored to the individual families, with 69% of parents (9/13) increasing the frequency of the tailored SMS from being sent once weekly to as many as 5 times a week. Conclusions: Utilizing a cognitive behavioral skills intervention with SMS has great potential for supporting clinical care of overweight and obese preschool children and their families. Further exploration of the potential effects on health and behavioral outcomes is warranted. %M 26976387 %R 10.2196/mhealth.4398 %U http://mhealth.jmir.org/2016/1/e21/ %U https://doi.org/10.2196/mhealth.4398 %U http://www.ncbi.nlm.nih.gov/pubmed/26976387 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e22 %T Hypertension Health Promotion via Text Messaging at a Community Health Center in South Africa: A Mixed Methods Study %A Hacking,Damian %A Haricharan,Hanne J %A Brittain,Kirsty %A Lau,Yan Kwan %A Cassidy,Tali %A Heap,Marion %+ Health and Human Rights Programme, Department of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, 7925, South Africa, 27 848238040, damianuct@gmail.com %K telemedicine %K health knowledge, attitudes, practice %K developing countries %K hypertension %D 2016 %7 10.03.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The use of mobile phones to deliver health care (mHealth) is increasing in popularity due to the high prevalence of mobile phone penetration. This is seen in developing countries, where mHealth may be particularly useful in overcoming traditional access barriers. Non-communicable diseases may be particularly amenable to mHealth interventions, and hypertension is one with an escalating burden in the developing world. Objective: The objective of this study was to test whether the dissemination of health information via a short message service (SMS) led to improvements in health knowledge and self-reported health-related behaviors. Methods: A mixed methods study was carried out among a cohort of 223 hypertension clinic patients, in a resource-poor setting in Cape Town, South Africa, in 2012. Hypertensive outpatients were recruited at the clinic and administered a baseline questionnaire to establish existing knowledge of hypertension. Participants were then randomly assigned to intervention or control groups. The intervention group received 90 SMSes over a period of 17 weeks. Thereafter, the baseline questionnaire was readministered to both groups to gauge if any improvements in health knowledge had occurred. Those who received SMSes were asked additional questions about health-related behavior changes. A focus group was then conducted to obtain in-depth feedback about participants’ experience with, and response to, the SMS campaign. Results: No statistically significant changes in overall health knowledge were observed between the control and intervention groups. The intervention group had positive increases in self-reported behavior changes. These were reaffirmed by the focus groups, which also revealed a strong preference for the SMS campaign and the belief that the SMSes acted as a reminder to change, as opposed to providing new information. Conclusions: Although the content of the SMSes was not new, and did not improve health knowledge, SMSes were effective in motivating positive self-reported behavior change among hypertensive patients. Trial Registration: Pan African Clinical Trials Registry Number: PACTR201412000968462. Registered 18 December 2014 (Archived by WebCite at http://www.webcitation.org/6fhtyLRcO). %M 26964505 %R 10.2196/mhealth.4569 %U http://mhealth.jmir.org/2016/1/e22/ %U https://doi.org/10.2196/mhealth.4569 %U http://www.ncbi.nlm.nih.gov/pubmed/26964505 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e10 %T Unpacking the Black Box: A Formative Research Approach to the Development of Theory-Driven, Evidence-Based, and Culturally Safe Text Messages in Mobile Health Interventions %A Maar,Marion A %A Yeates,Karen %A Toth,Zsolt %A Barron,Marcia %A Boesch,Lisa %A Hua-Stewart,Diane %A Liu,Peter %A Perkins,Nancy %A Sleeth,Jessica %A Wabano,Mary Jo %A Williamson,Pamela %A Tobe,Sheldon W %+ Faculty of Medicine, Northern Ontario School of Medicine, Laurentian University, 935 Ramsey Lake Road, Sudbury, ON, , Canada, 1 705 662 7233, mmaar@nosm.ca %K Aboriginal people %K behavioral change wheel %K cultural safety %K grounded theory %K mobile phone %K semiotics %K SMS %K Tanzania %K text messages %D 2016 %7 22.01.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile-cellular subscriptions have increased steadily over the past decade. The accessibility of SMS messages over existing mobile networks is high and has almost universal availability even on older and unsophisticated mobile phones and in geographic settings where wireless coverage is weak. There is intensive exploration of this inexpensive mobile telecommunication technology to improve health services and promote behavior change among vulnerable populations. However, a neglected area of research is the documentation and critical analysis of the formative research process required in the development and refinement of effective SMS messages. Objective: The objective of this qualitative research study was to identify major factors that may impact on the effectiveness of evidence-based SMS messages designed to reduce health inequities in hypertension management in low resource settings, including Aboriginal populations in high-income countries and rural populations in low-income countries. Specifically, we were interested in uncovering the range of mediators that impact on appropriate message content transmission and, ultimately, on health behavior improvements in a range of these sociocultural settings. Methods: Collaborative qualitative research with Canadian Aboriginal and Tanzanian participants was conducted to deconstruct the content and transmission of evidence-based health information contained in SMS messages in the context of an international research project designed to address health inequalities in hypertension, and to develop a grounded theory of the major factors that mediate the effectiveness of this communication. We also examined the interrelationship of these mediators with the three essential conditions of the behavior system of the Behavioral Change Wheel model (capability, opportunity, and motivation) and cultural safety. Results: Four focus groups with a total of 45 participants were conducted. Our grounded theory research revealed how discrepancies develop between the evidence-based text message created by researchers and the message received by the recipient in mobile health interventions. These discrepancies were primarily generated by six mediators of meaning in SMS messages: (1) negative or non-affirming framing of advocacies, (2) fear- or stress-inducing content, (3) oppressive or authoritarian content, (4) incongruity with cultural and traditional practices, (5) disconnect with the reality of the social determinants of health and the diversity of cultures within a population, and (6) lack of clarity and/or practicality of content. These 6 mediators of meaning provide the basis for sound strategies for message development because they impact directly on the target populations’ capability, opportunity, and motivation for behavior change. Conclusions: The quality of text messages impacts significantly on the effectiveness of a mobile health intervention. Our research underscores the urgent need for interventions to incorporate and evaluate the quality of SMS messages and to examine the mediators of meaning within each targeted cultural and demographic group. Reporting on this aspect of mobile health intervention research will allow researchers to move away from the current black box of SMS text message development, thus improving the transparency of the process as well as the quality of the outcomes. %M 26800712 %R 10.2196/mhealth.4994 %U http://mhealth.jmir.org/2016/1/e10/ %U https://doi.org/10.2196/mhealth.4994 %U http://www.ncbi.nlm.nih.gov/pubmed/26800712 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e1 %T Preferred Tone of Nutrition Text Messages for Young Adults: Focus Group Testing %A Pollard,Christina Mary %A Howat,Peter A %A Pratt,Iain S %A Boushey,Carol J %A Delp,Edward J %A Kerr,Deborah Anne %+ School of Public Health, Curtin University, Kent Street, Bentley, 6012, Australia, 61 892661142, C.Pollard@curtin.edu.au %K text messages %K tone of voice %K nutrition messages %K fruit %K vegetable %K junk food %K alcohol %K communication %D 2016 %7 19.01.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Young adults are a particularly hard to reach group using conventional health promotion practices as they do not see nutrition messages as personally relevant to them. Text messaging (short message service, SMS) offers an innovative approach to reaching young adults to support and promote dietary behavior change. Objective: The aim of this study was to develop and test tonal preferences for nutrition text messages among young adults using focus groups. Methods: A total of 39 young adults aged 18-30 years residing in Perth, Western Australia participated in four focus groups. Participants briefly discussed their perception of healthy eating and their responses to messages about increasing fruit and vegetables, and reducing “junk food” and alcohol intake. They ranked their preference for 15 nutrition messages across 3 dietary behaviors (fruit and vegetables, junk food, and alcohol) with 5 different message tones (authoritative, empathetic, generation Y, solutions, and substitutions) and identified the messages most likely to persuade young adults to change their diet. A 5-point ranking of the nutrition messages was from the most likely to least likely to persuade (1-5). The focus groups were conducted by a trained facilitator and observer and were recorded. Data driven content analysis was used to explore themes. Tonal preferences and potential motivators were collated and frequencies presented. Results: Participants ranked offering substitutes (29%, 11/39) and using empathy (22%, 9/39) as the most persuasive message techniques in improving diets of young adults, with low responses for Generation Y (17%, 7/39), solutions (17%, 7/39), and authoritative (15%, 6/39) tones. Females were more likely to consider substitution messages persuasive (35%, 7/20) compared with males (22%, 4/19). A greater proportion of males compared with females considered authoritative messages persuasive: (22%, 4/19) compared with (7%, 1/20). There is a strong preference for a substitution tone for fruit and vegetable messages (52%, 20/39), and no overall message tone preference for junk food and alcohol messages. Substitutions were viewed as helpful and practical. Empathy was liked as it acknowledged previous efforts. Responses to authoritative tone were mixed with some feeling guilt while others found them informative. Acceptability of the solutions depended on the behavioral change and acceptability of the solution proposed. Generation Y tone had some support for junk food and alcohol messages, and if favored, was considered casual, humorous, catchy, and motivational. Conclusions: Substitutions and tone of empathy were favored as the most likely execution styles to motivate nutrition behavior change across all participants. There is no “one size fits all” with different tones preferred by individuals for different dietary behaviors. Although text messaging provides instant message delivery direct to the individual, these results demonstrate the complexity of developing motivational nutrition message for young adults. These findings reveal the importance of considering the tone and content and pretesting messages for health promotion text message interventions. %M 26787115 %R 10.2196/mhealth.4764 %U http://mhealth.jmir.org/2016/1/e1/ %U https://doi.org/10.2196/mhealth.4764 %U http://www.ncbi.nlm.nih.gov/pubmed/26787115 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 1 %P e5 %T Text Messaging for Exercise Promotion in Older Adults From an Upper-Middle-Income Country: Randomized Controlled Trial %A Müller,Andre Matthias %A Khoo,Selina %A Morris,Tony %+ Sports Centre, University of Malaya, Jalan Universiti, Kuala Lumpur, 50603, Malaysia, 60 11 11556673, andrematthiasmueller@gmail.com %K exercise %K text message %K mobile phone %K older adults %K mHealth %K Asia %K health behavior %K behavior maintenance %K physical activity %K Malaysia %D 2016 %7 07.01.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile technology to promote exercise is effective; however, most evidence is from studies of younger groups in high-income countries. Investigating if short message service (SMS) texting can affect exercise participation in older adults from an upper-middle-income country is important considering the proliferation of mobile phones in developing regions and the increased interest of older adults in using mobile phones. Objective: The main objective was to examine the short- and long-term effects of SMS text messaging on exercise frequency in older adults. Secondary objectives were to investigate how SMS text messages impact study participants’ exercise frequency and the effects of the intervention on secondary outcomes. Methods: The Malaysian Physical Activity for Health Study (myPAtHS) was a 24-week, 2-arm, parallel randomized controlled trial conducted in urban Malaysia. Participants were recruited via health talks in resident associations and religious facilities. Older Malaysians (aged 55-70 years) who used mobile phones and did not exercise regularly were eligible to participate in the study. Participants randomly allocated to the SMS texting arm received an exercise booklet and 5 weekly SMS text messages over 12 weeks. The content of the SMS text messages was derived from effective behavior change techniques. The non-SMS texting arm participants received only the exercise booklet. Home visits were conducted to collect outcome data: (1) exercise frequency at 12 and 24 weeks, (2) secondary outcome data (exercise self-efficacy, physical activity–related energy expenditure, sitting time, body mass index, grip and leg strength) at baseline and at 12 and 24 weeks. Intention-to-treat procedures were applied for data analysis. Semistructured interviews focusing primarily on the SMS text messages and their impact on exercise frequency were conducted at weeks 12 and 24. Results: In total, 43 participants were randomized into the SMS texting arm (n=22) and the non-SMS texting arm (n=21). Study-unrelated injuries forced 4 participants to discontinue after a few weeks (they were not included in any analyses). Overall retention was 86% (37/43). After 12 weeks, SMS texting arm participants exercised significantly more than non-SMS texting arm participants (mean difference 1.21 times, bias-corrected and accelerated bootstrap [BCa] 95% CI 0.18-2.24). Interview analysis revealed that the SMS text messages positively influenced SMS texting arm participants who experienced exercise barriers. They described the SMS text messages as being encouraging, a push, and a reminder. After 24 weeks, there was no significant difference between the research arms (mean difference 0.74, BCa 95% CI –0.30 to 1.76). There were no significant effects for secondary outcomes. Conclusions: This study provides evidence that SMS text messaging is effective in promoting exercise in older adults from an upper-middle-income country. Although the effects were not maintained when SMS text messaging ceased, the results are promising and warrant more research on behavioral mobile health interventions in other regions. Trial Registration: Clinicaltrials.gov NCT02123342; http://clinicaltrials.gov/ct2/show/NCT02123342 (Archived by WebCite at http://www.webcitation.org/6eGSsu2EI). %M 26742999 %R 10.2196/jmir.5235 %U http://www.jmir.org/2016/1/e5/ %U https://doi.org/10.2196/jmir.5235 %U http://www.ncbi.nlm.nih.gov/pubmed/26742999 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 4 %P e24 %T Use of Commonly Available Technologies for Diabetes Information and Self-Management Among Adolescents With Type 1 Diabetes and Their Parents: A Web-Based Survey Study %A Vaala,Sarah E %A Hood,Korey K %A Laffel,Lori %A Kumah-Crystal,Yaa A %A Lybarger,Cindy K %A Mulvaney,Shelagh A %+ Vanderbilt University, School of Nursing, 461 21st Avenue South, Nashville, TN, 37240, United States, 1 1 615 322 1198, shelagh.mulvaney@vanderbilt.edu %K diabetes mellitus, Type 1 %K adolescent %K technology %K adoption %K self-management %K self-care %D 2015 %7 29.12.2015 %9 Original Paper %J Interact J Med Res %G English %X Background: For individuals with Type 1 diabetes (T1D), following a complicated daily medical regimen is critical to maintaining optimal health. Adolescents in particular struggle with regimen adherence. Commonly available technologies (eg, diabetes websites, apps) can provide diabetes-related support, yet little is known about how many adolescents with T1D use them, why they are used, or relationships between use and self-management. Objective: This study examined adolescent and parent use of 5 commonly available technologies for diabetes, including proportions who use each technology, frequency of use, and number of different technologies used for diabetes. Analyses also investigated the reasons adolescents reported for using or not using technologies for diabetes, and factors correlated with adolescents’ technology use. Finally, this study examined relationships between the type and number of technologies adolescents use for diabetes and their self-management and glycemic control. Methods: Adolescents (12-17 years) and their parents (N=174 pairs), recruited from a pediatric diabetes clinic (n=134) and the Children with Diabetes community website (n=40), participated in this Web-based survey study. Glycosylated hemoglobin (A1C) values were obtained from medical records for pediatric clinic patients. Adolescents reported their use of 5 commonly available technologies for diabetes (ie, social networking, diabetes websites, mobile diabetes apps, text messaging, and glucometer/insulin pump software), reasons for use, and self-management behavior (Self-Care Inventory-Revised, SCI-R). Results: Most adolescents and parents used at least one of the 5 technologies for diabetes. Among adolescents, the most commonly used technology for diabetes was text messaging (53%), and the least commonly used was diabetes websites (25%). Most adolescents who used diabetes apps, text messaging, or pump/glucometer software did so more frequently (≥2 times per week), compared to social networking and website use (≤1 time per week). The demographic, clinical, and parent-technology use factors related to adolescents’ technology use varied by technology. Adolescents who used social networking, websites, or pump/glucometer software for diabetes had better self-management behavior (SCI-R scores: beta=.18, P=.02; beta=.15, P=.046; beta=.15, P=.04, respectively), as did those who used several technologies for diabetes (beta=.23, P=.003). However, use of diabetes websites was related to poorer glycemic control (A1C: beta=.18, P=.01). Conclusions: Adolescents with T1D may be drawn to different technologies for different purposes, as individual technologies likely offer differing forms of support for diabetes self-management (eg, tracking blood glucose or aiding problem solving). Findings suggest that technologies that are especially useful for adolescents’ diabetes problem solving may be particularly beneficial for their self-management. Additional research should examine relationships between the nature of technology use and adolescents’ T1D self-management over time. %M 26715191 %R 10.2196/ijmr.4504 %U http://www.i-jmr.org/2015/4/e24/ %U https://doi.org/10.2196/ijmr.4504 %U http://www.ncbi.nlm.nih.gov/pubmed/26715191 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 4 %P e107 %T Developing and Pretesting a Text Messaging Program for Health Behavior Change: Recommended Steps %A Abroms,Lorien C %A Whittaker,Robyn %A Free,Caroline %A Mendel Van Alstyne,Judith %A Schindler-Ruwisch,Jennifer M %+ The Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, 3rd Floor, Washington, DC, 20052, United States, 1 202 994 3518, lorien@gwu.edu %K mHealth %K telemedicine %K SMS %K text messaging %K behavior change %K behavior modification %D 2015 %7 21.12.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: A growing body of evidence demonstrates that text messaging-based programs (short message service [SMS]) on mobile phones can help people modify health behaviors. Most of these programs have consisted of automated and sometimes interactive text messages that guide a person through the process of behavior change. Objective: This paper provides guidance on how to develop text messaging programs aimed at changing health behaviors. Methods: Based on their collective experience in designing, developing, and evaluating text messaging programs and a review of the literature, the authors drafted the guide. One author initially drafted the guide and the others provided input and review. Results: Steps for developing a text messaging program include conducting formative research for insights into the target audience and health behavior, designing the text messaging program, pretesting the text messaging program concept and messages, and revising the text messaging program. Conclusions: The steps outlined in this guide may help in the development of SMS-based behavior change programs. %M 26690917 %R 10.2196/mhealth.4917 %U http://mhealth.jmir.org/2015/4/e107/ %U https://doi.org/10.2196/mhealth.4917 %U http://www.ncbi.nlm.nih.gov/pubmed/26690917 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 4 %P e105 %T A Text-Messaging and Pedometer Program to Promote Physical Activity in People at High Risk of Type 2 Diabetes: The Development of the PROPELS Follow-On Support Program %A Morton,Katie %A Sutton,Stephen %A Hardeman,Wendy %A Troughton,Jacqui %A Yates,Tom %A Griffin,Simon %A Davies,Melanie %A Khunti,Kamlesh %A Eborall,Helen %+ Social Science Applied to Healthcare Improvement Research Group, Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester, , United Kingdom, 44 116 252 5400, hce3@le.ac.uk %K physical activity %K mHealth %K text messaging %K pedometer %K tailoring %K type 2 diabetes %K intervention development %D 2015 %7 15.12.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile technologies for health (mHealth) represent a promising strategy for reducing type 2 diabetes (T2DM) risk. The PROPELS trial investigates whether structured group-based education alone or supplemented with a follow-on support program combining self-monitoring with pedometers and tailored text-messaging is effective in promoting and maintaining physical activity among people at high risk of T2DM. Objective: This paper describes the iterative development of the PROPELS follow-on support program and presents evidence on its acceptability and feasibility. Methods: We used a modified mHealth development framework with four phases: (1) conceptualization of the follow-on support program using theory and evidence, (2) formative research including focus groups (n=15, ages 39-79 years), (3) pre-testing focus groups using a think aloud protocol (n=20, ages 52-78 years), and (4) piloting (n=11). Analysis was informed by the constant comparative approach, with findings from each phase informing subsequent phases. Results: The first three phases informed the structure, nature, and content of the follow-on support program, including the frequency of text messages, the need for tailored content and two-way interaction, the importance of motivational messages based on encouragement and reinforcement of affective benefits (eg, enjoyment) with minimal messages about weight and T2DM risk, and the need for appropriate language. The refined program is personalized and tailored to the individual’s perceived confidence, previous activity levels, and physical activity goals. The pilot phase indicated that the program appeared to fit well with everyday routines and was easy to use by older adults. Conclusions: We developed a feasible and innovative text messaging and pedometer program based on evidence and behavior change theory and grounded in the experiences, views, and needs of people at high diabetes risk. A large scale trial is testing the effectiveness of this 4-year program over and above structured group education alone. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 83465245; http://www.controlled-trials.com/ISRCTN83465245/83465245 (Archived by WebCite at http://www.webcitation.org/6dfSmrVAe) %M 26678750 %R 10.2196/mhealth.5026 %U http://mhealth.jmir.org/2015/4/e105/ %U https://doi.org/10.2196/mhealth.5026 %U http://www.ncbi.nlm.nih.gov/pubmed/26678750 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 12 %P e278 %T Preventing Alcohol Abuse Through Social Networking Sites: A First Assessment of a Two-Year Ecological Approach %A Flaudias,Valentin %A de Chazeron,Ingrid %A Zerhouni,Oulmann %A Boudesseul,Jordane %A Begue,Laurent %A Bouthier,Renaud %A Lévrier,Christel %A Llorca,Pierre Michel %A Brousse,Georges %+ CHU Clermont-Ferrand, Pôle Psychiatrie B, 58 Rue Montalembert, Clermont-Ferrand, F-63000, France, 33 473752072, vflaudias@chu-clermontferrand.fr %K social networking %K primary prevention %K alcohol consumption %K students %D 2015 %7 10.12.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Prevention strategies to reduce alcohol use/consumption among young people are crucial to reducing alcohol-related deaths and preventing disease. This paper focuses on the effectiveness of a social networking site (SNS) alcohol prevention program targeted toward young people. Objective: We hypothesized that the program would diminish the relation made by participants between alcohol and festive moments, and would result in a reduction of their declared consumption of alcohol at festive moments during the program. We also explored the interaction with the prevention program that was the most efficient. Methods: The prevention program took the form of 3 lotteries over 2 years. The participants periodically received prevention messages, particularly on alcohol and festive moments (eg, videos on Facebook and short message service [SMS] text messages on their mobile phones). For the 3 periods, the participants had to answer questions exploring the level of their belief that alcohol consumption and festive moments are highly associated. A control group that did not participate in the prevention program was asked the same questions over the same number of days for the first 2 periods. During the second period, the participants were asked to answer questions about their alcohol consumption during parties. During the third period, we explored the interaction with the prevention program on the reduction of their belief that alcohol consumption and festive moments are associated. Results: A total of 651 participants (age: mean 22.24, SD 4.10 years; women: n=430) during the first period, 301 participants (age: mean 21.27, SD 3.07 years; women n=199) during the second period, and 305 (age: mean 22.41, SD 4.65 years; women: n=190) during the third period correctly completed the survey. For the control group, 69 students completed the survey during the first period (age: mean 18.93, SD 1.14 years; women: n=59) and 50 during the second (age: mean 20.78, SD 1.94 years; women: n=45). We observed a significant reduction in the association of alcohol with festive moments in the participants over the 2 years (period 1: z=–4.80, P<.001; period 2: z=–2.11, P=.04; period 3: z=–2.30; P=.02), but not in the controls. We also observed a reduction in the number of glasses consumed during festive moments for the participants (z=–2.36, P=.02), but not for the controls during the second period. The third period showed that only the number of days since registration in the program had an impact on the reduction of the association of festive moments and alcohol consumption (t21=3.186, P=.005). Conclusions: The findings of this study suggest that the SNS prevention program is promising in preventing the association of alcohol with festive moments and, more generally, in impacting social norms. %M 26681577 %R 10.2196/jmir.4233 %U http://www.jmir.org/2015/12/e278/ %U https://doi.org/10.2196/jmir.4233 %U http://www.ncbi.nlm.nih.gov/pubmed/26681577 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 11 %P e267 %T The Impact of an eHealth Portal on Health Care Professionals’ Interaction with Patients: Qualitative Study %A Das,Anita %A Faxvaag,Arild %A Svanæs,Dag %+ Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Medisinsk Teknisk Forskningssenter, Trondheim, 7491, Norway, 47 97599434, anita.das@ntnu.no %K bariatric surgery %K online communication %K eHealth %K patient %K health care %K Web 2.0 %D 2015 %7 24.11.