%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e70163 %T Locomotive Syndrome Digital Therapeutics Provided via a Smartphone App: Protocol for a Single-Group Trial %A Sonobe,Tatsuru %A Matsumoto,Yoshihiro %+ Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan, 81 24 547 1276, tatsuru1@fmu.ac.jp %K locomotive syndrome %K locomotion training %K digital therapeutic %K TUG %K 25-Geriatric Locomotive Function Scale %K BREQ-3 %K behavioral change %K support application %D 2025 %7 17.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Locomotive syndrome (LS) is a condition in which muscle weakness and reduced motor function due to musculoskeletal disorders cause reduced mobility and physical function. In Japan, musculoskeletal disorders are the most frequent reason for requiring home support or nursing care, and the prevention and amelioration of LS are thus being emphasized. However, it is difficult for older people to make a habit of exercise therapy, which is the mainstay of LS treatment. We investigated whether digital therapy could (1) lead to behavioral change in older people and (2) prevent or improve LS in older people. Objective: We sought to determine whether digital therapeutics (DTx) are useful for the prevention and amelioration of LS in older people, and we assessed the effects of DTx on the participants’ exercise awareness and motor function. Methods: We conducted a multicenter, prospective, longitudinal, nonrandomized, single-group study of Japanese adults aged ≥40 years who were eligible for LS checks. Each participant underwent an 8-week locomotion training (LT) intervention, and their subjective and objective motor abilities and motor awareness were objectively assessed at the following time points: baseline (before the start of the DTx), interim (4 weeks after the start of the DTx), and end (8 weeks after the start of the DTx). We evaluated the participants’ objective motor function using the timed up and go (TUG) test, and we compare the results using a 3-way ANOVA with the TUG test at the 3 evaluation time points as the dependent variable. The results of the 25-question Geriatric Locomotive Function Scale, which is a subjective measure of motor function, and the results of the Behavioural Regulation in Exercise Questionnaire 3, which assesses motor awareness, were also evaluated using an ANOVA in the same way as the TUG test. The significance level was set at .05 / 3 = .0167 after Bonferroni correction. Results: As of April 2025, this study had enrolled 47 participants, and complete data had been gathered from 45 participants for the proposed analysis. Study participation was ongoing as of April 2025. Conclusions: The study cohort will be used as a basis for further observational and intervention studies. This research could lead to more efficient use of medical resources and a reduction in financial and medical burdens on individuals and the economy, and it could support the prevention and amelioration of LS and the establishment of exercise habits among older people. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000053922; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000061550 International Registered Report Identifier (IRRID): DERR1-10.2196/70163 %M 40246298 %R 10.2196/70163 %U https://www.researchprotocols.org/2025/1/e70163 %U https://doi.org/10.2196/70163 %U http://www.ncbi.nlm.nih.gov/pubmed/40246298 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65555 %T Acoustic and Natural Language Markers for Bipolar Disorder: A Pilot, mHealth Cross-Sectional Study %A Crocamo,Cristina %A Cioni,Riccardo Matteo %A Canestro,Aurelia %A Nasti,Christian %A Palpella,Dario %A Piacenti,Susanna %A Bartoccetti,Alessandra %A Re,Martina %A Simonetti,Valentina %A Barattieri di San Pietro,Chiara %A Bulgheroni,Maria %A Bartoli,Francesco %A Carrà,Giuseppe %K digital mental health %K remote assessment %K mHealth %K speech %K NLP %K natural language processing %K acoustic %K symptom severity %K machine learning %K markers %K mental health %K bipolar disorders %K app %K applications %K multimodal %K mobile health %K voice %K vocal %K bipolar %K verbal %K emotion %K emotional %K psychiatry %K psychiatric %K mental illness %D 2025 %7 16.4.2025 %9 %J JMIR Form Res %G English %X Background: Monitoring symptoms of bipolar disorder (BD) is a challenge faced by mental health services. Speech patterns are crucial in assessing the current experiences, emotions, and thought patterns of people with BD. Natural language processing (NLP) and acoustic signal processing may support ongoing BD assessment within a mobile health (mHealth) framework. Objective: Using both acoustic and NLP-based features from the speech of people with BD, we built an app-based tool and tested its feasibility and performance to remotely assess the individual clinical status. Methods: We carried out a pilot, observational study, sampling adults diagnosed with BD from the caseload of the Nord Milano Mental Health Trust (Italy) to explore the relationship between selected speech features and symptom severity and to test their potential to remotely assess mental health status. Symptom severity assessment was based on clinician ratings, using the Young Mania Rating Scale (YMRS) and Montgomery-Åsberg Depression Rating Scale (MADRS) for manic and depressive symptoms, respectively. Leveraging a digital health tool embedded in a mobile app, which records and processes speech, participants self-administered verbal performance tasks. Both NLP-based and acoustic features were extracted, testing associations with mood states and exploiting machine learning approaches based on random forest models. Results: We included 32 subjects (mean [SD] age 49.6 [14.3] years; 50% [16/32] females) with a MADRS median (IQR) score of 13 (21) and a YMRS median (IQR) score of 5 (16). Participants freely managed the digital environment of the app, without perceiving it as intrusive and reporting an acceptable system usability level (average score 73.5, SD 19.7). Small-to-moderate correlations between speech features and symptom severity were uncovered, with sex-based differences in predictive capability. Higher latency time (ρ=0.152), increased silences (ρ=0.416), and vocal perturbations correlated with depressive symptomatology. Pressure of speech based on the mean intraword time (ρ=–0.343) and lower voice instability based on jitter-related parameters (ρ ranging from –0.19 to –0.27) were detected for manic symptoms. However, a higher contribution of NLP-based and conversational features, rather than acoustic features, was uncovered, especially for predictive models for depressive symptom severity (NLP-based: R2=0.25, mean squared error [MSE]=110.07, mean absolute error [MAE]=8.17; acoustics: R2=0.11, MSE=133.75, MAE=8.86; combined: R2=0.16; MSE=118.53, MAE=8.68). Conclusions: Remotely collected speech patterns, including both linguistic and acoustic features, are associated with symptom severity levels and may help differentiate clinical conditions in individuals with BD during their mood state assessments. In the future, multimodal, smartphone-integrated digital ecological momentary assessments could serve as a powerful tool for clinical purposes, remotely complementing standard, in-person mental health evaluations. %R 10.2196/65555 %U https://formative.jmir.org/2025/1/e65555 %U https://doi.org/10.2196/65555 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e58337 %T Multilevel Factors and Indicators of Atypical Neurodevelopment During Early Infancy in Japan: Prospective, Longitudinal, Observational Study %A Kato,Daigo %A Okuno,Akiko %A Ishikawa,Tetsuo %A Itakura,Shoji %A Oguchi,Shinji %A Kasahara,Yoshiyuki %A Kanenishi,Kenji %A Kitadai,Yuzo %A Kimura,Yoshitaka %A Shimojo,Naoki %A Nakahara,Kazushige %A Hanai,Akiko %A Hamada,Hiromichi %A Mogami,Haruta %A Morokuma,Seiichi %A Sakurada,Kazuhiro %A Konishi,Yukuo %A Kawakami,Eiryo %K early developmental signs %K neurodevelopmental screening %K risk factors %K prediction %K early intervention %K longitudinal study %D 2025 %7 4.4.2025 %9 %J JMIR Pediatr Parent %G English %X Background: The early identification of developmental concerns requires understanding individual differences that may represent early signs of neurodevelopmental conditions. However, few studies have longitudinally examined how child and maternal factors interact to shape these early developmental characteristics. Objective: We aim to identify factors from the perinatal to infant periods associated with early developmental characteristics that may precede formal diagnoses and propose a method for evaluating individual differences in neurodevelopmental trajectories. Methods: A prospective longitudinal observational study of 147 mother-child pairs was conducted from gestation to 12 months post partum. Assessments included prenatal questionnaires and blood collection, cord blood at delivery, and postpartum questionnaires at 1, 6, and 12 months. The Modified Checklist for Autism in Toddlers (M-CHAT) was used to evaluate developmental characteristics that might indicate early signs of atypical neurodevelopment. Polychoric or polyserial correlation coefficients assessed relationships between M-CHAT scores and longitudinal variables. L2-regularized logistic regression and Shapley Additive Explanations predicted M-CHAT scores and determined feature contributions. Results: Twenty-one factors (4 prenatal, 3 at birth, and 14 postnatal) showed significant associations with M-CHAT scores (adjusted P values<.05). The predictive accuracy for M-CHAT scores demonstrated reasonable predictive accuracy (area under the receiver operating characteristic curve=0.79). Key predictors included infant sleep status after 6 months (nighttime sleep duration, bedtime, and difficulties falling asleep), maternal Kessler Psychological Distress Scale scores, and Mother-to-Infant Bonding Scale scores after late gestation. Conclusion: Maternal psychological distress, mother-infant bonding, and infant sleep patterns were identified as significant predictors of early developmental characteristics that may indicate emerging developmental concerns. This study advances our understanding of early developmental assessment by providing a novel approach to identifying and evaluating early indicators of atypical neurodevelopment. %R 10.2196/58337 %U https://pediatrics.jmir.org/2025/1/e58337 %U https://doi.org/10.2196/58337 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e62942 %T Machine Learning Models for Frailty Classification of Older Adults in Northern Thailand: Model Development and Validation Study %A Isaradech,Natthanaphop %A Sirikul,Wachiranun %A Buawangpong,Nida %A Siviroj,Penprapa %A Kitro,Amornphat %K aged care %K gerontology %K geriatric %K old %K aging %K clinical decision support %K delivering health information and knowledge to the public %K diagnostic systems %K digital health %K epidemiology %K surveillance %K diagnosis %K frailty %K machine learning %K prediction %K predictive %K AI %K artificial intelligence %K Thailand %K community dwelling %K health care intervention %K patient care %D 2025 %7 2.4.2025 %9 %J JMIR Aging %G English %X Background: Frailty is defined as a clinical state of increased vulnerability due to the age-associated decline of an individual’s physical function resulting in increased morbidity and mortality when exposed to acute stressors. Early identification and management can reverse individuals with frailty to being robust once more. However, we found no integration of machine learning (ML) tools and frailty screening and surveillance studies in Thailand despite the abundance of evidence of frailty assessment using ML globally and in Asia. Objective: We propose an approach for early diagnosis of frailty in community-dwelling older individuals in Thailand using an ML model generated from individual characteristics and anthropometric data. Methods: Datasets including 2692 community-dwelling Thai older adults in Lampang from 2016 and 2017 were used for model development and internal validation. The derived models were externally validated with a dataset of community-dwelling older adults in Chiang Mai from 2021. The ML algorithms implemented in this study include the k-nearest neighbors algorithm, random forest ML algorithms, multilayer perceptron artificial neural network, logistic regression models, gradient boosting classifier, and linear support vector machine classifier. Results: Logistic regression showed the best overall discrimination performance with a mean area under the receiver operating characteristic curve of 0.81 (95% CI 0.75‐0.86) in the internal validation dataset and 0.75 (95% CI 0.71‐0.78) in the external validation dataset. The model was also well-calibrated to the expected probability of the external validation dataset. Conclusions: Our findings showed that our models have the potential to be utilized as a screening tool using simple, accessible demographic and explainable clinical variables in Thai community-dwelling older persons to identify individuals with frailty who require early intervention to become physically robust. %R 10.2196/62942 %U https://aging.jmir.org/2025/1/e62942 %U https://doi.org/10.2196/62942 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65542 %T Increasing the Uptake of Breast and Cervical Cancer Screening Via the MAwar Application: Stakeholder-Driven Web Application Development Study %A Nasrudin,Nurfarhana %A Sazlina,Shariff-Ghazali %A Cheong,Ai Theng %A Lee,Ping Yein %A Teo,Soo-Hwang %A Aneesa,Abdul Rashid %A Teo,Chin Hai %A Rokhani,Fakhrul Zaman %A Haron,Nuzul Azam %A Harrun,Noor Harzana %A Ho,Bee Kiau %A Mohamed Isa,Salbiah %K cancer screening %K stakeholder engagement %K Quality Function Deployment %K web health app %D 2025 %7 28.3.2025 %9 %J JMIR Form Res %G English %X Background: Digital health interventions such as web health applications significantly enhance screening accessibility and uptake, particularly for individuals with low literacy and income levels. By involving stakeholders—including health care professionals, patients, and technical experts—an intervention can be tailored to effectively meet the users’ needs, ensuring contextual relevance for better acceptance and impact. Objective: The aim of this study is to prioritize the content and user interface appropriate for developing a web health application, known as the MAwar app, to promote breast and cervical cancer screening. Methods: A cross-sectional study for stakeholder engagement was conducted to develop a web-based application known as the MAwar app as part of a larger study entitled “The Effectiveness of an Interactive Web Application to Motivate and Raise Awareness on Early Detection of Breast and Cervical Cancers (The MAwar study)”. The stakeholder engagement process was conducted in a public health district that oversees 12 public primary care clinics with existing cervical and breast cancer screening programs. We purposively selected the stakeholders for their relevant roles in breast and cervical cancer screening (health care staff, patients, and public representatives), as well as expertise in software and user interface design (technology experts). The Quality Function Deployment method was used to reflect the priorities of diverse stakeholders (health care, technology experts, patients, and public representatives) in its design. The Quality Function Deployment method facilitated the translation of stakeholder perspectives into app features. Stakeholders rated features on a scale from 1 (least important) to 5 (most important), ensuring the app’s design resonated with user needs. The correlations between the “WHATs” (user requirements) and the “HOWs” (technical requirements) were scored using a 3-point ordinal scale, with 1 indicating weak correlation, 5 indicating medium correlation, and 9 indicating the strongest correlation. Results: A total of 13 stakeholders participated in the study, including women who had either underwent or never had health screening, a health administrator, a primary care physician, medical officers, nurses, and software designers. Stakeholder evaluations highlighted cost-free access (mean 4.64, SD 0.81), comprehensive cancer information (mean 4.55, SD 0.69), detailed screening benefits (mean 4.45, SD 0.68), detailed screening facilities (mean 4.45, SD 0.68) and personalized risk calculator for breast and cervical cancers (mean 4.45, SD 0.68) as essential priorities of the app. The highest-ranked features include detailed information on screening procedures (weighted score [WS]=367.84), information on treatment options (WS=345.80), benefits of screening (WS=333.75), information about breast and cervical cancers (WS=332.15), and frequently asked questions about the concerns around screening (WS=312.00). Conclusions: The MAwar app, conceived through a collaborative, stakeholder-driven process, represents a significant step in leveraging digital health solutions to tackle cancer screening disparities. By prioritizing accessibility, information quality, and clarity on benefits, the app promises to encourage early cancer detection and management for targeted communities. Trial Registration: ISRCTN Registry ISRCTN10403163; https://www.isrctn.com/ISRCTN10403163 %R 10.2196/65542 %U https://formative.jmir.org/2025/1/e65542 %U https://doi.org/10.2196/65542 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e52650 %T The Utility of a Smartphone-Based Retinal Imaging Device as a Screening Tool in an Outpatient Clinic Setting: Protocol for an Observational Study %A Mittal,Ajay %A Sanchez,Victor %A Azad,Navjot Singh %A Zuyev,Yaroslav %A Robles,Rafael %A Sherwood,Mark %+ University of Florida College of Medicine, 1600 SW Archer Rd, Gainesville, FL, 32610, United States, 1 3526158883, ajaymittal2400@gmail.com %K digital health %K digital ophthalmoscope %K ophthalmology %K smartphone-based %K mobile health %K applications %K screening tool %K retinal imaging device %K glaucoma %K eye disease %K visual problems %K ophthalmoscope %K ocular disease %K cost-effective %K mobile phone %D 2025 %7 25.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Glaucoma, a disease leading to the degeneration of retinal ganglion cells, results in changes to the optic nerve head that are often diagnosed late when visual problems arise. With the prevalence of glaucoma surpassing 76 million adults worldwide and with glaucoma being the leading cause of irreversible blindness in the world, the early detection and management of glaucoma is imperative. Digital ophthalmoscopes, such as the D-EYE (D-EYE, Srl), have emerged as a technology that uses smartphone cameras with an attachment on the lens to visualize the retina and optic nerve head without the need for dilation. The purpose of this pilot study is to examine the acceptability and feasibility of a D-EYE digital ophthalmoscope to screen for ocular pathology involving the optic nerve, particularly glaucoma. Objective: This study aimed to demonstrate the effect of a smartphone-based ophthalmoscope as a potential vision screening tool for optic nerve head pathology in participants enrolled in this study. The first specific aim was to determine the ability of the D-EYE smartphone ophthalmoscope to gather high-quality imaging to be used for grading the fundus into low- and high-risk categories for eye pathology. The second specific aim was to determine the difference in the quality of data capture between still retinal images and 30-second retinal video recordings produced by D-EYE smartphone ophthalmoscopes. Methods: This observational pilot study enrolled 110 patients receiving routine eye care at the University of Florida Health from February 2019 to February 2022 to assess the use of the D-EYE device in capturing still images and 30-second videos of the bilateral retina and optic nerves of each participant. Study participants completed a survey to gather demographics and past medical history data with a particular focus on previous eye health history. Images were reviewed by 5 ophthalmology residents with interrater reliability analysis performed to assess findings. Results: Ophthalmology resident review indicated greater visualizability and clarity of the bilateral retina and optic nerves with 30-second videos of retinal imaging compared with still-image ophthalmic capture. Furthermore, an increase in visualizability and clarity allowed for a more accurate measurement of the cup-to-disc ratio, a diagnostic marker for glaucoma. In addition, the likelihood of referral of the glaucomatous and healthy sample groups to ophthalmologists indicated a greater sensitivity of digital ophthalmoscopes in being able to detect retinal abnormalities requiring early intervention and management, supporting the technology’s use as a screening tool. Conclusions: This investigation suggests that the use of smartphone-based digital ophthalmoscopes can be more effectively applied as a screening tool by capturing 30-second videos compared with still images alone. This novel assessment of an emerging technology in the field of ophthalmology may better equip further research as smartphone camera technology advances. International Registered Report Identifier (IRRID): DERR1-10.2196/52650 %M 40132180 %R 10.2196/52650 %U https://www.researchprotocols.org/2025/1/e52650 %U https://doi.org/10.2196/52650 %U http://www.ncbi.nlm.nih.gov/pubmed/40132180 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e60424 %T Enhancing Early Language Disorder Detection in Preschools: Evaluation and Future Directions for the Gades Platform %A Dolón-Poza,María %A Gabaldón-Pérez,Ana-Marta %A Berrezueta-Guzman,Santiago %A López Gracia,David %A Martín-Ruiz,María-Luisa %A Pau De La Cruz,Iván %+ , Technical University of Munich, BildungsCampus 2, Heilbronn, 74076, Germany, 49 15159184710, s.berrezueta@tum.de %K developmental language disorder %K simple language delay %K adaptive screening system %K early childhood education %K pervasive therapy %D 2025 %7 14.3.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Language acquisition is a critical developmental milestone, with notable variability during the first 4 years of life. Developmental language disorder (DLD) often overlaps with other neurodevelopmental disorders or simple language delay (SLD), making early detection challenging, especially for primary caregivers. Objective: We aimed to evaluate the effectiveness of the Gades platform, an adaptive screening tool that enables preschool teachers to identify potential language disorders without direct support from nursery school language therapists (NSLTs). Methods: The study took place in a nursery school and an early childhood educational and psychopedagogical center in Madrid, Spain, involving 218 children aged 6 to 36 months, 24 preschool teachers, and 2 NSLTs. Initially, NSLTs conducted informational sessions to familiarize teachers with DLDs and how to identify them. Following this, the teachers used the Gades platform to conduct language screenings independently, without ongoing support from NSLTs. The Gades platform was enhanced to collect detailed profiles of each child and implemented an adaptive screening model tailored to account for variability in language development. This setup allowed preschool teachers, who are not language experts, to observe and assess language development effectively in natural, unsupervised educational environments. The study assessed the platform’s utility in guiding teachers through these observations and its effectiveness in such settings. Results: Gades identified language difficulties in 19.7% (43/218) of the children, with a higher prevalence in boys (29/218, 13.3%) than in girls (14/218, 6.4%). These challenges were most frequently observed in children aged 15 to 27 months. The platform demonstrated a high accuracy rate of 97.41%, with evaluators largely agreeing with its recommendations. Teachers also found Gades to be user friendly and a valuable tool for supporting language development observations in everyday educational settings. Conclusions: Gades demonstrates potential as a reliable and accessible tool for early detection of language disorders, empowering educators to identify DLD and SLD in the absence of NSLTs. However, further refinement of the platform is required to effectively differentiate between DLD and SLD. By integrating Gades into routine preschool assessments, educators can facilitate timely interventions, bridging gaps in early childhood education and therapy. Trial Registration: Pan-African Clinical Trial Registry (PACTR) PACTR202210657553944; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24051 %M 40086469 %R 10.2196/60424 %U https://humanfactors.jmir.org/2025/1/e60424 %U https://doi.org/10.2196/60424 %U http://www.ncbi.nlm.nih.gov/pubmed/40086469 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e58334 %T The Measurement of Vital Signs in Pediatric Patients by Lifelight Software in Comparison to the Standard of Care: Protocol for the VISION-Junior Observational Study %A Misra,Gauri %A Wegerif,Simon %A Fairlie,Louise %A Kapoor,Melissa %A Fok,James %A Salt,Gemma %A Halbert,Jay %A Maconochie,Ian %A Mullen,Niall %+ , Mind over Matter Medtech Ltd, Kemp House, 160 City Road, London, EC1V 2NX, United Kingdom, 44 7881927063, melissa@mind-medtech.com %K vital signs %K remote photoplethysmography %K pediatric health assessment %K pediatric health monitoring %K pediatric %K infant %K infants %K infancy %K child %K children %K Lifelight %K software %K app %K observational study %K study protocol %K clinical deterioration %K COVID-19 %K SARS-CoV-2 %K pandemic %K telemedicine %K medical device %K photoplethysmography %K eHealth %K mobile health %K mHealth %D 2025 %7 14.