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: People who undergo weight loss surgery require a comprehensive treatment program to achieve successful outcomes. eHealth solutions, such as secure online portals, create new opportunities for improved health care delivery and care, but depend on the organizational delivery systems and on the health care professionals providing it. So far, these have received limited attention and the overall adoption of eHealth solutions remains low. In this study, a secure eHealth portal was implemented in a bariatric surgery clinic and offered to their patients. During the study period of 6 months, 60 patients and 5 health care professionals had access. The portal included patient information, self-management tools, and communication features for online dialog with peers and health care providers at the bariatric surgery clinic. Objective: The aim of this study was to characterize and assess the impact of an eHealth portal on health care professionals’ interaction with patients in bariatric surgery. Methods: This qualitative case study involved a field study consisting of contextual interviews at the clinic involving observing and speaking with personnel in their actual work environment. Semi-structured in-depth interviews were conducted with health care professionals who interacted with patients through the portal. Analysis of the collected material was done inductively using thematic analysis. Results: The analysis revealed two main dimensions of using an eHealth portal in bariatric surgery: the transparency it represents and the responsibility that follows by providing it. The professionals reported the eHealth portal as (1) a source of information, (2) a gateway to approach and facilitate the patients, (3) a medium for irrevocable postings, (4) a channel that exposes responsibility and competence, and (5) a tool in the clinic. Conclusions: By providing an eHealth portal to patients in a bariatric surgery program, health care professionals can observe patients’ writings and revelations thereby capturing patient challenges and acting and implementing measures. Interacting with patients through the portal can prevent dropouts and deterioration of patients’ health. However, professionals report on organizational challenges and personal constraints related to communicating with patients in writing online. Further development of guidelines and education of health care professionals about how to handle, prioritize, communicate, and facilitate patients online is required in addition to increased attention to the organizational infrastructures and incentives for enabling such solutions in health care. %M 26601678 %R 10.2196/jmir.4950 %U http://www.jmir.org/2015/11/e267/ %U https://doi.org/10.2196/jmir.4950 %U http://www.ncbi.nlm.nih.gov/pubmed/26601678 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 1 %N 2 %P e12 %T Texting-Based Reporting of Adverse Drug Reactions to Ensure Patient Safety: A Feasibility Study %A Vergeire-Dalmacion,Godofreda %A Castillo-Carandang,Nina T %A Juban,Noel R %A Amarillo,Maria Lourdes %A Tagle,Maria Pamela %A Baja,Emmanuel S %+ College of Medicine, Department of Pharmacology and Toxicology, University of the Philippines-Manila, Department of Clinical Epidemiology Room 103, Paz Mendoza Building, Pedro Gil Street, Ermita, Manila, 1000, Philippines, 63 2 525 4098, jody.dalmacion@gmail.com %K adverse drug reactions %K pharmacovigilance %K postmarketing %K spontaneous reporting %K texting %D 2015 %7 19.11.2015 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Paper-based adverse drug reaction (ADR) reporting has been in practice for more than 6 decades. Health professionals remain the primary source of reports, while the value of patients’ reporting is yet unclear. With the increasing popularity of using electronic gadgets in health, it is expected that the electronic transmission of reports will become the norm within a few years. Objective: The aims of this study are to investigate whether short messaging service or texting can provide an alternative or supplemental method for ADR reporting given the increasing role of mobile phones in health care monitoring; to determine the usefulness of texting in addition to paper-based reporting of ADRs by resident physicians; and to describe the barriers to ADR reporting and estimate the cost for setting up and maintaining a texting-computer reporting system. Methods: This was a pre-post cross-sectional study that measured the number of ADRs texted by 51 resident physicians for 12 months from the Department of Obstetrics and Gynecology and the Department of Adult Medicine of a tertiary government hospital in Manila, Philippines, with 1350-bed capacity. Reports were captured by a texting-computer reporting system. Prior to its implementation, key informant interview and focus group discussion were conducted. Baseline information and practice on the existing paper-based reporting system were culled from the records of the hospital’s Pharmacy and Therapeutics Committee. A postintervention survey questionnaire was administered at the end of 12 months. Results: Only 3 ADRs were texted by 51 resident physicians in 12 months (reporting rate 3/51 or 6%). By contrast, 240 ADRs from the paper-based reporting system from 848 resident physicians of the study hospital were collected and tabulated (reporting rate 240/848 or 28.3%). Texting ADRs was not efficient because of power interruption, competition with the existing paper-based reporting system, and unforeseen expiration of prepaid text loads/credits. The 3 ADRs texted were a report of vivid dreams and nightmares, a report of disturbing dreams and memory lapses, both of which were due to montelukast use, and a report of hepatitis from an isoniazid/rifampicin fixed-dose combination. Nineteen of 51 resident physicians (37%) registered in the reporting system responded to the postintervention survey. The most common reasons for not reporting ADRs were no adverse reaction identified 11/19 (58%) and restrictive reporting syntax 4/19 (21%). All doctors preferred a free form of reporting. The direct cost of the texting-based reporting system was calculated to be US $5581.40 and the indirect cost was US $9989.40. The total cost for texting-based ADR reporting system for 12 months was US $15,570.79. Conclusions: Reporting of ADRs via texting could be lower compared with an existing ADR paper-based system. Problems of Internet connectivity, reporting syntax, and expiration and reliability of text loads/credits should be addressed while implementing a text-based ADR reporting system in a developing country. %M 27227130 %R 10.2196/publichealth.4605 %U http://publichealth.jmir.org/2015/2/e12/ %U https://doi.org/10.2196/publichealth.4605 %U http://www.ncbi.nlm.nih.gov/pubmed/27227130 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 4 %P e100 %T Crafting Appealing Text Messages to Encourage Colorectal Cancer Screening Test Completion: A Qualitative Study %A Weaver,Kathryn E %A Ellis,Shellie D %A Denizard-Thompson,Nancy %A Kronner,Donna %A Miller,David P %+ Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Medical Center Blvd, Winston-Salem, NC, , United States, 1 336 713 5062, keweaver@wakehealth.edu %K colorectal cancer %K screening %K mhealth %K text messages %K qualitative %K older adults %D 2015 %7 04.11.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: mHealth interventions that incorporate text messages have great potential to increase receipt of preventive health services such as colorectal cancer screening. However, little is known about older adult perspectives regarding the receipt of text messages from their health care providers. Objective: To assess whether older adults would value and access text messages from their physician’s practice regarding colorectal cancer screening. Methods: We conducted four focus groups with 26 adults, aged 50 to 75 years, who had either recently completed or were overdue for colorectal cancer screening. A trained moderator followed a semistructured interview guide covering participant knowledge and attitudes regarding colorectal cancer screening, potential barriers to colorectal cancer screening, attitudes about receiving electronic communications from a doctor’s office, and reactions to sample text messages. Results: Participant responses to three primary research questions were examined: (1) facilitators and barriers to colorectal cancer screening, (2) attitudes toward receiving text messages from providers, and (3) characteristics of appealing text messages. Two themes related to facilitators of colorectal cancer screening were perceived benefits/need and family experiences and encouragement. Themes related to barriers included unpleasantness, discomfort, knowledge gaps, fear of complications, and system factors. Four themes emerged regarding receipt of text messages from health care providers: (1) comfort and familiarity with technology, (2) privacy concerns/potential for errors, (3) impact on patient-provider relationship, and (4) perceived helpfulness. Many participants expressed initial reluctance to receiving text messages but responded favorably when shown sample messages. Participants preferred messages that contained content that was important to them and were positive and reassuring, personalized, and friendly to novice texters (eg, avoided the use of texting shorthand phrases and complicated replies); they did not want messages that contain bad news or test results. They wanted the ability to choose alternative options such as email or phone calls. Conclusions: Older adults are receptive to receiving cancer screening text messages from health care providers. Sharing sample messages with patients may increase acceptance of this tool in the clinic setting. Supportive tailored text messaging reminders could enhance uptake of colorectal cancer screening by enhancing patient self-efficacy and providing cues to action to complete colonoscopy or fecal occult blood testing. %M 26537553 %R 10.2196/mhealth.4651 %U http://mhealth.jmir.org/2015/4/e100/ %U https://doi.org/10.2196/mhealth.4651 %U http://www.ncbi.nlm.nih.gov/pubmed/26537553 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 10 %P e238 %T Using WhatsApp and Facebook Online Social Groups for Smoking Relapse Prevention for Recent Quitters: A Pilot Pragmatic Cluster Randomized Controlled Trial %A Cheung,Yee Tak Derek %A Chan,Ching Han Helen %A Lai,Chi-Keung Jonah %A Chan,Wai Fung Vivian %A Wang,Man Ping %A Li,Ho Cheung William %A Chan,Sophia Siu Chee %A Lam,Tai-Hing %+ School of Public Health, The University of Hong Kong, 5/F William MW Mong Block, 21 Sassoon Road, Hong Kong, Hong Kong, China (Hong Kong), 852 39176652, derekcheung@hku.hk %K social networking %K social media %K smoking cessation %K relapse prevention %D 2015 %7 22.10.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Quit attempters often have episodes of smoking relapse before they eventually quit. Interactive text messaging through mobile phones has been shown to increase abstinence. This service can be potentially applied on the platform of a social networking service to help quitters maintain abstinence. Objective: Our aim was to determine if the group discussion and reminders via the WhatsApp or Facebook social group were effective to prevent smoking relapse in quitters who had stopped smoking recently. Methods: This was a single-blinded, parallel, 3-arm pilot cluster randomized controlled trial allocating recent quitters, who had completed an 8-week treatment and reported abstinence for at least 7 days, to WhatsApp (n=42), Facebook (n=40), and a control group (n=54). The 2 intervention groups participated in a 2-month online group discussion with either WhatsApp or Facebook moderated by a trained smoking cessation counselor and received a self-help booklet on smoking cessation. The control group only received the booklet. The primary outcome was the 2- and 6-month relapse rates, defined as the proportion of participants who smoked at least 5 cigarettes in 3 consecutive days. Results: Fewer participants in the WhatsApp group (17%, 7/42) reported relapse than the control group (42.6%, 23/54) at 2-month (OR 0.27, 95% CI 0.10-0.71) and 6-month (40.5%, 17/42 vs 61.1%, 33/54; OR 0.43, 95% CI 0.19-0.99) follow-ups. The Facebook group (30.0%, 12/40) had an insignificantly lower relapse rate than the control group (42.6%, 23/54) at 2-month (OR 0.58, 95% CI 0.24-1.37) and 6-month (52.5%, 13/40 vs 61.1%, 33/54; OR 0.70, 95% CI 0.31-1.61) follow-ups. The WhatsApp social groups had more moderators’ posts (median 60, IQR 25 vs median 32, IQR 7; P=.05) and participants’ posts (median 35, IQR 50 vs median 6, IQR 9; P=.07) than their Facebook counterparts, but the difference was insignificant. Conclusions: The intervention via the WhatsApp social group was effective in reducing relapse probably because of enhanced discussion and social support. Inactive discussion in the Facebook social group might have attributed to the lower effectiveness. ClinicalTrial: Clinicaltrials.gov NCT02007369; https://clinicaltrials.gov/show/NCT02007369 (Archived by WebCite® at http://www.webcitation.org/6c3RbltQG) %M 26494159 %R 10.2196/jmir.4829 %U http://www.jmir.org/2015/10/e238/ %U https://doi.org/10.2196/jmir.4829 %U http://www.ncbi.nlm.nih.gov/pubmed/26494159 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 10 %P e237 %T Text Message and Internet Support for Coronary Heart Disease Self-Management: Results From the Text4Heart Randomized Controlled Trial %A Pfaeffli Dale,Leila %A Whittaker,Robyn %A Jiang,Yannan %A Stewart,Ralph %A Rolleston,Anna %A Maddison,Ralph %+ National Institute for Health Innovation, University of Auckland, School of Population Health, Tamaki Campus, 261 Morrin Rd, Auckland, 1072, New Zealand, 64 9 373 7599, l.pfaeffli@auckland.ac.nz %K text messaging %K mHealth %K cellular phone %K cardiovascular diseases %K intervention %K lifestyle change %K behavior %D 2015 %7 21.10.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile technology has the potential to deliver behavior change interventions (mHealth) to reduce coronary heart disease (CHD) at modest cost. Previous studies have focused on single behaviors; however, cardiac rehabilitation (CR), a component of CHD self-management, needs to address multiple risk factors. Objective: The aim was to investigate the effectiveness of a mHealth-delivered comprehensive CR program (Text4Heart) to improve adherence to recommended lifestyle behaviors (smoking cessation, physical activity, healthy diet, and nonharmful alcohol use) in addition to usual care (traditional CR). Methods: A 2-arm, parallel, randomized controlled trial was conducted in New Zealand adults diagnosed with CHD. Participants were recruited in-hospital and were encouraged to attend center-based CR (usual care control). In addition, the intervention group received a personalized 24-week mHealth program, framed in social cognitive theory, sent by fully automated daily short message service (SMS) text messages and a supporting website. The primary outcome was adherence to healthy lifestyle behaviors measured using a self-reported composite health behavior score (≥3) at 3 and 6 months. Secondary outcomes included clinical outcomes, medication adherence score, self-efficacy, illness perceptions, and anxiety and/or depression at 6 months. Baseline and 6-month follow-up assessments (unblinded) were conducted in person. Results: Eligible patients (N=123) recruited from 2 large metropolitan hospitals were randomized to the intervention (n=61) or the control (n=62) group. Participants were predominantly male (100/123, 81.3%), New Zealand European (73/123, 59.3%), with a mean age of 59.5 (SD 11.1) years. A significant treatment effect in favor of the intervention was observed for the primary outcome at 3 months (AOR 2.55, 95% CI 1.12-5.84; P=.03), but not at 6 months (AOR 1.93, 95% CI 0.83-4.53; P=.13). The intervention group reported significantly greater medication adherence score (mean difference: 0.58, 95% CI 0.19-0.97; P=.004). The majority of intervention participants reported reading all their text messages (52/61, 85%). The number of visits to the website per person ranged from zero to 100 (median 3) over the 6-month intervention period. Conclusions: A mHealth CR intervention plus usual care showed a positive effect on adherence to multiple lifestyle behavior changes at 3 months in New Zealand adults with CHD compared to usual care alone. The effect was not sustained to the end of the 6-month intervention. A larger study is needed to determine the size of the effect in the longer term and whether the change in behavior reduces adverse cardiovascular events. Trial Registration: ACTRN 12613000901707; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364758&isReview=true (Archived by WebCite at http://www.webcitation.org/6c4qhcHKt) %M 26490012 %R 10.2196/jmir.4944 %U http://www.jmir.org/2015/10/e237/ %U https://doi.org/10.2196/jmir.4944 %U http://www.ncbi.nlm.nih.gov/pubmed/26490012 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e88 %T Efficacy of a Text Message-Delivered Extended Contact Intervention on Maintenance of Weight Loss, Physical Activity, and Dietary Behavior Change %A Spark,Lauren C %A Fjeldsoe,Brianna S %A Eakin,Elizabeth G %A Reeves,Marina M %+ Cancer Prevention Research Centre, School of Public Health, The University of Queensland, Herston Road, Herston, Brisbane, 4006, Australia, 61 3346 4692, m.reeves@sph.uq.edu.au %K weight %K physical activity %K diet %K mobile telephone %K intervention %K behavior change %K maintenance %K SMS %K mhealth %K textmessaging %D 2015 %7 15.09.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Extending contact with participants after the end of an initial intervention is associated with successful maintenance of weight loss and behavior change. However, cost-effective methods of extending intervention contact are needed. Objective: This study investigated whether extended contact via text message was efficacious in supporting long-term weight loss and physical activity and dietary behavior change in breast cancer survivors. Methods: Following the end of an initial 6-month randomized controlled trial of a telephone-delivered weight loss intervention versus usual care, eligible and consenting intervention participants received a 6-month extended contact intervention via tailored text messages targeting a range of factors proposed to influence the maintenance of behavior change. In this single-group, pre-post designed study, within group changes in weight, moderate-to-vigorous physical activity (Actigraph GT3X+ accelerometers), and total energy intake (2x24 hour dietary recalls) were evaluated from baseline to end of initial intervention (6 months), end of extended contact intervention (12 months), and after a no-contact follow-up (18 months) via linear mixed models. Feasibility of implementation was assessed through systematic tracking of text message delivery process outcomes, and participant satisfaction was assessed through semistructured interviews. Results: Participants at baseline (n=29) had a mean age of 54.9 years (SD 8.8), body mass index of 30.0 kg/m2 (SD 4.2), and were recruited a mean 16.6 months (SD 3.2) post diagnosis. From baseline to 18 months, participants showed statistically significantly lower mean weight (-4.2 kg [95% CI -6.0 to -2.4]; P<.001) and higher physical activity (mean 10.4 mins/day [95% CI 3.6-17.2]; P=.003), but no significant differences in energy intake (P=.200). Participants received a mean of 8 text messages every 2 weeks (range 2-11) and reported a high rate of satisfaction. Conclusions: In comparison to interventions without extended contact, results suggest text message–delivered extended contact may support the attenuation of weight regain and promote the maintenance of physical activity. %M 26373696 %R 10.2196/mhealth.4114 %U http://mhealth.jmir.org/2015/3/e88/ %U https://doi.org/10.2196/mhealth.4114 %U http://www.ncbi.nlm.nih.gov/pubmed/26373696 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 7 %P e185 %T Medium-Term Effectiveness of a Comprehensive Internet-Based and Patient-Specific Telerehabilitation Program With Text Messaging Support for Cardiac Patients: Randomized Controlled Trial %A Frederix,Ines %A Hansen,Dominique %A Coninx,Karin %A Vandervoort,Pieter %A Vandijck,Dominique %A Hens,Niel %A Van Craenenbroeck,Emeline %A Van Driessche,Niels %A Dendale,Paul %+ Mobile Health Institute, Faculty of Medicine & Life Sciences, Hasselt University, Building D, Agoralaan, Diepenbeek, 3590, Belgium, 32 16583382, ines.frederix@gmail.com %K telemedicine %K eHealth %K effectiveness %K Internet %D 2015 %7 23.07.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Cardiac telerehabilitation has been introduced as an adjunct or alternative to conventional center-based cardiac rehabilitation to increase its long-term effectiveness. However, before large-scale implementation and reimbursement in current health care systems is possible, well-designed studies on the effectiveness of this new additional treatment strategy are needed. Objective: The aim of this trial was to assess the medium-term effectiveness of an Internet-based, comprehensive, and patient-tailored telerehabilitation program with short message service (SMS) texting support for cardiac patients. Methods: This multicenter randomized controlled trial consisted of 140 cardiac rehabilitation patients randomized (1:1) to a 24-week telerehabilitation program in combination with conventional cardiac rehabilitation (intervention group; n=70) or to conventional cardiac rehabilitation alone (control group; n=70). In the telerehabilitation program, initiated 6 weeks after the start of ambulatory rehabilitation, patients were stimulated to increase physical activity levels. Based on registered activity data, they received semiautomatic telecoaching via email and SMS text message encouraging them to gradually achieve predefined exercise training goals. Patient-specific dietary and/or smoking cessation advice was also provided as part of the telecoaching. The primary endpoint was peak aerobic capacity (VO2 peak). Secondary endpoints included accelerometer-recorded daily step counts, self-assessed physical activities by International Physical Activity Questionnaire (IPAQ), and health-related quality of life (HRQL) assessed by the HeartQol questionnaire at baseline and at 6 and 24 weeks. Results: Mean VO2 peak increased significantly in intervention group patients (n=69) from baseline (mean 22.46, SD 0.78 mL/[min*kg]) to 24 weeks (mean 24.46, SD 1.00 mL/[min*kg], P<.01) versus control group patients (n=70), who did not change significantly (baseline: mean 22.72, SD 0.74 mL/[min*kg]; 24 weeks: mean 22.15, SD 0.77 mL/[min*kg], P=.09). Between-group analysis of aerobic capacity confirmed a significant difference between the intervention group and control group in favor of the intervention group (P<.001). At 24 weeks, self-reported physical activity improved more in the intervention group compared to the control group (P=.01) as did the global HRQL score (P=.01). Conclusions: This study showed that an additional 6-month patient-specific, comprehensive telerehabilitation program can lead to a bigger improvement in both physical fitness (VO2 peak) and associated HRQL compared to center-based cardiac rehabilitation alone. These results are supportive in view of possible future implementation in standard cardiac care. %M 26206311 %R 10.2196/jmir.4799 %U http://www.jmir.org/2015/7/e185/ %U https://doi.org/10.2196/jmir.4799 %U http://www.ncbi.nlm.nih.gov/pubmed/26206311 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e66 %T Effectiveness of a mHealth Lifestyle Program With Telephone Support (TXT2BFiT) to Prevent Unhealthy Weight Gain in Young Adults: Randomized Controlled Trial %A Partridge,Stephanie R %A McGeechan,Kevin %A Hebden,Lana %A Balestracci,Kate %A Wong,Annette TY %A Denney-Wilson,Elizabeth %A Harris,Mark F %A Phongsavan,Philayrath %A Bauman,Adrian %A Allman-Farinelli,Margaret %+ School of Molecular Bioscience, Charles Perkins Centre, University of Sydney, Level 4 East, Charles Perkins Centre, Sydney, 2006, Australia, 61 2 9036 7045, margaret.allman-farinelli@sydney.edu.au %K young adults %K weight gain prevention %K lifestyle behavior %K mHealth %D 2015 %7 15.06.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Weight gained in young adulthood often persists throughout later life with associated chronic disease risk. Despite this, current population prevention strategies are not specifically designed for young adults. Objective: We designed and assessed the efficacy of an mHealth prevention program, TXT2BFiT, in preventing excess weight gain and improving dietary and physical activity behaviors in young adults at increased risk of obesity and unhealthy lifestyle choices. Methods: A two-arm, parallel-group randomized controlled trial was conducted. Subjects and analyzing researchers were blinded. A total of 250 18- to 35-year-olds with a high risk of weight gain, a body mass index (BMI) of 23.0 to 24.9 kg/m2 with at least 2 kg of weight gain in the previous 12 months, or a BMI of 25.0 to 31.9 kg/m2 were randomized to the intervention or control group. In the 12-week intervention period, the intervention group received 8 text messages weekly based on the transtheoretical model of behavior change, 1 email weekly, 5 personalized coaching calls, a diet booklet, and access to resources and mobile phone apps on a website. Control group participants received only 4 text messages and printed dietary and physical activity guidelines. Measured body weight and height were collected at baseline and at 12 weeks. Outcomes were assessed via online surveys at baseline and at 12 weeks, including self-reported weight and dietary and physical activity measures. Results: A total of 214 participants—110 intervention and 104 control—completed the 12-week intervention period. A total of 10 participants out of 250 (4.0%)—10 intervention and 0 control—dropped out, and 26 participants (10.4%)—5 intervention and 21 control—did not complete postintervention online surveys. Adherence to coaching calls and delivery of text messages was over 90%. At 12 weeks, the intervention group were 2.2 kg (95% CI 0.8-3.6) lighter than controls (P=.005). Intervention participants consumed more vegetables (P=.009), fewer sugary soft drinks (P=.002), and fewer energy-dense takeout meals (P=.001) compared to controls. They also increased their total physical activity by 252.5 MET-minutes (95% CI 1.2-503.8, P=.05) and total physical activity by 1.3 days (95% CI 0.5-2.2, P=.003) compared to controls. Conclusions: The TXT2BFiT low-intensity intervention was successful in preventing weight gain with modest weight loss and improvement in lifestyle behaviors among overweight young adults. The short-term success of the 12-week intervention period shows potential. Maintenance of the behavior change will be monitored at 9 months. Trial Registration: Trial Registration: The Australian New Zealand Clinical Trials Registry ACTRN12612000924853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612000924853 (Archived by WebCite at http://www.webcitation.org/6Z6w9LlS9). %M 26076688 %R 10.2196/mhealth.4530 %U http://mhealth.jmir.org/2015/2/e66/ %U https://doi.org/10.2196/mhealth.4530 %U http://www.ncbi.nlm.nih.gov/pubmed/26076688 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e63 %T Cartographic Analysis of Antennas and Towers: A Novel Approach to Improving the Implementation and Data Transmission of mHealth Tools on Mobile Networks %A Brown III,William %A Ibitoye,Mobolaji %A Bakken,Suzanne %A Schnall,Rebecca %A Balán,Iván %A Frasca,Timothy %A Carballo-Diéguez,Alex %+ HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, HIV Center, Unit 15, 1051 Riverside Drive, New York, NY, , United States, 1 646 774 6963, wb2253@columbia.edu %K cartographic analysis %K mHealth %K mobile health %K antenna %K short message service %K text messaging %K SMS %K wireless %K HIV %D 2015 %7 04.06.