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Measuring vital signs (VS) is important in potentially unwell children, as a change in VS may indicate a more serious infection than is clinically apparent or herald clinical deterioration. However, currently available methods are not suitable for regular measurement of VS in the home or community setting, and adherence can be poor. The COVID-19 pandemic highlighted a need for the contactless measurement of VS by nonclinical personnel, reinforced by the growing use of telemedicine. The Lifelight app is being developed as a medical device for the contactless measurement of VS using remote photoplethysmography via the camera on smart devices. The VISION-D (Measurement of Vital Signs by Lifelight Software in Comparison to the Standard of Care—Development) and -V (Validation) studies demonstrated the accuracy of the app compared with standard of care (SOC) measurement of blood pressure, pulse rate (PR), and respiratory rate (RR) in adults, supporting certification of Lifelight as a class I Conformité Européenne medical device. Objective: To support the development of the Lifelight app for pediatric patients, the VISION-Junior study is collecting high-quality data that will be used to develop algorithms for the measurement of VS (PR, RR, and oxygen saturation) in pediatric patients. The accuracy of the app will be assessed against SOC measurements made simultaneously with app measurements. Methods: The study is recruiting pediatric patients (younger than 18 years of age) attending the Sunderland Royal Hospital pediatric emergency department of the South Tyneside and Sunderland National Health Service Foundation Trust. High-resolution videos of the face (and torso in children younger than 5 years of age) and audio recordings (to explore the value of crying, wheezing, coughing, and other sounds in predicting illness) are made using the Lifelight Data Collect app. VS are measured simultaneously using SOC methods (finger clip sensor for PR and oxygen saturation; manual counting of RR). Feedback from patients, parents, carers, and nurses who use Lifelight is collected via questionnaires. Anticipated recruitment is 500 participants, with subtargets for age, sex, and skin tone distribution (Fitzpatrick 6-point scale). Early data will be used to refine the algorithms. A separate dataset will be retained to test the performance of the app against predefined targets. Results: The study started on June 12, 2023, and reached its recruitment target (n=532) in April 2024 after extending the deadline. Algorithm refinement is in progress, after which the performance of Lifelight will be compared with the SOC measurement of VS. The analyses are expected to be completed by mid-August 2024. Conclusions: Data collected in this study will be used to develop and assess the accuracy of the app for the measurement of VS in pediatric patients of all ages. Trial Registration: ClinicalTrials.gov NCT05850013; https://clinicaltrials.gov/study/NCT05850013 International Registered Report Identifier (IRRID): DERR1-10.2196/58334 %M 40085833 %R 10.2196/58334 %U https://www.researchprotocols.org/2025/1/e58334 %U https://doi.org/10.2196/58334 %U http://www.ncbi.nlm.nih.gov/pubmed/40085833 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66695 %T Digital Assessment of Cognitive Health in Outpatient Primary Care: Usability Study %A Doerr,Adam J %A Orwig,Taylor A %A McNulty,Matthew %A Sison,Stephanie Denise M %A Paquette,David R %A Leung,Robert %A Ding,Huitong %A Erban,Stephen B %A Weinstein,Bruce R %A Guilarte-Walker,Yurima %A Zai,Adrian H %A Walkey,Allan J %A Soni,Apurv %A McManus,David D %A Lin,Honghuang %+ Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, S6-755, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 7744554881, honghuang.lin@umassmed.edu %K cognitive assessment %K primary care %K digital %K cognitive impairment %K digital assessment %K assessment %K cognitive health %K cognition %K primary care %K cognitive evaluation %K Core Cognitive Evaluation %K CCE %K cohort %K impairment %K cognitive %K outpatient %D 2025 %7 12.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Screening for cognitive impairment in primary care is important, yet primary care physicians (PCPs) report conducting routine cognitive assessments for less than half of patients older than 60 years of age. Linus Health’s Core Cognitive Evaluation (CCE), a tablet-based digital cognitive assessment, has been used for the detection of cognitive impairment, but its application in primary care is not yet studied. Objective: This study aimed to explore the integration of CCE implementation in a primary care setting. Methods: A cohort of participants was recruited from the upcoming schedules of participating PCPs at UMass Memorial Medical Center. Eligibility criteria included individuals aged ≥65 years; ability to read, write, and speak in English or Spanish; no previous diagnosis of cognitive impairment; and no known untreated hearing or vision impairment. Research coordinators collected consent from participants and facilitated the screening process. PCPs reviewed reports in real time, immediately before the scheduled visits, and shared results at their discretion. A report was uploaded to each participant’s REDCap (Research Electronic Data Capture; Vanderbilt University) record and linked to the encounter in the electronic health record. Feedback from patients and their caregivers (if applicable) was collected by a tablet-based survey in the clinic before and after screening. Participating PCPs were interviewed following the completion of the study. Results: The screened cohort included 150 patients with a mean age of 74 (SD 7) years, of whom 65% (97/150) were female. The CCE identified 40 patients as borderline and 7 as positive for cognitive impairment. A total of 84 orders were placed for select laboratory tests or referrals to neurology and neuropsychology within 20 days of CCE administration. Before the assessment, 95% (143/150) of patients and all 15 caregivers expressed a desire to know if their or their loved one’s brain health was declining. All except one patient also completed the postassessment survey. Among them, 96% (143/149) of patients reported finding the CCE easy to complete, and 70% (105/149) felt that the experience was beneficial. In addition, 87% (130/149) of patients agreed or strongly agreed that they wanted to know their CCE results. Among the 7 participating PCPs, 6 stated that the CCE results influenced their patient care management, and all 7 indicated they would continue using the CCE if it were made available after the study. Conclusions: We explored the integration of the CCE into primary care visits, which showed minimal disruption to the practice workflow. Future studies will be warranted to further validate the implementation of digital cognitive impairment screening tools within primary care settings in the real world. %M 40073397 %R 10.2196/66695 %U https://formative.jmir.org/2025/1/e66695 %U https://doi.org/10.2196/66695 %U http://www.ncbi.nlm.nih.gov/pubmed/40073397 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69068 %T Diagnostic Performance of Artificial Intelligence–Based Methods for Tuberculosis Detection: Systematic Review %A Hansun,Seng %A Argha,Ahmadreza %A Bakhshayeshi,Ivan %A Wicaksana,Arya %A Alinejad-Rokny,Hamid %A Fox,Greg J %A Liaw,Siaw-Teng %A Celler,Branko G %A Marks,Guy B %+ School of Clinical Medicine, South West Sydney, UNSW Medicine & Health, UNSW Sydney, High Street, Kensington, NSW, Sydney, 2052, Australia, 61 456541224, s.hansun@unsw.edu.au %K AI %K artificial intelligence %K deep learning %K diagnostic performance %K machine learning %K PRISMA %K Preferred Reporting Items for Systematic Reviews and Meta-Analysis %K QUADAS-2 %K Quality Assessment of Diagnostic Accuracy Studies version 2 %K systematic literature review %K tuberculosis detection %D 2025 %7 7.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Tuberculosis (TB) remains a significant health concern, contributing to the highest mortality among infectious diseases worldwide. However, none of the various TB diagnostic tools introduced is deemed sufficient on its own for the diagnostic pathway, so various artificial intelligence (AI)–based methods have been developed to address this issue. Objective: We aimed to provide a comprehensive evaluation of AI-based algorithms for TB detection across various data modalities. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020 guidelines, we conducted a systematic review to synthesize current knowledge on this topic. Our search across 3 major databases (Scopus, PubMed, Association for Computing Machinery [ACM] Digital Library) yielded 1146 records, of which we included 152 (13.3%) studies in our analysis. QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies version 2) was performed for the risk-of-bias assessment of all included studies. Results: Radiographic biomarkers (n=129, 84.9%) and deep learning (DL; n=122, 80.3%) approaches were predominantly used, with convolutional neural networks (CNNs) using Visual Geometry Group (VGG)-16 (n=37, 24.3%), ResNet-50 (n=33, 21.7%), and DenseNet-121 (n=19, 12.5%) architectures being the most common DL approach. The majority of studies focused on model development (n=143, 94.1%) and used a single modality approach (n=141, 92.8%). AI methods demonstrated good performance in all studies: mean accuracy=91.93% (SD 8.10%, 95% CI 90.52%-93.33%; median 93.59%, IQR 88.33%-98.32%), mean area under the curve (AUC)=93.48% (SD 7.51%, 95% CI 91.90%-95.06%; median 95.28%, IQR 91%-99%), mean sensitivity=92.77% (SD 7.48%, 95% CI 91.38%-94.15%; median 94.05% IQR 89%-98.87%), and mean specificity=92.39% (SD 9.4%, 95% CI 90.30%-94.49%; median 95.38%, IQR 89.42%-99.19%). AI performance across different biomarker types showed mean accuracies of 92.45% (SD 7.83%), 89.03% (SD 8.49%), and 84.21% (SD 0%); mean AUCs of 94.47% (SD 7.32%), 88.45% (SD 8.33%), and 88.61% (SD 5.9%); mean sensitivities of 93.8% (SD 6.27%), 88.41% (SD 10.24%), and 93% (SD 0%); and mean specificities of 94.2% (SD 6.63%), 85.89% (SD 14.66%), and 95% (SD 0%) for radiographic, molecular/biochemical, and physiological types, respectively. AI performance across various reference standards showed mean accuracies of 91.44% (SD 7.3%), 93.16% (SD 6.44%), and 88.98% (SD 9.77%); mean AUCs of 90.95% (SD 7.58%), 94.89% (SD 5.18%), and 92.61% (SD 6.01%); mean sensitivities of 91.76% (SD 7.02%), 93.73% (SD 6.67%), and 91.34% (SD 7.71%); and mean specificities of 86.56% (SD 12.8%), 93.69% (SD 8.45%), and 92.7% (SD 6.54%) for bacteriological, human reader, and combined reference standards, respectively. The transfer learning (TL) approach showed increasing popularity (n=89, 58.6%). Notably, only 1 (0.7%) study conducted domain-shift analysis for TB detection. Conclusions: Findings from this review underscore the considerable promise of AI-based methods in the realm of TB detection. Future research endeavors should prioritize conducting domain-shift analyses to better simulate real-world scenarios in TB detection. Trial Registration: PROSPERO CRD42023453611; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023453611 %M 40053773 %R 10.2196/69068 %U https://www.jmir.org/2025/1/e69068 %U https://doi.org/10.2196/69068 %U http://www.ncbi.nlm.nih.gov/pubmed/40053773 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e59660 %T Applying AI in the Context of the Association Between Device-Based Assessment of Physical Activity and Mental Health: Systematic Review %A Woll,Simon %A Birkenmaier,Dennis %A Biri,Gergely %A Nissen,Rebecca %A Lutz,Luisa %A Schroth,Marc %A Ebner-Priemer,Ulrich W %A Giurgiu,Marco %+ Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Hertzstrasse 16, Karlsruhe, 76187, Germany, 49 721 608 ext 41974, simon.woll@kit.edu %K machine learning %K mental health %K wearables %K physical behavior %K artificial intelligence %K mobile phone %K smartphone %D 2025 %7 6.3.2025 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Wearable technology is used by consumers worldwide for continuous activity monitoring in daily life but more recently also for classifying or predicting mental health parameters like stress or depression levels. Previous studies identified, based on traditional approaches, that physical activity is a relevant factor in the prevention or management of mental health. However, upcoming artificial intelligence methods have not yet been fully established in the research field of physical activity and mental health. Objective: This systematic review aims to provide a comprehensive overview of studies that integrated passive monitoring of physical activity data measured via wearable technology in machine learning algorithms for the detection, prediction, or classification of mental health states and traits. Methods: We conducted a review of studies processing wearable data to gain insights into mental health parameters. Eligibility criteria were (1) the study uses wearables or smartphones to acquire physical behavior and optionally other sensor measurement data, (2) the study must use machine learning to process the acquired data, and (3) the study had to be published in a peer-reviewed English language journal. Studies were identified via a systematic search in 5 electronic databases. Results: Of 11,057 unique search results, 49 published papers between 2016 and 2023 were included. Most studies examined the connection between wearable sensor data and stress (n=15, 31%) or depression (n=14, 29%). In total, 71% (n=35) of the studies had less than 100 participants, and 47% (n=23) had less than 14 days of data recording. More than half of the studies (n=27, 55%) used step count as movement measurement, and 44% (n=21) used raw accelerometer values. The quality of the studies was assessed, scoring between 0 and 18 points in 9 categories (maximum 2 points per category). On average, studies were rated 6.47 (SD 3.1) points. Conclusions: The use of wearable technology for the detection, prediction, or classification of mental health states and traits is promising and offers a variety of applications across different settings and target groups. However, based on the current state of literature, the application of artificial intelligence cannot realize its full potential mostly due to a lack of methodological shortcomings and data availability. Future research endeavors may focus on the following suggestions to improve the quality of new applications in this context: first, by using raw data instead of already preprocessed data. Second, by using only relevant data based on empirical evidence. In particular, crafting optimal feature sets rather than using many individual detached features and consultation with in-field professionals. Third, by validating and replicating the existing approaches (ie, applying the model to unseen data). Fourth, depending on the research aim (ie, generalization vs personalization) maximizing the sample size or the duration over which data are collected. %M 40053765 %R 10.2196/59660 %U https://mhealth.jmir.org/2025/1/e59660 %U https://doi.org/10.2196/59660 %U http://www.ncbi.nlm.nih.gov/pubmed/40053765 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54921 %T Long-Term Experiences of Health Care Providers Using Iris Scanning as an Identification Tool in a Vaccine Trial in the Democratic Republic of the Congo: Qualitative Study %A Zola Matuvanga,Trésor %A Paviotti,Antea %A Bikioli Bolombo,Freddy %A Lemey,Gwen %A Larivière,Ynke %A Salloum,Maha %A Isekah Osang'ir,Bernard %A Esanga Longomo,Emmanuel %A Milolo,Solange %A Matangila,Junior %A Maketa,Vivi %A Mitashi,Patrick %A Van Damme,Pierre %A Muhindo-Mavoko,Hypolite %A Van geertruyden,Jean-Pierre %+ Department of Tropical Medicine, Faculty of Medicine, University of Kinshasa, Avenue Université, N° 1, Commune de Lemba, Kinshasa, BP 834 KINSHASA XI, the Democratic Republic of the Congo, 243 810046306, zola.matuvanga@unikin.ac.cd %K iris scan %K vaccine trial %K iris %K perception %K experience %K views %K biometric identification %K Democratic Republic of the Congo %D 2025 %7 6.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Iris scanning has increasingly been used for biometric identification over the past decade, with continuous advancements and expanding applications. To better understand the acceptability of this technology, we report the long-term experiences of health care providers and frontline worker participants with iris scanning as an identification tool in the EBL2007 Ebola vaccine trial conducted in the Democratic Republic of the Congo. Objective: This study aims to document the long-term experiences of using iris scanning for identity verification throughout the vaccine trial. Methods: Two years after the start of the EBL2007 vaccine trial (February to March 2022), 69 trial participants—including nurses, first aid workers, midwives, and community health workers—were interviewed through focus group discussions. Additionally, 13 in-depth individual interviews were conducted with physicians involved in the trial, iris scan operators, trial staff physicians, and trial participants who declined iris scanning. Qualitative content analysis was used to identify key themes. Results: Initially, interviewees widely accepted the iris scan and viewed it as a distinctive tool for identifying participants in the EBL2007 vaccine trial. However, over time, perceptions became less favorable. Some participants expressed concerns that their vision had diminished shortly after using the tool and continued to decline until the end of the study. Others reported experiencing perceived vision loss long after the trial had concluded. However, no vision impairment was reported as an adverse event or assessed in the trial as being linked to the iris scan, which uses a previously certified safe infrared light for scanning. Conclusions: Our findings highlight the sustained acceptability and perceived high accuracy of the iris scan tool for uniquely identifying adult participants in a vaccine trial over time. Continued efforts to systematically disseminate and reinforce information about the function and safety of this technology are essential. Clearly presenting iris scanning as a safe procedure could help dispel misconceptions, concerns, and perceived risks among potential users in vaccine trials. %M 40053756 %R 10.2196/54921 %U https://formative.jmir.org/2025/1/e54921 %U https://doi.org/10.2196/54921 %U http://www.ncbi.nlm.nih.gov/pubmed/40053756 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63110 %T Evidence on Digital HIV Self-Testing From Accuracy to Impact: Updated Systematic Review %A Beecroft,Ashlyn %A Vaikla,Olivia %A Engel,Nora %A Duchaine,Thomas %A Liang,Chen %A Pant Pai,Nitika %+ Research Institute of the McGill University Health Centre, 5252 boul de Maisonneuve W., Montreal, QC, H4A 3S5, Canada, 1 514 934 1934 ext 44729, nitika.pai@mcgill.ca %K digital HIV self-testing %K impact %K linkage %K outcomes %K HIV %K HIV infection %K HIV self-testing %K self-testing %K digital innovation %K systematic review %K accuracy %K patient-centered %K middle- to high-income countries %K digital health %K mHealth %K health education %K sexually transmitted diseases %K sexual behavior %D 2025 %7 4.3.2025 %9 Review %J J Med Internet Res %G English %X Background: HIV self-testing has gained momentum following the approval of self-testing methods and novel technological advancements. Digital HIV self-testing involves completing an oral or blood-based HIV self-test with support from a digital innovation. Objective: We conducted a systematic review on the existing data analyzing digital HIV self-testing accuracy while updating research on digital HIV self-test acceptability, preference, feasibility, and impact. Methods: We searched Embase and PubMed for records on HIV self-testing with digital support. Included studies significantly incorporated a form of digital innovation throughout the HIV self-test process and reported quantitative data. For accuracy measures, the search spanned January 1, 2013, to October 15, 2024; for patient-centered and impact outcomes, we updated existing literature (June 16, 2021, to October 15, 2024) reported in a previous systematic review. Studies’ quality was assessed using the QUADAS 2 Tool, Newcastle-Ottawa Scale, and Cochrane Risk of Bias Tool 2. Results: Fifty-five studies (samples ranging 120-21,035, median 1267 participants) were summarized from 19 middle- to high-income countries. Seven studies reported on the accuracy of HIV self-testing with innovations from >5000 participants. Diagnostic performance metrics, including point estimates of specificity, sensitivity, positive predictive value, and negative predictive value were measured (n=3), and ranged from: 96.8% to 99.9%, 92.9% to 100.0%, 76.5% to 99.2%, and 99.2% to 100.0%, respectively. The percentage of invalid test results for oral and blood-based self-tests ranged from 0.2% to 12.7% (n=4). Fifty-one studies reported data on metrics beyond accuracy, including acceptability, preference, feasibility, and impact outcomes from >30,000 participants. Majority (38/51, 74.5%) were observational studies, while 25.5% (13/51) reported data from randomized controlled trials. Acceptability and preference outcomes varied from 64.5% to 99.0% (14/51) and 4.6% to 99.3% (8/51), respectively. Feasibility outcomes included test uptake (30.9% to 98.2%; 28/51), response rate (26.0% to 94.8%; 7/51), and visits to web-based providers (43.0% to 70.7%; n=4). Impact outcomes assessed new infections (0.0% to 25.8%; 31/51), first-time testers (2.0% to 53.0%; 26/51), result return proportions (22.1% to 100.0%; 24/51), linkage to care as both connections to confirmatory testing and counseling (53.0% to 100.0%; 16/51), and referrals for treatment initiation (44.4% to 98.1%; 8/51). The quality of studies varied, though they generally demonstrated low risk of bias. Conclusions: Digital innovations improved the accuracy of HIV self-test results, and were well-accepted and preferred by participants. Operationally, they were found to be feasible and reported impacting the HIV self-testing process. These findings are in favor of the use of digital HIV self-test innovations as a promising support tool and suggest that digital HIV self-tests’ service delivery models hold promise in not only facilitating HIV testing but also impacting operational outcomes that are crucial to reaching Joint United Nations Program on HIV/AIDS targets in middle- to high-income countries. Trial Registration: PROSPERO CRD42020205025; https://www.crd.york.ac.uk/prospero/CRD42020205025 %M 40053740 %R 10.2196/63110 %U https://www.jmir.org/2025/1/e63110 %U https://doi.org/10.2196/63110 %U http://www.ncbi.nlm.nih.gov/pubmed/40053740 %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 %@ 2291-9279 %I JMIR Publications %V 13 %N %P e54797 %T Machine Learning Analysis of Engagement Behaviors in Older Adults With Dementia Playing Mobile Games: Exploratory Study %A Torabgar,Melika %A Figeys,Mathieu %A Esmail,Shaniff %A Stroulia,Eleni %A Ríos Rincón,Adriana M %K dementia %K gaming %K engagement %K cognition %K machine learning %K games %K cognitive %K screening %K classification %K Alzheimer disease %K gerontology %K geriatric %K older adult %K elderly %K aging %D 2025 %7 3.3.2025 %9 %J JMIR Serious Games %G English %X Background: The prevalence of dementia is expected to rise with an aging population, necessitating accessible early detection methods. Serious games have emerged as potential cognitive screening tools. They provide not only an engaging platform for assessing cognitive function but also serve as valuable indicators of cognitive health through engagement levels observed during play. Objective: This study aims to examine the differences in engagement-related behaviors between older adults with and without dementia during serious gaming sessions. Further, it seeks to identify the key contributors that enhance the effectiveness of machine learning for dementia classification based on engagement-related behaviors. Methods: This was an exploratory proof-of-concept study. Over 8 weeks, 20 older adults, 6 of whom were living with dementia, were enrolled in a single-case design study. Participants played 1 of 4 “Vibrant Minds” serious games (Bejeweled, Whack-A-Mole, Mah-jong, and Word-Search) over 8 weeks (16 30-min sessions). Throughout the study, sessions were recorded to analyze engagement-related behaviors. This paper reports on the analysis of the engagement-related behaviors of 15 participants. The videos of these 15 participants (10 cognitively intact, 5 with dementia) were analyzed by 2 independent raters, individually annotating engagement-related behaviors at 15-second intervals using a coding system. This analysis resulted in 1774 data points categorized into 47 behavior codes, augmented by 54 additional features including personal characteristics, technical issues, and environmental factors. Each engagement-related behavior was compared between older adults living with dementia and older adults without dementia using the χ² test with a 2×2 contingency table with a significance level of .05. Codes underwent one-hot encoding and were processed using random forest classifiers to distinguish between participant groups. Results: Significant differences in 64% of engagement-related behaviors were found between groups, notably in torso movements, voice modulation, facial expressions, and concentration. Including engagement-related behaviors, environmental disturbances, technical issues, and personal characteristics resulted in the best model for classifying cases of dementia correctly, achieving an F1-score of 0.91 (95% CI 0.851‐0.963) and an area under the receiver operating curve of 0.99 (95% CI 0.984‐1.000). Conclusions: Key features distinguishing between older adults with and without dementia during serious gameplay included torso, voice, facial, and concentration behaviors, as well as age. The best performing machine learning model identified included features of engagement-related behavios, environmental disturbances, technical challenges, and personal attributes. Engagement-related behaviors observed during serious gaming offer crucial markers for identifying dementia. Machine learning models that incorporate these unique behavioral markers present a promising, noninvasive approach for early dementia screening in a variety of settings. %R 10.2196/54797 %U https://games.jmir.org/2025/1/e54797 %U https://doi.org/10.2196/54797 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e65292 %T Performance of a Digital Cognitive Assessment in Predicting Dementia Stages Delineated by the Dementia Severity Rating Scale: Retrospective Study %A Huynh,Duong %A Sun,Kevin %A Patterson,Mary %A Hosseini Ghomi,Reza %A Huang,Bin %K stage %K severity %K progression %K correlation %K association %K cognitive impairment %K functional activities %K cognitive assessment %K BrainCheck %K dementia %K Alzheimer disease %K gerontology %K geriatric %K old %K elderly %K aging %K retrospective analysis %K digital assessment %K patient assessment %K digital cognitive assessment %K digital health %K neurodegeneration %K memory loss %K memory function %K risk factors %D 2025 %7 26.2.2025 %9 %J JMIR Aging %G English %X Background: Dementia is characterized by impairments in an individual’s cognitive and functional abilities. Digital cognitive assessments have been shown to be effective in detecting mild cognitive impairment and dementia, but whether they can stage the disease remains to be studied. Objective: In this study, we examined (1) the correlation between scores obtained from BrainCheck standard battery of cognitive assessments (BC-Assess), a digital cognitive assessment, and scores obtained from the Dementia Severity Rating Scale (DSRS), and (2) the accuracy of using the BC-Assess score to predict dementia stage delineated by the DSRS score. We also explored whether BC-Assess can be combined with information from the Katz Index of Independence in activities of daily living (ADL) to obtain enhanced accuracy. Methods: Retrospective analysis was performed on a BrainCheck dataset containing 1751 patients with dementia with different cognitive and functional assessments completed for cognitive care planning, including the DSRS, the ADL, and the BC-Assess. The patients were staged according to their DSRS total score (DSRS-TS): 982 mild (DSRS-TS 10‐18), 656 moderate (DSRS-TS 19-26), and 113 severe (DSRS-TS 37-54) patients. Pearson correlation was used to assess the associations between BC-Assess overall score (BC-OS), ADL total score (ADL-TS), and DSRS-TS. Logistic regression was used to evaluate the possibility of using patients’ BC-OS and ADL-TS to predict their stage. Results: We found moderate Pearson correlations between DSRS-TS and BC-OS (r=−0.53), between DSRS-TS and ADL-TS (r=−0.55), and a weak correlation between BC-OS and ADL-TS (r=0.37). Both BC-OS and ADL-TS significantly decreased with increasing severity. BC-OS demonstrated to be a good predictor of dementia stages, with an area under the receiver operating characteristic curve (ROC-AUC) of classification using logistic regression ranging from .733 to .917. When BC-Assess was combined with ADL, higher prediction accuracies were achieved, with an ROC-AUC ranging from 0.786 to 0.961. Conclusions: Our results suggest that BC-Assess could serve as an effective alternative tool to DSRS for grading dementia severity, particularly in cases where DSRS, or other global assessments, may be challenging to obtain due to logistical and time constraints. %R 10.2196/65292 %U https://aging.jmir.org/2025/1/e65292 %U https://doi.org/10.2196/65292 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e68668 %T Social Determinants of Health Screening Tools for Adults in Primary Care: Protocol for a Scoping Review %A Martínez-Alfonso,Julia %A Sebastian-Valles,Fernando %A Martinez-Vizcaino,Vicente %A Jimenez-Olivas,Nuria %A Cabrera-Majada,Antonio %A De los Mozos-Hernando,Iván %A Cekrezi,Shkelzen %A Martínez-Martínez,Héctor %A Mesas,Arthur Eumann %+ Centro de estudios sociosanitarios, Universidad de Castilla-La Mancha, Campus universitario, Calle Santa Teresa Jornet, Cuenca, 16071, Spain, 34 680222972, vicente.martinez@uclm.es %K social deprivation %K social determinants of health %K primary health care %K social inequality %K screening %D 2025 %7 19.