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Most mHealth tools such as short message service (SMS), mobile apps, wireless pill counters, and ingestible wireless monitors use mobile antennas to communicate. Limited signal availability, often due to poor antenna infrastructure, negatively impacts the implementation of mHealth tools and remote data collection. Assessing the antenna infrastructure prior to starting a study can help mitigate this problem. Currently, there are no studies that detail whether and how the antenna infrastructure of a study site or area is assessed. Objective: To address this literature gap, we analyze and discuss the use of a cartographic analysis of antennas and towers (CAAT) for mobile communications for geographically assessing mobile antenna and tower infrastructure and identifying signal availability for mobile devices prior to the implementation of an SMS-based mHealth pilot study. Methods: An alpha test of the SMS system was performed using 11 site staff. A CAAT for the study area’s mobile network was performed after the alpha test and pre-implementation of the pilot study. The pilot study used a convenience sample of 11 high-risk men who have sex with men who were given human immunodeficiency virus test kits for testing nonmonogamous sexual partners before intercourse. Product use and sexual behavior were tracked through SMS. Message frequency analyses were performed on the SMS text messages, and SMS sent/received frequencies of 11 staff and 11 pilot study participants were compared. Results: The CAAT helped us to successfully identify strengths and weaknesses in mobile service capacity within a 3-mile radius from the epicenters of four New York City boroughs. During the alpha test, before CAAT, 1176/1202 (97.84%) text messages were sent to staff, of which 26/1176 (2.21%) failed. After the CAAT, 2934 messages were sent to pilot study participants and none failed. Conclusions: The CAAT effectively illustrated the research area’s mobile infrastructure and signal availability, which allowed us to improve study setup and sent message success rates. The SMS messages were sent and received with a lower fail rate than those reported in previous studies. %M 26043766 %R 10.2196/mhealth.3941 %U http://mhealth.jmir.org/2015/2/e63/ %U https://doi.org/10.2196/mhealth.3941 %U http://www.ncbi.nlm.nih.gov/pubmed/26043766 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 2 %P e55 %T Supportive Text Messages to Reduce Mood Symptoms and Problem Drinking in Patients With Primary Depression or Alcohol Use Disorder: Protocol for an Implementation Research Study %A Agyapong,Vincent Israel Opoku %A Mrklas,Kelly %A Suen,Victoria Yung Mei %A Rose,Marianne Sarah %A Jahn,Megan %A Gladue,Irene %A Kozak,Jody %A Leslie,Maureen %A Dursun,Serdar %A Ohinmaa,Arto %A Greenshaw,Andrew %+ Faculty of Health Sciences, Department of Psychiatry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 780 215 7771, agyapong@ualberta.ca %K depression %K alcohol use disorder %K supportive text messages %K intervention %D 2015 %7 15.05.2015 %9 Protocol %J JMIR Res Protoc %G English %X Background: Depression and Alcohol Use Disorders (AUDs) are two leading causes of disability worldwide and are associated with significant treatment challenges requiring new, innovative, cost-effective and technologically-based therapies including the use of supportive text messages. Objective: To determine the feasibility and effectiveness of supportive text messages in long-term follow-up to reduce mood symptoms and problem drinking in patients with Depression or AUD respectively and to explore the usefulness of self-reports of health services utilization as an outcomes measure. Methods: This will be a longitudinal, prospective, parallel-design, two-arm, placebo-controlled single-rater-blinded randomized clinical trial with a recruitment period of 6 months and an observation period of 12 months for each participant, with two strata based on primary diagnosis of Major Depressive Disorder or AUD. The sample size will be 120, with about 60 patients randomized from each primary diagnostic grouping. Patients in all intervention groups will receive twice-daily supportive SMS text messages for 3 months and then daily supportive text messages for the next three months. Patients will also receive a phone call every two weeks from the research assistant assigning treatment allocation to confirm that they are still receiving the text messages and to thank them for taking part in the study. Patients in the control group will receive no text messages but will also receive a phone call from the same research assistant every two weeks to thank them for taking part in the study. Results: The study starts in April 2015 and ends in September 2016. It is envisaged that both qualitative and quantitative primary and secondary outcomes, including patient perceptions of the intervention, will shed light on the feasibility of using automated supportive text message interventions in long term for patients with Depression and AUD. This will inform a full-scale clinical trial. Conclusions: The paradigm for behavior change using text messages as a patient-direct intervention is consistent with a cognitive behavior therapy approach and addictions counselling principles. Given the automaticity of the messages, we anticipate that if the intervention proves successful, it will represent a low cost strategy that will be readily available and can bring relief to patients in hard-to-reach areas with limited access to psychological therapies. Trial Registration: ClinicalTrials.gov: NCT02327858; https://clinicaltrials.gov/ct2/show/NCT02327858 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT02327858). %M 25979786 %R 10.2196/resprot.4371 %U http://www.researchprotocols.org/2015/2/e55/ %U https://doi.org/10.2196/resprot.4371 %U http://www.ncbi.nlm.nih.gov/pubmed/25979786 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e32 %T Diabetes Text-Message Self-Management Support Program (SMS4BG): A Pilot Study %A Dobson,Rosie %A Carter,Karen %A Cutfield,Richard %A Hulme,Ashley %A Hulme,Richard %A McNamara,Catherine %A Maddison,Ralph %A Murphy,Rinki %A Shepherd,Matthew %A Strydom,Johan %A Whittaker,Robyn %+ National Institute for Health Innovation, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, National Institute for Health Innovation, School of Population Health, University of Auckland, Tamaki Campus,, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand, Auckland, , New Zealand, 64 9 3737599 ext 84766, r.dobson@auckland.ac.nz %K mHealth %K diabetes mellitus %K text message %K mobile phone %K SMS %K self-management %D 2015 %7 25.03.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The increasing prevalence of diabetes and costly long-term complications associated with poor glycemic control are issues facing health services worldwide. Diabetes self-management, with the support of health care providers, is critical for successful outcomes, however, frequent clinical contact is costly. Text messages via short message service (SMS) have the advantage of instant transmission at low cost and, given the ubiquity of mobile phones, may be the ideal platform for the delivery of diabetes self-management support. A tailored text message-based diabetes support intervention called Self-Management Support for Blood Glucose (SMS4BG) was developed. The intervention incorporates prompts around diabetes education, management, and lifestyle factors (healthy eating, exercise, and stress management), as well as blood glucose monitoring reminders, and is tailored to patient preferences and clinical characteristics. Objective: To determine the usability and acceptability of SMS4BG among adults with poorly controlled diabetes. Methods: Adults (aged 17 to 69 years) with type 1 (n=12) or type 2 diabetes (n=30), a hemoglobin A1c (HbA1c) over 70 mmol/mol (8.6%), and who owned a mobile phone (n=42) were recruited to take part in a 3-month pilot study of SMS4BG. At registration, participants selected the modules they would like to receive and, where appropriate, the frequency and timing of blood glucose monitoring reminders. Patient satisfaction and perceptions of the usability of the program were obtained via semistructured phone interviews conducted at completion of the pilot study. HbA1c was obtained from patient records at baseline and completion of the pilot study. Results: Participants received on average 109 messages during the 3-month program with 2 participants withdrawing early from the study. Follow-up interviews were completed with 93% of participants with all reporting SMS4BG to be useful and appropriate to their age and culture. Participants reported a range of perceived positive impacts of SMS4BG on their diabetes and health behaviors. HbA1c results indicated a positive impact of the program on glycemic control with a significant decrease in HbA1c from baseline to follow-up. Conclusions: A tailored text message-based intervention is both acceptable and useful in supporting self-management in people with poorly controlled diabetes. A randomized controlled trial of longer duration is needed to assess the efficacy and sustainability of SMS4BG. %M 25830952 %R 10.2196/mhealth.3988 %U http://mhealth.jmir.org/2015/1/e32/ %U https://doi.org/10.2196/mhealth.3988 %U http://www.ncbi.nlm.nih.gov/pubmed/25830952 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 3 %P e78 %T Know Your Audience: Predictors of Success for a Patient-Centered Texting App to Augment Linkage to HIV Care in Rural Uganda %A Siedner,Mark J %A Santorino,Data %A Haberer,Jessica E %A Bangsberg,David R %+ Center for Global Health, Massachusetts Genneral Hospital, Harvard Medical School, 15th Floor, 100 Cambridge Street, Boston, MA, 02114, United States, 1 617 726 4686, msiedner@partners.org %K telemedicine %K text messaging %K randomized controlled trial %K Uganda %K HIV %D 2015 %7 24.03.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite investments in infrastructure and evidence for high acceptability, few mHealth interventions have been implemented in sub-Saharan Africa. Objective: We sought to (1) identify predictors of uptake of an mHealth application for a low-literacy population of people living with HIV (PLWH) in rural Uganda and (2) evaluate the efficacy of various short message service (SMS) text message formats to optimize the balance between confidentiality and accessibility. Methods: The trial evaluated the efficacy of a SMS text messaging app to notify PLWH of their laboratory results and request return to care for those with abnormal test results. Participants with a normal laboratory result received a single SMS text message indicating results were normal. Participants with an abnormal test result were randomized to 1 of 3 message formats designed to evaluate trade-offs between clarity and privacy: (1) an SMS text message that stated results were abnormal and requested return to clinic (“direct”), (2) the same message protected by a 4-digit PIN code (“PIN”), and (3) the message “ABCDEFG” explained at enrollment to indicate abnormal results (“coded”). Outcomes of interest were (1) self-reported receipt of the SMS text message, (2) accurate identification of the message, and (3) return to care within 7 days (for abnormal results) or on the date of the scheduled appointment (for normal results). We fit regression models for each outcome with the following explanatory variables: sociodemographic characteristics, CD4 count result, ability to read a complete sentence, ability to access a test message on enrollment, and format of SMS text message. Results: Seventy-two percent (234/385) of participants successfully receiving a message, 87.6% (219/250) correctly identified the message format, and 60.8% (234/385) returned to clinic at the requested time. Among participants with abnormal tests results (138/385, 35.8%), the strongest predictors of reported message receipt were the ability to read a complete sentence and a demonstrated ability to access a test message on enrollment. Participants with an abnormal result who could read a complete sentence were also more likely to accurately identify the message format (AOR 4.54, 95% CI 1.42-14.47, P=.01) and return to clinic appropriately (AOR 3.81, 95% CI 1.61-9.03, P=.002). Those who were sent a PIN-protected message were less likely to identify the message (AOR 0.11, 95% CI 0.03-0.44, P=.002) or return within 7 days (AOR 0.26, 95% CI 0.10-0.66, P=.005). Gender, age, and socioeconomic characteristics did not predict any outcomes and there were no differences in outcomes between those receiving direct or coded messages. Conclusions: Confirmed literacy at the time of enrollment was a robust predictor of SMS text message receipt, identification, and appropriate response for PLWH in rural Uganda. PIN-protected messages reduced odds of clinic return, but coded messages were as effective as direct messages and might augment privacy. Trial Registration: Clinicaltrials.gov NCT 01579214; https://clinicaltrials.gov/ct2/show/NCT01579214 (Archived by WebCite at http://www.webcitation.org/6Ww8R4sKq). %M 25831269 %R 10.2196/jmir.3859 %U http://www.jmir.org/2015/3/e78/ %U https://doi.org/10.2196/jmir.3859 %U http://www.ncbi.nlm.nih.gov/pubmed/25831269 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 2 %N 1 %P e4 %T Feasibility and Perception of Using Text Messages as an Adjunct Therapy for Low-Income, Minority Mothers With Postpartum Depression %A Broom,Matthew A %A Ladley,Amy S %A Rhyne,Elizabeth A %A Halloran,Donna R %+ SSM Cardinal Glennon Children's Medical Center, Department of Pediatrics, Saint Louis University School of Medicine, 1465 S. Grand Blvd, St. Louis, MO, 63104, United States, 1 314 268 4150, broomma@slu.edu %K short message service %K health care disparities %K mobile health %K mental illness %D 2015 %7 16.03.2015 %9 Original Paper %J JMIR Mental Health %G English %X Background: Postpartum depression (PPD) is the most common medical problem among new mothers that can have a negative impact on infant health. Traditional treatments are often difficult for low-income mothers to complete, particularly given the numerous barriers families face. Objective: Among low-income, primarily racial, and ethnic minority mothers with postpartum depression, our aim was to evaluate (1) the feasibility of sending supportive text messages, and (2) the perception of receiving private, supportive text messages for postpartum depression. Methods: Mothers found to be at risk for postpartum depression received supportive text messages four times weekly for 6 months in addition to receiving access to traditional counseling services based within an academic pediatric office. Feasibility was evaluated along with cellular and text messaging use, access, and perception of the message protocol. Perception of the message protocol was evaluated at study completion via a Likert scale questionnaire and open-ended qualitative survey. Results: In total, 4158/4790 (86.81%) text messages were successfully delivered to 54 mothers over a 6-month period at a low cost (US $777.60). Among the 96 scripted messages, 37 unique messages (38.54%) allowed for a response. Of all sent messages that allowed for responses, 7.30% (118/1616) were responded to, and 66.1% of those responses requested a call back; 46% (25/54) of mothers responded at least once to a text message. Mothers felt that messages were easily received and read (25/28, 89%) and relevant to them personally (23/28, 82%). Most shared texts with others (21/28, 75%). Conclusions: Text messaging is feasible, well-accepted, and may serve as a simple, inexpensive adjunct therapy well-suited to cross socioeconomic boundaries and provide private support for at-risk mothers suffering from postpartum depression. %M 26543910 %R 10.2196/mental.4074 %U http://mental.jmir.org/2015/1/e4/ %U https://doi.org/10.2196/mental.4074 %U http://www.ncbi.nlm.nih.gov/pubmed/26543910 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 1 %P e31 %T The Mobile Insulin Titration Intervention (MITI) for Insulin Glargine Titration in an Urban, Low-Income Population: Randomized Controlled Trial Protocol %A Levy,Natalie %A Moynihan,Victoria %A Nilo,Annielyn %A Singer,Karyn %A Bernik,Lidia S %A Etiebet,Mary-Ann %A Fang,Yixin %A Cho,James %A Natarajan,Sundar %+ Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, Bellevue CD building, 630, 462 First Ave, New York, NY, 10016, United States, 1 646 501 0691, Victoria.Ramsay@nyumc.org %K patient care management %K delivery of care %K health care disparities %K telemedicine %K remote consultation %D 2015 %7 13.03.2015 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients on insulin glargine typically visit a clinician to obtain advice on how to adjust their insulin dose. These multiple clinic visits can be costly and time-consuming, particularly for low-income patients. It may be feasible to achieve insulin titration through text messages and phone calls with patients instead of face-to-face clinic visits. Objective: The objectives of this study are to (1) evaluate if the Mobile Insulin Titration Intervention (MITI) is clinically effective by helping patients reach their optimal dose of insulin glargine, (2) determine if the intervention is feasible within the setting and population, (3) assess patient satisfaction with the intervention, and (4) measure the costs associated with this intervention. Methods: This is a pilot study evaluating an approach to insulin titration using text messages and phone calls among patients with insulin-dependent type 2 diabetes in the outpatient medical clinic of Bellevue Hospital Center, a safety-net hospital in New York City. Patients will be randomized in a 1:1 ratio to either the MITI arm (texting/phone call intervention) or the usual-care arm (in-person clinic visits). Using a Web-based platform, weekday text messages will be sent to patients in the MITI arm, asking them to text back their fasting blood glucose values. In addition to daily reviews for alarm values, a clinician will rereview the texted values weekly, consult our physician-approved titration algorithm, and call the patients with advice on how to adjust their insulin dose. The primary outcome will be whether or not a patient reaches his/her optimal dose of insulin glargine within 12 weeks. Results: Recruitment for this study occurred between June 2013 and December 2014. We are continuing to collect intervention and follow-up data from our patients who are currently enrolled. The results of our data analysis are expected to be available in 2015. Conclusions: This study explores the use of widely-available text messaging and voice technologies for insulin titration. We aim to show that remote insulin titration is clinically effective, feasible, satisfactory, and cost saving for low-income patients in a busy, urban clinic. Trial Registration: Trial Registration: Clinicaltrials.gov NCT01879579; http://clinicaltrials.gov/ct2/show/NCT01879579 (Archived by WebCite at http://www.webcitation.org/6WUEgjZUO). %M 25794243 %R 10.2196/resprot.4206 %U http://www.researchprotocols.org/2015/1/e31/ %U https://doi.org/10.2196/resprot.4206 %U http://www.ncbi.nlm.nih.gov/pubmed/25794243 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e26 %T SMSaúde: Design, Development, and Implementation of a Remote/Mobile Patient Management System to Improve Retention in Care for HIV/AIDS and Tuberculosis Patients %A Nhavoto,José António %A Grönlund,Åke %A Chaquilla,Walter Ponce %+ Informatics, School of Business, Örebro University, Fakultetsgatan 1, Örebro, 70182, Sweden, 46 760833032, janhavoto@gmail.com %K mobile health %K text messaging %K SMS system %K patient management %K design science research %K Mozambique %D 2015 %7 09.03.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The widespread and low cost of mobile phones and the convenience of short message service (SMS) text messaging suggest potential suitability for use with alternative strategies for supporting retention in care and adherence to the treatment of various chronic diseases, such as HIV and tuberculosis (TB). Despite the growing body of literature reporting positive outcomes of SMS text message-based communication with patients, there is yet very little research about the integration of communication technologies and electronic medical records or electronic patient tracking systems. Objective: To design, develop, and implement an integrated mobile phone text messaging system used to follow up with patients with HIV and TB in treatment in Mozambique. Methods: Following the design science research methodology, we developed a Web-based system that provides support to patients. A case study involving three health care sites in Mozambique was a basis for discussing design issues for this kind of system. We used brainstorming techniques to solicit usability requirements, focus group meetings to discuss and define system architecture, and prototyping to test in real environments and to improve the system. Results: We found six sets of system requirements that need to be addressed for success: data collection, telecommunication costs, privacy and data security, text message content, connectivity, and system scalability. A text messaging system was designed and implemented in three health facilities. These sites feed data into a central data repository, which can be used for analysis of operations and decision support. Based on the treatment schedule, the system automatically sent SMS text message appointment reminders, medication reminders, as well as motivational and educational messages to patients enrolled in antiretroviral therapy and TB treatment programs. Conclusions: We successfully defined the requirements for, designed, and implemented a mobile phone text messaging system to support HIV and TB treatments. Implementation of this system could improve patients’ self-management skills and strengthen communication between patients and health care providers. %M 25757551 %R 10.2196/mhealth.3854 %U http://mhealth.jmir.org/2015/1/e26/ %U https://doi.org/10.2196/mhealth.3854 %U http://www.ncbi.nlm.nih.gov/pubmed/25757551 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 2 %N 1 %P e3 %T Breaking Open the Black Box: Isolating the Most Potent Features of a Web and Mobile Phone-Based Intervention for Depression, Anxiety, and Stress %A Whitton,Alexis E %A Proudfoot,Judith %A Clarke,Janine %A Birch,Mary-Rose %A Parker,Gordon %A Manicavasagar,Vijaya %A Hadzi-Pavlovic,Dusan %+ The Black Dog Institute, University of New South Wales, Hospital Road, Prince of Wales Hospital, Sydney, 2031, Australia, 61 2 9382 3767, alexis.e.whitton@gmail.com %K eHealth %K depression %K anxiety %K stress %K psychological stress %K self-help %K Web-based %K mental health %D 2015 %7 04.03.2015 %9 Original Paper %J JMIR Mental Health %G English %X Background: Internet-delivered mental health (eMental Health) interventions produce treatment effects similar to those observed in face-to-face treatment. However, there is a large degree of variation in treatment effects observed from program to program, and eMental Health interventions remain somewhat of a black box in terms of the mechanisms by which they exert their therapeutic benefit. Trials of eMental Health interventions typically use large sample sizes and therefore provide an ideal context within which to systematically investigate the therapeutic benefit of specific program features. Furthermore, the growth and impact of mobile phone technology within eMental Health interventions provides an opportunity to examine associations between symptom improvement and the use of program features delivered across computer and mobile phone platforms. Objective: The objective of this study was to identify the patterns of program usage associated with treatment outcome in a randomized controlled trial (RCT) of a fully automated, mobile phone- and Web-based self-help program, “myCompass”, for individuals with mild-to-moderate symptoms of depression, anxiety, and/or stress. The core features of the program include interactive psychotherapy modules, a symptom tracking feature, short motivational messages, symptom tracking reminders, and a diary, with many of these features accessible via both computer and mobile phone. Methods: Patterns of program usage were recorded for 231 participants with mild-to-moderate depression, anxiety, and/or stress, and who were randomly allocated to receive access to myCompass for seven weeks during the RCT. Depression, anxiety, stress, and functional impairment were examined at baseline and at eight weeks. Results: Log data indicated that the most commonly used components were the short motivational messages (used by 68.4%, 158/231 of participants) and the symptom tracking feature (used by 61.5%, 142/231 of participants). Further, after controlling for baseline symptom severity, increased use of these alert features was associated with significant improvements in anxiety and functional impairment. Associations between use of symptom tracking reminders and improved treatment outcome remained significant after controlling for frequency of symptom tracking. Although correlations were not statistically significant, reminders received via SMS (ie, text message) were more strongly associated with symptom reduction than were reminders received via email. Conclusions: These findings indicate that alerts may be an especially potent component of eMental Health interventions, both via their association with enhanced program usage, as well as independently. Although there was evidence of a stronger association between symptom improvement and use of alerts via the mobile phone platform, the degree of overlap between use of email and SMS alerts may have precluded identification of alert delivery modalities that were most strongly associated with symptom reduction. Future research using random assignment to computer and mobile delivery is needed to fully determine the most ideal platform for delivery of this and other features of online interventions. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN): 12610000625077; http://www.anzctr.org.au/TrialSearch.aspx? (Archived by WebCite http://www.webcitation.org/6WPqHK0mQ). %M 26543909 %R 10.2196/mental.3573 %U http://mental.jmir.org/2015/1/e3/ %U https://doi.org/10.2196/mental.3573 %U http://www.ncbi.nlm.nih.gov/pubmed/26543909 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e21 %T Qualitative Evaluation of a Text Messaging Intervention to Support Patients With Active Tuberculosis: Implementation Considerations %A Iribarren,Sarah J %A Sward,Katherine A %A Beck,Susan L %A Pearce,Patricia F %A Thurston,Diana %A Chirico,Cristina %+ School of Nursing, Columbia University, 617 West 168th Street, New York, NY, 10032, United States, 1 212 342 0689, si2277@cumc.columbia.edu %K mHealth %K tuberculosis %K sociotechnical evaluation %K text messaging %D 2015 %7 27.02.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Tuberculosis (TB) remains a major global public health problem and mobile health (mHealth) interventions have been identified as a modality to improve TB outcomes. TextTB, an interactive text-based intervention to promote adherence with TB medication, was pilot-tested in Argentina with results supporting the implementation of trials at a larger scale. Objective: The objective of this research was to understand issues encountered during pilot-testing in order to inform future implementation in a larger-scale trial. Methods: A descriptive, observational qualitative design guided by a sociotechnical framework was used. The setting was a clinic within a public pulmonary-specialized hospital in Argentina. Data were collected through workflow observation over 115 days, text messages (n=2286), review of the study log, and stakeholder input. Emerging issues were categorized as organizational, human, technical, or sociotechnical considerations. Results: Issues related to the intervention included workflow issues (eg, human, training, security), technical challenges (eg, data errors, platform shortcomings), and message delivery issues (eg, unintentional sending of multiple messages, auto-confirmation problems). System/contextual issues included variable mobile network coverage, electrical and Internet outages, and medication shortages. Conclusions: Intervention challenges were largely manageable during pilot-testing, but need to be addressed systematically before proceeding with a larger-scale trial. Potential solutions are outlined. Findings may help others considering implementing an mHealth intervention to anticipate and mitigate certain challenges. Although some of the issues may be context dependent, other issues such as electrical/Internet outages and limited resources are not unique issues to our setting. Release of new software versions did not result in solutions for certain issues, as specific features used were removed. Therefore, other software options will need to be considered before expanding into a larger-scale endeavor. Improved automation of some features will be necessary, however, a goal will be to retain the intervention capability to be interactive, user friendly, and patient focused. Continued collaboration with stakeholders will be required to conduct further research and to understand how such an mHealth intervention can be effectively integrated into larger health systems. %M 25802968 %R 10.2196/mhealth.3971 %U http://mhealth.jmir.org/2015/1/e21/ %U https://doi.org/10.2196/mhealth.3971 %U http://www.ncbi.nlm.nih.gov/pubmed/25802968 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e22 %T Translating Behavioral Interventions Onto mHealth Platforms: Developing Text Message Interventions for Smoking and Alcohol %A Bock,Beth C %A Rosen,Rochelle K %A Barnett,Nancy P %A Thind,Herpreet %A Walaska,Kristen %A Foster,Robert %A Deutsch,Christopher %A Traficante,Regina %+ Centers for Behavioral and Preventive Medicine, Alpert Medical School, Brown University, 164 Summit Avenue, Coro West, Suite 1b, Providence, RI, 02903, United States, 1 4017938020, Bbock@lifespan.org %K mHealth %K text message %K smoking cessation %K alcohol %K qualitative methods %D 2015 %7 24.02.2015 %9 Tutorial %J JMIR mHealth uHealth %G English %X The development of mHealth applications is often driven by the investigators and developers with relatively little input from the targeted population. User input is commonly limited to “like/dislike” post- intervention consumer satisfaction ratings or device or application specific user analytics such as usability. However, to produce successful mHealth applications with lasting effects on health behaviors it is crucial to obtain user input from the start of each project and throughout development. The aim of this tutorial is to illustrate how qualitative methods in an iterative process of development have been used in two separate behavior change interventions (targeting smoking and alcohol) delivered through mobile technologies (ie, text messaging). A series of focus groups were conducted to assist in translating a face-to-face smoking cessation intervention onto a text message (short message service, SMS) delivered format. Both focus groups and an advisory panel were used to shape the delivery and content of a text message delivered intervention for alcohol risk reduction. An in vivo method of constructing message content was used to develop text message content that was consistent with the notion of texting as “fingered speech”. Formative research conducted with the target population using a participatory framework led to important changes in our approach to intervention structure, content development, and delivery. Using qualitative methods and an iterative approach that blends consumer-driven and investigator-driven aims can produce paradigm-shifting, novel intervention applications that maximize the likelihood of use by the target audience and their potential impact on health behaviors. %M 25714907 %R 10.2196/mhealth.3779 %U http://mhealth.jmir.org/2015/1/e22/ %U https://doi.org/10.2196/mhealth.3779 %U http://www.ncbi.nlm.nih.gov/pubmed/25714907 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e19 %T Design and Multi-Country Validation of Text Messages for an mHealth Intervention for Primary Prevention of Progression to Hypertension in Latin America %A Diez-Canseco,Francisco %A Zavala-Loayza,J Alfredo %A Beratarrechea,Andrea %A Kanter,Rebecca %A Ramirez-Zea,Manuel %A Rubinstein,Adolfo %A Martinez,Homero %A Miranda,J Jaime %+ CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 497, Miraflores, Lima, Lima 18, Peru, 51 12416978, Jaime.Miranda@upch.pe %K cross-cultural comparison %K developing countries %K health literacy %K hypertension %K Latin America %K mHealth %K preventive medicine %K prehypertension %K text messages %K validation studies %D 2015 %7 18.02.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile health (mHealth) has been posited to contribute to the reduction in health gaps and has shown fast and widespread growth in developing countries. This growth demands understanding of, and preparedness for, local cultural contexts. Objective: To describe the design and validation of text messages (short message service, SMS) that will be used for an mHealth behavioral change intervention to prevent hypertension in three Latin American countries: Argentina, Guatemala, and Peru. Methods: An initial set of 64 SMS text messages were designed to promote healthy lifestyles among individuals in different stages of behavior change, addressing four key domains: salt and sodium intake, fruit and vegetable intake, consumption of high fat and sugar foods, and physical activity. The 64 SMS text messages were organized into nine subsets for field validation. In each country 36 people were recruited, half of them being male. Of the participants, 4 per country evaluated each subset of SMS text messages, which contained between 6 and 8 SMS text messages regarding different key domains and stages of change. The understanding and appeal of each SMS text message was assessed using a 7-item questionnaire. The understanding and appeal ratings were used to reach a final set of 56 SMS text messages. Results: Overall, each of the 64 SMS text messages received a total of 12 evaluations (4 per country). The majority of evaluations—742 out of a total of 767 (96.7%) valid responses—revealed an adequate understanding of the key idea contained in the SMS text message. On a scale from 1 to 10, the average appeal score was 8.7 points, with a range of 4 to 10 points. Based on their low scores, 8 SMS text messages per country were discarded. Once the final set of 56 SMS text messages was established, and based on feedback obtained in the field, wording and content of some SMS text messages were improved. Of the final set, 9, 8, and 16 of the SMS text messages were improved based on participant evaluations from Argentina, Guatemala, and Peru, respectively. Most SMS text messages selected for the final set (49/56, 88%) were the same in all countries, except for small wording differences. Conclusions: The final set of SMS text messages produced had very high rates of understanding and appeal in three different Latin American countries. This study highlights the importance of developing and validating a package of simple, preventative SMS text messages, grounded in evidence and theory, across three different Latin American countries with active engagement of end users. %M 25693595 %R 10.2196/mhealth.3874 %U http://mhealth.jmir.org/2015/1/e19/ %U https://doi.org/10.2196/mhealth.3874 %U http://www.ncbi.nlm.nih.gov/pubmed/25693595 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e14 %T Effectiveness of 6 Months of Tailored Text Message Reminders for Obese Male Participants in a Worksite Weight Loss Program: Randomized Controlled Trial %A Kim,Ju-Young %A Oh,Sohee %A Steinhubl,Steven %A Kim,Sohye %A Bae,Woo Kyung %A Han,Jong Soo %A Kim,Jeong-Hyun %A Lee,Keehyuck %A Kim,Mi Jin %+ Department of Family Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon gil, Bundang-gu, Seongnam-si, 463-707, Republic Of Korea, 82 31 787 7796, kkamduri@snubh.org %K weight reduction program %K text messaging %K worksite %K health promotion %D 2015 %7 03.02.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Worksite nutrition and physical activity interventions are important to help overweight and obese employees lose weight, but costs and insufficient sustained motivation prevent the majority of these programs from succeeding. Tailored text messaging in aiding weight management has been effective in several studies, but no studies have evaluated the effect of a tailored text message service on weight loss in a worksite health promotion program. Objective: We studied the efficacy of a tailored text-messaging intervention for obese male participants in a worksite weight loss program of 6 months duration. Methods: The study was an unblinded, randomized controlled trial. Men with a body mass index greater than 25 kg/m2 were recruited from the Korea District Heating Corporation, the Korea Expressway Corporation, and the Korea Gas Corporation. The participants were identified by nurse managers. Participants were randomly allocated to 1 of the following 2 groups for 24 weeks: (1) intervention group, which received tailored text message reminders every other day plus 4 offline education sessions and brief counseling with monthly weight check by nurses for weight control over 6 months and (2) control group, which received the 4 offline education sessions and brief counseling with monthly weight check by nurses about weight control over 6 months. The primary outcome was the difference in weight loss at 6 months. A mixed-model repeated-measures analysis was performed to evaluate the effect of the intervention group’s weight loss compared with the control group. Results: A total of 205 obese men were randomized into either the intervention (n=104) or the control group (n=101). At the end of 6 months, the intervention group (n=63) had lost 1.71 kg (95% CI –2.53 to –0.88) and the control group (n=59) had lost 1.56 kg (95% CI –2.45 to –0.66); the difference between the 2 groups was not significant (mean difference –0.15, 95% CI –1.36 to 1.07). At the end of the study, 60% (34/57) of the intervention group rated the message program as helpful for weight control and 46% (26/57) would recommend the text message service to their friends. Conclusions: Tailored text message reminders did not have a significant effect on weight loss in obese men as part of a worksite weight loss program. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 39629189; http://www.isrctn.com/ISRCTN39629189?q=39629189&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search (Archived by WebCite at http://www.webcitation.org/6VsFkwJH6). %M 25648325 %R 10.2196/mhealth.3949 %U http://mhealth.jmir.org/2015/1/e14/ %U https://doi.org/10.2196/mhealth.3949 %U http://www.ncbi.nlm.nih.gov/pubmed/25648325 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e12 %T Dose-Response Effects of the Text4baby Mobile Health Program: Randomized Controlled Trial %A Evans,William %A Nielsen,Peter E %A Szekely,Daniel R %A Bihm,Jasmine W %A Murray,Elizabeth A %A Snider,Jeremy %A Abroms,Lorien C %+ Milken Institute School of Public Health, Department of Prevention and Community Health, The George Washington University, 950 New Hampshire Avenue, Washington, DC, 20052, United States, 1 12029943632, wdevans@gwu.edu %K mobile health %K prenatal health care %K health communication %D 2015 %7 28.01.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile health (mHealth) is growing rapidly, but more studies are needed on how to optimize programs, including optimal timing of messaging, dose of exposure, and value of interactive features. This study evaluates final outcomes of text4baby (a text message service for pregnant and postpartum women) from a randomized trial performed in a population of pregnant female soldiers and family members. Objective: The study aims were to evaluate (1) treatment effects and (2) dose-response effects of text4baby on behavioral outcomes compared to control (no text4baby) condition. Methods: The study was a randomized trial of text4baby at Madigan Army Medical Center. Female military health beneficiaries who met inclusion criteria were eligible for the study. Participants provided consent, completed a baseline questionnaire, and then were randomized to enroll in text4baby or not. They were followed up at 3 time points thereafter through delivery of their baby. Generalized estimating equation models were used to evaluate outcomes. We examined treatment effects and the effects of higher doses of text4baby messages on outcomes. Results: We report descriptive statistics including dosage of text messages delivered. The main finding was a significant effect of high exposure to text4baby on self-reported alcohol consumption postpartum (OR 0.212, 95% CI 0.046-0.973, P=.046), as measured by the question “Since you found out about your pregnancy, have you consumed alcoholic beverages?” The text4baby participants also reported lower quantities of alcohol consumed postpartum. Conclusions: Studies of text4baby have helped to build the mHealth evidence base. The effects of text4baby offer lessons for future scalable mHealth programs and suggest the need to study dose-response effects of these interventions. %M 25630361 %R 10.2196/mhealth.3909 %U http://mhealth.jmir.org/2015/1/e12/ %U https://doi.org/10.2196/mhealth.3909 %U http://www.ncbi.nlm.nih.gov/pubmed/25630361 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 1 %P e1 %T Text Messaging to Improve Hypertension Medication Adherence in African Americans: BPMED Intervention Development and Study Protocol %A Buis,Lorraine R %A Artinian,Nancy T %A Schwiebert,Loren %A Yarandi,Hossein %A Levy,Phillip D %+ University of Michigan, Department of Family Medicine, 1018 Fuller St., Ann Arbor, MI, 48104, United States, 1 734 998 7120, buisl@umich.edu %K mobile phone %K text messaging %K hypertension %K blood pressure %K African Americans %K medication adherence %K mobile health %D 2015 %7 02.01.2015 %9 Protocol %J JMIR Res Protoc %G English %X Background: Hypertension (HTN) is a major public health concern in the United States, with almost 78 million Americans age 20 years and over suffering from the condition. Moreover, HTN is a key risk factor for health disease and stroke. African Americans disproportionately shoulder the burdens of HTN, with greater prevalence, disease severity, earlier onset, and more HTN-related complications than age-matched whites. Medication adherence for the treatment of HTN is poor, with estimates indicating that only about half of hypertensive patients are adherent to prescribed medication regimens. Although no single intervention for improving medication adherence has emerged as superior to others, text message medication reminders have the potential to help improve medication adherence in African Americans with uncontrolled HTN as mobile phone adoption is very high in this population. Objective: The purpose of this two-phased study was to develop (Phase I) and test in a randomized controlled trial (RCT) (Phase II) a text message system, BPMED, to improve the quality of medication management through increasing medication adherence in African Americans with uncontrolled HTN. Methods: In Phase I, we recruited 16 target end-users from a primary care clinic, to assist in the development of BPMED through participating in one of three focus groups. Focus groups sought to gain patient perspectives on HTN, medication adherence, mobile phone use, and the use of text messaging to support medication adherence. Potential intervention designs were presented to participants, and feedback on the designs was solicited. In Phase II, we conducted two pilot RCTs to determine the feasibility, acceptability, and preliminary efficacy of BPMED in primary care and emergency department settings. Both pilot studies recruited approximately 60 participants, who were randomized equally between usual care and the BPMED intervention. Results: Although data collection is now complete, data analysis from the two pilot RCTs is still ongoing and results are expected in 2015. Conclusions: This study was designed to determine preliminary feasibility and acceptability of our approach among African Americans with uncontrolled HTN in primary care and emergency department settings. Results from these studies are of great interest as little work has been done to document the use of text message medication reminders to improve HTN-related outcomes, particularly within underserved urban minorities. Trial Registration: Clinicaltrials.gov NCT01465217; https://clinicaltrials.gov/ct2/show/NCT01465217 (Archived by WebCite at http://www.webcitation.org/6V0tto0lZ). %M 25565680 %R 10.2196/resprot.4040 %U http://www.researchprotocols.org/2015/1/e1/ %U https://doi.org/10.2196/resprot.4040 %U http://www.ncbi.nlm.nih.gov/pubmed/25565680 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 4 %P e45 %T Texting Teens in Transition: The Use of Text Messages in Clinical Intervention Research %A Rempel,Gwen R %A Ballantyne,Ross T %A Magill-Evans,Joyce %A Nicholas,David B %A Mackie,Andrew S %+ Athabasca University, Faculty of Health Disciplines, 1 University Drive, Athabasca, AB, T9S 3A3, Canada, 1 855 833 5699, gwen.rempel@ualberta.ca %K teens %K congenital heart disease %K text messaging %K SMS %K qualitative research %D 2014 %7 06.11.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The rapidly growing population of young adults living with congenital heart disease (CHD), currently challenging ill-prepared cardiac care systems, presents a novel population in which to consider the use of mHealth. This methodological study was part of a larger study that tested the effectiveness of a clinic-based nursing intervention to prepare teens for transfer from pediatric to adult cardiology care. The intervention included creation of a MyHealth Passport and subsequently SMS (short message service) text messages between the intervention nurse and study participant. Objective: Our aim was to determine (1) the preference of teens with CHD to be contacted via text message following the nursing intervention, (2) the effectiveness of texting to collect data regarding the use of MyHealth Passport after participation in the intervention, (3) the nature of the texting interaction, and (4) the risks and benefits of texting. Methods: Participants were recruited through the intervention study (n=24) by either choosing to receive information from the study coordinator through text message, or texting a question to the study nurses. Inclusion criteria were age 15-17 years, diagnosed with moderate or complex heart disease, and currently being followed by the Division of Cardiology at Stollery Children’s Hospital. Exclusion criteria were heart transplantation and/or less than a 6th grade reading and comprehension ability. Text message transcripts were analyzed by qualitative inductive content analysis. Results: Two-thirds of teens (16/24, 67%) chose text messaging as their preferred contact, making them eligible for the study. Texting was effective in collecting information regarding the MyHealth Passport; all but one teen had their MyHealth Passport on them, and many reported carrying it with them wherever they went. All teens reported showing their MyHealth Passport to at least one person. Seven themes were identified in the texting transcripts: mixing formal and informal language, the passive teen, interaction with health care providers, texting teens in transition, texting as a mechanism to initiate other forms of communication, affirmation, and the nurse as an educator. Benefits of texting were identified as flexibility, ability to respond over time, information presented in byte-sized amounts, and information directly related to patient questions. Risks of texting were identified as the possibility that interactions may not be in-depth, distraction of teen and researcher, and invasiveness. Conclusions: Text messaging was useful in collecting data regarding the use of the MyHealth Passport. Text messaging resulted in conversations with the teens that were sometimes in-depth and meaningful, especially when combined with other communication modalities. Using text messaging in a manner resulting in full conversations with the patients requires more study and may benefit from protocols and the use of solid theoretical foundations that would standardize the interaction so that more conclusions could be drawn. %M 25379624 %R 10.2196/mhealth.3232 %U http://mhealth.jmir.org/2014/4/e45/ %U https://doi.org/10.2196/mhealth.3232 %U http://www.ncbi.nlm.nih.gov/pubmed/25379624 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 4 %P e46 %T Qualitative Feedback From a Text Messaging Intervention for Depression: Benefits, Drawbacks, and Cultural Differences %A Aguilera,Adrian %A Berridge,Clara %+ University of California, Berkeley, School of Social Welfare, 120 Haviland Hall, MC7400, Berkeley, CA, 94720, United States, 1 5106428564, aguila@berkeley.edu %K mobile health %K depression %K text messaging %K culture %K digital health %K cognitive behavioral therapy %K disparities %K mental health %K behavior change %D 2014 %7 05.11.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile health interventions are often standardized and assumed to work the same for all users; however, we may be missing cultural differences in the experiences of interventions that may impact how and if an intervention is effective. Objective: The objective of the study was to assess qualitative feedback from participants to determine if there were differences between Spanish speakers and English speakers. Daily text messages were sent to patients as an adjunct to group Cognitive Behavioral Therapy (CBT) for depression. Methods: Messages inquired about mood and about specific themes (thoughts, activities, social interactions) of a manualized group CBT intervention. There were thirty-nine patients who participated in the text messaging pilot study. The average age of the participants was 53 years (SD 10.4; range of 23-72). Results: Qualitative feedback from Spanish speakers highlighted feelings of social support, whereas English speakers noted increased introspection and self-awareness of their mood state. Conclusions: These cultural differences should be explored further, as they may impact the effect of supportive mobile health interventions. Trial Registration: Trial Registration: Clinicaltrials.gov NCT01083628; http://clinicaltrials.gov/ct2/show/study/NCT01083628 (Archived by WebCite at http://www.webcitation.org/6StpbdHuq). %M 25373390 %R 10.2196/mhealth.3660 %U http://mhealth.jmir.org/2014/4/e46/ %U https://doi.org/10.2196/mhealth.3660 %U http://www.ncbi.nlm.nih.gov/pubmed/25373390 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 4 %P e40 %T The Medium and the Message: Fitting Sound Health Promotion Methodology Into 160 Characters %A Lim,Megan S C %A Wright,Cassandra %A Hellard,Margaret E %+ Burnet Institute, Centre for Population Health, 85 Commercial Rd, Melbourne, 3004, Australia, 61 385062403, lim@burnet.edu.au %K text messaging %K mobile phone %K health promotion %K program evaluation  %D 2014 %7 03.11.2014 %9 Editorial %J JMIR mHealth uHealth %G English %X Text messaging health promotion projects continue to proliferate due to their relative low-cost, simplicity, non-intrusiveness, and proven effectiveness in several randomized controlled trials. In these past trials, participants have typically been recruited through traditional means, received the text messaging intervention, and then completed evaluation. In this issue of the Journal of Medical Internet Research, Sheoran et al have demonstrated how use of text messaging alone can be a feasible method for all three stages: recruitment, intervention, and evaluation. Use of text messages without any other modes of communication could be a key to population-level dissemination and wider uptake of health promotion messages. However, in the rush to utilize new technologies and in the brevity of 160 characters, it should not be forgotten that quality, rigour, and careful development remain essential in any health promotion practice. %M 25367387 %R 10.2196/mhealth.3888 %U http://mhealth.jmir.org/2014/4/e40/ %U https://doi.org/10.2196/mhealth.3888 %U http://www.ncbi.nlm.nih.gov/pubmed/25367387 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 4 %P e51 %T The Hookup: Collaborative Evaluation of a Youth Sexual Health Program Using Text Messaging Technology %A Sheoran,Bhupendra %A Braun,Rebecca A %A Gaarde,Jenna Patrice %A Levine,Deborah K %+ Internet Sexuality Information Services, Inc (dba YTH), 409 13th Street, Oakland, CA, 94612, United States, 1 510 835 9400, sheoran@yth.org %K sexual health %K STDs %K HIV %K mobile phone %K youth %K SMS %K text messaging %K program evaluation %D 2014 %7 03.11.2014 %9 Short Paper %J JMIR mHealth uHealth %G English %X Background: The Hookup is a collaborative project reaching young people in California with valuable sexual and reproductive health information and linkage to local resources. Due to limited access to subscriber contact information, it has been a challenge to evaluate the program. Objective: The aims of this study were to determine the feasibility of using text messaging (short message service, SMS) as an evaluation tool for an educational text message-based program and to evaluate the program itself. Methods: All subscribers of The Hookup were sent four survey questions via SMS about age, gender, location, referral source and behavior change. An incentive was offered for completing the survey and an opt-out option was provided in the initial message. Results: All existing subscribers of The Hookup (N=2477) received a request to complete the survey using the SMS application on their mobile phones. A total of 832 (33.6%) subscribers responded to the initial question and 481 (20%) answered all four questions. Of the responses, 85% were received in the first two hours of the initial request. Respondents who answered the question about behavior change, 90% reported having made some positive change since subscribing to Hookup, including getting tested for STDs and HIV. Conclusions: The survey methodology initiated a high response rate from The Hookup subscribers. The survey was able to provide data about subscribers in a short time period at minimal cost. The results show potential for using mobile SMS applications to evaluate SMS campaigns. The findings also support using SMS to provide young people with sexual health prevention messaging and linkage to health services. %M 25367444 %R 10.2196/mhealth.3583 %U http://mhealth.jmir.org/2014/4/e51/ %U https://doi.org/10.2196/mhealth.3583 %U http://www.ncbi.nlm.nih.gov/pubmed/25367444 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 10 %P e222 %T Use of Mobile Phone Text Message Reminders in Health Care Services: A Narrative Literature Review %A Kannisto,Kati Anneli %A Koivunen,Marita Hannele %A Välimäki,Maritta Anneli %+ Department of Nursing Science, University of Turku, Lemminkäisenkatu 1, Turku, 20014, Finland, 358 50 5312652, kaankan@utu.fi %K text messaging %K short message service %K cellular phone %K reminder system %K review %D 2014 %7 17.10.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile text messages are a widely recognized communication method in societies, as the global penetration of the technology approaches 100% worldwide. Systematic knowledge is still lacking on how the mobile telephone text messaging (short message service, SMS) has been used in health care services. Objective: This study aims to review the literature on the use of mobile phone text message reminders in health care. Methods: We conducted a systematic literature review of studies on mobile telephone text message reminders. The data sources used were PubMed (MEDLINE), CINAHL, Proquest Databases/ PsycINFO, EMBASE, Cochrane Library, Scopus, and hand searching since 2003. Studies reporting the use of SMS intended to remind patients in health services were included. Given the heterogeneity in the studies, descriptive characteristics, purpose of the study, response rates, description of the intervention, dose and timing, instruments, outcome measures, and outcome data from the studies were synthesized using a narrative approach. Results: From 911 initial citations, 60 studies were included in the review. The studies reported a variety of use for SMS. Mobile telephone text message reminders were used as the only intervention in 73% (44/60) of the studies, and in 27% (16/60) of the remaining studies, SMS was connected to another comprehensive health intervention system. SMS reminders were sent to different patient groups: patients with HIV/AIDS (15%, 9/60) and diabetes (13%, 8/60) being the most common groups. The response rates of the studies varied from 22-100%. Typically, the text message reminders were sent daily. The time before the specific intervention to be rendered varied from 10 minutes (eg, medication taken) to 2 weeks (eg, scheduled appointment). A wide range of different evaluation methods and outcomes were used to assess the impact of SMS varying from existing databases (eg, attendance rate based on medical records), questionnaires, and physiological measures. About three quarters of the studies (77%, 46/60) reported improved outcomes: adherence to medication or to treatment reportedly improved in 40% (24/60) of the studies, appointment attendance in 18% (11/60) of the studies, and non-attendance rates decreased in 18% (11/60) of the studies. Other positive impacts were decreased amount of missed medication doses, more positive attitudes towards medication, and reductions in treatment interruptions. Conclusions: We can conclude that although SMS reminders are used with different patient groups in health care, SMS is less systematically studied with randomized controlled trial study design. Although the amount of evidence for SMS application recommendations is still limited, having 77% (46/60) of the studies showing improved outcomes may indicate its use in health care settings. However, more well-conducted SMS studies are still needed. %M 25326646 %R 10.2196/jmir.3442 %U http://www.jmir.org/2014/10/e222/ %U https://doi.org/10.2196/jmir.3442 %U http://www.ncbi.nlm.nih.gov/pubmed/25326646 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 10 %P e219 %T A Comparison Between Phone-Based Psychotherapy With and Without Text Messaging Support In Between Sessions for Crisis Patients %A Furber,Gareth %A Jones,Gabrielle Margaret %A Healey,David %A Bidargaddi,Niranjan %+ Health Economics and Social Policy Group, School of Population Health, University of South Australia, South Australian Health & Medical Research Institute (SAHMRI), North Terrace, Adelaide, 5000, Australia, 61 80429344065, gareth.furber@unisa.edu.au %K telemedicine %K psychotherapy %K mental health services %K mobile health %K mHealth %K short message service %K eHealth %D 2014 %7 08.10.