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social determinants of health (SDH) have been shown to be predictors of health outcomes. Integrating SDH screening tools into primary care may help identify individuals or groups with a greater burden of social vulnerability and promote health equity. Objective: This study aimed (1) to identify the existing screening tools to assess social deprivation in adults in primary care settings; (2) to describe the characteristics of these tools and, where appropriate, their psychometric properties; (3) to describe their validity and reliability in those scales in which validation processes have been conducted; and (4) to identify evidence gaps and provide recommendations for future research. Methods: This study protocol was structured according to the Joanna Briggs Institute methodology for scoping reviews and reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Furthermore, since not all SDH assessment tools are published as scientific papers, we will use a slightly modified form of the scoping review framework to retrieve specific information about specific tools for screening SDH in primary care contexts. The following electronic databases will be searched by 2 reviewers: MEDLINE (via PubMed), CINAHL Plus, Web of Science, and Scopus. In addition, the following sources will also be searched for gray literature: DART-Europe E-thesis Portal, OpenGrey, and Google Scholar. After the revision of inclusion and exclusion criteria, the titles, abstracts, and full text of the included studies will be separately screened by 2 reviewers. A PRISMA-ScR flowchart will be used to depict the sources of evidence screened, and data charting will be used to gain in-depth knowledge. The findings of the scoping review will be presented in both narrative and tabular formats, summarizing the existing literature on tools used for SDH in primary care settings. A critical analysis will be undertaken to address the variability in tool validation, cultural adaptability, and integration into different health care systems. Finally, key gaps in the existing evidence will be explored, and research priorities will be proposed, emphasizing the need for screening tools that are culturally sensitive, scalable, and easily integrated into primary care workflows. This critically appraised information may be useful for implementing SDH screening tools in primary care settings and may contribute to future research addressing feasibility and validation studies in different primary health care systems. Results: The study began in July 2024. Data collection is expected to be completed in April 2025, with publication expected in October 2025. Conclusions: This scoping review will provide a comprehensive and critical description of the available tools aimed at screening SDH in primary care settings. Incorporating these tools into routine care has been recognized as a key strategy for addressing health inequalities, given the growing evidence base on the influence of SDH on health outcomes. International Registered Report Identifier (IRRID): PRR1-10.2196/68668 %M 39969980 %R 10.2196/68668 %U https://www.researchprotocols.org/2025/1/e68668 %U https://doi.org/10.2196/68668 %U http://www.ncbi.nlm.nih.gov/pubmed/39969980 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59015 %T A New Computer-Based Cognitive Measure for Early Detection of Dementia Risk (Japan Cognitive Function Test): Validation Study %A Shimada,Hiroyuki %A Doi,Takehiko %A Tsutsumimoto,Kota %A Makino,Keitaro %A Harada,Kenji %A Tomida,Kouki %A Morikawa,Masanori %A Makizako,Hyuma %+ Department of Preventive Gerontology, Centre for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Ōbu, 474-8511, Japan, 81 0562 46 2311, shimada@ncgg.go.jp %K cognition %K neurocognitive test %K dementia %K Alzheimer disease %K aged %K MMSE %K cognitive impairment %K Mini-Mental State Examination %K monitoring %K eHealth %D 2025 %7 14.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The emergence of disease-modifying treatment options for Alzheimer disease is creating a paradigm shift in strategies to identify patients with mild symptoms in primary care settings. Systematic reviews on digital cognitive tests reported that most showed diagnostic performance comparable with that of paper-and-pencil tests for mild cognitive impairment and dementia. However, most studies have small sample sizes, with fewer than 100 individuals, and are based on case-control or cross-sectional designs. Objective: This study aimed to examine the predictive validity of the Japanese Cognitive Function Test (J-Cog), a new computerized cognitive battery test, for dementia development. Methods: We randomly assigned 2520 older adults (average age 72.7, SD 6.7 years) to derivation and validation groups to determine and validate cutoff points for the onset of dementia. The Mini-Mental State Examination (MMSE) was used for comparison purposes. The J-Cog consists of 12 tasks that assess orientation, designation, attention and calculation, mental rotation, verbal fluency, sentence completion, working memory, logical reasoning, attention, common knowledge, word memory recall, and episodic memory recall. The onset of dementia was monitored for 60 months. In the derivation group, receiver operating characteristic curves were plotted to determine the MMSE and J-Cog cutoff points that best discriminated between the groups with and without dementia. In the validation group, Cox proportional regression models were developed to predict the associations of the group classified using the cutoff points of the J-Cog or MMSE with dementia incidence. Harrell C-statistic was estimated to summarize how well a predicted risk score described an observed sequence of events. The Akaike information criterion was calculated for relative goodness of fit, where lower absolute values indicate a better model fit. Results: Significant hazard ratios (HRs) for dementia incidence were found using the MMSE cutoff between 23 and 24 point (HR 1.93, 95% CI 1.13-3.27) and the J-Cog cutoff between 43 and 44 points (HR 2.42, 95% CI 1.50-3.93). In the total validation group, the C-statistic was above 0.8 for all cutoff points. Akaike information criterion with MMSE cutoff between 23 and 24 points as a reference showed a poor fit for MMSE cutoff between 28 and 29 points, and a good fit for the J-Cog cutoff between 43 and 44 points. Conclusions: The J-Cog has higher accuracy in predicting the development of dementia than the MMSE and has advantages for use in the community as a test of cognitive function, which can be administered by nonprofessionals. %M 39951718 %R 10.2196/59015 %U https://www.jmir.org/2025/1/e59015 %U https://doi.org/10.2196/59015 %U http://www.ncbi.nlm.nih.gov/pubmed/39951718 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e67043 %T Think-Aloud Testing of a Companion App for Colonoscopy Examinations: Usability Study %A Jacob,Christine %A Müller,Roman %A Schüler,Sonja %A Rey,Alix %A Rey,Guillaume %A Armenian,Berj %A Vonlaufen,Alain %A Drepper,Michael %A Zimmerli,Marius %K eHealth %K mobile health %K mHealth %K digital health %K technology assessment %K technology adoption %K technology implementation %K usability study %K colonoscopy %K app %K application %K examinations %K smartphone %K usability %D 2025 %7 12.2.2025 %9 %J JMIR Hum Factors %G English %X Background: Colonoscopies are vital for initial screening, follow-ups, surveillance of neoplasia, and assessing symptoms such as rectal bleeding. Successful colonoscopies require thorough colon preparation, but up to 25% fail due to poor preparation. This can lead to longer procedures, repeat colonoscopies, inconvenience, poorer health outcomes, and higher costs. eHealth tools can enhance bowel preparation and potentially reduce the need for repeat procedures. Objective: This usability study aimed to identify strengths and weaknesses in a prototype companion app for colonoscopy examinations. The objective was to obtain in-depth insights into the app’s usability, ease of use, and content comprehension, with the aim of refining the tool to effectively fulfill its intended purpose, guided by feedback from potential users. Methods: From February to August 2024, we conducted a qualitative study using the think-aloud procedure. Each session involved 6 tasks and a semistructured interview to delve deeper into participants’ task experiences. All think-aloud sessions and interviews were recorded. Quantitative usability questions were analyzed using Microsoft Excel, while qualitative data underwent coding and analysis based on thematic analysis principles. Results: In total, 17 individuals, all smartphone users, participated in this study. Participants were recruited from 1 hospital, 1 private clinic, and 1 patient organization in Switzerland. The study found that participants rated the app’s usability metrics positively, with an overall mean rating of ease of use at 4.29 (SD 0.59), usefulness at 4.53 (SD 0.72), and comprehensibility at 4.29 (SD 0.92). For the individual features, the mean ratings for ease of use were between 4 and 4.65, usefulness ranged from 4.35 to 4.82, and comprehensibility received ratings between 4.29 and 4.53, all measured on a 5-point scale, where 1 represented low agreement and 5 indicated high agreement. Additionally, 100% of participants indicated they will or may use the app if they require a colonoscopy examination. Participants highlighted the need for reminders and alerts in the week leading up to the colonoscopy, along with tailored content, simplified language, and visual aids. Conclusions: The app prototype demonstrated favorable results with the majority of participants, and the testing process enabled the prompt identification and resolution of usability issues. The next phase will prioritize and assess potential improvements based on urgency and feasibility to guide a focused development plan. Usability testing highlighted features such as push notifications and personalized content as top priorities for participants, making them key areas for immediate attention. Moving forward, the app has the potential to function effectively as a companion app for colonoscopy examinations. To achieve this, further studies with a larger sample in real-world settings will be crucial. %R 10.2196/67043 %U https://humanfactors.jmir.org/2025/1/e67043 %U https://doi.org/10.2196/67043 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e62915 %T Women Empowered to Connect With Addiction Resources and Engage in Evidence-Based Treatment (WE-CARE)—an mHealth Application for the Universal Screening of Alcohol, Substance Use, Depression, and Anxiety: Usability and Feasibility Study %A Isaacs,Krystyna %A Shifflett,Autumn %A Patel,Kajal %A Karpisek,Lacey %A Cui,Yi %A Lawental,Maayan %A Tzilos Wernette,Golfo %A Borsari,Brian %A Chang,Katie %A Ma,Tony %+ Benten Technologies, 9408 Grant Ave, Unit 206, Manassas, VA, 20110, United States, 1 7036625858, krysisaacs@gmail.com %K service linkage %K digital health %K education %K mental health %K substance use disorder %K SUD %K alcohol use disorder %K chatbot %K childbearing women %K women %K alcohol %K substance use %K empowerment %K evidence-based treatment %K usability %K feasibility %K mobile health %K mhealth %K app %K depression %K anxiety %K screening %K e-screening %D 2025 %7 7.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Women of childbearing age (aged 18-44 years) face multiple barriers to receiving screening and treatment for unhealthy alcohol and substance use, depression, and anxiety, including lack of screening in the primary care setting and lack of support in accessing care. The Women Empowered to Connect with Addiction Resources and Engage in Evidence-based Treatment (WE-CARE) mobile app was developed to test universal screening with women of childbearing age and linkage to care after an anonymous assessment. Objective: In this study, we aimed to investigate the feasibility and acceptability of providing anonymous screening instruments through mobile phones for alcohol and substance use, as well as depression and anxiety, for women of childbearing age. Methods: We used agile development principles based on previous formative research to test WE-CARE mobile health app with women of childbearing age (N=30) who resided in 1 of 6 counties in central Florida. WE-CARE included screening instruments (for alcohol, substance use, depression, and anxiety), a moderated discussion forum, educational microlearning videos, a frequently asked questions section, and resources for linkage to treatment. Individuals were recruited using flyers, academic listserves, and a commercial human subject recruiting company (Prolific). Upon completion of the screening instruments, women explored the educational and linkage to care features of the app and filled out a System Usability Scale to evaluate the mobile health app’s usability and acceptability. Postpilot semistructured interviews (n=4) were conducted to further explore the women’s reactions to the app. Results: A total of 77 women downloaded the application and 30 completed testing. Women of childbearing age gave the WE-CARE app an excellent System Usability Scale score of 86.7 (SD 12.43). Our results indicate elevated risk for substance use in 18 of the 30 (60%) participants, 9/18 (50%) also had an elevated risk for anxiety or depression, and 11/18 (61%) had an elevated risk for substance use, anxiety, or depression. Participants reported that WE-CARE was easy to navigate and use but they would have liked to see more screening questions and more educational content. Linkage to care was an issue; however, as none of the women identified as “at-risk” for substance use disorders contacted the free treatment clinic for further evaluation. Conclusions: The mobile health app was highly rated for acceptability and usability, but participants were not receptive to seeking help at a treatment center after only a few brief encounters with the app. The linkage to care design features was likely insufficient to encourage them to seek treatment. The next version of WE-CARE will include normative scores for participants to self-evaluate their screening status compared with their age- and gender-matched peers and enhanced linkages to care features. Future development will focus on enhancing engagement to improve change behaviors and assess readiness for change. %M 39918861 %R 10.2196/62915 %U https://formative.jmir.org/2025/1/e62915 %U https://doi.org/10.2196/62915 %U http://www.ncbi.nlm.nih.gov/pubmed/39918861 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65974 %T Impact of Online Interactive Decision Tools on Women’s Decision-Making Regarding Breast Cancer Screening: Systematic Review and Meta-Analysis %A Villain,Patricia %A Downham,Laura %A Le Bonniec,Alice %A Bauquier,Charlotte %A Mandrik,Olena %A Nadarzynski,Tom %A Donelle,Lorie %A Murillo,Raúl %A Tolma,Eleni L %A Johnson,Sonali %A Soler-Michel,Patricia %A Smith,Robert %+ International Agency for Research on Cancer, World Health Organization, 25 Avenue Tony Garnier CS 90627, Lyon, 69366, France, 33 4 72 73 84 40, patriciavillain1@gmail.com %K breast cancer screening %K decision-making %K online interactive %K decision aid %K average risk %K shared decision-making %K screening participation %K cognitive determinants %K women %D 2025 %7 29.1.2025 %9 Review %J J Med Internet Res %G English %X Background: The online nature of decision aids (DAs) and related e-tools supporting women’s decision-making regarding breast cancer screening (BCS) through mammography may facilitate broader access, making them a valuable addition to BCS programs. Objective: This systematic review and meta-analysis aims to evaluate the scientific evidence on the impacts of these e-tools and to provide a comprehensive assessment of the factors associated with their increased utility and efficacy. Methods: We followed the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and conducted a search of MEDLINE, PsycINFO, Embase, CINAHL, and Web of Science databases from August 2010 to April 2023. We included studies reporting on populations at average risk of breast cancer, which utilized DAs or related e-tools, and assessed women’s participation in BCS by mammography or other key cognitive determinants of decision-making as primary or secondary outcomes. We conducted meta-analyses on the identified randomized controlled trials, which were assessed using the revised Cochrane Risk of Bias 2 (RoB 2) tool. We further explored intermediate and high heterogeneity between studies to enhance the validity of our results. Results: In total, 22 different e-tools were identified across 31 papers. The degree of tailoring in the e-tools, specifically whether the tool was fully tailored or featured with tailoring, was the most influential factor in women’s decision-making regarding BCS. Compared with control groups, tailored e-tools significantly increased women’s long-term participation in BCS (risk ratio 1.14, 95% CI 1.07-1.23, P<.001, I2=0%). Tailored-to-breast-cancer-risk e-tools increased women’s level of worry (mean difference 0.31, 95% CI 0.13-0.48, P<.001, I2=0%). E-tools also improved women’s adequate knowledge of BCS, with features-with-tailoring e-tools designed and tested with the general population being more effective than tailored e-tools designed for or tested with non-BCS participants (χ21=5.1, P=.02). Features-with-tailoring e-tools increased both the rate of women who intended not to undergo BCS (risk ratio 1.88, 95% CI 1.43-2.48, P<.001, I2=0%) and the rate of women who had made an informed choice regarding their intention to undergo BCS (risk ratio 1.60, 95% CI 1.09-2.33, P=.02, I2=91%). Additionally, these tools decreased the proportion of women with decision conflict (risk ratio 0.77, 95% CI 0.65-0.91, P=.002, I2=0%). Shared decision-making was not formally evaluated. This review is limited by small sample sizes, including only a few studies in the meta-analysis, some with a high risk of bias, and high heterogeneity between the studies and e-tools. Conclusions: Features-with-tailoring e-tools could potentially negatively impact BCS programs by fostering negative intentions and attitudes toward BCS participation. Conversely, tailored e-tools may increase women’s participation in BCS but, when tailored to risk, they may elevate their levels of worry. To maximize the effectiveness of e-tools while minimizing potential negative impacts, we advocate for an “on-demand” layered approach to their design. %M 39879616 %R 10.2196/65974 %U https://www.jmir.org/2025/1/e65974 %U https://doi.org/10.2196/65974 %U http://www.ncbi.nlm.nih.gov/pubmed/39879616 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e53503 %T A New Smartphone-Based Cognitive Screening Battery for Multiple Sclerosis (icognition): Validation Study %A Denissen,Stijn %A Van Laethem,Delphine %A Baijot,Johan %A Costers,Lars %A Descamps,Annabel %A Van Remoortel,Ann %A Van Merhaegen-Wieleman,Annick %A D’hooghe,Marie %A D'Haeseleer,Miguel %A Smeets,Dirk %A Sima,Diana M %A Van Schependom,Jeroen %A Nagels,Guy %+ AIMS Lab, Center for Neurosciences, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, 1090, Belgium, 32 2 477 41 02, stijn.denissen@vub.be %K multiple sclerosis %K telemedicine %K cognition %K memory %K information processing speed %K mobile phone %D 2025 %7 20.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive deterioration is common in multiple sclerosis (MS) and requires regular follow-up. Currently, cognitive status is measured in clinical practice using paper-and-pencil tests, which are both time-consuming and costly. Remote monitoring of cognitive status could offer a solution because previous studies on telemedicine tools have proved its feasibility and acceptance among people with MS. However, existing smartphone-based apps include designs that are prone to motor interference and focus primarily on information processing speed, although memory is also commonly affected. Objective: This study aims to validate a smartphone-based cognitive screening battery, icognition, to detect deterioration in both memory and information processing speed. Methods: The icognition screening battery consists of 3 tests: the Symbol Test for information processing speed, the Dot Test for visuospatial short-term memory and learning, and the visual Backward Digit Span (vBDS) for working memory. These tests are based on validated paper-and-pencil tests: the Symbol Digit Modalities Test, the 10/36 Spatial Recall Test, and the auditory Backward Digit Span, respectively. To establish the validity of icognition, 101 people with MS and 82 healthy participants completed all tests. Of the 82 healthy participants, 20 (24%) repeated testing 2 to 3 weeks later. For each icognition test, validity was established by the correlation with its paper-and-pencil equivalent (concurrent validity), the correlation and intraclass correlation coefficient (ICC) between baseline and follow-up testing (test-retest reliability), the difference between people with MS and healthy participants, and the correlation with other clinical parameters such as the Expanded Disability Status Scale. Results: All icognition tests correlated well with their paper-and-pencil equivalents (Symbol Test: r=0.67; P<.001; Dot Test: r=0.31; P=.002; vBDS: r=0.69; P<.001), negatively correlated with the Expanded Disability Status Scale (Symbol Test: ρ=–0.34; P<.001; Dot Test: ρ=−0.32; P=.003; vBDS: ρ=−0.21; P=.04), and showed moderate test-retest reliability (Symbol Test: ICC=0.74; r=0.85; P<.001; Dot Test: ICC=0.71; r=0.74; P<.001; vBDS: ICC=0.72; r=0.83; P<.001). Test performance was comparable between people with MS and healthy participants for all cognitive tests, both in icognition (Symbol Test: U=4431; P=.42; Dot Test: U=3516; P=.32; vBDS: U=3708; P=.27) and the gold standard paper-and-pencil tests (Symbol Digit Modalities Test: U=4060.5, P=.82; 10/36 Spatial Recall Test: U=3934; P=.74; auditory Backward Digit Span: U=3824.5, P=.37). Conclusions: icognition is a valid tool to remotely screen cognitive performance in people with MS. It is planned to be included in a digital health platform that includes volumetric brain analysis and patient-reported outcome measures. Future research should establish the usability and psychometric properties of icognition in a remote setting. %M 39832354 %R 10.2196/53503 %U https://www.jmir.org/2025/1/e53503 %U https://doi.org/10.2196/53503 %U http://www.ncbi.nlm.nih.gov/pubmed/39832354 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 17 %N %P e51602 %T E-Screening for Prenatal Depression in Kampala, Uganda Using the Edinburgh Postnatal Depression Scale: Survey Results %A Namatovu,Hasifah Kasujja %A Magumba,Mark Abraham %A Akena,Dickens %K perinatal %K prenatal %K antenatal %K antepartum %K depression %K Edinburgh Postnatal Depression Scale %D 2025 %7 14.1.2025 %9 %J Online J Public Health Inform %G English %X Background: Perinatal depression remains a substantial public health challenge, often overlooked or incorrectly diagnosed in numerous low-income nations. Objective: The goal of this study was to establish statistical baselines for the prevalence of perinatal depression in Kampala and understand its relationship with key demographic variables. Methods: We employed an Android-based implementation of the Edinburgh Postnatal Depression Scale (EPDS) to survey 12,913 women recruited from 7 government health facilities located in Kampala, Uganda. We used the standard EPDS cutoff, which classifies women with total scores above 13 as possibly depressed and those below 13 as not depressed. The χ2 test of independence was used to determine the most influential categorical variables. We further analyzed the most influential categorical variable using odds ratios. For continuous variables such as age and the weeks of gestation, we performed a simple correlation analysis. Results: We found that 21.5% (2783/12,913, 95% CI 20.8%‐22.3%) were possibly depressed. Respondents’ relationship category was found to be the most influential variable (χ21=806.9, P<.001; Cramer’s V=0.25), indicating a small effect size. Among quantitative variables, we found a weak negative correlation between respondents’ age and the total EPDS score (r=−0.11, P<.001). Similarly, a weak negative correlation was also observed between the total EPDS score and the number of previous children of the respondent (r=−0.07, P<.001). Moreover, a weak positive correlation was noted between weeks of gestation and the total EPDS score (r=0.02, P=.05) Conclusions: This study shows that demographic factors such as spousal employment category, age, and relationship status have an influence on the respondents’ EPDS scores. These variables may serve as proxies for latent factors such as financial stability and emotional support. %R 10.2196/51602 %U https://ojphi.jmir.org/2025/1/e51602 %U https://doi.org/10.2196/51602 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e62772 %T Verification of the Reliability of an Automated Urine Test Strip Colorimetric Program Using Colorimetric Analysis: Survey Study %A Inagaki,Keigo %A Tsuriya,Daisuke %A Hashimoto,Takuya %A Nakamura,Katsumasa %K urine test strip %K reliability %K automatic urine analyzer %K quasi-experimental study %K colorimetric analysis %K colorimetric %K urinalysis %K urinary %K urine %K evaluation %K mobile phone %D 2025 %7 14.1.2025 %9 %J JMIR Form Res %G English %X Background: One method for noninvasive and simple urinary microalbumin testing is urine test strips. However, when visually assessing urine test strips, accurate assessment may be difficult due to environmental influences—such as lighting color and intensity—and the physical and psychological influences of the assessor. These complicate the formation of an objective assessment. Objectives: This study developed an “automated urine test strip colorimetric program” (hereinafter referred to as “this program”) to objectively assess urine test strips. Using this program may allow urine tests to be conducted at home. In this study, urine samples from hospitalized or outpatient patients were randomly obtained, and the reliability of this program was verified by comparing the agreement rate between this program and an automatic urine analyzer (US-3500 [Eiken Chemical Co, Ltd] and LABOSPECT 006 [Hitachi High-Tech Co, Ltd]). Furthermore, the sensitivity and specificity of the urine albumin test were investigated, and its applicability to screening for microalbuminuria was verified. Methods: A urine test strip was placed in a photography box with constant light intensity and color temperature conditions. The image taken with a smartphone camera on top of the photography box was judged by this program. This program used Accelerated KAZE to perform image-matching processing to reduce the effect of misalignment during photography. It also calculated and judged the item with the smallest color difference between the color chart and the urine test strip using the CIEDE2000 color difference formula. The agreement rate of the results of this program was investigated using the results of an automatic urine analyzer as the gold standard. Results: Compared with the judgments of an automatic urine analyzer, the average agreement rate for 12 items (protein, glucose, urobilinogen, bilirubin, ketone bodies, specific gravity, occult blood, pH, white blood cells, nitrite, creatinine, and albumin) was 78.6%. Furthermore, the average agreement rate of the 12 items within ±1 rank was 95.4%. The results showed a sensitivity of 100% and a specificity of 58.6% in determining albumin in urine, which is important for determining the stage of diabetic nephropathy. Finally, the area under the curve (0.907) derived from the receiver operating characteristic curve was satisfactory. Conclusions: The program developed by the authors can determine urine test strips without requiring calibration in a certain shooting environment. If this program can be used at home to perform urinary microalbumin tests, the early detection and treatment of diabetic nephropathy may prevent the condition from becoming severe. %R 10.2196/62772 %U https://formative.jmir.org/2025/1/e62772 %U https://doi.org/10.2196/62772 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60520 %T Usefulness of Automatic Speech Recognition Assessment of Children With Speech Sound Disorders: Validation Study %A Kim,Do Hyung %A Jeong,Joo Won %A Kang,Dayoung %A Ahn,Taekyung %A Hong,Yeonjung %A Im,Younggon %A Kim,Jaewon %A Kim,Min Jung %A Jang,Dae-Hyun %+ Department of Rehabilitation Medicine, Incheon St Mary’s Hospital, College of Medicine, The Catholic University of Korea, 22 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea, 82 0322806601, dhjangmd@naver.com %K speech sound disorder %K speech recognition software %K speech articulation tests %K speech-language pathology %K child %D 2025 %7 14.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Speech sound disorders (SSDs) are common communication challenges in children, typically assessed by speech-language pathologists (SLPs) using standardized tools. However, traditional evaluation methods are time-intensive and prone to variability, raising concerns about reliability. Objective: This study aimed to compare the evaluation outcomes of SLPs and an automatic speech recognition (ASR) model using two standardized SSD assessments in South Korea, evaluating the ASR model’s performance. Methods: A fine-tuned wav2vec 2.0 XLS-R model, pretrained on 436,000 hours of adult voice data spanning 128 languages, was used. The model was further trained on 93.6 minutes of children’s voices with articulation errors to improve error detection. Participants included children referred to the Department of Rehabilitation Medicine at a general hospital in Incheon, South Korea, from August 19, 2022, to June 14, 2023. Two standardized assessments—the Assessment of Phonology and Articulation for Children (APAC) and the Urimal Test of Articulation and Phonology (U-TAP)—were used, with ASR transcriptions compared to SLP transcriptions. Results: This study included 30 children aged 3-7 years who were suspected of having SSDs. The phoneme error rates for the APAC and U-TAP were 8.42% (457/5430) and 8.91% (402/4514), respectively, indicating discrepancies between the ASR model and SLP transcriptions across all phonemes. Consonant error rates were 10.58% (327/3090) and 11.86% (331/2790) for the APAC and U-TAP, respectively. On average, there were 2.60 (SD 1.54) and 3.07 (SD 1.39) discrepancies per child for correctly produced phonemes, and 7.87 (SD 3.66) and 7.57 (SD 4.85) discrepancies per child for incorrectly produced phonemes, based on the APAC and U-TAP, respectively. The correlation between SLPs and the ASR model in terms of the percentage of consonants correct was excellent, with an intraclass correlation coefficient of 0.984 (95% CI 0.953-0.994) and 0.978 (95% CI 0.941-0.990) for the APAC and UTAP, respectively. The z scores between SLPs and ASR showed more pronounced differences with the APAC than the U-TAP, with 8 individuals showing discrepancies in the APAC compared to 2 in the U-TAP. Conclusions: The results demonstrate the potential of the ASR model in assessing children with SSDs. However, its performance varied based on phoneme or word characteristics, highlighting areas for refinement. Future research should include more diverse speech samples, clinical settings, and speech data to strengthen the model’s refinement and ensure broader clinical applicability. %M 39576242 %R 10.2196/60520 %U https://www.jmir.org/2025/1/e60520 %U https://doi.org/10.2196/60520 %U http://www.ncbi.nlm.nih.gov/pubmed/39576242 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e55043 %T A Proposed mHealth Intervention to Address Patient Barriers to Colposcopy Attendance: Qualitative Interview Study of Clinic Staff and Patient Perspectives %A Hemler,Jennifer R %A Wagner,Rachel B %A Sullivan,Brittany %A Macenat,Myneka %A Tagai,Erin K %A Vega,Jazmarie L %A Hernandez,Enrique %A Miller,Suzanne M %A Wen,Kuang-Yi %A Ayers,Charletta A %A Einstein,Mark H %A Hudson,Shawna V %A Kohler,Racquel E %+ Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 303 George St., Suite 301, Rm 305, New Brunswick, NJ, 08901, United States, 1 848 932 0209, hemlerje@rwjms.rutgers.edu %K cervical cancer screening %K colposcopy %K HPV %K human papillomavirus %K mHealth %K health communication %K qualitative research %K cancer screening %K cancer %K cervical cancer %K screening %K women %K clinic staff %K barrier %K messaging %K privacy %K text message %K qualitative %K colposcopic %K mhealth intervention %K mobile phone %D 2025 %7 14.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Cervical cancer disparities persist among minoritized women due to infrequent screening and poor follow-up. Structural and psychosocial barriers to following up with colposcopy are problematic for minoritized women. Evidence-based interventions using patient navigation and tailored telephone counseling, including the Tailored Communication for Cervical Cancer Risk (TC3), have modestly improved colposcopy attendance. However, the efficacious TC3 intervention is human resource-intense and could have greater reach if adapted for mobile health, which increases convenience and access to health information. Objective: This study aimed to describe feedback from clinic staff members involved in colposcopy processes and patients referred for colposcopy regarding adaptions to the TC3 phone-based intervention to text messaging, which addresses barriers among those referred for colposcopy after abnormal screening results. Methods: Semistructured depth qualitative interviews were conducted over Zoom [Zoom Communications, Inc] or telephone with a purposive sample of 22 clinic staff members (including clinicians and support staff members) and 34 patients referred for colposcopy from 3 academic obstetrics and gynecology (OB-GYN) clinics that serve predominantly low-income, minoritized patients in different urban locations in New Jersey and Pennsylvania. Participants were asked about colposcopy attendance barriers and perspectives on a proposed text message intervention to provide tailored education and support in the time between abnormal cervical screening and colposcopy. The analytic team discussed interviews, wrote summaries, and consensus-coded transcripts, analyzing output for emergent findings and crystallizing themes. Results: Clinic staff members and patients had mixed feelings about a text-only intervention. They overwhelmingly perceived a need to provide patients with appointment reminders and information about abnormal cervical screening results and colposcopy purpose and procedure. Both groups also thought messages emphasizing that human papillomavirus is common and cervical cancer can be prevented with follow-up could enhance attendance. However, some had concerns about the privacy of text messages and text fatigue. Both groups thought that talking to clinic staff members was needed in certain instances; they proposed connecting patients experiencing complex psychosocial or structural barriers to staff members for additional information, psychological support, and help with scheduling around work and finding childcare and transportation solutions. They also identified inadequate scheduling and reminder systems as barriers. From this feedback, we revised our text message content and intervention design, adding a health coaching component to support patients with complex barriers and concerns. Conclusions: Clinic staff members and patient perspectives are critical for designing appropriate and relevant interventions. These groups conveyed that text message-only interventions may be useful for patients with lesser barriers who may benefit from reminders, basic educational information, and scheduling support. However, multimodal interventions may be necessary for patients with complex barriers to colposcopy attendance, which we intend to evaluate in a subsequent trial. %M 39808485 %R 10.2196/55043 %U https://formative.jmir.org/2025/1/e55043 %U https://doi.org/10.2196/55043 %U http://www.ncbi.nlm.nih.gov/pubmed/39808485 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e53460 %T Development and Beta Validation of an mHealth-Based Hearing Screener (SRESHT) for Young Children in Resource-Limited Countries: Pilot Validation Study %A Ramkumar,Vidya %A Joshi B,Deepashree %A Prabhakar,Anil %A Hall,James W %A Vaidyanath,Ramya %+ Faculty of Audiology and Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research, Sri Ramachandra Nagar, Porur, Chennai, 600116, India, 91 9894170609, deepasrijoshi25@sriramachandra.edu.in %K audiometry %K mHealth %K devices %K wireless %K tablet-based screening %K childhood hearing loss %K early hearing detection and intervention %K tablets %K children %K neonates %K hearing loss %K infants %K development %K validation %K mobile phones %D 2025 %7 13.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of hearing loss in infants in India varies between 4 and 5 per 1000. Objective-based otoacoustic emissions and auditory brainstem response have been used in high-income countries for establishing early hearing screening and intervention programs. Nevertheless, the use of objective screening tests in low- and middle-income countries (LMICs) such as India is not feasible. Mobile health (mHealth) solutions have been demonstrated to be a viable option for hearing screening in LMICs. Objective: This study aims to develop and beta-validate an affordable hearing screener for children younger than 6 years of age to identify moderately severe or higher degrees of hearing loss. Methods: In phase 1, a mHealth-based hearing screener (SRESHT) was developed using a single board computer with wireless commercial headphones and speakers as transducers, which were calibrated according to the standard procedure. Three subjective hearing screening modules were conceptualized and developed for different age groups: (1) behavioral observation audiometry–screening for infants aged from 0 to 1 year; (2) speech spectrum awareness task–screening for children 1 to 3 years old; and (3) speech recognition task–screening for children 3 to 6 years old. Different auditory stimuli for the screening modules were generated and suitability was assessed: (1) noisemakers, animal sounds, and environmental sounds for infants (birth to 1 year old); (2) animal sounds and nonsense syllables for children (1 to 3 years old); and (3) eighteen picturable spondee words for children (3 to 6 years old). In phase 2, the SRESHT screener was beta-validated in children aged below 6 years to establish the agreement between SRESHT modules and the gold-standard procedure in identifying moderately severe and higher degrees of hearing loss. Results: Off-the-shelf commercial speakers and headphones were selected and calibrated. On comparison of stimuli for behavioral observation audiometry on 15 children, Noisemaker stimuli were found suitable based on the average minimum response levels. On comparison of different stimuli for speech spectrum awareness task on 15 children, animal sounds were found to be suitable. On familiarity check of 18 spondee words for speech recognition task among 20 children, 12 spondee words had the eligibility cutoff (85%) and a presentation level of 5 dB SL (re-pure tone threshold) was sufficient to achieve 80% psychometric function. In phase 2, a total of 55 children aged 0 to 6 years (31 normal hearing and 24 hearing impairment) underwent SRESHT screening for beta validation. Cohen κ indicated that the overall SRESHT screener had a very good agreement (κ=0.82) with gold-standard audiometric screening for identifying moderately severe and higher degrees of hearing loss. Conclusions: The development and beta validation of the SRESHT screener using the selected auditory stimuli showed that the stimuli were suitable for screening children. %M 39805111 %R 10.2196/53460 %U https://formative.jmir.org/2025/1/e53460 %U https://doi.org/10.2196/53460 %U http://www.ncbi.nlm.nih.gov/pubmed/39805111 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58421 %T Predicting Age and Visual-Motor Integration Using Origami Photographs: Deep Learning Study %A Huang,Chien-Yu %A Yu,Yen-Ting %A Chen,Kuan-Lin %A Lien,Jenn-Jier %A Lin,Gong-Hong %A Hsieh,Ching-Lin %K artificial intelligence %K origami %K child development screening %K child development %K visual motor integration %K children %K developmental status %K activity performance %K deep learning %D 2025 %7 10.1.2025 %9 %J JMIR Form Res %G English %X Background: Origami is a popular activity among preschool children and can be used by therapists as an evaluation tool to assess children’s development in clinical settings. It is easy to implement, appealing to children, and time-efficient, requiring only simple materials—pieces of paper. Furthermore, the products of origami may reflect children’s ages and their visual-motor integration (VMI) development. However, therapists typically evaluate children’s origami creations based primarily on their personal background knowledge and clinical experience, leading to subjective and descriptive feedback. Consequently, the effectiveness of using origami products to determine children’s age and VMI development lacks empirical support. Objective: This study had two main aims. First, we sought to apply artificial intelligence (AI) techniques to origami products to predict children’s ages and VMI development, including VMI level (standardized scores) and VMI developmental status (typical, borderline, or delayed). Second, we explored the performance of the AI models using all combinations of photographs taken from different angles. Methods: A total of 515 children aged 2-6 years were recruited and divided into training and testing groups at a 4:1 ratio. Children created origami dogs, which were photographed from 8 different angles. The Beery–Buktenica Developmental Test of Visual-Motor Integration, 6th Edition, was used to assess the children’s VMI levels and developmental status. Three AI models—ResNet-50, XGBoost, and a multilayer perceptron—were combined sequentially to predict age z scores and VMI z scores using the training group. The trained models were then tested using the testing group, and the accuracy of the predicted VMI developmental status was also calculated. Results: The R2 of the age and the VMI trained models ranged from 0.50 to 0.73 and from 0.50 to 0.66, respectively. The AI models that obtained an R2>0.70 for the age model and an R2>0.60 for the VMI model were selected for model testing. Those models were further examined for the accuracy of the VMI developmental status, the correlations, and the mean absolute error (MAE) of both the age and the VMI models. The accuracy of the VMI developmental status was about 71%-76%. The correlations between the final predicted age z score and the real age z score ranged from 0.84 to 0.85, and the correlations of the final predicted VMI z scores to the real z scores ranged from 0.77 to 0.81. The MAE of the age models ranged from 0.42 to 0.46 and those of the VMI models ranged from 0.43 to 0.48. Conclusion: Our findings indicate that AI techniques have a significant potential for predicting children’s development. The insights provided by AI may assist therapists in better interpreting children’s performance in activities. %R 10.2196/58421 %U https://formative.jmir.org/2025/1/e58421 %U https://doi.org/10.2196/58421 %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 %@ 2368-7959 %I JMIR Publications %V 11 %N %P e64578 %T Momentary Depression Severity Prediction in Patients With Acute Depression Who Undergo Sleep Deprivation Therapy: Speech-Based Machine Learning Approach %A Hartnagel,Lisa-Marie %A Emden,Daniel %A Foo,Jerome C %A Streit,Fabian %A Witt,Stephanie H %A Frank,Josef %A Limberger,Matthias F %A Schmitz,Sara E %A Gilles,Maria %A Rietschel,Marcella %A Hahn,Tim %A Ebner-Priemer,Ulrich W %A Sirignano,Lea %K ambulatory assessment %K depression %K speech features %K openSMILE %K machine learning %K sleep deprivation therapy %K remote monitoring %K depressive disorder %K mobile phone %K digital health %K mobile health %K mHealth %K mental health %D 2024 %7 23.12.2024 %9 %J JMIR Ment Health %G English %X Background: Mobile devices for remote monitoring are inevitable tools to support treatment and patient care, especially in recurrent diseases such as major depressive disorder. The aim of this study was to learn if machine learning (ML) models based on longitudinal speech data are helpful in predicting momentary depression severity. Data analyses were based on a dataset including 30 inpatients during an acute depressive episode receiving sleep deprivation therapy in stationary care, an intervention inducing a rapid change in depressive symptoms in a relatively short period of time. Using an ambulatory assessment approach, we captured speech samples and assessed concomitant depression severity via self-report questionnaire over the course of 3 weeks (before, during, and after therapy). We extracted 89 speech features from the speech samples using the Extended Geneva Minimalistic Acoustic Parameter Set from the Open-Source Speech and Music Interpretation by Large-Space Extraction (audEERING) toolkit and the additional parameter speech rate. Objective: We aimed to understand if a multiparameter ML approach would significantly improve the prediction compared to previous statistical analyses, and, in addition, which mechanism for splitting training and test data was most successful, especially focusing on the idea of personalized prediction. Methods: To do so, we trained and evaluated a set of >500 ML pipelines including random forest, linear regression, support vector regression, and Extreme Gradient Boosting regression models and tested them on 5 different train-test split scenarios: a group 5-fold nested cross-validation at the subject level, a leave-one-subject-out approach, a chronological split, an odd-even split, and a random split. Results: In the 5-fold cross-validation, the leave-one-subject-out, and the chronological split approaches, none of the models were statistically different from random chance. The other two approaches produced significant results for at least one of the models tested, with similar performance. In total, the superior model was an Extreme Gradient Boosting in the odd-even split approach (R²=0.339, mean absolute error=0.38; both P<.001), indicating that 33.9% of the variance in depression severity could be predicted by the speech features. Conclusions: Overall, our analyses highlight that ML fails to predict depression scores of unseen patients, but prediction performance increased strongly compared to our previous analyses with multilevel models. We conclude that future personalized ML models might improve prediction performance even more, leading to better patient management and care. %R 10.2196/64578 %U https://mental.jmir.org/2024/1/e64578 %U https://doi.org/10.2196/64578 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63680 %T Exploring Individuals’ Views and Feedback on a Nutritional Screening Mobile App: Qualitative Focus Group Study %A Jones,Debra %A Sowerbutts,Anne Marie %A Burden,Sorrel %+ School of Health Sciences, University of Manchester, Jean McFarlane Building, 5th Floor, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 1613061508, debra.jones@manchester.ac.uk %K malnutrition %K malnutrition risk %K malnutrition screening %K MUST %K mobile application %K mHealth app %K malnutrition universal screening tool %D 2024 %7 18.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Malnutrition is a major global health challenge. Worldwide, approximately 390 million adults are underweight, while 2.5 billion are overweight. The Malnutrition Universal Screening Tool (MUST) has been implemented successfully in the United Kingdom to assess the nutritional status of patients in health care settings. Currently, MUST is available as a web-based tool or as a paper-based version, However, the paper tool can lead to calculation errors, and web-based tools require internet access, limiting use in some communities. The MUST app uses clear and simple navigation and processes information precisely, so could potentially improve the accuracy and accessibility of malnutrition screening for health care professionals (HCP) in all settings. Objective: This study aimed to explore the views of HCPs on the content, functionality, and usability of a newly developed mobile app for MUST. Methods: We performed a qualitative study using deductive and inductive framework analysis. A series of online focus groups (~1 hour each) were conducted, exploring potential users’ views on the app’s content design, functionality, and usefulness, which was set in demonstration mode and not available for direct use with patients. Each focus group used a semistructured approach and predefined topic guide. Participants were recruited consecutively and United Kingdom–wide using advertisements through emails, newsletters, and on social media across appropriate local and national networks. Participants had the opportunity to look at the app on their phones before giving feedback and an on-screen demonstration of the app was provided during the focus group. Data were analyzed using deductive and inductive framework analysis. Results: In total, 8 online focus groups were conducted between August 2022 and January 2023. Participants (n=32) were dietetic and nutrition HCPs or educators with experience in using MUST in clinical or community settings. Data analysis revealed three broad themes: (1) improving the app for better use in practice, (2) user experience of design, and (3) barriers and facilitators in different settings. Overall feedback for the app was positive with potential users considering it to be very useful for improving routine and accurate screening, particularly in the community, and mainly because of the automatic calculation feature, which may help with improving discrepancies. Participants generally considered the app to be for professional use only, stating that patients may find it too clinical or technical. Participants also made suggestions for app sustainability and improvements, such as incentives to complete the demographics section or the option to skip questions, and the addition of more subjective measures and instructions on measuring ulna length. Conclusions: The MUST app was positively evaluated by potential users, who reported it was user-friendly and an accessible way to screen for malnutrition risk, whilst improving the accuracy of screening and availability in community settings. %M 39693128 %R 10.2196/63680 %U https://formative.jmir.org/2024/1/e63680 %U https://doi.org/10.2196/63680 %U http://www.ncbi.nlm.nih.gov/pubmed/39693128 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60879 %T A Digital Approach for Addressing Suicidal Ideation and Behaviors in Youth Mental Health Services: Observational Study %A Chong,Min K %A Hickie,Ian B %A Ottavio,Antonia %A Rogers,David %A Dimitropoulos,Gina %A LaMonica,Haley M %A Borgnolo,Luke J %A McKenna,Sarah %A Scott,Elizabeth M %A Iorfino,Frank %+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, 2050, Australia, 61 (02) 9114 2199, min.chong@sydney.edu.au %K mental health service %K youth mental health %K suicide management %K clinical decision support %K primary care %K personalization %K suicide %K suicidal %K youth %K mental health %K mental health care %K suicide prevention %K digital technology %K online assessment %K clinician %K digital health %K health informatics %K clinical information %D 2024 %7 18.