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Few studies have tested whether individually tailored text messaging interventions have an effect on clinical outcomes when used to supplement traditional psychotherapy. This is despite the potential to improve outcomes through symptom monitoring, prompts for between-session activities, and psychoeducation. Objective: The intent of the study was to explore the use of individually tailored between-session text messaging, or short message service (SMS), as an adjunct to telephone-based psychotherapy for consumers who present to the Emergency Department (ED) in situational and/or emotional crises. Methods: Over a 4-month period, two therapists offered 68 prospective consumers of a telephone-based psychotherapy service individually tailored between-session text messaging alongside their telephone-based psychotherapy. Attendance and clinical outcomes (depression, anxiety, functional impairment) of those receiving messages were compared against a historical control group (n=157) who received telephone psychotherapy only. Results: A total of 66% (45/68) of the consumers offered SMS accepted the intervention. A total of 432 messages were sent over the course of the trial, the majority involving some kind of psychoeducation or reminders to engage in therapy goals. There were no significant differences in clinical outcomes between consumers who received the SMS and those in the control group. There was a trend for participants in the intervention group to attend fewer sessions than those in the control group (mean 3.7, SD 1.9 vs mean 4.4, SD 2.3). Conclusions: Both groups showed significant improvement over time. Individually tailored SMS were not found to improve clinical outcomes in consumers receiving telephone-based psychotherapy, but the study was underpowered, given the effect sizes noted and the significance level chosen. Given the ease of implementation and positive feedback from therapists and clients, individually tailored text messages should be explored further in future trials with a focus on enhancing the clinical impact of the tailored text messages, and utilizing designs with additional power to test for between-group effects. %M 25295667 %R 10.2196/jmir.3096 %U http://www.jmir.org/2014/10/e219/ %U https://doi.org/10.2196/jmir.3096 %U http://www.ncbi.nlm.nih.gov/pubmed/25295667 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 8 %P e196 %T Mobile Phone Text Messaging Intervention for Cervical Cancer Screening: Changes in Knowledge and Behavior Pre-Post Intervention %A Lee,Hee Yun %A Koopmeiners,Joseph S %A Rhee,Taeho Greg %A Raveis,Victoria H %A Ahluwalia,Jasjit S %+ School of Social Work and University of Minnesota Masonic Cancer Center, College of Education and Human Development, University of Minnesota, Twin Cities, 1404 Gortner Ave, St Paul, MN, 55108, United States, 1 612 624 3689, hylee@umn.edu %K cervical cancer %K Pap test %K mobile health %K text-messaging intervention %K health behavior change %K Korean American women %K health disparity %D 2014 %7 27.08.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Cervical cancer poses a significant threat to Korean American women, who are reported to have one of the highest cervical cancer mortality rates in the United States. Studies consistently report that Korean American women have the lowest Pap test screening rates across US ethnic groups. Objective: In response to the need to enhance cervical cancer screening in this vulnerable population, we developed and tested a 7-day mobile phone text message-based cervical cancer Screening (mScreening) intervention designed to promote the receipt of Pap tests by young Korean American women. Methods: We developed and assessed the acceptability and feasibility of a 1-week mScreening intervention to increase knowledge of cervical cancer screening, intent to receive screening, and the receipt of a Pap test. Fogg’s Behavior Model was the conceptual framework that guided the development of the mScreening intervention. A series of focus groups were conducted to inform the development of the intervention. The messages were individually tailored for each participant and delivered to them for a 7-day period at each participant’s preferred time. A quasi-experimental research design of 30 Korean American women aged 21 to 29 years was utilized with baseline, post (1 week after the completion of mScreening), and follow-up (3 months after the completion of mScreening) testing. Results: Findings revealed a significant increase in participants’ knowledge of cervical cancer (P<.001) and guidelines for cervical cancer screening (P=.006). A total of 23% (7/30) (95% CI 9.9-42.3) of the mScreening participants received a Pap test; 83% (25/30) of the participants expressed satisfaction with the intervention and 97% (29/30) reported that they would recommend the program to their friends, indicating excellent acceptability and feasibility of the intervention. Conclusions: This study provides evidence of the effectiveness and feasibility of the mScreening intervention. Mobile technology is a promising tool to increase both knowledge and receipt of cervical cancer screening. Given the widespread usage of mobile phones among young adults, a mobile phone-based health intervention could be a low-cost and effective method of reaching populations with low cervical cancer screening rates, using individually tailored messages that cover broad content areas and overcome restrictions to place and time of delivery. %M 25164545 %R 10.2196/jmir.3576 %U http://www.jmir.org/2014/8/e196/ %U https://doi.org/10.2196/jmir.3576 %U http://www.ncbi.nlm.nih.gov/pubmed/25164545 %0 Journal Article %@ 22915222 %I JMIR Publications Inc. %V 2 %N 3 %P e18 %T Development of an Evidence-Based mHealth Weight Management Program Using a Formative Research Process %A Waterlander,Wilma %A Whittaker,Robyn %A McRobbie,Hayden %A Dorey,Enid %A Ball,Kylie %A Maddison,Ralph %A Myers Smith,Katie %A Crawford,David %A Jiang,Yannan %A Gu,Yulong %A Michie,Jo %A Ni Mhurchu,Cliona %+ National Institute for Health Innovation, School of Population Health, University of Auckland, Tamaki Campus, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand, 64 (0)9 9234612, w.waterlander@nihi.auckland.ac.nz %K weight loss %K intervention %K Internet %K mobile phone %K focus groups %D 2014 %7 11.07.2014 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is a critical need for weight management programs that are effective, cost efficient, accessible, and acceptable to adults from diverse ethnic and socioeconomic backgrounds. mHealth (delivered via mobile phone and Internet) weight management programs have potential to address this need. To maximize the success and cost-effectiveness of such an mHealth approach it is vital to develop program content based on effective behavior change techniques, proven weight management programs, and closely aligned with participants’ needs. Objective: This study aims to develop an evidence-based mHealth weight management program (Horizon) using formative research and a structured content development process. Methods: The Horizon mHealth weight management program involved the modification of the group-based UK Weight Action Program (WAP) for delivery via short message service (SMS) and the Internet. We used an iterative development process with mixed methods entailing two phases: (1) expert input on evidence of effective programs and behavior change theory; and (2) target population input via focus group (n=20 participants), one-on-one phone interviews (n=5), and a quantitative online survey (n=120). Results: Expert review determined that core components of a successful program should include: (1) self-monitoring of behavior; (2) prompting intention formation; (3) promoting specific goal setting; (4) providing feedback on performance; and (5) promoting review of behavioral goals. Subsequent target group input confirmed that participants liked the concept of an mHealth weight management program and expressed preferences for the program to be personalized, with immediate (prompt) and informative text messages, practical and localized physical activity and dietary information, culturally appropriate language and messages, offer social support (group activities or blogs) and weight tracking functions. Most target users expressed a preference for at least one text message per day. We present the prototype mHealth weight management program (Horizon) that aligns with those inputs. Conclusions: The Horizon prototype described in this paper could be used as a basis for other mHealth weight management programs. The next priority will be to further develop the program and conduct a full randomized controlled trial of effectiveness. %M 25098337 %R 10.2196/mhealth.2850 %U http://www.jmir.org/2014/3/e18/ %U https://doi.org/10.2196/mhealth.2850 %U http://www.ncbi.nlm.nih.gov/pubmed/25098337 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 2 %P e30 %T Feasibility and User Perception of a Fully Automated Push-Based Multiple-Session Alcohol Intervention for University Students: Randomized Controlled Trial %A Bendtsen,Marcus %A Bendtsen,Preben %+ Medical Faculty, Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Linköping, 581 83, Sweden, 46 702324615, preben.bendtsen@liu.se %K alcohol intervention %K text messages %K SMS %K email %K students %K multiple-session intervention %K push-based intervention %D 2014 %7 23.06.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: In recent years, many electronic health behavior interventions have been developed in order to reach individuals with unhealthy behaviors, such as risky drinking. This is especially relevant for university students, many of whom are risky drinkers. Objective: This study explored the acceptability and feasibility in a nontreatment-seeking group of university students (including both risk and nonrisk drinkers), of a fully automated, push-based, multiple-session, alcohol intervention, comparing two modes of delivery by randomizing participants to receive the intervention either by SMS text messaging (short message service, SMS) or by email. Methods: A total of 5499 students at Luleå University in northern Sweden were invited to participate in a single-session alcohol assessment and feedback intervention; 28.04% (1542/5499) students completed this part of the study. In total, 29.44% (454/1542) of those participating in the single-session intervention accepted to participate further in the extended multiple-session intervention lasting for 4 weeks. The students were randomized to receive the intervention messages via SMS or email. A follow-up questionnaire was sent immediately after the intervention and 52.9% (240/454) responded. Results: No difference was seen regarding satisfaction with the length and frequency of the intervention, regardless of the mode of delivery. Approximately 15% in both the SMS (19/136) and email groups (15/104) would have preferred the other mode of delivery. On the other hand, more students in the SMS group (46/229, 20.1%) stopped participating in the intervention during the 4-week period compared with the email group (10/193, 5.2%). Most students in both groups expressed satisfaction with the content of the messages and would recommend the intervention to a fellow student in need of reducing drinking. A striking difference was seen regarding when a message was read; 88.2% (120/136) of the SMS group read the messages within 1 hour in contrast to 45.2% (47/104) in the email group. In addition, 83.1% (113/136) in the SMS group stated that they read all or almost all the messages, compared with only 63.5% (66/104) in the email group. Conclusions: Based on the feedback from the students, an extended, multiple-session, push-based intervention seems to be a feasible option for students interested in additional support after a single-session alcohol intervention. SMS as a mode of delivery seems to have some advantages over email regarding when a message is read and the proportion of messages read. However, more students in the SMS group stopped the intervention than in the email group. Based on these promising findings, further studies comparing the effectiveness of single-session interventions with extended multiple-session interventions delivered separately or in combination are warranted. %M 25098296 %R 10.2196/mhealth.3233 %U http://mhealth.jmir.org/2014/2/e30/ %U https://doi.org/10.2196/mhealth.3233 %U http://www.ncbi.nlm.nih.gov/pubmed/25098296 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 4 %P e103 %T Adolescents Just Do Not Know What They Want: A Qualitative Study to Describe Obese Adolescents’ Experiences of Text Messaging to Support Behavior Change Maintenance Post Intervention %A Smith,Kyla L %A Kerr,Deborah A %A Fenner,Ashley A %A Straker,Leon M %+ School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Building 408, GPO Box U1987, Perth, 6845, Australia, 61 8 9266 3694, kyla.smith@curtin.edu.au %K telemedicine %K text messaging %K adolescent %K obesity %D 2014 %7 08.04.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescents are considered a hard to reach group and novel approaches are needed to encourage good health. Text messaging interventions have been reported as acceptable to adolescents but there is little evidence regarding the use of text messages with overweight and obese adolescents to support engagement or behavior change after the conclusion of a healthy lifestyle program. Objective: The intent of this study was to explore the opinions of overweight adolescents and their parents regarding the use of text messages as a support during the maintenance period following an intervention. Methods: This paper reports on the findings from focus groups conducted with adolescents (n=12) and parents (n=13) who had completed an eight-week intensive intervention known as Curtin University’s Activity, Food and Attitudes Program (CAFAP). Focus groups were conducted three months post intensive intervention. Participants were asked about their experiences of the prior three-month maintenance phase during which adolescents had received tri-weekly text messages based on the self-determination theory and goal-setting theory. Participants were asked about the style and content of text messages used as well as how they used the text messages. Data were analyzed using content and thematic analyses. Results: Two clear themes emerged from the focus groups relating to (1) what adolescents liked or thought they wanted in a text message to support behavior change, and (2) how they experienced or responded to text messages. Within the “like/want” theme, there were five sub-themes relating to the overall tone of the text, frequency, timing, reference to long-term goals, and inclusion of practical tips. Within the “response to text” theme, there were four sub-themes describing a lack of motivation, barriers to change, feelings of shame, and perceived unfavorable comparison with other adolescents. What adolescents said they wanted in text messages often conflicted with their actual experiences. Parent reports provided a useful secondary view of adolescent experience. Conclusions: The conflicting views described in this study suggest that overweight and obese adolescents may not know or have the ability to articulate how they would best be supported with text messages during a healthy lifestyle maintenance phase. Further, supporting both engagement and behavior change simultaneously with text messaging may not be possible. Intervention texts should be personalized as much as possible and minimize feelings of guilt and shame in overweight and obese adolescents. Future research with text messaging for overweight and obese adolescents should incorporate clear intervention aims and evaluation methods specifically related to adolescent engagement or behavior change. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12611001187932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611001187932 (Archived by WebCite at http://www.webcitation.org/6LGSbk8d9). %M 24713407 %R 10.2196/jmir.3113 %U http://www.jmir.org/2014/4/e103/ %U https://doi.org/10.2196/jmir.3113 %U http://www.ncbi.nlm.nih.gov/pubmed/24713407 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 3 %N 2 %P e20 %T Preventing Postpartum Smoking Relapse Among Inner City Women: Development of a Theory-Based and Evidence-Guided Text Messaging Intervention %A Wen,Kuang-Yi %A Miller,Suzanne M %A Kilby,Linda %A Fleisher,Linda %A Belton,Tanisha D %A Roy,Gem %A Hernandez,Enrique %+ Fox Chase Cancer Center/Temple University Health System, Cancer Prevention and Control, 333 Cottman Avenue, Philadelphia, PA, 19111, United States, 1 215 728 4069, suzanne.miller@fccc.edu %K smoking relapse intervention %K low-income women %K mHealth %K text messaging %D 2014 %7 03.04.2014 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Underserved women are at high risk for smoking relapse after childbirth due to their unique socioeconomic and postpartum stressors and barriers. Mobile text messaging technology allows delivery of relapse prevention programs targeted to their personal needs over time. Objective: To describe the development of a social-cognitive theory-based and evidence-guided text messaging intervention for preventing postpartum smoking relapse among inner city women. Methods: Guided by the cognitive-social health information processing framework, user-centered design, and health communication best practices, the intervention was developed through a systematic process that included needs assessment, followed by an iterative cycling through message drafting, health literacy evaluation and rewriting, review by target community members and a scientific advisory panel, and message revision, concluding with usability testing. Results: All message content was theory-grounded, derived by needs assessment analysis and evidence-based materials, reviewed and revised by the target population, health literacy experts, and scientific advisors. The final program, “Txt2Commit,” was developed as a fully automated system, designed to deliver 3 proactive messages per day for a 1-month postpartum smoking relapse intervention, with crave and lapse user-initiated message functions available when needed. Conclusions: The developmental process suggests that the application of theory and best practices in the design of text messaging smoking cessation interventions is not only feasible but necessary for ensuring that the interventions are evidence based and user-centered. %M 24698804 %R 10.2196/resprot.3059 %U http://www.researchprotocols.org/2014/2/e20/ %U https://doi.org/10.2196/resprot.3059 %U http://www.ncbi.nlm.nih.gov/pubmed/24698804 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 3 %P e93 %T Characterizing Periodic Messaging Interventions Across Health Behaviors and Media: Systematic Review %A De Leon,Elaine %A Fuentes,Laura W %A Cohen,Joanna E %+ Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, 4th Floor, Baltimore, MD, 21205, United States, 1 410 955 3549, edeleon@jhsph.edu %K prompts %K periodic messaging %K health behavior %K review, systematic %D 2014 %7 25.03.2014 %9 Review %J J Med Internet Res %G English %X Background: Periodic prompts serve as tools for health behavior interventions to encourage and maintain behavior changes. Past literature reviews have examined periodic messages targeting specific behaviors (smoking, physical activity, diet, etc) or media (telephone, email, face-to-face, newsletter, etc) and have found them to be effective in impacting health behavior in the short term. Objective: Our goal was to review the literature related to periodic messaging and prompts in order to explore typical characteristics, assess the role of prompt timing, identify common theoretical models used, and identify characteristics associated with the effectiveness of periodic prompts. Methods: Electronic searches of PubMed, PsycINFO, CINAHL, and Web of Science were conducted in October 2012 and May 2013. Database search terms included variant terms for periods, prompts, interventions, media, and health behaviors. Results: Forty-two of the 55 included research articles found that prompts resulted in significant positive behavioral outcomes for participants. Prompts were delivered via text messages, email, mailed communications, and in a few instances via phone. Generally, the provision of feedback and specific strategies to accomplish behavior change appears to be important for the success of periodic prompts. Rationale for prompt timing was rarely provided, although some studies did organize message content around days of the week or times perceived to be high risk for particular behaviors. Smoking cessation interventions tended to be organized around quit date. Among studies using theoretical models to inform their interventions, the transtheoretical model was most common. Conclusions: Periodic messaging interventions yield positive results for short-term health behavior changes. Interventions including feedback and prompts that included strategies were more likely to report significantly positive outcomes. Work remains to better understand elements that make periodic prompts successful and whether they are effective in producing long-term outcomes. %M 24667840 %R 10.2196/jmir.2837 %U http://www.jmir.org/2014/3/e93/ %U https://doi.org/10.2196/jmir.2837 %U http://www.ncbi.nlm.nih.gov/pubmed/24667840 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 1 %P e5 %T Integrating Mobile Phones into Medical Abortion Provision: Intervention Development, Use, and Lessons Learned From a Randomized Controlled Trial %A de Tolly,Katherine Marianne %A Constant,Deborah %+ Cell-Life, Avalon 4 Building, 123 Hope Street, Gardens, Cape Town, 8001, South Africa, 27 21 462 6481, kmdetolly@gmail.com %K mHealth %K telemedicine %K SMS %K medical abortion %K USSD %K mobisite %D 2014 %7 14.02.2014 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Medical abortion is legal in South Africa but access and acceptability are hampered by the current protocol requiring a follow-up visit to assess abortion completion. Objective: To assess the feasibility and efficacy of information and follow-up provided via mobile phone after medical abortion in a randomized controlled trial (RCT). Methods: Mobile phones were used in three ways in the study: (1) coaching women through medical abortion using short message service (SMS; text messages); (2) a questionnaire to assess abortion completion via unstructured supplementary service data (USSD, a protocol used by GSM mobile telephones that allows the user to interact with a server via text-based menus) and the South African mobile instant message and social networking application Mxit; and (3) family planning information via SMS, mobisite and Mxit. A needs and context assessment was done to learn about women’s experiences undergoing medical abortion and their use of mobile phones. After development, the mobile interventions were piloted. Recruitment was done by field workers at the clinics. In the RCT, women were interviewed at baseline and exit. Computer logs were also analyzed. All study participants received standard of care at the clinics. Results: In the RCT, 234 women were randomized to the intervention group. Eight did not receive the intervention due to invalid numbers, mis-registration, system failure, or opt-out, leaving 226 participants receiving the full intervention. Of the 226, 190 returned and were interviewed at their clinic follow-up visit. The SMSs were highly acceptable, with 97.9% (186/190) saying that the SMSs helped them through the medical abortion. In terms of mobile phone privacy, 86.3% (202/234) said that it was not likely or possible that someone would see SMSs on their phone, although at exit, 20% (38/190) indicated that they had worried about phone privacy. Having been given training at baseline and subsequently asked via SMS to complete the self-assessment questionnaire, 90.3% (204/226) attempted it, and of those, 86.3% (176/204) reached an endpoint of the questionnaire. For the family planning information, a preference for SMS was indicated by study clients, although the publicly available Mxit/mobisite was heavily used (813,375 pages were viewed) over the study duration. Conclusions: SMS provided a good medium for timed, "push" information that guided and supported women through medical abortion. Women were able to perform a self-assessment questionnaire via mobile phones if provided training and prompted by SMS. Phone privacy needs to be protected in similar settings. This study may contribute to the successful expansion of medical abortion provision aided by mobile phones. Trial Registration: Pan African Clinical Trials Registry (PACTR): PACTR201302000427144; http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry?dar=true&tNo=PACTR201302000427144 (Archived by WebCite at http://www.webcitation.org/6N0fnZfzm). %M 25098569 %R 10.2196/mhealth.3165 %U http://mhealth.jmir.org/2014/1/e5/ %U https://doi.org/10.2196/mhealth.3165 %U http://www.ncbi.nlm.nih.gov/pubmed/25098569 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 2 %P e14 %T Understanding Messaging Preferences to Inform Development of Mobile Goal-Directed Behavioral Interventions %A Muench,Frederick %A van Stolk-Cooke,Katherine %A Morgenstern,Jon %A Kuerbis,Alexis N %A Markle,Kendra %+ CASPIR, Department of Psychiatry, Columbia University College of Physicians & Surgeons, 3 Columbus Circle 1404, New York, NY, 10017, United States, 1 212 974 0547, fm2148@columbia.edu %K mHealth %K text messaging %K behavioral health %K preferences %K linguistics %K tailoring %K participatory design %K agile design %D 2014 %7 05.02.