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Long wait times for mental health treatments may cause delays in early detection and management of suicidal ideation and behaviors, which are crucial for effective mental health care and suicide prevention. The use of digital technology is a potential solution for prompt identification of youth with high suicidality. Objective: The primary aim of this study was to evaluate the use of a digital suicidality notification system designed to detect and respond to suicidal needs in youth mental health services. Second, the study aimed to characterize young people at different levels of suicidal ideation and behaviors. Methods: Young people aged between 16 and 25 years completed multidimensional assessments using a digital platform, collecting demographic, clinical, social, functional, and suicidality information. When the suicidality score exceeded a predetermined threshold, established based on clinical expertise and service policies, a rule-based algorithm configured within the platform immediately generated an alert for treating clinicians. Subsequent clinical actions and response times were analyzed. Results: A total of 2021 individuals participated, of whom 266 (11%) triggered one or more high suicidal ideation and behaviors notification. Of the 292 notifications generated, 76% (222/292) were resolved, with a median response time of 1.9 (range 0-50.8) days. Clinical actions initiated to address suicidality included creating safety plans (60%, 134/222), conducting safety checks (18%, 39/222), psychological therapy (8%, 17/222), transfer to another service (3%, 8/222), and scheduling of new appointments (2%, 4/222). Young people with high levels of suicidality were more likely to present with more severe and comorbid symptoms, including low engagement in work or education, heterogenous psychopathology, substance misuse, and recurrent illness. Conclusions: The digital suicidality notification system facilitated prompt clinical actions by alerting clinicians to high levels of suicidal ideation and behaviors detected among youth. Further, the multidimensional assessment revealed complex and comorbid symptoms exhibited in youth with high suicidality. By expediting and personalizing care for those displaying elevated suicidality, the digital notification system can play a pivotal role in preventing rapid symptom progression and its detrimental impacts on young people’s mental health. %M 39693140 %R 10.2196/60879 %U https://www.jmir.org/2024/1/e60879 %U https://doi.org/10.2196/60879 %U http://www.ncbi.nlm.nih.gov/pubmed/39693140 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e65469 %T Exploring Self-Reported Symptoms for Developing and Evaluating Digital Symptom Checkers for Polycystic Ovarian Syndrome, Endometriosis, and Uterine Fibroids: Exploratory Survey Study %A Wickham,Aidan P %A Hewings-Martin,Yella %A Goddard,Frederick GB %A Rodgers,Allison K %A Cunningham,Adam C %A Prentice,Carley %A Wilks,Octavia %A Kaplan,Yusuf C %A Marhol,Andrei %A Meczner,András %A Stsefanovich,Heorhi %A Klepchukova,Anna %A Zhaunova,Liudmila %+ Flo Health UK Limited, 27 Old Gloucester Street, London, WC1N 3AX, United Kingdom, 44 44 60396823, a_wickham@flo.health %K polycystic ovary syndrome %K PCOS %K self-assessment %K self-reported %K endometriosis %K uterine fibroids %K symptoms %K digital symptom checker %K women's health %K gynecological conditions %K reproductive health %D 2024 %7 12.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Reproductive health conditions such as polycystic ovary syndrome (PCOS), endometriosis, and uterine fibroids pose a significant burden to people who menstruate, health care systems, and economies. Despite clinical guidelines for each condition, prolonged delays in diagnosis are commonplace, resulting in an increase to health care costs and risk of health complications. Symptom checker apps have the potential to significantly reduce time to diagnosis by providing users with health information and tools to better understand their symptoms. Objective: This study aims to study the prevalence and predictive importance of self-reported symptoms of PCOS, endometriosis, and uterine fibroids, and to explore the efficacy of 3 symptom checkers (developed by Flo Health UK Limited) that use self-reported symptoms when screening for each condition. Methods: Flo’s symptom checkers were transcribed into separate web-based surveys for PCOS, endometriosis, and uterine fibroids, asking respondents their diagnostic history for each condition. Participants were aged 18 years or older, female, and living in the United States. Participants either had a confirmed diagnosis (condition-positive) and reported symptoms retrospectively as experienced at the time of diagnosis, or they had not been examined for the condition (condition-negative) and reported their current symptoms as experienced at the time of surveying. Symptom prevalence was calculated for each condition based on the surveys. Least absolute shrinkage and selection operator regression was used to identify key symptoms for predicting each condition. Participants’ symptoms were processed by Flo’s 3 single-condition symptom checkers, and accuracy was assessed by comparing the symptom checker output with the participant’s condition designation. Results: A total of 1317 participants were included with 418, 476, and 423 in the PCOS, endometriosis, and uterine fibroids groups, respectively. The most prevalent symptoms for PCOS were fatigue (92%), feeling anxious (87%), BMI over 25 (84%); for endometriosis: very regular lower abdominal pain (89%), fatigue (85%), and referred lower back pain (80%); for uterine fibroids: fatigue (76%), bloating (69%), and changing sanitary protection often (68%). Symptoms of anovulation and amenorrhea (long periods, irregular cycles, and absent periods), and hyperandrogenism (excess hair on chin and abdomen, scalp hair loss, and BMI over 25) were identified as the most predictive symptoms for PCOS, while symptoms related to abdominal pain and the effect pain has on life, bleeding, and fertility complications were among the most predictive symptoms for both endometriosis and uterine fibroids. Symptom checker accuracy was 78%, 73%, and 75% for PCOS, endometriosis, and uterine fibroids, respectively. Conclusions: This exploratory study characterizes self-reported symptomatology and identifies the key predictive symptoms for 3 reproductive conditions. The Flo symptom checkers were evaluated using real, self-reported symptoms and demonstrated high levels of accuracy. %M 39666967 %R 10.2196/65469 %U https://formative.jmir.org/2024/1/e65469 %U https://doi.org/10.2196/65469 %U http://www.ncbi.nlm.nih.gov/pubmed/39666967 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55856 %T Screening for Depression and Anxiety Using a Nonverbal Working Memory Task in a Sample of Older Brazilians: Observational Study of Preliminary Artificial Intelligence Model Transferability %A Georgescu,Alexandra Livia %A Cummins,Nicholas %A Molimpakis,Emilia %A Giacomazzi,Eduardo %A Rodrigues Marczyk,Joana %A Goria,Stefano %K depression %K anxiety %K Brazil %K machine learning %K n-back %K working memory %K artificial intelligence %K gerontology %K older adults %K mental health %K AI %K transferability %K detection %K screening %K questionnaire %K longitudinal study %D 2024 %7 12.12.2024 %9 %J JMIR Form Res %G English %X Background: Anxiety and depression represent prevalent yet frequently undetected mental health concerns within the older population. The challenge of identifying these conditions presents an opportunity for artificial intelligence (AI)–driven, remotely available, tools capable of screening and monitoring mental health. A critical criterion for such tools is their cultural adaptability to ensure effectiveness across diverse populations. Objective: This study aims to illustrate the preliminary transferability of two established AI models designed to detect high depression and anxiety symptom scores. The models were initially trained on data from a nonverbal working memory game (1- and 2-back tasks) in a dataset by thymia, a company that develops AI solutions for mental health and well-being assessments, encompassing over 6000 participants from the United Kingdom, United States, Mexico, Spain, and Indonesia. We seek to validate the models’ performance by applying it to a new dataset comprising older Brazilian adults, thereby exploring its transferability and generalizability across different demographics and cultures. Methods: A total of 69 Brazilian participants aged 51-92 years old were recruited with the help of Laços Saúde, a company specializing in nurse-led, holistic home care. Participants received a link to the thymia dashboard every Monday and Thursday for 6 months. The dashboard had a set of activities assigned to them that would take 10-15 minutes to complete, which included a 5-minute game with two levels of the n-back tasks. Two Random Forest models trained on thymia data to classify depression and anxiety based on thresholds defined by scores of the Patient Health Questionnaire (8 items) (PHQ-8) ≥10 and those of the Generalized Anxiety Disorder Assessment (7 items) (GAD-7) ≥10, respectively, were subsequently tested on the Laços Saúde patient cohort. Results: The depression classification model exhibited robust performance, achieving an area under the receiver operating characteristic curve (AUC) of 0.78, a specificity of 0.69, and a sensitivity of 0.72. The anxiety classification model showed an initial AUC of 0.63, with a specificity of 0.58 and a sensitivity of 0.64. This performance surpassed a benchmark model using only age and gender, which had AUCs of 0.47 for PHQ-8 and 0.53 for GAD-7. After recomputing the AUC scores on a cross-sectional subset of the data (the first n-back game session), we found AUCs of 0.79 for PHQ-8 and 0.76 for GAD-7. Conclusions: This study successfully demonstrates the preliminary transferability of two AI models trained on a nonverbal working memory task, one for depression and the other for anxiety classification, to a novel sample of older Brazilian adults. Future research could seek to replicate these findings in larger samples and other cultural contexts. Trial Registration: ISRCTN Registry ISRCTN90727704; https://www.isrctn.com/ISRCTN90727704 %R 10.2196/55856 %U https://formative.jmir.org/2024/1/e55856 %U https://doi.org/10.2196/55856 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58444 %T Reliable Web-Based Auditory Cognitive Testing: Observational Study %A Lad,Meher %A Taylor,John-Paul %A Griffiths,Timothy David %+ Translational and Clinical Research Institute, Newcastle University, Auditory Laboratory, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom, 44 0191 208 6000, meher.lad@newcastle.ac.uk %K auditory testing %K hearing loss %K cognitive testing %K auditory %K observational study %K older adult %K hearing %K questionnaire %K auditory cognitive testing %K in person %K web-based setting %K auditory memory %K Pearson %K female %K women %K audiology %D 2024 %7 9.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based experimentation, accelerated by the COVID-19 pandemic, has enabled large-scale participant recruitment and data collection. Auditory testing on the web has shown promise but faces challenges such as uncontrolled environments and verifying headphone use. Prior studies have successfully replicated auditory experiments but often involved younger participants, limiting the generalizability to older adults with varying hearing abilities. This study explores the feasibility of conducting reliable auditory cognitive testing using a web-based platform, especially among older adults. Objective: This study aims to determine whether demographic factors such as age and hearing status influence participation in web-based auditory cognitive experiments and to assess the reproducibility of auditory cognitive measures—specifically speech-in-noise perception and auditory memory (AuM)—between in-person and web-based settings. Additionally, this study aims to examine the relationship between musical sophistication, measured by the Goldsmiths Musical Sophistication Index (GMSI), and auditory cognitive measures across different testing environments. Methods: A total of 153 participants aged 50 to 86 years were recruited from local registries and memory clinics; 58 of these returned for web-based, follow-up assessments. An additional 89 participants from the PREVENT cohort were included in the web-based study, forming a combined sample. Participants completed speech-in-noise perception tasks (Digits-in-Noise and Speech-in-Babble), AuM tests for frequency and amplitude modulation rate, and the GMSI questionnaire. In-person testing was conducted in a soundproof room with standardized equipment, while web-based tests required participants to use headphones in a quiet room via a web-based app. The reproducibility of auditory measures was evaluated using Pearson and intraclass correlation coefficients, and statistical analyses assessed relationships between variables across settings. Results: Older participants and those with severe hearing loss were underrepresented in the web-based follow-up. The GMSI questionnaire demonstrated the highest reproducibility (r=0.82), while auditory cognitive tasks showed moderate reproducibility (Digits-in-Noise and Speech-in-Babble r=0.55 AuM tests for frequency r=0.75 and amplitude modulation rate r=0.44). There were no significant differences in the correlation between age and auditory measures across in-person and web-based settings (all P>.05). The study replicated previously reported associations between AuM and GMSI scores, as well as sentence-in-noise perception, indicating consistency across testing environments. Conclusions: Web-based auditory cognitive testing is feasible and yields results comparable to in-person testing, especially for questionnaire-based measures like the GMSI. While auditory tasks demonstrated moderate reproducibility, the consistent replication of key associations suggests that web-based testing is a viable alternative for auditory cognition research. However, the underrepresentation of older adults and those with severe hearing loss highlights a need to address barriers to web-based participation. Future work should explore methods to enhance inclusivity, such as remote guided testing, and address factors like digital literacy and equipment standards to improve the representativeness and quality of web-based auditory research. %M 39652871 %R 10.2196/58444 %U https://www.jmir.org/2024/1/e58444 %U https://doi.org/10.2196/58444 %U http://www.ncbi.nlm.nih.gov/pubmed/39652871 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54127 %T Challenges and Opportunities in Digital Screening for Hypertension and Diabetes Among Community Groups of Older Adults in Vietnam: Mixed Methods Study %A Nong,Trang Thi Thu %A Nguyen,Giang Hoang %A Lepe,Alexander %A Tran,Thuy Bich %A Nguyen,Lan Thi Phuong %A Koot,Jaap A R %+ HelpAge International in Vietnam, A201, No 2, Alley 59, Lang Ha street, Thanh Cong ward, Ba Dinh district, Hanoi, 100000, Vietnam, 84 0947375689, trangnt@helpagevn.org %K NCD screening %K DHIS2 tracker %K District Health Information Software, version 2 tracker %K digital application %K ISHC health volunteers %K non-communicable diseases %K prevention %K Vietnam %K mobile phone %D 2024 %7 2.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The project of scaling up noncommunicable disease (NCD) interventions in Southeast Asia aimed to strengthen the prevention and control of hypertension and diabetes, focusing on primary health care and community levels. In Vietnam, health volunteers who were members of the Intergenerational Self-Help Clubs (ISHCs) implemented community-based NCD screening and health promotion activities in communities. The ISHC health volunteers used an app based on District Health Information Software, version 2 (DHIS2) tracker (Society for Health Information Systems Programmes, India) to record details of participants during screening and other health activities. Objective: This study aimed to assess the strengths, barriers, and limitations of the NCD screening app used by the ISHC health volunteers on tablets and to provide recommendations for further scaling up. Methods: A mixed methods observational study with a convergent parallel design was performed. For the quantitative data analysis, 2 rounds of screening data collected from all 59 ISHCs were analyzed on completeness and quality. For the qualitative analysis, 2 rounds of evaluation of the screening app were completed. Focus group discussions with ISHC health volunteers and club management boards and in-depth interviews with members of the Association of the Elderly and Commune Health Station staff were performed. Results: In the quantitative analysis, data completeness of all 6704 screenings (n=3485 individuals) was very high. For anthropomorphic measurements, such as blood pressure, body weight, and abdominal circumference, less than 1% errors were found. The data on NCD risk factors were not adequately recorded in 1908 (29.5%) of the screenings. From the qualitative analysis, the NCD screening app was appreciated by ISHC health volunteers and supervisors, as an easier and more efficient way to report to higher levels, secure data, and strengthen relationships with relevant stakeholders, using tablets to connect to the internet and internet-based platforms to access information for self-learning and sharing to promote a healthy lifestyle as the strengths. The barriers and limitations reported by the respondents were a non–age-friendly app, incomplete translation of parts of the app into Vietnamese, some issues with the tablet’s display, lack of sharing of responsibilities among the health volunteers, and suboptimal involvement of the health sector; limited digital literacy among ISHC health volunteers. Recommendations are continuous capacity building, improving app issues, improving tablet issues, and involving relevant stakeholders or younger members in technology adoption to support older people. Conclusions: The implementation of the NCD screening app by ISHC volunteers can be an effective way to improve community-led NCD screening and increase the uptake of NCD prevention and management services at the primary health care level. However, our study has shown that some barriers need to be addressed to maximize the efficient use of the app by ISHC health volunteers to record, report, and manage the screening data. %M 39622043 %R 10.2196/54127 %U https://www.jmir.org/2024/1/e54127 %U https://doi.org/10.2196/54127 %U http://www.ncbi.nlm.nih.gov/pubmed/39622043 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e58927 %T Auxiliary Diagnosis of Children With Attention-Deficit/Hyperactivity Disorder Using Eye-Tracking and Digital Biomarkers: Case-Control Study %A Liu,Zhongling %A Li,Jinkai %A Zhang,Yuanyuan %A Wu,Dan %A Huo,Yanyan %A Yang,Jianxin %A Zhang,Musen %A Dong,Chuanfei %A Jiang,Luhui %A Sun,Ruohan %A Zhou,Ruoyin %A Li,Fei %A Yu,Xiaodan %A Zhu,Daqian %A Guo,Yao %A Chen,Jinjin %+ Child Health Care Medical Division, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, 355 Luding Road, Putuo District, Shanghai, 200062, China, 86 52976152, chenjj@shchildren.com.cn %K attention deficit disorder with hyperactivity %K eye-tracking %K auxiliary diagnosis %K digital biomarker %K antisaccade %K machine learning %D 2024 %7 29.11.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in school-aged children. The lack of objective biomarkers for ADHD often results in missed diagnoses or misdiagnoses, which lead to inappropriate or delayed interventions. Eye-tracking technology provides an objective method to assess children’s neuropsychological behavior. Objective: The aim of this study was to develop an objective and reliable auxiliary diagnostic system for ADHD using eye-tracking technology. This system would be valuable for screening for ADHD in schools and communities and may help identify objective biomarkers for the clinical diagnosis of ADHD. Methods: We conducted a case-control study of children with ADHD and typically developing (TD) children. We designed an eye-tracking assessment paradigm based on the core cognitive deficits of ADHD and extracted various digital biomarkers that represented participant behaviors. These biomarkers and developmental patterns were compared between the ADHD and TD groups. Machine learning (ML) was implemented to validate the ability of the extracted eye-tracking biomarkers to predict ADHD. The performance of the ML models was evaluated using 5-fold cross-validation. Results: We recruited 216 participants, of whom 94 (43.5%) were children with ADHD and 122 (56.5%) were TD children. The ADHD group showed significantly poorer performance (for accuracy and completion time) than the TD group in the prosaccade, antisaccade, and delayed saccade tasks. In addition, there were substantial group differences in digital biomarkers, such as pupil diameter fluctuation, regularity of gaze trajectory, and fixations on unrelated areas. Although the accuracy and task completion speed of the ADHD group increased over time, their eye-movement patterns remained irregular. The TD group with children aged 5 to 6 years outperformed the ADHD group with children aged 9 to 10 years, and this difference remained relatively stable over time, which indicated that the ADHD group followed a unique developmental pattern. The ML model was effective in discriminating the groups, achieving an area under the curve of 0.965 and an accuracy of 0.908. Conclusions: The eye-tracking biomarkers proposed in this study effectively identified differences in various aspects of eye-movement patterns between the ADHD and TD groups. In addition, the ML model constructed using these digital biomarkers achieved high accuracy and reliability in identifying ADHD. Our system can facilitate early screening for ADHD in schools and communities and provide clinicians with objective biomarkers as a reference. %M 39477792 %R 10.2196/58927 %U https://mhealth.jmir.org/2024/1/e58927 %U https://doi.org/10.2196/58927 %U http://www.ncbi.nlm.nih.gov/pubmed/39477792 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48914 %T Preliminary Screening for Hereditary Breast and Ovarian Cancer Using an AI Chatbot as a Genetic Counselor: Clinical Study %A Sato,Ann %A Haneda,Eri %A Hiroshima,Yukihiko %A Narimatsu,Hiroto %+ Department of Genetic Medicine, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan, 81 045 520 2222, hiroto-narimatsu@umin.org %K hereditary cancer %K familial cancer %K IBM Watson %K family history %K medical history %K cancer %K feasibility %K social network %K screening %K breast cancer %K ovarian cancer %K artificial intelligence %K AI %K chatbot %K genetic %K counselling %K oncology %K conversational agent %K implementation %K usability %K acceptability %D 2024 %7 27.11.2024 %9 Research Letter %J J Med Internet Res %G English %X Background: Hereditary breast and ovarian cancer (HBOC) is a major type of hereditary cancer. Establishing effective screening to identify high-risk individuals for HBOC remains a challenge. We developed a prototype of a chatbot system that uses artificial intelligence (AI) for preliminary HBOC screening to determine whether individuals meet the National Comprehensive Cancer Network BRCA1/2 testing criteria. Objective: This study’s objective was to validate the feasibility of this chatbot in a clinical setting by using it on a patient population that visited a hospital. Methods: We validated the medical accuracy of the chatbot system by performing a test on patients who consecutively visited the Kanagawa Cancer Center. The participants completed a preoperation questionnaire to understand their background, including information technology literacy. After the operation, qualitative interviews were conducted to collect data on the usability and acceptability of the system and examine points needing improvement. Results: A total of 11 participants were enrolled between October and December 2020. All of the participants were women, and among them, 10 (91%) had cancer. According to the questionnaire, 6 (54%) participants had never heard of a chatbot, while 7 (64%) had never used one. All participants were able to complete the chatbot operation, and the average time required for the operation was 18.0 (SD 5.44) minutes. The determinations by the chatbot of whether the participants met the BRCA1/2 testing criteria based on their medical and family history were consistent with those by certified genetic counselors (CGCs). We compared the medical histories obtained from the participants by the CGCs with those by the chatbot. Of the 11 participants, 3 (27%) entered information different from that obtained by the CGCs. These discrepancies were caused by the participant’s omissions or communication errors with the chatbot. Regarding the family histories, the chatbot provided new information for 3 (27%) of the 11 participants and complemented information for the family members of 5 (45%) participants not interviewed by the CGCs. The chatbot could not obtain some information on the family history of 6 (54%) participants due to several reasons, such as being outside of the scope of the chatbot’s interview questions, the participant’s omissions, and communication errors with the chatbot. Interview data were classified into the following: (1) features, (2) appearance, (3) usability and preferences, (4) concerns, (5) benefits, and (6) implementation. Favorable comments on implementation feasibility and comments on improvements were also obtained. Conclusions: This study demonstrated that the preliminary screening system for HBOC using an AI chatbot was feasible for real patients. %M 39602801 %R 10.2196/48914 %U https://www.jmir.org/2024/1/e48914 %U https://doi.org/10.2196/48914 %U http://www.ncbi.nlm.nih.gov/pubmed/39602801 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51477 %T Performance of a Full-Coverage Cervical Cancer Screening Program Using on an Artificial Intelligence– and Cloud-Based Diagnostic System: Observational Study of an Ultralarge Population %A Ji,Lu %A Yao,Yifan %A Yu,Dandan %A Chen,Wen %A Yin,Shanshan %A Fu,Yun %A Tang,Shangfeng %A Yao,Lan %+ School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, China, 86 027 83692727, ylhuster@163.com %K full coverage %K cervical cancer screening %K artificial intelligence %K primary health institutions %K accessibility %K efficiency %D 2024 %7 20.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The World Health Organization has set a global strategy to eliminate cervical cancer, emphasizing the need for cervical cancer screening coverage to reach 70%. In response, China has developed an action plan to accelerate the elimination of cervical cancer, with Hubei province implementing China’s first provincial full-coverage screening program using an artificial intelligence (AI) and cloud-based diagnostic system. Objective: This study aimed to evaluate the performance of AI technology in this full-coverage screening program. The evaluation indicators included accessibility, screening efficiency, diagnostic quality, and program cost. Methods: Characteristics of 1,704,461 individuals screened from July 2022 to January 2023 were used to analyze accessibility and AI screening efficiency. A random sample of 220 individuals was used for external diagnostic quality control. The costs of different participating screening institutions were assessed. Results: Cervical cancer screening services were extended to all administrative districts, especially in rural areas. Rural women had the highest participation rate at 67.54% (1,147,839/1,699,591). Approximately 1.7 million individuals were screened, achieving a cumulative coverage of 13.45% in about 6 months. Full-coverage programs could be achieved by AI technology in approximately 1 year, which was 87.5 times more efficient than the manual reading of slides. The sample compliance rate was as high as 99.1%, and compliance rates for positive, negative, and pathology biopsy reviews exceeded 96%. The cost of this program was CN ¥49 (the average exchange rate in 2022 is as follows: US $1=CN ¥6.7261) per person, with the primary screening institution and the third-party testing institute receiving CN ¥19 and ¥27, respectively. Conclusions: AI-assisted diagnosis has proven to be accessible, efficient, reliable, and low cost, which could support the implementation of full-coverage screening programs, especially in areas with insufficient health resources. AI technology served as a crucial tool for rapidly and effectively increasing screening coverage, which would accelerate the achievement of the World Health Organization’s goals of eliminating cervical cancer. %M 39566061 %R 10.2196/51477 %U https://www.jmir.org/2024/1/e51477 %U https://doi.org/10.2196/51477 %U http://www.ncbi.nlm.nih.gov/pubmed/39566061 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58892 %T AI-Based Noninvasive Blood Glucose Monitoring: Scoping Review %A Chan,Pin Zhong %A Jin,Eric %A Jansson,Miia %A Chew,Han Shi Jocelyn %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore, 117597, Singapore, 65 65168687, jocelyn.chew.hs@nus.edu.sg %K artificial intelligence %K blood glucose %K diabetes %K noninvasive %K self-monitoring %K machine learning %K scoping review %K monitoring %K management %K health informatics %K deep learning %K accuracy %K heterogeneity %K mobile phone %D 2024 %7 19.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Current blood glucose monitoring (BGM) methods are often invasive and require repetitive pricking of a finger to obtain blood samples, predisposing individuals to pain, discomfort, and infection. Noninvasive blood glucose monitoring (NIBGM) is ideal for minimizing discomfort, reducing the risk of infection, and increasing convenience. Objective: This review aimed to map the use cases of artificial intelligence (AI) in NIBGM. Methods: A systematic scoping review was conducted according to the Arksey O’Malley five-step framework. Eight electronic databases (CINAHL, Embase, PubMed, Web of Science, Scopus, The Cochrane-Central Library, ACM Digital Library, and IEEE Xplore) were searched from inception until February 8, 2023. Study selection was conducted by 2 independent reviewers, descriptive analysis was conducted, and findings were presented narratively. Study characteristics (author, country, type of publication, study design, population characteristics, mean age, types of noninvasive techniques used, and application, as well as characteristics of the BGM systems) were extracted independently and cross-checked by 2 investigators. Methodological quality appraisal was conducted using the Checklist for assessment of medical AI. Results: A total of 33 papers were included, representing studies from Asia, the United States, Europe, the Middle East, and Africa published between 2005 and 2023. Most studies used optical techniques (n=19, 58%) to estimate blood glucose levels (n=27, 82%). Others used electrochemical sensors (n=4), imaging (n=2), mixed techniques (n=2), and tissue impedance (n=1). Accuracy ranged from 35.56% to 94.23% and Clarke error grid (A+B) ranged from 86.91% to 100%. The most popular machine learning algorithm used was random forest (n=10) and the most popular deep learning model was the artificial neural network (n=6). The mean overall checklist for assessment of medical AI score on the included papers was 33.5 (SD 3.09), suggesting an average of medium quality. The studies reviewed demonstrate that some AI techniques can accurately predict glucose levels from noninvasive sources while enhancing comfort and ease of use for patients. However, the overall range of accuracy was wide due to the heterogeneity of models and input data. Conclusions: Efforts are needed to standardize and regulate the use of AI technologies in BGM, as well as develop consensus guidelines and protocols to ensure the quality and safety of AI-assisted monitoring systems. The use of AI for NIBGM is a promising area of research that has the potential to revolutionize diabetes management. %M 39561353 %R 10.2196/58892 %U https://www.jmir.org/2024/1/e58892 %U https://doi.org/10.2196/58892 %U http://www.ncbi.nlm.nih.gov/pubmed/39561353 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58873 %T The Effect of Interventions Based on the Information-Motivation-Behavioral Skills Model on the Human Papillomavirus Vaccination Rate Among 11-13-Year-Old Girls in Central and Western China: Protocol for a Randomized Controlled Trial %A Jing,Shu %A Wu,Yijin %A Dai,Zhenwei %A Tang,Shenglan %A Su,Xiaoyou %A Qiao,Youlin %+ School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, No 9 Dong Dan San Tiao, Dongcheng District, Beijing, 100730, China, 86 65105830, suxiaoyou@hotmail.com %K human papillomavirus %K HPV %K HPV vaccine %K vaccine hesitancy %K information-motivation-behavioral skills model %K HPV vaccination rate %K randomized controlled trial %K vaccination rate %K China %D 2024 %7 19.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Persistent infection of high-risk human papillomavirus (HPV) can lead to cervical intraepithelial neoplasia, cervical cancer, and even death. HPV vaccination for girls aged 9-14 years can effectively prevent the occurrence of cervical cancer. Some Chinese provinces and cities have launched free HPV vaccination programs for school-age girls; however, due to the lack of supportive government policies, the high price and supply shortage of HPV vaccines, and vaccine hesitancy, some parents refuse to vaccinate their daughters. Objective: This protocol reports the design of a randomized controlled trial (RCT) aiming to explore the efficacy of a digital HPV vaccination education intervention based on the information-motivation-behavioral skills (IMB) model in improving the HPV vaccination rate among 11-13-year-old girls in central and western China. Methods: A multicenter intervention study based on an online applet will be conducted in December 2024, and about 750 eligible parents of 11-13-year-old girls will be assigned in a 1:1 ratio to an intervention group receiving 7-day digital HPV vaccination education based on the IMB model or a control group using non-HPV publicity materials. Free HPV vaccination pilot projects will be carried out among this population by our research team in central and western China (some parents might refuse to vaccinate their daughters). All participants will be asked to complete online questionnaires at baseline; postintervention; and 1 week, 1 month, and 3 months after the intervention. Results: The primary outcome of this study will be receipt of the first HPV vaccination within 3 months. Data will be analyzed based on an intention-to-treat approach, and Stata 16.0 will be used for statistical analysis. Conclusions: This study aims to improve the HPV vaccination rate among 11-13-year-old girls and will examine the impact of a digital HPV vaccination education intervention based on the IMB model. The findings of this study may offer promising intervention measures for HPV vaccine hesitancy in low-health-resource areas in the future. Trial Registration: Chinese Clinical Trial Registry, ChiCTR2300067402; https://tinyurl.com/v5zt4hc9 International Registered Report Identifier (IRRID): PRR1-10.2196/58873 %M 39560975 %R 10.2196/58873 %U https://www.researchprotocols.org/2024/1/e58873 %U https://doi.org/10.2196/58873 %U http://www.ncbi.nlm.nih.gov/pubmed/39560975 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e57360 %T The Doctors, Their Patients, and the Symptom Checker App: Qualitative Interview Study With General Practitioners in Germany %A Preiser,Christine %A Radionova,Natalia %A Ög,Eylem %A Koch,Roland %A Klemmt,Malte %A Müller,Regina %A Ranisch,Robert %A Joos,Stefanie %A Rieger,Monika A %+ Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstr. 27, Tübingen, 72074, Germany, 49 70712984361, christine.preiser@med.uni-tuebingen.de %K symptom checker app %K qualitative interviews %K general practice %K perceived work-related psychosocial stress %K job satisfaction %K professional identity %K medical diagnosis %D 2024 %7 18.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Symptom checkers are designed for laypeople and promise to provide a preliminary diagnosis, a sense of urgency, and a suggested course of action. Objective: We used the international symptom checker app (SCA) Ada App as an example to answer the following question: How do general practitioners (GPs) experience the SCA in relation to the macro, meso, and micro level of their daily work, and how does this interact with work-related psychosocial resources and demands? Methods: We conducted 8 semistructured interviews with GPs in Germany between December 2020 and February 2022. We analyzed the data using the integrative basic method, an interpretative-reconstructive method, to identify core themes and modes of thematization. Results: Although most GPs in this study were open to digitization in health care and their practice, only one was familiar with the SCA. GPs considered the SCA as part of the “unorganized stage” of patients’ searching about their conditions. Some preferred it to popular search engines. They considered it relevant to their work as soon as the SCA would influence patients’ decisions to see a doctor. Some wanted to see the results of the SCA in advance in order to decide on the patient’s next steps. GPs described the diagnostic process as guided by shared decision-making, with the GP taking the lead and the patient deciding. They saw diagnosis as an act of making sense of data, which the SCA would not be able to do, despite the huge amounts of data. Conclusions: GPs took a techno-pragmatic view of SCA. They operate in a health care system of increasing scarcity. They saw the SCA as a potential work-related resource if it helped them to reduce administrative tasks and unnecessary patient contacts. The SCA was seen as a potential work-related demand if it increased workload, for example, if it increased patients’ anxiety, was too risk-averse, or made patients more insistent on their own opinions. %M 39556813 %R 10.2196/57360 %U https://humanfactors.jmir.org/2024/1/e57360 %U https://doi.org/10.2196/57360 %U http://www.ncbi.nlm.nih.gov/pubmed/39556813 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59155 %T Collecting Real-Time Patient-Reported Outcome Data During Latent Labor: Feasibility Study of the MyCap Mobile App in Prospective Person-Centered Research %A Kissler,Katherine %A Phillippi,Julia C %A Erickson,Elise %A Holmes,Leah %A Tilden,Ellen %+ College of Nursing, Anschutz Medical Campus, University of Colorado, 13120 E 19th Ave., Mailstop C288, Aurora, CO, 80045, United States, 1 3037244769, katherine.kissler@cuanschutz.edu %K patient-reported outcomes %K survey methods %K smartphone %K labor onset %K prodromal symptoms %K prospective studies %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The growing emphasis on patient experience in medical research has increased the focus on patient-reported outcomes and symptom measures. However, patient-reported outcomes data are subject to recall bias, limiting reliability. Patient-reported data are most valid when reported by patients in real time; however, this type of data is difficult to collect from patients experiencing acute health events such as labor. Mobile technologies such as the MyCap app, integrated with the REDCap (Research Electronic Data Capture) platform, have emerged as tools for collecting patient-generated health data in real time offering potential improvements in data quality and relevance. Objective: This study aimed to evaluate the feasibility of using MyCap for real-time, patient-reported data collection during latent labor. The objective was to assess the usability of MyCap in characterizing patient experiences during this acute health event and to identify any challenges in data collection that could inform future research. Methods: In this descriptive cohort study, we quantified and characterized data collected prospectively through MyCap and the extent to which participants engaged with the app as a research tool for collecting patient-reported data in real time. Longitudinal quantitative and qualitative surveys were sent to (N=18) enrolled patients with term pregnancies planning vaginal birth at Oregon Health Sciences University. Participants were trained in app use prenatally. Then participants were invited to initiate the research survey on their personal smartphone via MyCap when they experienced labor symptoms and were asked to return to MyCap every 3 hours to provide additional longitudinal symptom data. Results: Out of 18 enrolled participants, 17 completed the study. During latent labor, 13 (76.5%) participants (all those who labored at home and two-thirds of those who were induced) recorded at least 1 symptom report during latent labor. A total of 191 quantitative symptom reports (mean of 10 per participant) were recorded. The most commonly reported symptoms were fatigue, contractions, and pain, with nausea and diarrhea being less frequent but more intense. Four participants recorded qualitative data during labor and 14 responded to qualitative prompts in the postpartum period. The study demonstrated that MyCap could effectively capture real-time patient-reported data during latent labor, although qualitative data collection during active symptoms was less robust. Conclusions: MyCap is a feasible tool for collecting prospective data on patient-reported symptoms during latent labor. Participants engaged actively with quantitative symptom reporting, though qualitative data collection was more challenging. The use of MyCap appears to reduce recall bias and facilitate more accurate data collection for patient-reported symptoms during acute health events outside of health care settings. Future research should explore strategies to enhance qualitative data collection and assess the tool’s usability across more diverse populations and disease states. %M 39515816 %R 10.2196/59155 %U https://formative.jmir.org/2024/1/e59155 %U https://doi.org/10.2196/59155 %U http://www.ncbi.nlm.nih.gov/pubmed/39515816 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58591 %T Effects of HIV Self-Testing on Testing Promotion and Risk Behavior Reduction Among Transgender Women in China: Randomized Controlled Trial %A Zhu,Yan-Yan %A Ye,Ze-Hao %A Chu,Zhen-Xing %A Liu,Yingjie %A Wei,Jie %A Jia,Le %A Jiang,Yong-Jun %A Shang,Hong %A Hu,Qing-Hai %+ State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, NHC Key Laboratory of AIDS Prevention and Treatment, National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China, 86 024 83282192, qhhu@cmu.edu.cn %K HIV %K HIV self-testing %K testing behavior %K sexual behaviours %K transgender women %K sexual health %K mobile phone %D 2024 %7 29.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: To date, no randomized controlled trials have specifically addressed behavior changes after HIV self-testing (HIVST) among transgender women. Objective: This study aims to evaluate the effects of HIVST on changes in HIV testing behavior, frequency of condomless sex, and partner numbers among transgender women in China. Methods: Participants were recruited from 2 Chinese cities using both online and offline methods. Transgender women were randomly assigned to receive an HIVST intervention. Data from the previous 3 months were collected at baseline, 3 months, and 6 months. The primary outcome was the mean change in the number of HIV tests among transgender women during the 6-month follow-up. An intention-to-treat analysis was conducted. The statistical analysis used analysis of covariance and linear mixed-effects models. Results: From February to June 2021, and 255 transgender women were recruited, of which only 36.5% (93/255) had a steady job, and 27.1% (69/255) earned less than US $414.9 of income per month. They were randomly assigned to the intervention (n=127) and control (n=128) groups. At 6 months, the mean number of HIV tests was 2.14 (95% CI 1.80-2.48) in the intervention group and 1.19 (95% CI 0.99-1.40) in the control group (P<.001), with increases of 0.84 (95% CI 0.54-1.14) and 0.11 (95% CI –0.19-0.41) over 6 months, respectively. The net increase was 0.73 (95% CI 0.31-1.15; P<.001), with a similar adjusted result. No significant differences in the frequency of condomless sex or partner numbers were observed between the 2 groups. Conclusions: HIVST is an effective strategy for enhancing regular HIV testing behavior among transgender women in China. This strategy should be combined with measures to address the financial vulnerability of the transgender women community to reduce subsequent risk behaviors, including condomless sex. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000039766; https://www.chictr.org.cn/showproj.html?proj=61402 %M 39471367 %R 10.2196/58591 %U https://www.jmir.org/2024/1/e58591 %U https://doi.org/10.2196/58591 %U http://www.ncbi.nlm.nih.gov/pubmed/39471367 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55075 %T Feasibility, Preference, and Impact of a Rapid Multiplexed Point-of-Care Digital Innovation (AideSmart!) to Expedite Screening of Sexually Transmitted Blood-Borne Infections in At-Risk Populations in Canada: Cross-Sectional Study %A Karellis,Angela %A Webster,Duncan %A Boulanger,Jean %A Harland,Kate %A Feltmate,Paige %A Materniak,Stefanie %A Daunais-Laurin,Gabriel %A Mesa,Christine %A Vaikla,Olivia %A Kim,John %A Pant Pai,Nitika %+ Infectious Diseases and Immunity in Global Health, Research Institute of the McGill University Health Centre, 5252 boul de Maisonneuve Ouest, Montreal, QC, H4A3S5, Canada, 1 514 934 1934 ext 44729, nitika.pai@mcgill.ca %K sexually transmitted blood-borne infections %K rapid multiplexed biomarker-based screening %K digital strategy %K feasibility %K preference %K impact %D 2024 %7 18.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: With the need to expedite the detection of multiple sexually transmitted blood-borne infections (STBBIs), there is an increased demand for digital innovations and tests that improve the efficiency of point-of-care testing in outreach community settings. Multiplexed testing is being offered to at-risk populations by frontline health care professionals. Objective: With this in mind, we evaluated AideSmart! (for health aides or health care workers), an integrated app and platform solution that enables multiplexed STBBI screening at the point of care, for feasibility, preference, accuracy, and impact. With AideSmart!, we provided trained health care workers with the ability to perform rapid multiplexed tests; offer STBBI pre- or posttest counseling; maintain quality assurance of testing; facilitate linkages to care; and enhance health care provider–patient communication, data documentation, and patient engagement through the multiplexed STBBI screening and linkage process. We evaluated the performance of multiplexed tests. Methods: In a cross-sectional study conducted during the COVID-19 pandemic, we recruited at-risk populations in Canada from community-based organizations in Montreal, Quebec, and Saint John, New Brunswick, with unknown serostatus for HIV, hepatitis C virus (HCV), and syphilis. Following orientation and pretest counseling with AideSmart!, we performed multiplexed tests, simultaneously screening for HIV, HCV, and syphilis, using 2 rapid investigational multiplexed tests (Chembio for HIV and syphilis and MedMira for HIV, HCV, and syphilis) followed by confirmatory testing from local and national laboratories. Results: Of the 401 participants, all (100%) accepted the AideSmart! multiplexed strategy: 59.4% (148/249) preferred multiplexed rapid tests over laboratory tests, and 56.6% (141/249) preferred receiving same-day test results. Rapid test results were obtained in 15 minutes (vs laboratory tests at 4-24 days). A total of 29 new infections (n=27, 93% HCV; n=1, 3% syphilis; and n=1, 3% HIV) were identified and treated within a week. Feasibility of the strategy (completion of testing and linkages to care) was at 76.1% (305/401). Health care professionals provided positive feedback and emphasized the importance of knowing one’s negative or positive serostatus, especially during a pandemic. Multiplexed rapid tests’ specificity (against laboratory reference standards) exceeded 98% (98.7%-100%) for all pathogens and devices. An electronic reader, used by the Chembio rapid test, enhanced sensitivity (HIV: 100%, 95% CI 79.4%-100%; syphilis: 86.8%, 95% CI 71.9%-95.6% [Chembio] vs HIV: 100%, 95% CI 78.2%-100%; HCV: 90.3%, 95% CI 80.1%-96.4%; and syphilis: 57.9%, 95% CI 40.8%-73.7% [MedMira]). Conclusions: The AideSmart! digital multiplexed rapid screening strategy for health care workers facilitated STBBI testing for multiple STBBIs and arranged for pre- or posttest counseling and rapid linkages with high feasibility and acceptability. Electronic readers enhanced the diagnostic performance of multiplexed biomarker tests. This study generated data in support of digital multiplexed strategies in digitally enabled settings for at-risk populations nationally and worldwide. %R 10.2196/55075 %U https://www.jmir.org/2024/1/e55075 %U https://doi.org/10.2196/55075 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50745 %T Feasibility, Acceptability, Satisfaction, and Challenges of an mHealth App (e-ASCov) for Community-Based COVID-19 Screening by Community Health Workers in Rwanda: Mixed Methods Study %A Omorou,Abdou Y %A Ndishimye,Pacifique %A Hoen,Bruno %A Mutesa,Léon %A Karame,Prosper %A Nshimiyimana,Ladislas %A Galmiche,Simon %A Mugabo,Hassan %A Murayire,Janvier %A Mugisha,Muco %A Umulisa,Marie Michele %A Uwera,Yvonne Delphine Nsaba %A Musanagabanwa,Clarisse %A Bigirimana,Noella %A Nsanzimana,Sabin %A Guillemin,Francis %A Rwabihama,Jean Paul %K community health workers %K COVID-19 screening tool %K COVID-19 %K SARS-CoV-2 %K screening %K acceptability %K feasibility %K satisfaction %K community based %K LMIC %K Africa %K challenges %K barriers %K smartphone %K proof-of-concept %K mHealth %K mobile health %K apps %K COVID-19 screening %D 2024 %7 14.10.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Although at the base of the pyramid-shaped organization of the Rwandan health system, community health workers (CHWs) are central to the community-based management of disease outbreaks. Objective: This mixed methods study aimed to explore the feasibility, acceptability, satisfaction, and challenges of a mobile health (mHealth) tool for community-based COVID-19 screening in Rwanda. Methods: Two urban (Gasabo and Nyarugenge) and 2 rural (Rusizi and Kirehe) districts in Rwanda participated in the project (smartphone app for COVID-19 screening). A mixed methods approach was used to inform the feasibility (awareness and expectation), acceptability (use and perceived benefits), satisfaction, and challenges of the mHealth intervention. At the end of the project, CHWs were asked to complete a quantitative questionnaire on the use of and satisfaction with the app. Then, in-depth interviews and focus group discussions were organized with CHWs. A content analysis was performed on the transcripts. Results: Overall, 383 CHWs were recruited and trained; 378 CHWs participated in the study. The mean age of CHWs was 36.7 (SD 6.6) to 45.3 (SD 9.9) years and most were women (237/378, 62.7%). More than 7000 people were registered with the use of the app and 20% were referred to a local COVID-19 testing facility. According to CHW reporting, the median number of people screened by each CHW ranged from 152 (IQR 70-276) for Nyarugenge to 24 (IQR 16-90) for Rusizi. COVID-19 positivity rates were higher in urban than rural districts: more than half of the CHWs in Gasabo reported a confirmed positive case versus only 2.4% for Kirehe and 15.4% for Rusizi. Despite the app being a novel tool, CHWs were well aware of the use of such a tool and had appropriate expectations. Acceptability and satisfaction were very high, with differences between urban and rural districts. Satisfaction was higher in Nyarugenge (72.8/100) and Gasabo (80.7/100) than in Kirehe (61.6/100) and Rusizi (64.5/100). More than 80% of the CHWs were willing to continue using the e-ASCov app, with the exception of CHWs in Kirehe (56.7%). The app was perceived as a tool to generate information on COVID-19, inform on the status of the pandemic, and help curb the spread of the pandemic in Rwanda. CHWs were satisfied with the app at all stages of its implementation in their districts. Conclusions: In this proof-of-concept study, a smartphone app for screening COVID-19 was useful as an mHealth tool to be used by CHWs, with the potential to increase health system efficiency in an epidemic context. The context should be analyzed for generalization on a country-wide scale, both in case of an epidemic and to take into account certain conditions at the community level. Information is needed on the conditions of generalization and transferability of this type of app to other health conditions so that CHWs can be given their full place in a pyramidal health system. %R 10.2196/50745 %U https://mhealth.jmir.org/2024/1/e50745 %U https://doi.org/10.2196/50745 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53465 %T Automated Detection of Neurodevelopmental Disorders Using Face-to-Face Mobile Technology Among Typically Developing Greek Children: Randomized Controlled Trial %A Toki,Eugenia I %A Zakopoulou,Victoria %A Tatsis,Giorgos %A Pange,Jenny %+ Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Panepistimioupoli B, Rm 148, Ioannina, 45500, Greece, 30 2651050720, toki@uoi.gr %K main principles %K automated detection %K neurodevelopmental disorders %K principal component analysis %K early screening %K early intervention %K detection %K screening %K assessment %K digital tool %K serious game %K child %K Greece %K speech %K psychomotor %K cognitive %K psychoemotional %K hearing %K machine learning %K apps %K predictions %K screening %K prognosis %D 2024 %7 11.