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile messaging interventions have been shown to improve outcomes across a number of mental health and health-related conditions, but there are still significant gaps in our knowledge of how to construct and deliver the most effective brief messaging interventions. Little is known about the ways in which subtle linguistic variations in message content can affect user receptivity and preferences. Objective: The aim of this study was to determine whether any global messaging preferences existed for different types of language content, and how certain characteristics moderate those preferences, in an effort to inform the development of mobile messaging interventions. Methods: This study examined user preferences for messages within 22 content groupings. Groupings were presented online in dyads of short messages that were identical in their subject matter, but structurally or linguistically varied. Participants were 277 individuals residing in the United States who were recruited and compensated through Amazon’s Mechanical Turk (MTurk) system. Participants were instructed to select the message in each dyad that they would prefer to receive to help them achieve a personal goal of their choosing. Results: Results indicate global preferences of more than 75% of subjects for certain types of messages, such as those that were grammatically correct, free of textese, benefit-oriented, polite, nonaggressive, and directive as opposed to passive, among others. For several classes of messages, few or no clear global preferences were found. There were few personality- and trait-based moderators of message preferences, but subtle manipulations of message structure, such as changing “Try to…” to “You might want to try to…” affected message choice. Conclusions: The results indicate that individuals are sensitive to variations in the linguistic content of text messages designed to help them achieve a personal goal and, in some cases, have clear preferences for one type of message over another. Global preferences were indicated for messages that contained accurate spelling and grammar, as well as messages that emphasize the positive over the negative. Research implications and a guide for developing short messages for goal-directed behaviors are presented in this paper. %M 24500775 %R 10.2196/jmir.2945 %U http://www.jmir.org/2014/2/e14/ %U https://doi.org/10.2196/jmir.2945 %U http://www.ncbi.nlm.nih.gov/pubmed/24500775 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 1 %P e3 %T Teenagers and Texting: Use of a Youth Ecological Momentary Assessment System in Trajectory Health Research With Latina Adolescents %A Garcia,Carolyn %A Hardeman,Rachel R %A Kwon,Gyu %A Lando-King,Elizabeth %A Zhang,Lei %A Genis,Therese %A Brady,Sonya S %A Kinder,Elizabeth %+ University of Minnesota, School of Nursing, 5-140 Weaver Densford Hall, 308 Harvard Street SE, Minneapolis, MN, 55455, United States, 1 6126246179, garcia@umn.edu %K texting %K data collection %K intervention research %K longitudinal %K trajectory %D 2014 %7 24.01.2014 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adolescent females send and receive more text messages than any others, with an average of 4050 texts a month. Despite this technological inroad among adolescents, few researchers are utilizing text messaging technology to collect real time, contextualized data. Temporal variables (ie, mood) collected regularly over a period of time could yield useful insights, particularly for evaluating health intervention outcomes. Use of text messaging technology has multiple benefits, including capacity of researchers to immediately act in response to texted information. Objective: The objective of our study was to custom build a short messaging service (SMS) or text messaging assessment delivery system for use with adolescents. The Youth Ecological Momentary Assessment System (YEMAS) was developed to collect automated texted reports of daily activities, behaviors, and attitudes among adolescents, and to examine the feasibility of YEMAS. This system was created to collect and transfer real time data about individual- and social-level factors that influence physical, mental, emotional, and social well-being. Methods: YEMAS is a custom designed system that interfaces with a cloud-based communication system to automate scheduled delivery of survey questions via text messaging; we designed this university-based system to meet data security and management standards. This was a two-phase study that included development of YEMAS and a feasibility pilot with Latino adolescent females. Relative homogeneity of participants was desired for the feasibility pilot study; adolescent Latina youth were sought because they represent the largest and fastest growing ethnic minority group in the United States. Females were targeted because they demonstrate the highest rate of text messaging and were expected to be interested in participating. Phase I involved development of YEMAS and Phase II involved piloting of the system with Latina adolescents. Girls were eligible to participate if they were attending one of the participating high schools and self-identified as Latina. We contacted 96 adolescents; of these, 24 returned written parental consent forms, completed assent processes, and enrolled in the study. Results: YEMAS was collaboratively developed and implemented. Feasibility was established with Latina adolescents (N=24), who responded to four surveys daily for two two-week periods (four weeks total). Each survey had between 12 and 17 questions, with responses including yes/no, Likert scale, and open-ended options. Retention and compliance rates were high, with nearly 18,000 texts provided by the girls over the course of the pilot period. Conclusions: Pilot results support the feasibility and value of YEMAS, an automated SMS-based text messaging data collection system positioned within a secure university environment. This approach capitalizes on immediate data transfer protocols and enables the documentation of participants’ thoughts, feelings, and behaviors in real time. Data are collected using mobile devices that are familiar to participants and nearly ubiquitous in developed countries. %M 25098355 %R 10.2196/mhealth.2576 %U http://www.mhealth.jmir.org/2014/1/e3/ %U https://doi.org/10.2196/mhealth.2576 %U http://www.ncbi.nlm.nih.gov/pubmed/25098355 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 12 %P e282 %T Use of a Text Message Program to Raise Type 2 Diabetes Risk Awareness and Promote Health Behavior Change (Part II): Assessment of Participants' Perceptions on Efficacy %A Buis,Lorraine R %A Hirzel,Lindsey %A Turske,Scott A %A Des Jardins,Terrisca R %A Yarandi,Hossein %A Bondurant,Patricia %+ University of Michigan, Department of Family Medicine, 1018 Fuller St, Ann Arbor, MI, 48104-1213, United States, 1 734 998 7120 ext 312, buisl@umich.edu %K diabetes mellitus, type 2 %K mobile health %K cellular phone %K text messaging %K risk reduction behavior %K program evaluation %D 2013 %7 19.12.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Although there is great enthusiasm in both the public and private sector for the further development and use of large-scale consumer-facing public health applications for mobile platforms, little is known about user experience and satisfaction with this type of approach. As a part of the Beacon Community Cooperative Agreement Program, txt4health, a public-facing, mobile phone-based health information service targeting type 2 diabetes, was launched in 3 Beacon Communities: the Southeast Michigan Beacon Community in Detroit, MI, the Greater Cincinnati Beacon Community in Cincinnati, OH, and the Crescent City Beacon Community in New Orleans, LA. This program was marketed via large public health campaigns and drew many users within the respective communities. Objective: The purpose of this investigation was to use the RE-AIM framework to document txt4health efficacy by focusing on perceptions of satisfaction, usage, and behavior change among individuals who used txt4health in pilot studies in Southeast Michigan and Greater Cincinnati. Methods: We conducted a multimodal user survey with txt4health users recruited via text message through the program to understand participant perceptions of program use and satisfaction, as well as self-reported perceptions of behavior change as a result of using txt4health. Results: Txt4health users reported very high levels of program satisfaction, with 67.1% (108/161) reporting satisfaction scores of ≥8 on a 10-point scale, with 10 equivalent to most satisfied (mean 8.2, SD 1.6). All survey participants agreed/strongly agreed that the messages included in txt4health were clear and easy to understand (100.0%, 160/160), and most found txt4health made them knowledgeable about their risk for type 2 diabetes (88.1%, 140/159) and made them conscious of their diet and physical activity (88.8%, 142/160). Most participants reported that txt4health helped them to make behavior changes related to diet; after having completed txt4health, most agreed/strongly agreed that they are more likely to replace sugary drinks, such as juice or soda, with water (78.0%, 124/159), have a piece of fresh fruit instead of dessert (74.2%, 118/159), substitute a small salad for chips or fries when dining out (76.1%, 121/159), buy healthier foods when grocery shopping (79.7%, 126/158), and eat more grilled, baked, or broiled foods instead of fried (75.5%, 120/159). Conclusions: Results from this study suggest that participants in txt4health, a large-scale, public health–focused text message program targeting type 2 diabetes, have positive perceptions of the program and that participation has led to positive behavior change. %M 24356359 %R 10.2196/jmir.2929 %U http://www.jmir.org/2013/12/e282/ %U https://doi.org/10.2196/jmir.2929 %U http://www.ncbi.nlm.nih.gov/pubmed/24356359 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 12 %P e281 %T Use of a Text Message Program to Raise Type 2 Diabetes Risk Awareness and Promote Health Behavior Change (Part I): Assessment of Participant Reach and Adoption %A Buis,Lorraine R %A Hirzel,Lindsey %A Turske,Scott A %A Des Jardins,Terrisca R %A Yarandi,Hossein %A Bondurant,Patricia %+ University of Michigan, Department of Family Medicine, 1018 Fuller St, Ann Arbor, MI, 48104-1213, United States, 1 734 998 7120 ext 312, buisl@umich.edu %K diabetes mellitus, type 2 %K mobile health %K cellular phone %K text messaging %K risk reduction behavior %K program evaluation %D 2013 %7 19.12.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: There are an estimated 25.8 million American children and adults, equivalent to 8.3% of the US population, living with diabetes. Diabetes is particularly burdensome on minority populations. The use of mobile technologies for reaching broad populations is a promising approach, given its wide footprint and ability to deliver inexpensive personalized messages, to increase awareness of type 2 diabetes and promote behavior changes targeting risk factors associated with type 2 diabetes. As a part of the Beacon Community Cooperative Agreement Program, txt4health, a public-facing mobile health information service, was launched in 3 Beacon Communities: the Southeast Michigan Beacon Community in Detroit, MI, the Greater Cincinnati Beacon Community in Cincinnati, OH, and the Crescent City Beacon Community in New Orleans, LA. Txt4health is a mobile health information service designed to help people understand their risk for type 2 diabetes and become more informed about the steps they can take to lead healthy lives. Objective: The purpose of this investigation was to use the RE-AIM framework to document txt4health reach and adoption by focusing on enrollment and participant engagement in program pilots in Southeast Michigan and Greater Cincinnati. Methods: We conducted a retrospective records analysis of individual-level txt4health system data from participants in Southeast Michigan and Greater Cincinnati to determine participant usage of txt4health and engagement with the program. Results: Results from the retrospective records analysis revealed that 5570 participants initiated the 2-step enrollment process via 1 of 3 enrollment strategies: text message, website, or directly with Beacon staff who signed participants up via the website. In total, 33.00% (1838/5570) of participants completed the 2-step enrollment process and were fully enrolled in the program. All participants (100.00%, 1620/1620) who enrolled via text message completed the entire 2-step enrollment process versus 5.52% (218/3950) of participants who enrolled via website or a Beacon staff member. Of those who fully enrolled, 71.00% (1305/1838) completed the diabetes risk assessment and 74.27% (1365/1838) set an initial weight loss goal. Overall, 39.06% (718/1838) of participants completed all 14 weeks of the program and 56.26% (1034/1838) dropped out before completing all 14 weeks, with the bulk of dropouts occurring in the first 4 weeks. Length of participation varied greatly, ranging from 0-48.7 weeks (median 8.6, mean 15.8, SD 15.8). Wide variability of participant engagement in regards to weekly weight and physical activity was documented. Conclusions: Although broadly focused public health text message interventions may have the potential to reach large populations and show high levels of engagement among some users, the level of individual engagement among participants varies widely, suggesting that this type of approach may not be appropriate for all. %M 24356329 %R 10.2196/jmir.2928 %U http://www.jmir.org/2013/12/e281/ %U https://doi.org/10.2196/jmir.2928 %U http://www.ncbi.nlm.nih.gov/pubmed/24356329 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 12 %P e272 %T Leveraging Text Messaging and Mobile Technology to Support Pediatric Obesity-Related Behavior Change: A Qualitative Study Using Parent Focus Groups and Interviews %A Sharifi,Mona %A Dryden,Eileen M %A Horan,Christine M %A Price,Sarah %A Marshall,Richard %A Hacker,Karen %A Finkelstein,Jonathan A %A Taveras,Elsie M %+ Division of General Pediatrics, Massachusetts General Hospital for Children, Harvard Medical School, 100 Cambridge Street, 15th floor, Suite 1523, Boston, MA, 02114, United States, 1 617 724 4007, msharifi@partners.org %K child %K obesity %K overweight %K health behavior %K text messaging %K telemedicine %D 2013 %7 06.12.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Text messaging (short message service, SMS) is a widely accessible and potentially cost-effective medium for encouraging behavior change. Few studies have examined text messaging interventions to influence child health behaviors or explored parental perceptions of mobile technologies to support behavior change among children. Objective: Our aim was to examine parental acceptability and preferences for text messaging to support pediatric obesity-related behavior change. Methods: We conducted focus groups and follow-up interviews with parents of overweight and obese children, aged 6-12 years, seen for “well-child” care in eastern Massachusetts. A professional moderator used a semistructured discussion guide and sample text messages to catalyze group discussions. Seven participants then received 3 weeks of text messages before a follow-up one-on-one telephone interview. All focus groups and interviews were recorded and transcribed verbatim. Using a framework analysis approach, we systematically coded and analyzed group and interview data to identify salient and convergent themes. Results: We reached thematic saturation after five focus groups and seven follow-up interviews with a total of 31 parents of diverse race/ethnicity and education levels. Parents were generally enthusiastic about receiving text messages to support healthy behaviors for their children and preferred them to paper or email communication because they are brief and difficult to ignore. Participants anticipated high responsiveness to messaging endorsed by their child’s doctor and indicated they would appreciate messages 2-3 times/week or more as long as content remains relevant. Suggestions for maintaining message relevance included providing specific strategies for implementation and personalizing information. Most felt the negative features of text messaging (eg, limited message size) could be overcome by providing links within messages to other media including email or websites. Conclusions: Text messaging is a promising medium for supporting pediatric obesity-related behavior change. Parent perspectives could assist in the design of text-based interventions. Trial Registration: Clinicaltrials.gov NCT01565161; http://clinicaltrials.gov/show/NCT01565161 (Archived by WebCite at http://www.webcitation.org/6LSaqFyPP). %M 24317406 %R 10.2196/jmir.2780 %U http://www.jmir.org/2013/12/e272/ %U https://doi.org/10.2196/jmir.2780 %U http://www.ncbi.nlm.nih.gov/pubmed/24317406 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 12 %P e269 %T Text Messaging Data Collection for Monitoring an Infant Feeding Intervention Program in Rural China: Feasibility Study %A Li,Ye %A Wang,Wei %A van Velthoven,Michelle Helena %A Chen,Li %A Car,Josip %A Rudan,Igor %A Zhang,Yanfeng %A Wu,Qiong %A Du,Xiaozhen %A Scherpbier,Robert W %+ Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, 100020, China, 86 1085695554, summyzh@126.com %K text messaging %K data collection %K program evaluation %K child nutrition sciences %D 2013 %7 04.12.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: An effective data collection method is crucial for high quality monitoring of health interventions. The traditional face-to-face data collection method is labor intensive, expensive, and time consuming. With the rapid increase of mobile phone subscribers, text messaging has the potential to be used for evaluation of population health interventions in rural China. Objective: The objective of this study was to explore the feasibility of using text messaging as a data collection tool to monitor an infant feeding intervention program. Methods: Participants were caregivers of children aged 0 to 23 months in rural China who participated in an infant feeding health education program. We used the test-retest method. First, we collected data with a text messaging survey and then with a face-to-face survey for 2 periods of 3 days. We compared the response rate, data agreement, costs, and participants’ acceptability of the two methods. Also, we interviewed participants to explore their reasons for not responding to the text messages and the reasons for disagreement in the two methods. In addition, we evaluated the most appropriate time during the day for sending text messages. Results: We included 258 participants; 99 (38.4%) participated in the text messaging survey and 177 (68.6%) in the face-to-face survey. Compared with the face-to-face survey, the text messaging survey had much lower response rates to at least one question (38.4% vs 68.6%) and to all 7 questions (27.9% vs 67.4%) with moderate data agreement (most kappa values between .5 and .75, the intraclass correlation coefficients between .53 to .72). Participants who took part in both surveys gave the same acceptability rating for both methods (median 4.0 for both on a 5-point scale, 1=disliked very much and 5=liked very much). The costs per questionnaire for the text messaging method were much lower than the costs for the face-to-face method: ¥19.7 (US $3.13) versus ¥33.9 (US $5.39) for all questionnaires, and ¥27.1 (US $4.31) versus ¥34.4 (US $5.47) for completed questionnaires. The main reasons for not replying were that participants did not receive text messages, they were too busy to reply, or they did not see text messages in time. The main reasons for disagreement in responses were that participants forgot their answers in the text messaging survey and that they changed their minds. We found that participants were more likely to reply to text messages immediately during 2 time periods: 8 AM to 3 PM and 8 PM to 9 PM. Conclusions: The text messaging method had reasonable data agreement and low cost, but a low response rate. Further research is needed to evaluate effectiveness of measures that can increase the response rate, especially in collecting longitudinal data by text messaging. %M 24305514 %R 10.2196/jmir.2906 %U http://www.jmir.org/2013/12/e269/ %U https://doi.org/10.2196/jmir.2906 %U http://www.ncbi.nlm.nih.gov/pubmed/24305514 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 11 %P e244 %T Daily Text Messaging for Weight Control Among Racial and Ethnic Minority Women: Randomized Controlled Pilot Study %A Steinberg,Dori M %A Levine,Erica L %A Askew,Sandy %A Foley,Perry %A Bennett,Gary G %+ Duke Obesity Prevention Program, Duke Global Health Institute, Duke University, 134 Trent Hall, Box 90519, 310 Trent Drive, Durham, NC, 27708, United States, 1 919 613 5453, dori.steinberg@duke.edu %K self-monitoring %K mHealth %K text messaging %K weight loss %K black women %D 2013 %7 18.11.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Daily self-monitoring of diet and physical activity behaviors is a strong predictor of weight loss success. Text messaging holds promise as a viable self-monitoring modality, particularly among racial/ethnic minority populations. Objective: This pilot study evaluated the feasibility of a text messaging intervention for weight loss among predominantly black women. Methods: Fifty obese women were randomized to either a 6-month intervention using a fully automated system that included daily text messages for self-monitoring tailored behavioral goals (eg, 10,000 steps per day, no sugary drinks) along with brief feedback and tips (n=26) or to an education control arm (n=24). Weight was objectively measured at baseline and at 6 months. Adherence was defined as the proportion of text messages received in response to self-monitoring prompts. Results: The average daily text messaging adherence rate was 49% (SD 27.9) with 85% (22/26) texting self-monitored behavioral goals 2 or more days per week. Approximately 70% (16/23) strongly agreed that daily texting was easy and helpful and 76% (16/21) felt the frequency of texting was appropriate. At 6 months, the intervention arm lost a mean of 1.27 kg (SD 6.51), and the control arm gained a mean of 1.14 kg (SD 2.53; mean difference –2.41 kg, 95% CI –5.22 to 0.39; P=.09). There was a trend toward greater text messaging adherence being associated with greater percent weight loss (r=–.36; P=.08), but this did not reach statistical significance. There was no significant association between goal attainment and text messaging adherence and no significant predictors of adherence. Conclusions: Given the increasing penetration of mobile devices, text messaging may be a useful self-monitoring tool for weight control, particularly among populations most in need of intervention. Trial Registration: Clinicaltrials.gov: NCT00939081; http://clinicaltrials.gov/show/NCT00939081 (Archived by WebCite at http://www.webcitation.org/6KiIIcnk1). %M 24246427 %R 10.2196/jmir.2844 %U http://www.jmir.org/2013/11/e244/ %U https://doi.org/10.2196/jmir.2844 %U http://www.ncbi.nlm.nih.gov/pubmed/24246427 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 2 %N 2 %P e48 %T Feasibility and Effectiveness of an Automated Bilingual Text Message Intervention for Weight Loss: Pilot Study %A Kolodziejczyk,Julia K %A Norman,Gregory J %A Barrera-Ng,Angelica %A Dillon,Lindsay %A Marshall,Simon %A Arredondo,Elva %A Rock,Cheryl L %A Raab,Fred %A Griswold,William G %A Sullivan,Mark %A Patrick,Kevin %+ Center for Wireless & Population Health Systems (CWPHS), Qualcomm Institute/Calit2, University of California, San Diego, 9500 Gilman Drive, Dept 0811, La Jolla, CA, 92093, United States, 1 858 534 9550, jkolodzi@ucsd.edu %K physical activity %K diet %K obesity %K health behavior %K Hispanic Americans %K weight loss %K cellular phone %K text messaging %D 2013 %7 06.11.2013 %9 Short Paper %J JMIR Res Protoc %G English %X Background: Little is known about the feasibility and acceptability of tailored text message based weight loss programs for English and Spanish-language speakers. Objective: This pilot study evaluated the feasibility, acceptability, and estimated impact of a tailored text message based weight loss program for English and Spanish-language speakers. The purpose of this pilot study was to inform the development of a full-scale randomized trial. Methods: There were 20 overweight or obese participants (mean age 40.10, SD 8.05; 8/20, 40% male; 9/20, 45% Spanish-speakers) that were recruited in San Diego, California, from March to May 2011 and evaluated in a one-group pre/post clinical trial. For 8 weeks, participants received and responded to 3-5 text messages daily sent from a fully automated text messaging system. They also received printed weight loss materials and brief 10-15 minute weekly counseling calls. To estimate the impact of the program, the primary outcome was weight (kg) measured during face-to-face measurement visits by trained research staff. Pre and post differences in weight were analyzed with a one-way repeated measures analysis of variance. Differences by language preference at both time points were analyzed with t tests. Body mass index and weight management behaviors also were examined. Feasibility and acceptability were determined by recruitment success, adherence (ie, percentage of replies to interactive text messages and attrition), and participant satisfaction. Results: Participants who completed the final assessment (N=18) decreased body weight by 1.85 kg (F1,17=10.80, P=.004, CI∆ 0.66-3.03, η2=0.39). At both time points, there were no differences in weight by language preference. Participants responded to 88.04% (986/1120) of interactive text messages, attrition rate was 10% (2/20), and 94% (19/20) of participants reported satisfaction with the program. Conclusions: This fully automated text message based weight program was feasible with English and Spanish-speakers and may have promoted modest weight loss over an 8-week period. Trial Registration: Clinicaltrials.gov NCT01171586; http://clinicaltrials.gov/ct2/show/NCT01171586 (Archived by WebCite at http://www.webcitation.org/6Ksr6dl7n). %M 24200517 %R 10.2196/resprot.2789 %U http://www.researchprotocols.org/2013/2/e48/ %U https://doi.org/10.2196/resprot.2789 %U http://www.ncbi.nlm.nih.gov/pubmed/24200517 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 2 %P e22 %T Acceptability of Delivering and Accessing Health Information Through Text Messaging Among Community Health Advisors %A Schoenberger,Yu-Mei %A Phillips,Janice %A Mohiuddin,Mohammed Omar %A McNees,Patrick %A Scarinci,Isabel %+ Division of Preventive Medicine, University of Alabama at Birmingham, 1720 2nd Ave S, MT 624, Birmingham, AL, 35294-4410, United States, 1 205 934 1724, yumeis@uab.edu %K community health workers %K mobile health %K text messaging %K cancer %D 2013 %7 09.09.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Communication technologies can play a significant role in decreasing communication inequalities and cancer disparities by promoting cancer control and enhancing population and individual health. Studies have shown that technology, such as the mobile phone short message service (SMS) or text messaging, can be an effective health communication strategy that influences individuals’ health-related decisions, behaviors, and outcomes. Objective: The purpose of this study was to explore usage of communication technologies, assess the acceptability of mobile technology for delivery and access of health information, and identify cancer and health information needs among Deep South Network for Cancer Control trained Community Health Advisors as Research Partners (CHARPs). Methods: A mixed-method design was used, and a triangulation protocol was followed to combine quantitative and qualitative data. Focus groups (4 focus groups; n=37) and self-administered surveys (n=77) were conducted to determine CHARPs mobile phone and text message usage. The objective was to include identification of barriers and facilitators to a mobile phone intervention. Results: All participants were African American (37/37, 100%), 11/37 (89%) were women, and the mean age was 53.4 (SD 13.9; focus groups) and 59.9 (SD 8.7; survey). Nearly all (33/37, 89%) of focus group participants reported owning a mobile phone. Of those, 8/33 (24%) owned a smartphone, 22/33 (67%) had a text messaging plan, and 18/33 (55%) and 11/33 (33%) received and sent text messages several times a week or day, respectively. Similar responses were seen among the survey participants, with 75/77 (97%) reporting owning a mobile phone, and of those, 22/75 (30%) owned a smartphone, 39/75 (53%) had a text messaging plan, and 37/75 (50%) received and 27/75 (37%) sent text messages several times a week or day. The benefits of a text messaging system mentioned by focus group participants included alternative form of communication, quick method for disseminating information, and privacy of communication. The main barriers reported by both groups to using mobile technology to receive health information were cost and not knowing how to text message. Ways to overcome barriers were explored with focus group participants, and education was the most proposed solution. Majority of CHARPs were in favor of receiving a weekly text message that would provide cancer/health information. Conclusions: The findings from this study indicate that CHARPs are receptive to receiving text messages focusing on cancer/health information and would be likely to engage in mobile health research. These findings represent the first step in the development of an interactive mobile health program designed to provide cancer/health information and a support network for the Deep South Network Community Health Advisors as Research Partners (DSN CHARPs). %M 25099140 %R 10.2196/mhealth.2641 %U http://mhealth.jmir.org/2013/2/e22/ %U https://doi.org/10.2196/mhealth.2641 %U http://www.ncbi.nlm.nih.gov/pubmed/25099140 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 9 %P e196 %T A Pre-Post Study on the Appropriateness and Effectiveness of a Web- and Text Messaging-Based Intervention to Reduce Problem Drinking in Emerging Adults %A Haug,Severin %A Schaub,Michael P %A Venzin,Vigeli %A Meyer,Christian %A John,Ulrich %A Gmel,Gerhard %+ Swiss Research Institute for Public Health and Addiction at Zurich University, Konradstrasse 32, Zurich, 8031, Switzerland, 41 44 448 11 74, severin.haug@isgf.uzh.ch %K alcohol intervention %K problem drinking %K young people %K text messaging %K Internet %D 2013 %7 02.09.