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Neurodevelopmental disorders (NDs) are characterized by heterogeneity, complexity, and interactions among multiple domains with long-lasting effects in adulthood. Early and accurate identification of children at risk for NDs is crucial for timely intervention, yet many cases remain undiagnosed, leading to missed opportunities for effective interventions. Digital tools can help clinicians assist and identify NDs. The concept of using serious games to enhance health care has gained attention among a growing group of scientists, entrepreneurs, and clinicians. Objective: This study aims to explore the core principles of automated mobile detection of NDs in typically developing Greek children, using a serious game developed within the SmartSpeech project, designed to evaluate multiple developmental domains through principal component analysis (PCA). Methods: A total of 229 typically developing children aged 4 to 12 years participated in the study. The recruitment process involved open calls through public and private health and educational institutions across Greece. Parents were thoroughly informed about the study’s objectives and procedures, and written consent was obtained. Children engaged under the clinician’s face-to-face supervision with the serious game “Apsou,” which assesses 18 developmental domains, including speech, language, psychomotor, cognitive, psychoemotional, and hearing abilities. Data from the children’s interactions were analyzed using PCA to identify key components and underlying principles of ND detection. Results: A sample of 229 typically developing preschoolers and early school-aged children played the Apsou mobile serious game for automated detection of NDs. Performing a PCA, the findings identified 5 main components accounting for about 80% of the data variability that potentially have significant prognostic implications for a safe diagnosis of NDs. Varimax rotation explained 61.44% of the total variance. The results underscore key theoretical principles crucial for the automated detection of NDs. These principles encompass communication skills, speech and language development, vocal processing, cognitive skills and sensory functions, and visual-spatial skills. These components align with the theoretical principles of child development and provide a robust framework for automated ND detection. Conclusions: The study highlights the feasibility and effectiveness of using serious games for early ND detection in children. The identified principal components offer valuable insights into critical developmental domains, paving the way for the development of advanced machine learning applications to support highly accurate predictions and classifications for automated screening, diagnosis, prognosis, or intervention planning in ND clinical decision-making. Future research should focus on validating these findings across diverse populations integrating additional features such as biometric data and longitudinal tracking to enhance the accuracy and reliability of automated detection systems. Trial Registration: ClinicalTrials.gov NCT06633874; https://clinicaltrials.gov/study/NCT06633874 International Registered Report Identifier (IRRID): RR2-https://doi.org/10.3390/signals4020021 %M 39393054 %R 10.2196/53465 %U https://formative.jmir.org/2024/1/e53465 %U https://doi.org/10.2196/53465 %U http://www.ncbi.nlm.nih.gov/pubmed/39393054 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e62864 %T Effectiveness of Risk-Adapted Upper Gastrointestinal Cancer Screening in China: Prospective Cohort Study %A Wang,Youqing %A Zhu,Juan %A Li,Huizhang %A Wang,Le %A Zhu,Chen %A Li,Xue %A Wang,Shi %A Du,Lingbin %K upper gastrointestinal cancer %K screening %K endoscopy %K effectiveness, incidence, mortality, all-cause mortality %D 2024 %7 10.10.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Previous studies have proved the effectiveness of endoscopic screening in rural areas; however, long-term, high-quality evidence regarding the effectiveness of risk-adapted upper gastrointestinal cancer (UGC) sequential screening strategies in resource-rich regions is currently lacking. Objective: The objectives were to validate the effectiveness of risk-adapted sequential screening strategies in UGC prevention and control and assess the potential of sequential screening to lower mortality rates. Methods: Based on the Cancer Screening Program in Urban China, a prospective, large-scale cohort study based on population was conducted to recruit individuals from 4 cities in China from 2013‐2019. Those identified as having a high risk of UGC according to a validated risk-score model were advised to undergo endoscopy tests. Follow-up outcomes were tracked until June 2021. Incidence of UGC, UGC-related mortality, and all-cause mortality were evaluated between the screened and nonscreened cohorts. Results: The study included 153,079 participants at baseline. In total, 113,916 (74.42%) of the participants were designated as low risk of UGC. The remaining 39,163 (25.68%) participants were deemed to be at high risk of UGC and were offered gastroscopy tests. Among the high-risk participants, 9627 (compliance rate 24.6%) adhered to the gastroscopy tests. Over a median follow-up of 6.05 (IQR 3.06‐7.06) years, 622 UGC cases, 180 UGC deaths, and 1958 all-cause death cases were traced. The screened cohort exhibited the highest cumulative incidence of UGC (119.2 per 100,000 person-years), followed by the nonscreened and low-risk cohorts. Obvious reductions in both all-cause mortality and UGC mortality were observed between those who undertook screening (153.7 and 4.7 per 100,000 person-years, respectively) and the nonscreened group (245.3 and 27 per 100,000 person-years, respectively). The screening population showed a significant 36% and 82% reduction in both all-cause mortality (hazard ratio [HR] 0.64, 95% CI 0.49‐0.83, P<.001) and UGC mortality (HR 0.18, 95% CI 0.04‐0.74, P=.02), respectively, compared to the nonscreened group. Reductions of 35% in all-cause mortality (HR 0.65, 95% CI 0.49‐0.86, P=.003) and 81% in UGC mortality (HR 0.19, 95% CI 0.05‐0.80, P=.02) were observed in participants aged older than 55 years in the screened group compared to the nonscreened group. The reductions in all-cause mortality and UGC mortality were statistically significant in males (all-cause mortality: HR 0.64, 95% CI 0.47‐0.88, P=.005; UGC mortality: HR 0.10, 95% CI 0.01‐0.72, P=.02), but significant reductions were not observed in females (all P values were >.05). Conclusions: Our study suggests the significance of one-off risk-adapted UGC screening in reducing both all-cause mortality and UGC mortality, particularly among high-risk individuals, indicating its effectiveness in UGC prevention and management. %R 10.2196/62864 %U https://publichealth.jmir.org/2024/1/e62864 %U https://doi.org/10.2196/62864 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50028 %T Increasing Colorectal Cancer Screening Among Black Men in Virginia: Development of an mHealth Intervention %A Thomson,Maria D %A Shahab,Guleer H %A Cooper-McGill,Chelsey A %A Sheppard,Vanessa B %A Hill,Sherrick S %A Preston,Michael %A Keen II,Larry %+ Department of Social and Behavioral Sciences, Virginia Commonwealth University, 830 E Main Street, Richmond, VA, 23219, United States, 1 8044844910, mthomson2@vcu.edu %K colorectal cancer %K cancer screening %K mHealth %K screening %K Black men %K early detection %K health disparities %K design thinking %D 2024 %7 10.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, colorectal cancer (CRC) is the third leading cause of cancer death among Black men. Compared to men of all other races or ethnicities, Black men have the lowest rates of CRC screening participation, which contributes to later-stage diagnoses and greater mortality. Despite CRC screening being a critical component of early detection and increased survival, few interventions have been tailored for Black men. Objective: This study aims to report on the multistep process used to translate formative research including prior experiences implementing a national CRC education program, community advisory, and preliminary survey results into a culturally tailored mobile health (mHealth) intervention. Methods: A theoretically and empirically informed translational science public health intervention was developed using the Behavioral Design Thinking approach. Data to inform how content should be tailored were collected from the empirical literature and a community advisory board of Black men (n=7) and reinforced by the preliminary results of 98 survey respondents. Results: A community advisory board identified changes for delivery that were private, self-paced, and easily accessible and content that addressed medical mistrust, access delays for referrals and appointments, lack of local information, misinformation, and the role of families. Empirical literature and survey results identified the need for local health clinic involvement as critical to screening uptake, leading to a partnership with local Federally Qualified Health Centers to connect participants directly to clinical care. Men surveyed (n=98) who live or work in the study area were an average of 59 (SD 7.9) years old and held high levels of mistrust of health care institutions. In the last 12 months, 25% (24/98) of them did not see a doctor and 16.3% (16/98) of them did not have a regular doctor. Regarding CRC, 27% (26/98) and 38% (37/98) of them had never had a colonoscopy or blood stool test, respectively. Conclusions: Working with a third-party developer, a prototype mHealth app that is downloadable, optimized for iPhone and Android users, and uses familiar sharing, video, and text messaging modalities was created. Guided by our results, we created 4 short videos (1:30-2 min) including a survivor vignette, animated videos about CRC and the type of screening tests, and a message from a community clinic partner. Men also receive tailored feedback and direct navigation to local Federally Qualified Health Center partners including via school-based family clinics. These content and delivery elements of the mHealth intervention were the direct result of the multipronged, theoretically informed approach to translate an existing but generalized CRC knowledge–based intervention into a digital, self-paced, tailored intervention with links to local community clinics. Trial Registration: ClinicalTrials.gov NCT05980182; https://clinicaltrials.gov/study/NCT05980182 %M 39388688 %R 10.2196/50028 %U https://formative.jmir.org/2024/1/e50028 %U https://doi.org/10.2196/50028 %U http://www.ncbi.nlm.nih.gov/pubmed/39388688 %0 Journal Article %@ 2817-092X %I JMIR Publications %V 3 %N %P e52832 %T Validity of a Smartphone App to Objectively Monitor Performance Outcomes in Degenerative Cervical Myelopathy: Preliminary Findings From a Longitudinal Observational Study %A Yanez Touzet,Alvaro %A Houhou,Tatiana %A Rahic,Zerina %A Laufer,Ilya %A Margetis,Konstantinos %A Martin,Allan R %A Dea,Nicolas %A Ghogawala,Zoher %A Kapushesky,Misha %A Kotter,Mark R N %A Davies,Benjamin M %A , %+ Department of Clinical Neurosciences, University of Cambridge, Level 3 'A' Block, Box 165, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, United Kingdom, 44 01223746454, bd375@cam.ac.uk %K validation study %K patient outcome assessment %K smartphone %K neurology %K psychometrics %K validity %K validation %K outcomes %K degenerative %K myelopathy %K neuroscience %K spine %K monitor %K monitoring %K neuromuscular %K muscular %K mHealth %K apps %K measure %K measures %K measurements %D 2024 %7 9.9.2024 %9 Original Paper %J JMIR Neurotech %G English %X Background: Developing new clinical measures for degenerative cervical myelopathy (DCM) is an AO Spine RECODE-DCM research priority. Difficulties detecting DCM, and changes in DCM, cause diagnostic and treatment delays in clinical settings and heightened costs in clinical trials due to elevated recruitment targets. Digital outcome measures can tackle these challenges due to their ability to measure disease remotely, repeatedly, and more economically. Objective: The study aims to assess the validity of MoveMed, a battery of performance outcome measures performed using a smartphone app, in the measurement of DCM. Methods: A prospective observational study in decentralized secondary care was performed in England, United Kingdom. Validity and risk of bias were assessed using criteria from the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) manual. Each MoveMed outcome was compared with 2 patient-reported comparators, with a priori hypotheses of convergence or divergence tested against consensus thresholds. The primary outcome was the correlation coefficient between the MoveMed outcome and the patient-reported comparators. The secondary outcome was the percentage of correlations that aligned with the a priori hypotheses. The comparators used were the patient-derived modified Japanese Orthopaedic Association score and the World Health Organization Quality of Life Brief Version questionnaire. Thresholds for convergence or divergence were set at ≥0.3 for convergence, <0.3 for divergence, and >0/<0 for directionality. Results: A total of 27 adults aged 60 (SD 11) years who live with DCM and possess an approved smartphone were included in a preliminary analysis. As expected, MoveMed tests of neuromuscular function correlated most with questionnaires of neuromuscular function (≥0.3) and least with questionnaires of quality of life (<0.3). Furthermore, directly related constructs correlated positively to each other (>0), while inversely related constructs correlated negatively (<0). Overall, 74% (67/90) and 47% (8/17) of correlations (unidimensional and multidimensional, respectively) were in accordance with hypotheses. No risk-of-bias factors from the COSMIN Risk of Bias checklist were recorded. Overall, this was equivalent to “very good” quality evidence of sufficient construct validity in DCM. Conclusions: MoveMed outcomes and patient-reported questionnaires converge and diverge in accordance with expectations. These findings support the validity of the MoveMed tests in an adult population living with DCM. Criteria from COSMIN provide “very good” quality evidence to support this. %R 10.2196/52832 %U https://neuro.jmir.org/2024/1/e52832 %U https://doi.org/10.2196/52832 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 9 %N %P e59867 %T Implementation of Artificial Intelligence–Based Diabetic Retinopathy Screening in a Tertiary Care Hospital in Quebec: Prospective Validation Study %A Antaki,Fares %A Hammana,Imane %A Tessier,Marie-Catherine %A Boucher,Andrée %A David Jetté,Maud Laurence %A Beauchemin,Catherine %A Hammamji,Karim %A Ong,Ariel Yuhan %A Rhéaume,Marc-André %A Gauthier,Danny %A Harissi-Dagher,Mona %A Keane,Pearse A %A Pomp,Alfons %+ Institute of Ophthalmology, University College London, 11-43 Bath St, London, EC1V 9EL, United Kingdom, 44 20 7608 6800, f.antaki@ucl.ac.uk %K artificial intelligence %K diabetic retinopathy %K screening %K clinical validation %K diabetic %K diabetes %K screening %K tertiary care hospital %K validation study %K Quebec %K Canada %K vision %K vision loss %K ophthalmological %K AI %K detection %K eye %D 2024 %7 3.9.2024 %9 Original Paper %J JMIR Diabetes %G English %X Background: Diabetic retinopathy (DR) affects about 25% of people with diabetes in Canada. Early detection of DR is essential for preventing vision loss. Objective: We evaluated the real-world performance of an artificial intelligence (AI) system that analyzes fundus images for DR screening in a Quebec tertiary care center. Methods: We prospectively recruited adult patients with diabetes at the Centre hospitalier de l’Université de Montréal (CHUM) in Montreal, Quebec, Canada. Patients underwent dual-pathway screening: first by the Computer Assisted Retinal Analysis (CARA) AI system (index test), then by standard ophthalmological examination (reference standard). We measured the AI system's sensitivity and specificity for detecting referable disease at the patient level, along with its performance for detecting any retinopathy and diabetic macular edema (DME) at the eye level, and potential cost savings. Results: This study included 115 patients. CARA demonstrated a sensitivity of 87.5% (95% CI 71.9-95.0) and specificity of 66.2% (95% CI 54.3-76.3) for detecting referable disease at the patient level. For any retinopathy detection at the eye level, CARA showed 88.2% sensitivity (95% CI 76.6-94.5) and 71.4% specificity (95% CI 63.7-78.1). For DME detection, CARA had 100% sensitivity (95% CI 64.6-100) and 81.9% specificity (95% CI 75.6-86.8). Potential yearly savings from implementing CARA at the CHUM were estimated at CAD $245,635 (US $177,643.23, as of July 26, 2024) considering 5000 patients with diabetes. Conclusions: Our study indicates that integrating a semiautomated AI system for DR screening demonstrates high sensitivity for detecting referable disease in a real-world setting. This system has the potential to improve screening efficiency and reduce costs at the CHUM, but more work is needed to validate it. %M 39226095 %R 10.2196/59867 %U https://diabetes.jmir.org/2024/1/e59867 %U https://doi.org/10.2196/59867 %U http://www.ncbi.nlm.nih.gov/pubmed/39226095 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e53211 %T Using mHealth Technologies for Case Finding in Tuberculosis and Other Infectious Diseases in Africa: Systematic Review %A Mudzengi,Don Lawrence %A Chomutare,Herbert %A Nagudi,Jeniffer %A Ntshiqa,Thobani %A Davis,J Lucian %A Charalambous,Salome %A Velen,Kavindhran %+ The Aurum Institute, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa, 27 833697946, dmudzengi@auruminstitute.org %K mobile health %K mHealth %K design thinking %K tuberculosis %K Ebola %K HIV %K COVID-19 %K infectious diseases %K contact tracing %K mobile phone %D 2024 %7 26.8.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) technologies are increasingly used in contact tracing and case finding, enhancing and replacing traditional methods for managing infectious diseases such as Ebola, tuberculosis, COVID-19, and HIV. However, the variations in their development approaches, implementation scopes, and effectiveness introduce uncertainty regarding their potential to improve public health outcomes. Objective: We conducted this systematic review to explore how mHealth technologies are developed, implemented, and evaluated. We aimed to deepen our understanding of mHealth’s role in contact tracing, enhancing both the implementation and overall health outcomes. Methods: We searched and reviewed studies conducted in Africa focusing on tuberculosis, Ebola, HIV, and COVID-19 and published between 1990 and 2023 using the PubMed, Scopus, Web of Science, and Google Scholar databases. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to review, synthesize, and report the findings from articles that met our criteria. Results: We identified 11,943 articles, but only 19 (0.16%) met our criteria, revealing a large gap in technologies specifically aimed at case finding and contact tracing of infectious diseases. These technologies addressed a broad spectrum of diseases, with a predominant focus on Ebola and tuberculosis. The type of technologies used ranged from mobile data collection platforms and smartphone apps to advanced geographic information systems (GISs) and bidirectional communication systems. Technologies deployed in programmatic settings, often developed using design thinking frameworks, were backed by significant funding and often deployed at a large scale but frequently lacked rigorous evaluations. In contrast, technologies used in research settings, although providing more detailed evaluation of both technical performance and health outcomes, were constrained by scale and insufficient funding. These challenges not only prevented these technologies from being tested on a wider scale but also hindered their ability to provide actionable and generalizable insights that could inform public health policies effectively. Conclusions: Overall, this review underscored a need for organized development approaches and comprehensive evaluations. A significant gap exists between the expansive deployment of mHealth technologies in programmatic settings, which are typically well funded and rigorously developed, and the more robust evaluations necessary to ascertain their effectiveness. Future research should consider integrating the robust evaluations often found in research settings with the scale and developmental rigor of programmatic implementations. By embedding advanced research methodologies within programmatic frameworks at the design thinking stage, mHealth technologies can potentially become technically viable and effectively meet specific contact tracing health outcomes to inform policy effectively. %M 39186366 %R 10.2196/53211 %U https://mhealth.jmir.org/2024/1/e53211 %U https://doi.org/10.2196/53211 %U http://www.ncbi.nlm.nih.gov/pubmed/39186366 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e55126 %T Detection of Mild Cognitive Impairment From Non-Semantic, Acoustic Voice Features: The Framingham Heart Study %A Ding,Huitong %A Lister,Adrian %A Karjadi,Cody %A Au,Rhoda %A Lin,Honghuang %A Bischoff,Brian %A Hwang,Phillip H %+ Department of Epidemiology, Boston University School of Public Health, T3E, 715 Albany Street, Boston, MA, 02118, United States, 1 (617) 358 4049, phhwang@bu.edu %K early detection %K Alzheimer disease and related dementias %K mild cognitive impairment %K digital voice %K machine learning %K smartphone %K mobile phone %D 2024 %7 22.8.2024 %9 Original Paper %J JMIR Aging %G English %X Background: With the aging global population and the rising burden of Alzheimer disease and related dementias (ADRDs), there is a growing focus on identifying mild cognitive impairment (MCI) to enable timely interventions that could potentially slow down the onset of clinical dementia. The production of speech by an individual is a cognitively complex task that engages various cognitive domains. The ease of audio data collection highlights the potential cost-effectiveness and noninvasive nature of using human speech as a tool for cognitive assessment. Objective: This study aimed to construct a machine learning pipeline that incorporates speaker diarization, feature extraction, feature selection, and classification to identify a set of acoustic features derived from voice recordings that exhibit strong MCI detection capability. Methods: The study included 100 MCI cases and 100 cognitively normal controls matched for age, sex, and education from the Framingham Heart Study. Participants' spoken responses on neuropsychological tests were recorded, and the recorded audio was processed to identify segments of each participant's voice from recordings that included voices of both testers and participants. A comprehensive set of 6385 acoustic features was then extracted from these voice segments using OpenSMILE and Praat software. Subsequently, a random forest model was constructed to classify cognitive status using the features that exhibited significant differences between the MCI and cognitively normal groups. The MCI detection performance of various audio lengths was further examined. Results: An optimal subset of 29 features was identified that resulted in an area under the receiver operating characteristic curve of 0.87, with a 95% CI of 0.81-0.94. The most important acoustic feature for MCI classification was the number of filled pauses (importance score=0.09, P=3.10E–08). There was no substantial difference in the performance of the model trained on the acoustic features derived from different lengths of voice recordings. Conclusions: This study showcases the potential of monitoring changes to nonsemantic and acoustic features of speech as a way of early ADRD detection and motivates future opportunities for using human speech as a measure of brain health. %M 39173144 %R 10.2196/55126 %U https://aging.jmir.org/2024/1/e55126 %U https://doi.org/10.2196/55126 %U http://www.ncbi.nlm.nih.gov/pubmed/39173144 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e56035 %T Establishment and Evaluation of a Noninvasive Metabolism-Related Fatty Liver Screening and Dynamic Monitoring Model: Cross-Sectional Study %A Ni,Jiali %A Huang,Yong %A Xiang,Qiangqiang %A Zheng,Qi %A Xu,Xiang %A Qin,Zhiwen %A Sheng,Guoping %A Li,Lanjuan %+ State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd, Hangzhou, 310058, China, 86 571 87236458, ljli@zju.edu.cn %K metabolic-associated fatty liver disease %K nonalcoholic fatty liver disease %K nonalcoholic steatohepatitis %K body fat mass %K waist-height ratio %K basal metabolic rate %K liver %D 2024 %7 22.8.