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Problem drinking, particularly risky single-occasion drinking (RSOD), also called “binge drinking”, is widespread among adolescents and young adults in most Western countries. Few studies have tested the effectiveness of interventions to reduce RSOD in young people with heterogeneous and particularly lower educational background. Objective: To test the appropriateness and initial effectiveness of a combined, individually tailored Web- and text messaging (SMS)–based intervention program to reduce problem drinking in vocational school students. Methods: The fully automated program provided: (1) online feedback about an individual’s drinking pattern compared to the drinking norms of an age- and gender-specific reference group, and (2) recurrent individualized SMS messages over a time period of 3 months. Generalized Estimating Equation (GEE) analyses were used to investigate the longitudinal courses of the following outcomes over the study period of 3 months: RSOD, alcohol-related problems, mean number of standard drinks per week, and maximum number of standard drinks on an occasion. Results: The program was tested in 36 school classes at 7 vocational schools in Switzerland. Regardless of their drinking behavior, 477 vocational school students who owned a mobile phone were invited to participate in the program. Of these, 364 (76.3%) participated in the program. During the intervention period, 23 out of 364 (6.3%) persons unsubscribed from participating in the program. The GEE analyses revealed decreases in the percentage of persons with RSOD from baseline (75.5%, 210/278) to follow-up assessment (67.6%, 188/278, P<.001), in the percentage of persons with alcohol-related problems (20.4%, 57/280 to 14.3%, 40/280, P=.009), and in the mean number of standard drinks per week: 13.4 (SD 15.3) to 11.3 (SD 14.0), P=.002. They also revealed a trend toward a decrease in the mean of the maximum number of drinks consumed on an occasion: 11.3 (SD 10.3) to 10.5 (SD 10.3), P=.08. Conclusions: The results show high acceptance and promising effectiveness of this interventional approach, which could be easily and economically implemented within school classes. %M 23999406 %R 10.2196/jmir.2755 %U http://www.jmir.org/2013/9/e196/ %U https://doi.org/10.2196/jmir.2755 %U http://www.ncbi.nlm.nih.gov/pubmed/23999406 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 8 %P e194 %T Enhancing Retention of an Internet-Based Cohort Study of Men Who Have Sex With Men (MSM) via Text Messaging: Randomized Controlled Trial %A Khosropour,Christine M %A Johnson,Brent A %A Ricca,Alexandra V %A Sullivan,Patrick S %+ Rollins School of Public Health, Department of Epidemiology, Emory University, Grace Crum Rollins Building, 4th Floor, 1518 Clifton Road NE, Atlanta, GA, 30322, United States, 1 404 727 2038, pssulli@emory.edu %K HIV infections/prevention and control %K prospective studies %K Internet/organization and administration %K SMS text messaging %K homosexuality %K male/statistics and numerical data %D 2013 %7 27.08.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Black and Hispanic men who have sex with men (MSM) are disproportionately affected by HIV in the United States. The Internet is a promising vehicle for delivery of HIV prevention interventions to these men, but retention of MSM of color in longitudinal Internet-based studies has been problematic. Text message follow-up may enhance retention in these studies. Objective: To compare retention in a 12-month prospective Internet-based study of HIV-negative MSM randomized to receive bimonthly follow-up surveys either through an Internet browser online or through text messages. Methods: Internet-using MSM were recruited through banner advertisements on social networking and Internet-dating sites. White, black, and Hispanic men who were ≥18, completed an online baseline survey, and returned an at-home HIV test kit, which tested HIV negative, were eligible. Men were randomized to receive follow-up surveys every 2 months on the Internet or by text message for 12 months (unblinded). We used time-to-event methods to compare the rate of loss-to-follow-up (defined as non-response to a follow-up survey after multiple systematically-delivered contact attempts) in the 2 follow-up groups, overall and by race/ethnicity. Results are reported as hazard ratios (HR) and 95% confidence intervals (CI) of the rate of loss-to-follow-up for men randomized to text message follow-up compared to online follow-up. Results: Of 1489 eligible and consenting men who started the online baseline survey, 895 (60%) completed the survey and were sent an at-home HIV test kit. Of these, 710 of the 895 (79%) returned the at-home HIV test kit, tested HIV-negative, and were followed prospectively. The study cohort comprised 66% white men (470/710), 15% (106/710) black men, and 19% (134/710) Hispanic men. At 12 months, 77% (282/366) of men randomized to online follow-up were retained in the study, compared to 70% (241/344) men randomized to text message follow-up (HR=1.30, 95% CI 0.97-1.73). The rate of loss-to-follow-up was non-significantly higher in the text message arm compared to the online arm for both white (HR=1.43, 95% CI 0.97-1.73) and Hispanic men (HR=1.71, 95% CI 0.91-3.23); however, loss-to-follow-up among black men was non-significantly lower among those who received text message follow-up compared to online follow-up (HR=0.78, 95% CI 0.41-1.50). In the online arm, black men were significantly more likely to be lost to follow-up compared to white men (HR=2.25, 95% CI 1.36-3.71), but this was not the case in the text message arm (HR=1.23, 95% CI 0.70-2.16). Conclusions: We retained >70% of MSM enrolled in an online study for 12 months; thus, engaging men in online studies for a sufficient time to assess sustained outcomes is possible. Text message follow-up of an online cohort of MSM is feasible, and may result in higher retention among black MSM. %M 23981905 %R 10.2196/jmir.2756 %U http://www.jmir.org/2013/8/e194/ %U https://doi.org/10.2196/jmir.2756 %U http://www.ncbi.nlm.nih.gov/pubmed/23981905 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 8 %P e171 %T Efficacy of a Text Message-Based Smoking Cessation Intervention for Young People: A Cluster Randomized Controlled Trial %A Haug,Severin %A Schaub,Michael P %A Venzin,Vigeli %A Meyer,Christian %A John,Ulrich %+ Swiss Research Institute for Public Health and Addiction, an associated Institute of the University of Zurich, Konradstrasse 32, Zurich, PO Box 8031, Switzerland, 41 44 448 11 74, severin.haug@isgf.uzh.ch %K smoking cessation %K text messaging (SMS) %K young people %K school %K students %D 2013 %7 16.08.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Smoking prevalence remains high, particularly among adolescents and young adults with lower educational levels, posing a serious public health problem. There is limited evidence of effective smoking cessation interventions in this population. Objective: To test the efficacy of an individually tailored, fully automated text messaging (short message service, SMS)–based intervention for smoking cessation in young people. Methods: A 2-arm cluster randomized controlled trial, using school class as the randomization unit, was conducted to test the efficacy of the SMS text messaging intervention compared to an assessment-only control group. Students who smoked were proactively recruited via online screening in vocational school classes. Text messages, tailored to demographic and smoking-related variables, were sent to the participants of the intervention group at least 3 times per week over a period of 3 months. A follow-up assessment was performed 6 months after study inclusion. The primary outcome measure was 7-day smoking abstinence. Secondary outcomes were 4-week smoking abstinence, cigarette consumption, stage of change, and attempts to quit smoking. We used regression models controlling for baseline differences between the study groups to test the efficacy of the intervention. Both complete-case analyses (CCA) and intention-to-treat analyses (ITT) were performed. Subgroup analyses were conducted for occasional and daily smokers. Results: A total of 2638 students in 178 vocational school classes in Switzerland participated in the online screening. Overall, 1012 persons met the inclusion criteria for study participation, and 755 persons (74.6%) participated in the study (intervention: n=372; control: n=383). Of the 372 program participants, 9 (2.4%) unsubscribed from the program during the intervention period. Six-month follow-up data were obtained for 559 study participants (74.0%). The 7-day smoking abstinence rate at follow-up was 12.5% in the intervention group and 9.6% in the control group (ITT: P=.92). No differences between the study groups were observed in 4-week point prevalence abstinence rates. The decrease in the mean number of cigarettes smoked per day from baseline to follow-up was higher in the intervention group than in the control group (ITT: P=.002). No differences between the groups were observed in stage of change (ITT: P=.82) and quit attempts (ITT: P=.38). The subgroup analyses revealed lower cigarette consumption in both occasional and daily smokers in the intervention group compared to the control group. Occasional smokers in the intervention group made more attempts to quit smoking than occasional smokers in the control group. Conclusions: This study demonstrated the potential of an SMS text message–based intervention to reach a high proportion of young smokers with low education levels. The intervention did not have statistically significant short-term effects on smoking cessation; however, it resulted in statistically significant lower cigarette consumption. Additionally, it resulted in statistically significant more attempts to quit smoking in occasional smokers. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 19739792; http://www.controlled-trials.com/ISRCTN19739792 (Archived by WebCite at http://webcitation.org/6IGETTHmr). %M 23956024 %R 10.2196/jmir.2636 %U http://www.jmir.org/2013/8/e171/ %U https://doi.org/10.2196/jmir.2636 %U http://www.ncbi.nlm.nih.gov/pubmed/23956024 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 2 %P e17 %T A Text Message Delivered Smoking Cessation Intervention: The Initial Trial of TXT-2-Quit: Randomized Controlled Trial %A Bock,Beth %A Heron,Kristin %A Jennings,Ernestine %A Morrow,Kathleen %A Cobb,Victoria %A Magee,Joshua %A Fava,Joseph %A Deutsch,Christopher %A Foster,Robert %+ Alpert Medical School, Brown University, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States, 1 401 793 8020, Bbock@lifespan.org %K smoking cessation %K tobacco %K texting, text messaging %K mobile health %K mHealth %K health communications %D 2013 %7 30.07.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile technology offers the potential to deliver health-related interventions to individuals who would not otherwise present for in-person treatment. Text messaging (short message service, SMS), being the most ubiquitous form of mobile communication, is a promising method for reaching the most individuals. Objective: The goal of the present study was to evaluate the feasibility and preliminary efficacy of a smoking cessation intervention program delivered through text messaging. Methods: Adult participants (N=60, age range 18-52 years) took part in a single individual smoking cessation counseling session, and were then randomly assigned to receive either daily non-smoking related text messages (control condition) or the TXT-2-Quit (TXT) intervention. TXT consisted of automated smoking cessation messages tailored to individual’s stage of smoking cessation, specialized messages provided on-demand based on user requests for additional support, and a peer-to-peer social support network. Generalized estimating equation analysis was used to assess the primary outcome (7-day point-prevalence abstinence) using a 2 (treatment groups)×3 (time points) repeated measures design across three time points: 8 weeks, 3 months, and 6 months. Results: Smoking cessation results showed an overall significant group difference in 7-day point prevalence abstinence across all follow-up time points. Individuals given the TXT intervention, with higher odds of 7-day point prevalence abstinence for the TXT group compared to the Mojo group (OR=4.52, 95% CI=1.24, 16.53). However, individual comparisons at each time point did not show significant between-group differences, likely due to reduced statistical power. Intervention feasibility was greatly improved by switching from traditional face-to-face recruitment methods (4.7% yield) to an online/remote strategy (41.7% yield). Conclusions: Although this study was designed to develop and provide initial testing of the TXT-2-Quit system, these initial findings provide promising evidence that a text-based intervention can be successfully implemented with a diverse group of adult smokers. Trial Registration: ClinicalTrials.gov: NCT01166464; http://clinicaltrials.gov/ct2/show/NCT01166464 (Archived by WebCite at http://www.webcitation.org/6IOE8XdE0). %M 25098502 %R 10.2196/mhealth.2522 %U http://mhealth.jmir.org/2013/2/e17/ %U https://doi.org/10.2196/mhealth.2522 %U http://www.ncbi.nlm.nih.gov/pubmed/25098502 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 1 %P e5 %T Development of a Theoretically Driven mHealth Text Messaging Application for Sustaining Recent Weight Loss %A Shaw,Ryan J %A Bosworth,Hayden B %A Hess,Jeffrey C %A Silva,Susan G %A Lipkus,Isaac M %A Davis,Linda L %A Johnson,Constance M %+ School of Nursing, Duke University, 307 Trent Dr., Durham, NC, 27710, United States, 1 919 410 6372, ryan.shaw@duke.edu %K mHealth %K short message service %K SMS %K text messaging %K weight loss maintenance %D 2013 %7 07.05.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone short message service (SMS) text messaging, has the potential to serve as an intervention medium to promote sustainability of weight loss that can be easily and affordably used by clinicians and consumers. Objective: To develop theoretically driven weight loss sustaining text messages and pilot an mHealth SMS text messaging intervention to promote sustaining recent weight loss in order to understand optimal frequency and timing of message delivery, and for feasibility and usability testing. Results from the pilot study were used to design and construct a patient privacy compliant automated SMS application to deliver weight loss sustaining messages. Methods: We first conducted a pilot study in which participants (N=16) received a daily SMS text message for one month following a structured weight loss program. Messages were developed from diet and exercise guidelines. Following the intervention, interviews were conducted and self-reported weight was collected via SMS text messaging. Results: All participants (N=16) were capable of sending and receiving SMS text messages. During the phone interview at 1 month post-baseline and at 3 months post-baseline, 13/14 (93%) of participants who completed the study reported their weight via SMS. At 3 months post-baseline, 79% (11/14) participants sustained or continued to lose weight. Participants (13/14, 93%) were favorable toward the messages and the majority (10/14, 71%) felt they were useful in helping them sustain weight loss. All 14 participants who completed the interview thought SMS was a favorable communication medium and was useful to receive short relevant messages promptly and directly. All participants read the messages when they knew they arrived and most (11/14, 79%) read the messages at the time of delivery. All participants felt that at least one daily message is needed to sustain weight loss behaviors and that they should be delivered in the morning. Results were then used to develop the SMS text messaging application. Conclusions: Study results demonstrated the feasibility of developing weight loss SMS text messages, and the development of an mHealth SMS text messaging application. SMS text messaging was perceived as an appropriate and accepted tool to deliver health promotion content. %M 25100678 %R 10.2196/mhealth.2343 %U http://mhealth.jmir.org/2013/1/e5/ %U https://doi.org/10.2196/mhealth.2343 %U http://www.ncbi.nlm.nih.gov/pubmed/25100678 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 15 %N 4 %P e68 %T Use of a Text Message-Based Pharmacovigilance Tool in Cambodia: Pilot Study %A Baron,Sophie %A Goutard,Flavie %A Nguon,Kunthy %A Tarantola,Arnaud %+ Epidemiology and Public Health Unit (epi@ipc), Institut Pasteur du Cambodge, 5, Bvd Monivong, Phnom Penh, BP983, Cambodia, 855 12 333 650, atarantola@pasteur-kh.org %K cellular phone %K text messages %K texting %K short message service %K vaccines %K adverse events %K surveillance %K adverse drug reaction reporting systems %K pharmacovigilance %D 2013 %7 16.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: There is no functional pharmacovigilance system in Cambodia to our knowledge. Mobile phone–based tools, such as short message service (SMS) text messages, are increasingly used for surveillance purposes. Objective: To pilot-test the FrontlineSMS mobile phone–based tool for notification of adverse events, using Cambodia’s only International Vaccination Center at the Institut Pasteur du Cambodge as a field site. Methods: People receiving vaccinations, aged over 18 years, and who owned a cell phone were recruited in the study following informed consent. The names and mobile phone numbers of the participants interviewed were entered each day into the FrontlineSMS software. Two days after being vaccinated, participants received an automatically generated SMS text message asking whether any adverse events had occurred. Their SMS reply was number-coded and exported from the software daily to an Excel spreadsheet and examined before being saved. If the participant replied with a code for a severe adverse event (8 or 9), they were automatically advised to consult the nearest doctor. Results: The active surveillance study was conducted over 72 days in the spring of 2012. Patients agreed to be asked by SMS text message whether unwanted events had occurred after vaccination. Of 1331 persons aged over 18 years referred to the vaccination unit, 184 (13.8%) were asked and agreed to participate. When texted for clinical status 48 hours after vaccination, 52 (28.3%) participants did not reply, 101 (54.9%) sent an immediate SMS reply, and 31 (16.8%) sent an SMS reply after additional prompting. Of the initial 184 participants, 132 (71.7%) replied. These 132 participants received 135 vaccine doses and 109 (82.6%) reported no adverse events, whereas 23 (17.4%) reported adverse events, all benign. Conclusions: Notification using an SMS-based text message system is already used in Cambodia for syndromic surveillance in health centers and reporting by health care workers. Our results show that such tools can also be useful for notification by patients or health users in Cambodia, especially in an urban setting. %M 23591700 %R 10.2196/jmir.2477 %U http://www.jmir.org/2013/4/e68/ %U https://doi.org/10.2196/jmir.2477 %U http://www.ncbi.nlm.nih.gov/pubmed/23591700 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 15 %N 4 %P e60 %T A Comparison of Two Delivery Modalities of a Mobile Phone-Based Assessment for Serious Mental Illness: Native Smartphone Application vs Text-Messaging Only Implementations %A Ainsworth,John %A Palmier-Claus,Jasper E %A Machin,Matthew %A Barrowclough,Christine %A Dunn,Graham %A Rogers,Anne %A Buchan,Iain %A Barkus,Emma %A Kapur,Shitij %A Wykes,Til %A Hopkins,Richard S %A Lewis,Shôn %+ NIBHI Manchester Health e-Research Centre, Institue of Population Health, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 1612751129, John.Ainsworth@manchester.ac.uk %K mobile phone %K psychosis %K assessment %K schizophrenia %K text-messages %D 2013 %7 05.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile phone–based assessment may represent a cost-effective and clinically effective method of monitoring psychotic symptoms in real-time. There are several software options, including the use of native smartphone applications and text messages (short message service, SMS). Little is known about the strengths and limitations of these two approaches in monitoring symptoms in individuals with serious mental illness. Objective: The objective of this study was to compare two different delivery modalities of the same diagnostic assessment for individuals with non-affective psychosis—a native smartphone application employing a graphical, touch user interface against an SMS text-only implementation. The overall hypothesis of the study was that patient participants with sewrious mental illness would find both delivery modalities feasible and acceptable to use, measured by the quantitative post-assessment feedback questionnaire scores, the number of data points completed, and the time taken to complete the assessment. It was also predicted that a native smartphone application would (1) yield a greater number of data points, (2) take less time, and (3) be more positively appraised by patient participant users than the text-based system. Methods: A randomized repeated measures crossover design was employed. Participants with currently treated Diagnostic and Statistical Manual (Fourth Edition) schizophrenia or related disorders (n=24) were randomly allocated to completing 6 days of assessment (four sets of questions per day) with a native smartphone application or the SMS text-only implementation. There was then a 1-week break before completing a further 6 days with the alternative delivery modality. Quantitative feedback questionnaires were administered at the end of each period of sampling. Results: A greater proportion of data points were completed with the native smartphone application in comparison to the SMS text-only implementation (β = -.25, SE=.11, P=.02), which also took significantly less time to complete (β =.78, SE= .09, P<.001). Although there were no significant differences in participants’ quantitative feedback for the two delivery modalities, most participants reported preferring the native smartphone application (67%; n=16) and found it easier to use (71%; n=16). 33% of participants reported that they would be willing to complete mobile phone assessment for 5 weeks or longer. Conclusions: Native smartphone applications and SMS text are both valuable methods of delivering real-time assessment in individuals with schizophrenia. However, a more streamlined graphical user interface may lead to better compliance and shorter entry times. Further research is needed to test the efficacy of this technology within clinical services, to assess validity over longer periods of time and when delivered on patients’ own phones. %M 23563184 %R 10.2196/jmir.2328 %U http://www.jmir.org/2013/4/e60/ %U https://doi.org/10.2196/jmir.2328 %U http://www.ncbi.nlm.nih.gov/pubmed/23563184 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 3 %P e53 %T A Text Messaging Intervention to Improve Heart Failure Self-Management After Hospital Discharge in a Largely African-American Population: Before-After Study %A Nundy,Shantanu %A Razi,Rabia R %A Dick,Jonathan J %A Smith,Bryan %A Mayo,Ainoa %A O'Connor,Anne %A Meltzer,David O %+ Section of General Internal Medicine, Department of Medicine, University of Chicago Medical Center, 5841 S Maryland Ave, MC2007, Chicago, IL, 60637, United States, 1 7737020620, shantanu.nundy@gmail.com %K heart failure %K self-care %K patient education %K cellular phone %K text messaging %K African Americans %D 2013 %7 11.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: There is increasing interest in finding novel approaches to reduce health disparities in readmissions for acute decompensated heart failure (ADHF). Text messaging is a promising platform for improving chronic disease self-management in low-income populations, yet is largely unexplored in ADHF. Objective: The purpose of this pre-post study was to assess the feasibility and acceptability of a text message–based (SMS: short message service) intervention in a largely African American population with ADHF and explore its effects on self-management. Methods: Hospitalized patients with ADHF were enrolled in an automated text message–based heart failure program for 30 days following discharge. Messages provided self-care reminders and patient education on diet, symptom recognition, and health care navigation. Demographic and cell phone usage data were collected on enrollment, and an exit survey was administered on completion. The Self-Care of Heart Failure Index (SCHFI) was administered preintervention and postintervention and compared using sample t tests (composite) and Wilcoxon rank sum tests (individual). Clinical data were collected through chart abstraction. Results: Of 51 patients approached for recruitment, 27 agreed to participate and 15 were enrolled (14 African-American, 1 White). Barriers to enrollment included not owning a personal cell phone (n=12), failing the Mini-Mental exam (n=3), needing a proxy (n=2), hard of hearing (n=1), and refusal (n=3). Another 3 participants left the study for health reasons and 3 others had technology issues. A total of 6 patients (5 African-American, 1 White) completed the postintervention surveys. The mean age was 50 years (range 23-69) and over half had Medicaid or were uninsured (60%, 9/15). The mean ejection fraction for those with systolic dysfunction was 22%, and at least two-thirds had a prior hospitalization in the past year. Participants strongly agreed that the program was easy to use (83%), reduced pills missed (66%), and decreased salt intake (66%). Maintenance (mean composite score 49 to 78, P=.003) and management (57 to 86, P=.002) improved at 4 weeks, whereas confidence did not change (57 to 75, P=.11). Of the 6 SCHFI items that showed a statistically significant improvement, 5 were specifically targeted by the texting intervention. Conclusions: Over half of ADHF patients in an urban, largely African American community were eligible and interested in participating in a text messaging program following discharge. Access to mobile phones was a significant barrier that should be addressed in future interventions. Among the participants who completed the study, we observed a high rate of satisfaction and preliminary evidence of improvements in heart failure self-management. %M 23478028 %R 10.2196/jmir.2317 %U http://www.jmir.org/2013/3/e53/ %U https://doi.org/10.2196/jmir.2317 %U http://www.ncbi.nlm.nih.gov/pubmed/23478028 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 3 %P e54 %T Using Text Messaging to Assess Adolescents' Health Information Needs: An Ecological Momentary Assessment %A Schnall,Rebecca %A Okoniewski,Anastasia %A Tiase,Victoria %A Low,Alexander %A Rodriguez,Martha %A Kaplan,Steven %+ Columbia University, School of Nursing, 617 W 168th Street, New York, NY, 10032, United States, 1 212 342 6886, rb897@columbia.edu %K text messaging %K ecological momentary assessment %K mobile health technology %D 2013 %7 06.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Use of mobile technology has made a huge impact on communication, access, and information/resource delivery to adolescents. Mobile technology is frequently used by adolescents. Objective: The purpose of this study was to understand the health information needs of adolescents in the context of their everyday lives and to assess how they meet their information needs. Methods: We gave 60 adolescents smartphones with unlimited text messaging and data for 30 days. Each smartphone had applications related to asthma, obesity, human immunodeficiency virus, and diet preinstalled on the phone. We sent text messages 3 times per week and asked the following questions: (1) What questions did you have about your health today? (2) Where did you look for an answer (mobile device, mobile application, online, friend, book, or parent)? (3) Was your question answered and how? (4) Anything else? Results: Our participants ranged from 13-18 years of age, 37 (62%) participants were male and 22 (37%) were female. Of the 60 participants, 71% (42/60) participants identified themselves as Hispanic and 77% (46/60) were frequent users of mobile devices. We had a 90% (1935/2150) response rate to our text messages. Participants sent a total of 1935 text messages in response to the ecological momentary assessment questions. Adolescents sent a total of 421 text messages related to a health information needs, and 516 text messages related to the source of information to the answers of their questions, which were related to parents, friends, online, mobile apps, teachers, or coaches. Conclusions: Text messaging technology is a useful tool for assessing adolescents’ health behavior in real-time. Adolescents are willing to use text messaging to report their health information. Findings from this study contribute to the evidence base on addressing the health information needs of adolescents. In particular, attention should be paid to issues related to diet and exercise. These findings may be the harbinger for future obesity prevention programs for adolescents. %M 23467200 %R 10.2196/jmir.2395 %U http://www.jmir.org/2013/3/e54/ %U https://doi.org/10.2196/jmir.2395 %U http://www.ncbi.nlm.nih.gov/pubmed/23467200 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 14 %N 6 %P e172 %T A Text Messaging-Based Smoking Cessation Program for Adult Smokers: Randomized Controlled Trial %A Ybarra,Michele %A Bağcı Bosi,A Tülay %A Korchmaros,Josephine %A Emri,Salih %+ Center for Innovative Public Health Research, 555 El Camino Real #A347, San Clemente, CA, 92672, United States, 1 8773026858 ext 801, Michele@InnovativePublicHealth.org %K smoking cessation %K Middle East %K text messaging %K pilot study %D 2012 %7 27.12.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite promising data in Western countries, there is a dearth of research into the efficacy of text messaging-based smoking cessation programs in other settings, including the Middle East, where smoking prevalence rates are higher. Objective: This paper reports cessation rates observed in SMS Turkey, a text messaging-based smoking cessation program for adult smokers in Ankara, Turkey. Methods: This study was a small-scale, parallel-group randomized controlled trial (RCT) conducted in Ankara, Turkey. Participants were adult daily smokers who were seriously thinking about quitting in the next 15 days and living in Ankara, Turkey. The text messaging intervention, SMS Turkey, provided 6 weeks of daily messages aimed at giving participants skills to help them quit smoking. Messages were sent in an automated fashion, except 2 days and 7 days after the initial quit day. On days 2 and 7, the research assistant manually assigned participants to content “paths” based on whether they were still not smoking or had relapsed. The control arm received a brochure that provided similar information about smoking cessation. The main outcome measure was self-reported 3-month sustained abstinence, verified by carbon monoxide (CO) readings. Neither participants nor researchers were blinded to arm assignment. Results: The 151 participants were randomly assigned to 1 of 2 groups: 76 to the SMS Turkey intervention group and 75 to the brochure control group. Using intention to treat, all 151 participants were included in analyses. Three-month cessation trends were not significantly higher in the intervention group: 11% intervention vs 5% control had quit (χ21=1.4, P=.24; R2=2.0, 95% CI 0.62-6.3). When the sample was stratified by sex, female intervention participants (14%, n=5) were significantly more likely to have quit at 3 months than female control participants (0%, n=0; χ21=3.7, P=.05). Among light smokers (ie, those smoking less than 20 cigarettes per day), intervention participants (17%, n=5) also were significantly more likely to have quit compared to control participants (0%, n=0; χ21=5.3, P=.02). We noted no difference in cessation rates for males or heavy smokers. Participants experienced significant technology problems during the study. Some participants received duplicate text messages at least once during the trial; others failed to receive some program messages. Neither receiving duplicate messages (χ21=0.12, P=.73), or missing 5 or more program messages (χ21=0.75, P=.39) negatively affected quitting rates. Conclusions: Although the study was not powered to detect statistically significant differences, as the primary aim was to provide estimates of effect size that could be used to better inform a power analysis for a larger trial, findings provide optimism that SMS Turkey may be able to affect quitting rates in environments with high smoking prevalence, such as Ankara, Turkey. The SMS Turkey software program did not work as well as it did 2 years previous. The system will need to be updated to maintain software compatibility with ongoing technology evolution. Trial Registration: Clinicaltrials.gov NCT00912795 http://clinicaltrials.gov/ct2/show/NCT00912795 (Archived by WebCite at http://www.webcitation.org/6Ch1cIA8l). %R 10.2196/jmir.2231 %U http://www.jmir.org/2012/6/e172/ %U https://doi.org/10.2196/jmir.2231 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 1 %N 2 %P e20 %T A Personalized Automated Messaging System to Improve Adherence to Prostate Cancer Screening: Research Protocol %A Yuan,Michael Juntao %A Hébert,Emily T %A Johnson,Ron K %A Long,Ju %A Vandewater,Elizabeth A %A Vickers,Andrew J %+ Ringful Health, LLC, 620 Congress Avenue, Suite 320, Austin, TX, 78701, United States, 1 5123006828, michael@ringful.com %K Early Detection of Cancer %K Text Messaging %K Prostatic Neoplasms %D 2012 %7 28.11.2012 %9 Protocol %J JMIR Res Protoc %G English %X Background: Public adherence to cancer screening guidelines is poor. Patient confusion over multiple recommendations and modalities for cancer screening has been found to be a major barrier to screening adherence. Such problems will only increase as screening guidelines and timetables become individualized. Objective: We propose to increase compliance with cancer screening through two-way rich media mobile messaging based on personalized risk assessment. Methods: We propose to develop and test a product that will store algorithms required to personalize cancer screening in a central database managed by a rule-based workflow engine, and implemented via messaging to the patient’s mobile phone. We will conduct a randomized controlled trial focusing on prostate cancer screening to study the hypothesis that mobile reminders improve adherence to screening guidelines. We will also explore a secondary hypothesis that patients who reply to the messaging reminders are more engaged and at lower risk of non-adherence. We will conduct a randomized controlled trial in a sample of males between 40 and 75 years (eligible for prostate cancer screening) who are willing to receive text messages, email, or automated voice messages. Participants will be recruited from a primary care clinic and asked to schedule prostate cancer screening at the clinic within the next 3 weeks. The intervention group will receive reminders and confirmation communications for making an appointment, keeping the appointment, and reporting the test results back to the investigators. Three outcomes will be evaluated: (1) the proportion of participants who make an appointment with a physician following a mobile message reminder, (2) the proportion of participants who keep the appointment, and (3) the proportion of participants who report the results of the screening (via text or Web). Results: This is an ongoing project, supported by by a small business commercialization grant from the National Center for Advancing Translational Sciences of the National Institutes of Health. Conclusions: We believe that the use of centralized databases and text messaging could improve adherence with screening guidelines. Furthermore, we anticipate this method of increasing patient engagement could be applied to a broad range of health issues, both inside and outside of the context of cancer. This project will be an important first step in determining the feasibility of personalized text messaging to improve long-term adherence to screening recommendations. %M 23612443 %R 10.2196/resprot.2398 %U http://www.researchprotocols.org/2012/2/e20/ %U https://doi.org/10.2196/resprot.2398 %U http://www.ncbi.nlm.nih.gov/pubmed/23612443 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 1 %N 2 %P e17 %T Technical Implementation of a Multi-Component, Text Message–Based Intervention for Persons Living with HIV %A Furberg,Robert D %A Uhrig,Jennifer D %A Bann,Carla M %A Lewis,Megan A %A Harris,Jennie L %A Williams,Peyton %A Coomes,Curtis %A Martin,Nicole %A Kuhns,Lisa %+ RTI International, 3040 Cornwallis Road, RTP, NC, 27709, United States, 1 919 316 3726, rfurberg@rti.org %K short message service %K SMS %K text message %K mobile phone %K mHealth %K HIV %K tailored messaging %D 2012 %7 16.11.2012 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Men who have sex with men (MSM) continue to be severely and disproportionately affected by the HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome) epidemic in the United States. Effective antiretroviral therapy has altered the HIV epidemic from being an acute disease to a chronic, manageable condition for many people living with HIV. The pervasiveness, low cost, and convenience of Short Message Service (SMS) suggests its potential suitability for supporting the treatment of conditions that must be managed over an extended period. Objective: The purpose of this proof-of-concept study was to develop, implement, and test a tailored SMS-based intervention for HIV-positive MSM. Prior studies do not routinely provide sufficiently detailed descriptions of their technical implementations, restricting the ability of subsequent efforts to reproduce successful interventions. This article attempts to fill this gap by providing a detailed description of the implementation of an SMS-based intervention to provide tailored health communication messages for HIV-positive MSM. Methods: We used archives from the SMS system, including participant responses to messages and questions sent via SMS, as the data sources for results reported in this article. Consistent with the purpose of this article, our analysis was limited to basic descriptive statistics, including frequency distributions, means and standard deviations. Results: During the implementation period, we sent a total of 7,194 messages to study participants, received 705 SMS responses to our two-way SMS questions of participants, and 317 unprompted SMS message acknowledgements from participants. Ninety two percent of participants on antiretroviral therapy (ART) responded to at least one of the weekly medication adherence questions administered via SMS, and 27% of those had their medication adherence messages changed over the course of the study based on their answers to the weekly questions. Participants who responded to items administered via SMS to assess satisfaction with and use of the messages reported generally positive perceptions, although response rates were low overall. Conclusions: Results confirm the technical feasibility of deploying a dynamically tailored, SMS-based intervention designed to provide ongoing behavioral reinforcement for HIV-positive MSM. Lessons learned related to text programming, message delivery and study logistics will be helpful to others planning and implementing similar interventions. %M 23612237 %R 10.2196/resprot.2017 %U http://www.researchprotocols.org/2012/2/e17/ %U https://doi.org/10.2196/resprot.2017 %U http://www.ncbi.nlm.nih.gov/pubmed/23612237 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 1 %N 2 %P e8 %T Mobile.net: Mobile Telephone Text Messages to Encourage Adherence to Medication and to Follow up With People With Psychosis: Methods and Protocol for a Multicenter Randomized Controlled Two-Armed Trial %A Välimäki,Maritta %A Hätönen,Heli %A Adams,Clive E %+ Department of Nursing Science, University of Turku and Southwest Hospital District, Lemminkäisenkatu 1, University of Turku, 20014, Finland, 358 406890546, mava@utu.fi %K Adherence %K text messages %K psychosis %D 2012 %7 02.08.2012 %9 Protocol %J JMIR Res Protoc %G English %X Background: Schizophrenia is a high-cost, chronic, serious mental illness. There is a clear need to improve treatments and expand access to care for persons with schizophrenia, but simple, tailored interventions are missing. Objective: To evaluate the impact of tailored mobile telephone text messages to encourage adherence to medication and to follow up with people with psychosis at 12 months. Methods: Mobile.Net is a pragmatic randomized trial with inpatient psychiatric wards allocated to two parallel arms. The trial will include 24 sites and 45 psychiatric hospital wards providing inpatient care in Finland. The participants will be adult patients aged 18–65 years, of either sex, with antipsychotic medication (Anatomical Therapeutic Chemical classification 2011) on discharge from a psychiatric hospital, who have a mobile phone, are able to use the Finnish language, and are able to give written informed consent to participate in the study. The intervention group will receive semiautomatic system (short message service [SMS]) messages after they have been discharged from the psychiatric hospital. Patients will choose the form, content, timing, and frequency of the SMS messages related to their medication, keeping appointments, and other daily care. SMS messages will continue to the end of the study period (12 months) or until participants no longer want to receive the messages. Patients will be encouraged to contact researchers if they feel that they need to adjust the message in any way. At all times, both groups will receive usual care at the discretion of their team (psychiatry and nursing). The primary outcomes are service use and healthy days by 12 months based on routine data (admission to a psychiatric hospital, time to next hospitalization, time in hospital during this year, and healthy days). The secondary outcomes are service use, coercive measures, medication, adverse events, satisfaction with care, the intervention, and the trial, social functioning, and economic factors. Data will be collected 12 months after baseline. The outcomes are based on the national health registers and patients’ subjective evaluations. The primary analysis will be by intention-to-treat. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN): 27704027; http://www.controlled-trials.com/ISRCTN27704027 (Archived by WebCite at http://www.webcitation.org/69FkM4vcq) %M 23611874 %R 10.2196/resprot.2136 %U http://www.researchprotocols.org/2012/2/e8/ %U https://doi.org/10.2196/resprot.2136 %U http://www.ncbi.nlm.nih.gov/pubmed/23611874 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 4 %P e103 %T Design Considerations in Developing a Text Messaging Program Aimed at Smoking Cessation %A Ybarra,Michele L %A Holtrop,Jodi Summers %A Bağci Bosi,A Tülay %A Emri,Salih %+ Center for Innovative Public Health Research, 555 El Camino Real, A347, San Clemente, CA, 92672, United States, 1 8773026858 ext 801, Michele@innovativepublichealth.org %K Smoking cessation %K mHealth %K text messaging %D 2012 %7 24.07.2012 %9 Tutorial %J J Med Internet Res %G English %X Background: Cell phone text messaging is gaining increasing recognition as an important tool that can be harnessed for prevention and intervention programs across a wide variety of health research applications. Despite the growing body of literature reporting positive outcomes, very little is available about the design decisions that scaffold the development of text messaging-based health interventions. What seems to be missing is documentation of the thought process of investigators in the initial stages of protocol and content development. This omission is of particular concern because many researchers seem to view text messaging as the intervention itself instead of simply a delivery mechanism. Certainly, aspects of this technology may increase participant engagement. Like other interventions, however, the content is a central driver of the behavior change. Objective: To address this noted gap in the literature, we discuss the protocol decisions and content development for SMS Turkey (or Cebiniz birakin diyor in Turkish), a smoking cessation text messaging program for adult smokers in Turkey. Methods: Content was developed in English and translated into Turkish. Efforts were made to ensure that the protocol and content were grounded in evidence-based smoking cessation theory, while also reflective of the cultural aspects of smoking and quitting in Turkey. Results: Methodological considerations included whether to provide cell phones and whether to reimburse participants for texting costs; whether to include supplementary intervention resources (eg, personal contact); and whether to utilize unidirectional versus bidirectional messaging. Program design considerations included how messages were tailored to the quitting curve and one’s smoking status after one’s quit date, the number of messages participants received per day, and over what period of time the intervention lasted. Conclusion: The content and methods of effective smoking cessation quitline programs were a useful guide in developing SMS Turkey. Proposed guidelines in developing text messaging-based behavior change programs are offered. %M 22832182 %R 10.2196/jmir.2061 %U http://www.jmir.org/2012/4/e103/ %U https://doi.org/10.2196/jmir.2061 %U http://www.ncbi.nlm.nih.gov/pubmed/22832182 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 4 %P e99 %T Public Health Interventions: Reaching Latino Adolescents via Short Message Service and Social Media %A Vyas,Amita N %A Landry,Megan %A Schnider,Marisa %A Rojas,Angela M %A Wood,Susan F %+ Maternal and Child Health, Department of Prevention and Community Health, George Washington University, Suite 700, 2175 K Street NW, Washington, DC, 20007, United States, 1 2029943695, avyas@gwu.edu %K Public health interventions %K SMS %K short message service %K social media %K health behavior %K Latinos %K adolescents %D 2012 %7 12.07.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescents are substantial users of short message service (SMS) and social media. The public health community now has more opportunities to reach this population with positive youth development and health messages through these media. Latinos are a growing and youthful population with significant health risks and needs. This population may benefit from SMS and social media health interventions. Objective: To examine (1) SMS and social media utilization and behavior among Latino youth, and (2) how SMS and social media can be effectively used as a component of public health interventions focused on decreasing sexual risk taking among Latino youth. Methods: A mixed-methods approach, using both quantitative survey data and qualitative interview data, was used to provide a robust understanding of SMS and social media use and behavior for public health interventions. We recruited 428 ninth and tenth grade, self-identifying Latino adolescents to participate in a quantitative survey. Additionally, we conducted five key informant interviews with staff and 15 youth. Results: We found that 90.8% (355/391) of respondents had access to a mobile phone either through having their own or through borrowing or sharing one. Of those who had access to a mobile phone, 94.1% (334/355) used SMS, with 41.1% (113/275) sending and receiving more than 100 text messages per day. Of 395 respondents, 384 (97.2%) had at least one social media account, and the mean number of accounts was 3.0 (range 0–8). A total of 75.8% (291/384) of adolescents logged in to their account daily. Of those with a social media account, 89.1% (342/384) had a Facebook account. Youth who took the survey in English were significantly more likely than those who took it in Spanish to have access to a mobile phone (χ21 = 5.3; 93.3% vs 86.3%; P = .02); to be high-volume texters (χ22 = 16.8; 49.4% vs 25.3%; P < .001); to use the Internet daily (χ21 = 5.0; 76.6% vs 66.0%; P = .03); to have a Facebook account (χ21 = 9.9; 90.9% vs 79.7%; P = .002); and to have a greater mean number of social media accounts (t387 = 7.9; 3.41 vs 2.07; P < .001). Conclusions: SMS and social media are pervasive among Latino youth. Program staff and youth perceive these as credible and essential methods of communication in the context of public health programs. Public health interventions must continue to innovate and maximize new ways to reach young people to reinforce public health messages and education. %M 22789678 %R 10.2196/jmir.2178 %U http://www.jmir.org/2012/4/e99/ %U https://doi.org/10.2196/jmir.2178 %U http://www.ncbi.nlm.nih.gov/pubmed/22789678 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 3 %P e83 %T Parent Opinions About Use of Text Messaging for Immunization Reminders %A Ahlers-Schmidt,Carolyn Rose %A Chesser,Amy K %A Paschal,Angelia M %A Hart,Traci A %A Williams,Katherine S %A Yaghmai,Beryl %A Shah-Haque,Sapna %+ University of Kansas School of Medicine - Wichita, Pediatrics, 1010 N. Kansas, Wichita, KS, 67214, United States, 1 316 293 1810, cschmidt3@kumc.edu %K Provider-patient communication %K child immunizations %K text message %D 2012 %7 06.06.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Adherence to childhood immunization schedules is a function of various factors. Given the increased use of technology as a strategy to increase immunization coverage, it is important to investigate how parents perceive different forms of communication, including traditional means and text-message reminders. Objective: To examine current forms of communication about immunization information, parents’ satisfaction levels with these communication modes, perceived barriers and benefits to using text messaging, and the ideal content of text messages for immunization reminders. Methods: Structured interviews were developed and approved by two Institutional Review Boards. A convenience sample of 50 parents was recruited from two local pediatric clinics. The study included a demographics questionnaire, the shortened form of the Test of Functional Health Literacy for Adults (S-TOFHLA), questions regarding benefits and barriers of text communication from immunization providers, and preferred content for immunization reminders. Content analyses were performed on responses to barriers, benefits, and preferred content (all Cohen’s kappas > 0.70). Results: Respondents were mostly female (45/50, 90%), white non-Hispanic (31/50, 62%), between 20–41 years (mean = 29, SD 5), with one or two children (range 1–9). Nearly all (48/50, 96%) had an S-TOFHLA score in the “adequate” range. All parents (50/50, 100%) engaged in face-to-face contact with their child’s physician at appointments, 74% (37/50) had contact via telephone, and none of the parents (0/50, 0%) used email or text messages. Most parents were satisfied with the face-to-face (48/50, 96%) and telephone (28/50, 75%) communication. Forty-nine of the 50 participants (98%) were interested in receiving immunization reminders by text message, and all parents (50/50, 100%) were willing to receive general appointment reminders by text message. Parents made 200 comments regarding text-message reminders. Benefits accounted for 63.5% of comments (127/200). The remaining 37.5% (73/200) regarded barriers; however, no barriers could be identified by 26% of participants (13/50). Parents made 172 comments regarding preferred content of text-message immunization reminders. The most frequently discussed topics were date due (50/172, 29%), general reminder (26/172, 26%), and child’s name (21/172, 12%). Conclusions: Most parents were satisfied with traditional communication; however, few had experienced any alternative forms of communication regarding immunizations. Benefits of receiving text messages for immunization reminders far outweighed the barriers identified by parents. Few barriers identified were text specific. Those that were, centered on cost if parents did not have unlimited texting plans. %M 22683920 %R 10.2196/jmir.1976 %U http://www.jmir.org/2012/3/e83/ %U https://doi.org/10.2196/jmir.1976 %U http://www.ncbi.nlm.nih.gov/pubmed/22683920 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 1 %N 1 %P e4 %T Harm Reduction Text Messages Delivered During Alcohol Drinking: Feasibility Study Protocol %A Renner,Karen Adell %A , %A , %A , %+ General Practice and Primary Health Care, School of Population Health, University of Auckland, Bldg 730, 261 Morrin Road, Glen Innes, Auckland, , New Zealand, 64 21440501, k.renner@auckland.ac.nz %K harm reduction %K alcohol %K eHealth %K mobile phone %K brief intervention %K smartphone %D 2012 %7 23.05.2012 %9 Protocol %J JMIR Res Protoc %G English %X Background: Recent research using mobile phone interventions to address public health issues such as smoking, obesity, depression, and diabetes provides a basis for trialing a similar approach toward reducing the negative consequences of risky drinking. Objective: This feasibility study aims to recruit drinkers between 18–34 years to a website where they will design and enter their own personal messages (repeating or one-off) to be sent to their mobile phones when they are drinking to remind them of their pre-drinking safety intentions. Methods/Design: Participants in the treatment group will have access to the messaging function for 3 months and will be compared to a control group who will have 3 months access to a web chat site only. Data collection will occur at baseline, 3 months, and 6 months. The primary outcome is a change in unintended negative consequences from drinking at 3 months. Secondary outcomes include the acceptability of the intervention to this population, recruitment rate, participant retention, reduction in alcohol consumption, and the self-motivation discourse in participant messages. Discussion: Existing alcohol interventions in New Zealand attempt to reduce alcohol consumption in the population, but with little effect. This study aims to target unintended negative consequences resulting from drinking by empowering the drinkers themselves to deliver safety messages during the drinking session. If proven effective, this strategy could provide a cost-effective means of reducing the public health burden associated with risky drinking. Trial Registration: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000242921 %M 23611773 %R 10.2196/resprot.1970 %U http://www.researchprotocols.org/2012/1/e4/ %U https://doi.org/10.2196/resprot.1970 %U http://www.ncbi.nlm.nih.gov/pubmed/23611773 %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 1 %P e3 %T Short Message Service (SMS) Applications for Disease Prevention in Developing Countries %A Déglise,Carole %A Suggs,L. Suzanne %A Odermatt,Peter %+ Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, Postfach, Basel, 4002, Switzerland, 41 61 284 8111, cardeglise@yahoo.com %K Mobile health %K developing countries %K prevention %K SMS %K short message service %D 2012 %7 12.01.2012 %9 Review %J J Med Internet Res %G English %X Background: The last decade has witnessed unprecedented growth in the number of mobile phones in the developing world, thus linking millions of previously unconnected people. The ubiquity of mobile phones, which allow for short message service (SMS), provides new and innovative opportunities for disease prevention efforts. Objective: The aim of this review was to describe the characteristics and outcomes of SMS interventions for disease prevention in developing countries and provide recommendations for future work. Methods: A systematic search of peer-reviewed and gray literature was performed for papers published in English, French, and German before May 2011 that describe SMS applications for disease prevention in developing countries. Results: A total of 34 SMS applications were described, among which 5 had findings of an evaluation reported. The majority of SMS applications were pilot projects in various levels of sophistication; nearly all came from gray literature sources. Many applications were initiated by the project with modes of intervention varying between one-way or two-way communication, with or without incentives, and with educative games. Evaluated interventions were well accepted by the beneficiaries. The primary barriers identified were language, timing of messages, mobile network fluctuations, lack of financial incentives, data privacy, and mobile phone turnover. Conclusion: This review illustrates that while many SMS applications for disease prevention exist, few have been evaluated. The dearth of peer-reviewed studies and the limited evidence found in this systematic review highlight the need for high-quality efficacy studies examining behavioral, social, and economic outcomes of SMS applications and mobile phone interventions aimed to promote health in developing country contexts. %M 22262730 %R 10.2196/jmir.1823 %U http://www.jmir.org/2012/1/e3/ %U https://doi.org/10.2196/jmir.1823 %U http://www.ncbi.nlm.nih.gov/pubmed/22262730