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Metabolically associated fatty liver disease (MAFLD) insidiously affects people's health, and many models have been proposed for the evaluation of liver fibrosis. However, there is still a lack of noninvasive and sensitive models to screen MAFLD in high-risk populations. Objective: The purpose of this study was to explore a new method for early screening of the public and establish a home-based tool for regular self-assessment and monitoring of MAFLD. Methods: In this cross-sectional study, there were 1758 eligible participants in the training set and 200 eligible participants in the testing set. Routine blood, blood biochemistry, and FibroScan tests were performed, and body composition was analyzed using a body composition instrument. Additionally, we recorded multiple factors including disease-related risk factors, the Forns index score, the hepatic steatosis index (HSI), the triglyceride glucose index, total body water (TBW), body fat mass (BFM), visceral fat area, waist-height ratio (WHtR), and basal metabolic rate. Binary logistic regression analysis was performed to explore the potential anthropometric indicators that have a predictive ability to screen for MAFLD. A new model, named the MAFLD Screening Index (MFSI), was established using binary logistic regression analysis, and BFM, WHtR, and TBW were included. A simple rating table, named the MAFLD Rating Table (MRT), was also established using these indicators. Results: The performance of the HSI (area under the curve [AUC]=0.873, specificity=76.8%, sensitivity=81.4%), WHtR (AUC=0.866, specificity=79.8%, sensitivity=80.8%), and BFM (AUC=0.842, specificity=76.9%, sensitivity=76.2%) in discriminating between the MAFLD group and non-fatty liver group was evaluated (P<.001). The AUC of the combined model including WHtR, HSI, and BFM values was 0.900 (specificity=81.8%, sensitivity=85.6%; P<.001). The MFSI was established based on better performance at screening MAFLD patients in the training set (AUC=0.896, specificity=83.8%, sensitivity=82.1%) and was confirmed in the testing set (AUC=0.917, specificity=89.8%, sensitivity=84.4%; P<.001). Conclusions: The novel MFSI model was built using WHtR, BFM, and TBW to screen for early MAFLD. These body parameters can be easily obtained using a body fat scale at home, and the mobile device software can record specific values and perform calculations. MFSI had better performance than other models for early MAFLD screening. The new model showed strong power and stability and shows promise in the area of MAFLD detection and self-assessment. The MRT was a practical tool to assess disease alterations in real time. %M 39172506 %R 10.2196/56035 %U https://www.i-jmr.org/2024/1/e56035 %U https://doi.org/10.2196/56035 %U http://www.ncbi.nlm.nih.gov/pubmed/39172506 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56514 %T Comparison of Two Symptom Checkers (Ada and Symptoma) in the Emergency Department: Randomized, Crossover, Head-to-Head, Double-Blinded Study %A Knitza,Johannes %A Hasanaj,Ragip %A Beyer,Jonathan %A Ganzer,Franziska %A Slagman,Anna %A Bolanaki,Myrto %A Napierala,Hendrik %A Schmieding,Malte L %A Al-Zaher,Nizam %A Orlemann,Till %A Muehlensiepen,Felix %A Greenfield,Julia %A Vuillerme,Nicolas %A Kuhn,Sebastian %A Schett,Georg %A Achenbach,Stephan %A Dechant,Katharina %+ Institute for Digital Medicine, University Hospital Giessen, Philipps University, Baldingerstrasse, Marburg, 35043, Germany, 49 642158 ext 62589, johannes.knitza@uni-marburg.de %K symptom checker %K triage %K emergency %K eHealth %K diagnostic accuracy %K apps, health service research %K decision support system %D 2024 %7 20.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Emergency departments (EDs) are frequently overcrowded and increasingly used by nonurgent patients. Symptom checkers (SCs) offer on-demand access to disease suggestions and recommended actions, potentially improving overall patient flow. Contrary to the increasing use of SCs, there is a lack of supporting evidence based on direct patient use. Objective: This study aimed to compare the diagnostic accuracy, safety, usability, and acceptance of 2 SCs, Ada and Symptoma. Methods: A randomized, crossover, head-to-head, double-blinded study including consecutive adult patients presenting to the ED at University Hospital Erlangen. Patients completed both SCs, Ada and Symptoma. The primary outcome was the diagnostic accuracy of SCs. In total, 6 blinded independent expert raters classified diagnostic concordance of SC suggestions with the final discharge diagnosis as (1) identical, (2) plausible, or (3) diagnostically different. SC suggestions per patient were additionally classified as safe or potentially life-threatening, and the concordance of Ada’s and physician-based triage category was assessed. Secondary outcomes were SC usability (5-point Likert-scale: 1=very easy to use to 5=very difficult to use) and SC acceptance net promoter score (NPS). Results: A total of 450 patients completed the study between April and November 2021. The most common chief complaint was chest pain (160/437, 37%). The identical diagnosis was ranked first (or within the top 5 diagnoses) by Ada and Symptoma in 14% (59/437; 27%, 117/437) and 4% (16/437; 13%, 55/437) of patients, respectively. An identical or plausible diagnosis was ranked first (or within the top 5 diagnoses) by Ada and Symptoma in 58% (253/437; 75%, 329/437) and 38% (164/437; 64%, 281/437) of patients, respectively. Ada and Symptoma did not suggest potentially life-threatening diagnoses in 13% (56/437) and 14% (61/437) of patients, respectively. Ada correctly triaged, undertriaged, and overtriaged 34% (149/437), 13% (58/437), and 53% (230/437) of patients, respectively. A total of 88% (385/437) and 78% (342/437) of participants rated Ada and Symptoma as very easy or easy to use, respectively. Ada’s NPS was –34 (55% [239/437] detractors; 21% [93/437] promoters) and Symptoma’s NPS was –47 (63% [275/437] detractors and 16% [70/437]) promoters. Conclusions: Ada demonstrated a higher diagnostic accuracy than Symptoma, and substantially more patients would recommend Ada and assessed Ada as easy to use. The high number of unrecognized potentially life-threatening diagnoses by both SCs and inappropriate triage advice by Ada was alarming. Overall, the trustworthiness of SC recommendations appears questionable. SC authorization should necessitate rigorous clinical evaluation studies to prevent misdiagnoses, fatal triage advice, and misuse of scarce medical resources. Trial Registration: German Register of Clinical Trials DRKS00024830; https://drks.de/search/en/trial/DRKS00024830 %M 39163594 %R 10.2196/56514 %U https://www.jmir.org/2024/1/e56514 %U https://doi.org/10.2196/56514 %U http://www.ncbi.nlm.nih.gov/pubmed/39163594 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e52310 %T Prediction of Hearing Help Seeking to Design a Recommendation Module of an mHealth Hearing App: Intensive Longitudinal Study of Feature Importance Assessment %A Angonese,Giulia %A Buhl,Mareike %A Kuhlmann,Inka %A Kollmeier,Birger %A Hildebrandt,Andrea %+ Psychological Methods and Statistics Lab, Department of Psychology, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstraße 114-118, Oldenburg, 26129, Germany, 49 0441 798 4629, giulia.angonese@uni-oldenburg.de %K hearing loss %K mobile health %K mHealth %K older adults %K help seeking %K mobile study %K machine learning %K supervised classification %K feature importance %K profiling %K mobile phone %D 2024 %7 12.8.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile health (mHealth) solutions can improve the quality, accessibility, and equity of health services, fostering early rehabilitation. For individuals with hearing loss, mHealth apps might be designed to support the decision-making processes in auditory diagnostics and provide treatment recommendations to the user (eg, hearing aid need). For some individuals, such an mHealth app might be the first contact with a hearing diagnostic service and should motivate users with hearing loss to seek professional help in a targeted manner. However, personalizing treatment recommendations is only possible by knowing the individual’s profile regarding the outcome of interest. Objective: This study aims to characterize individuals who are more or less prone to seeking professional help after the repeated use of an app-based hearing test. The goal was to derive relevant hearing-related traits and personality characteristics for personalized treatment recommendations for users of mHealth hearing solutions. Methods: In total, 185 (n=106, 57.3% female) nonaided older individuals (mean age 63.8, SD 6.6 y) with subjective hearing loss participated in a mobile study. We collected cross-sectional and longitudinal data on a comprehensive set of 83 hearing-related and psychological measures among those previously found to predict hearing help seeking. Readiness to seek help was assessed as the outcome variable at study end and after 2 months. Participants were classified into help seekers and nonseekers using several supervised machine learning algorithms (random forest, naïve Bayes, and support vector machine). The most relevant features for prediction were identified using feature importance analysis. Results: The algorithms correctly predicted action to seek help at study end in 65.9% (122/185) to 70.3% (130/185) of cases, reaching 74.8% (98/131) classification accuracy at follow-up. Among the most important features for classification beyond hearing performance were the perceived consequences of hearing loss in daily life, attitude toward hearing aids, motivation to seek help, physical health, sensory sensitivity personality trait, neuroticism, and income. Conclusions: This study contributes to the identification of individual characteristics that predict help seeking in older individuals with self-reported hearing loss. Suggestions are made for their implementation in an individual-profiling algorithm and for deriving targeted recommendations in mHealth hearing apps. %M 39133539 %R 10.2196/52310 %U https://humanfactors.jmir.org/2024/1/e52310 %U https://doi.org/10.2196/52310 %U http://www.ncbi.nlm.nih.gov/pubmed/39133539 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57038 %T Characterization of Psychopathology in Latin American Adolescents Using a Web-Based Screening Tool: Cross-Sectional Study %A Campos,Susana %A Nuñez,Daniel %A Pérez,J Carola %A Robinson,Jo %+ Center of Cognitive Sciences, Faculty of Psychology, University of Talca, Avenida Lircay s/n, Talca, 3460000, Chile, 56 712201782, dnunez@utalca.cl %K web-based screening %K adolescents %K psychopathology %K suicidal ideation %K early detection %K detection %K screening %K teens %K youths %K suicide %K mental health %K screening tool %K Latin American %K Latino %K psychiatric %K psychiatric symptoms %K psychological risk %D 2024 %7 8.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health problems and suicide ideation are common in adolescents. Early detection of these issues could prevent the escalation of mental health–related symptoms in the long term. Moreover, characterizing different profiles of prevalent symptoms in conjunction with emotional regulation strategies could guide the design of specific interventions. The use of web-based screening (WBS) tools has been regarded as a suitable strategy to timely detect symptomatology while improving the appeal, cost, timeliness, and reach of detection in young populations. However, the evidence regarding the accuracy of these approaches is not fully conclusive. Objective: The study aims (1) to examine the capability of a WBS to identify adolescents with psychiatric symptoms and suicidality and (2) to characterize the mental health profiles of a large sample of adolescents using WBS. Methods: A total of 1599 Latin American Spanish-speaking adolescents (mean age 15.56, SD 1.34 years), consisting of 47.3% (n=753) female, 98.5% Chilean (n=1570), and 1.5% Venezuelan (n=24) participants, responded to a mental health WBS. A randomized subsample of participants also responded to the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). McNemar χ2 and receiver-operating characteristic curves tested the detection accuracy of WBS contrasted with the MINI-KID. Latent profile analyses explored the symptomatic and emotional regulation profiles of participants. Results: Both measures showed an adequate level of agreement (area under the curve per symptom domain ranging from 0.70 to 0.89); however, WBS yielded a higher prevalence than MINI-KID for all psychiatric symptoms, except suicide ideation and depression. Latent profile analyses yielded 4 profiles—one of them presented elevated psychopathological symptoms, constituting 11% of the sample (n=175). Rumination (odds ratio [OR] 130.15, 95% CI 51.75-439.89; P<.001), entrapment (OR 96.35, 95% CI 29.21-317.79; P<.001), and defeat (OR 156.79, 95% CI 50.45-487.23; P<.001) contributed significantly to the prediction of latent profile memberships, while cognitive reappraisal did not contribute to the prediction of any latent profile memberships, and expressive suppression was only associated to profile-2 membership. Conclusions: WBS is acceptable for the timely detection of adolescents at risk of mental health conditions. Findings from the symptomatic and emotional regulation profiles highlight the need for comprehensive assessments and differential interventions. %M 39116425 %R 10.2196/57038 %U https://formative.jmir.org/2024/1/e57038 %U https://doi.org/10.2196/57038 %U http://www.ncbi.nlm.nih.gov/pubmed/39116425 %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 %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55542 %T Diagnostic Accuracy of a Mobile AI-Based Symptom Checker and a Web-Based Self-Referral Tool in Rheumatology: Multicenter Randomized Controlled Trial %A Knitza,Johannes %A Tascilar,Koray %A Fuchs,Franziska %A Mohn,Jacob %A Kuhn,Sebastian %A Bohr,Daniela %A Muehlensiepen,Felix %A Bergmann,Christina %A Labinsky,Hannah %A Morf,Harriet %A Araujo,Elizabeth %A Englbrecht,Matthias %A Vorbrüggen,Wolfgang %A von der Decken,Cay-Benedict %A Kleinert,Stefan %A Ramming,Andreas %A Distler,Jörg H W %A Bartz-Bazzanella,Peter %A Vuillerme,Nicolas %A Schett,Georg %A Welcker,Martin %A Hueber,Axel %+ Institute for Digital Medicine, University Hospital Giessen-Marburg, Philipps University Marburg, Baldingerstrasse, Marburg, 35043, Germany, 1 49 6421 ext 58, johannes.knitza@uni-marburg.de %K symptom checker %K artificial intelligence %K eHealth %K diagnostic decision support system %K rheumatology %K decision support %K decision %K diagnostic %K tool %K rheumatologists %K symptom assessment %K resources %K randomized controlled trial %K diagnosis %K decision support system %K support system %K support %D 2024 %7 23.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The diagnosis of inflammatory rheumatic diseases (IRDs) is often delayed due to unspecific symptoms and a shortage of rheumatologists. Digital diagnostic decision support systems (DDSSs) have the potential to expedite diagnosis and help patients navigate the health care system more efficiently. Objective: The aim of this study was to assess the diagnostic accuracy of a mobile artificial intelligence (AI)–based symptom checker (Ada) and a web-based self-referral tool (Rheport) regarding IRDs. Methods: A prospective, multicenter, open-label, crossover randomized controlled trial was conducted with patients newly presenting to 3 rheumatology centers. Participants were randomly assigned to complete a symptom assessment using either Ada or Rheport. The primary outcome was the correct identification of IRDs by the DDSSs, defined as the presence of any IRD in the list of suggested diagnoses by Ada or achieving a prespecified threshold score with Rheport. The gold standard was the diagnosis made by rheumatologists. Results: A total of 600 patients were included, among whom 214 (35.7%) were diagnosed with an IRD. Most frequent IRD was rheumatoid arthritis with 69 (11.5%) patients. Rheport’s disease suggestion and Ada’s top 1 (D1) and top 5 (D5) disease suggestions demonstrated overall diagnostic accuracies of 52%, 63%, and 58%, respectively, for IRDs. Rheport showed a sensitivity of 62% and a specificity of 47% for IRDs. Ada’s D1 and D5 disease suggestions showed a sensitivity of 52% and 66%, respectively, and a specificity of 68% and 54%, respectively, concerning IRDs. Ada’s diagnostic accuracy regarding individual diagnoses was heterogenous, and Ada performed considerably better in identifying rheumatoid arthritis in comparison to other diagnoses (D1: 42%; D5: 64%). The Cohen κ statistic of Rheport for agreement on any rheumatic disease diagnosis with Ada D1 was 0.15 (95% CI 0.08-0.18) and with Ada D5 was 0.08 (95% CI 0.00-0.16), indicating poor agreement for the presence of any rheumatic disease between the 2 DDSSs. Conclusions: To our knowledge, this is the largest comparative DDSS trial with actual use of DDSSs by patients. The diagnostic accuracies of both DDSSs for IRDs were not promising in this high-prevalence patient population. DDSSs may lead to a misuse of scarce health care resources. Our results underscore the need for stringent regulation and drastic improvements to ensure the safety and efficacy of DDSSs. Trial Registration: German Register of Clinical Trials DRKS00017642; https://drks.de/search/en/trial/DRKS00017642 %M 39042425 %R 10.2196/55542 %U https://www.jmir.org/2024/1/e55542 %U https://doi.org/10.2196/55542 %U http://www.ncbi.nlm.nih.gov/pubmed/39042425 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e52045 %T Bayesian Networks for Prescreening in Depression: Algorithm Development and Validation %A Maekawa,Eduardo %A Grua,Eoin Martino %A Nakamura,Carina Akemi %A Scazufca,Marcia %A Araya,Ricardo %A Peters,Tim %A van de Ven,Pepijn %+ Department of Electronic and Computer Engineering, University of Limerick, Plassey Park Road, Limerick, V94 T9PX, Ireland, 353 830150601, eduardo.maekawa@ul.ie %K Bayesian network %K target depressive symptomatology %K probabilistic machine learning %K stochastic gradient descent %K patient screening %K depressive symptom %K machine learning model %K machine learning %K survey %K prediction %K socioeconomic data sets %K utilization %K depression %K mental health %K digital mental health %K artificial intelligence %K AI %K prediction %K prediction modeling %K patient %K mood %K anxiety %K mood disorders %K mood disorder %K eHealth %K mobile health %K mHealth %K telehealth %D 2024 %7 4.7.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Identifying individuals with depressive symptomatology (DS) promptly and effectively is of paramount importance for providing timely treatment. Machine learning models have shown promise in this area; however, studies often fall short in demonstrating the practical benefits of using these models and fail to provide tangible real-world applications. Objective: This study aims to establish a novel methodology for identifying individuals likely to exhibit DS, identify the most influential features in a more explainable way via probabilistic measures, and propose tools that can be used in real-world applications. Methods: The study used 3 data sets: PROACTIVE, the Brazilian National Health Survey (Pesquisa Nacional de Saúde [PNS]) 2013, and PNS 2019, comprising sociodemographic and health-related features. A Bayesian network was used for feature selection. Selected features were then used to train machine learning models to predict DS, operationalized as a score of ≥10 on the 9-item Patient Health Questionnaire. The study also analyzed the impact of varying sensitivity rates on the reduction of screening interviews compared to a random approach. Results: The methodology allows the users to make an informed trade-off among sensitivity, specificity, and a reduction in the number of interviews. At the thresholds of 0.444, 0.412, and 0.472, determined by maximizing the Youden index, the models achieved sensitivities of 0.717, 0.741, and 0.718, and specificities of 0.644, 0.737, and 0.766 for PROACTIVE, PNS 2013, and PNS 2019, respectively. The area under the receiver operating characteristic curve was 0.736, 0.801, and 0.809 for these 3 data sets, respectively. For the PROACTIVE data set, the most influential features identified were postural balance, shortness of breath, and how old people feel they are. In the PNS 2013 data set, the features were the ability to do usual activities, chest pain, sleep problems, and chronic back problems. The PNS 2019 data set shared 3 of the most influential features with the PNS 2013 data set. However, the difference was the replacement of chronic back problems with verbal abuse. It is important to note that the features contained in the PNS data sets differ from those found in the PROACTIVE data set. An empirical analysis demonstrated that using the proposed model led to a potential reduction in screening interviews of up to 52% while maintaining a sensitivity of 0.80. Conclusions: This study developed a novel methodology for identifying individuals with DS, demonstrating the utility of using Bayesian networks to identify the most significant features. Moreover, this approach has the potential to substantially reduce the number of screening interviews while maintaining high sensitivity, thereby facilitating improved early identification and intervention strategies for individuals experiencing DS. %M 38963925 %R 10.2196/52045 %U https://mental.jmir.org/2024/1/e52045 %U https://doi.org/10.2196/52045 %U http://www.ncbi.nlm.nih.gov/pubmed/38963925 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e48811 %T Efficacy of an Artificial Intelligence App (Aysa) in Dermatological Diagnosis: Cross-Sectional Analysis %A Marri,Shiva Shankar %A Albadri,Warood %A Hyder,Mohammed Salman %A Janagond,Ajit B %A Inamadar,Arun C %+ Department of Dermatology, Venereology and Leprosy, Shri B M Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be) University, Bangaramma Sajjan Campus, Vijayapura, Karnataka, 586103, India, 91 9448102920, aruninamadar@gmail.com %K artificial intelligence %K AI %K AI-aided diagnosis %K dermatology %K mobile app %K application %K neural network %K machine learning %K dermatological %K skin %K computer-aided diagnosis %K diagnostic %K imaging %K lesion %D 2024 %7 2.7.2024 %9 Original Paper %J JMIR Dermatol %G English %X Background: Dermatology is an ideal specialty for artificial intelligence (AI)–driven image recognition to improve diagnostic accuracy and patient care. Lack of dermatologists in many parts of the world and the high frequency of cutaneous disorders and malignancies highlight the increasing need for AI-aided diagnosis. Although AI-based applications for the identification of dermatological conditions are widely available, research assessing their reliability and accuracy is lacking. Objective: The aim of this study was to analyze the efficacy of the Aysa AI app as a preliminary diagnostic tool for various dermatological conditions in a semiurban town in India. Methods: This observational cross-sectional study included patients over the age of 2 years who visited the dermatology clinic. Images of lesions from individuals with various skin disorders were uploaded to the app after obtaining informed consent. The app was used to make a patient profile, identify lesion morphology, plot the location on a human model, and answer questions regarding duration and symptoms. The app presented eight differential diagnoses, which were compared with the clinical diagnosis. The model’s performance was evaluated using sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and F1-score. Comparison of categorical variables was performed with the χ2 test and statistical significance was considered at P<.05. Results: A total of 700 patients were part of the study. A wide variety of skin conditions were grouped into 12 categories. The AI model had a mean top-1 sensitivity of 71% (95% CI 61.5%-74.3%), top-3 sensitivity of 86.1% (95% CI 83.4%-88.6%), and all-8 sensitivity of 95.1% (95% CI 93.3%-96.6%). The top-1 sensitivities for diagnosis of skin infestations, disorders of keratinization, other inflammatory conditions, and bacterial infections were 85.7%, 85.7%, 82.7%, and 81.8%, respectively. In the case of photodermatoses and malignant tumors, the top-1 sensitivities were 33.3% and 10%, respectively. Each category had a strong correlation between the clinical diagnosis and the probable diagnoses (P<.001). Conclusions: The Aysa app showed promising results in identifying most dermatoses. %M 38954807 %R 10.2196/48811 %U https://derma.jmir.org/2024/1/e48811 %U https://doi.org/10.2196/48811 %U http://www.ncbi.nlm.nih.gov/pubmed/38954807 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e51743 %T Chest X-Ray–Based Telemedicine Platform for Pediatric Tuberculosis Diagnosis in Low-Resource Settings: Development and Validation Study %A Gómez-Valverde,Juan J %A Sánchez-Jacob,Ramón %A Ribó,José Luis %A Schaaf,H Simon %A García Delgado,Lara %A Hernanz-Lobo,Alicia %A Capellán-Martín,Daniel %A Lancharro,Ángel %A Augusto,Orvalho %A García-Basteiro,Alberto L %A Santiago-García,Begoña %A López-Varela,Elisa %A Ledesma-Carbayo,María J %+ Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid, Avenida Complutense 30, Madrid, 28040, Spain, 34 910672210, juanjo.gomez@upm.es %K telemedicine %K telehealth %K pediatric tuberculosis %K tuberculosis %K screening %K chest radiograph %K usability %K low-resource settings %D 2024 %7 1.7.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Tuberculosis (TB) remains a major cause of morbidity and death worldwide, with a significant impact on children, especially those under the age of 5 years. The complex diagnosis of pediatric TB, compounded by limited access to more accurate diagnostic tests, underscores the need for improved tools to enhance diagnosis and care in resource-limited settings. Objective: This study aims to present a telemedicine web platform, BITScreen PTB (Biomedical Image Technologies Screen for Pediatric Tuberculosis), aimed at improving the evaluation of pulmonary TB in children based on digital chest x-ray (CXR) imaging and clinical information in resource-limited settings. Methods: The platform was evaluated by 3 independent expert readers through a retrospective assessment of a data set with 218 imaging examinations of children under 3 years of age, selected from a previous study performed in Mozambique. The key aspects assessed were the usability through a standardized questionnaire, the time needed to complete the assessment through the platform, the performance of the readers to identify TB cases based on the CXR, the association between the TB features identified in the CXRs and the initial diagnostic classification, and the interreader agreement of the global assessment and the radiological findings. Results: The platform’s usability and user satisfaction were evaluated using a questionnaire, which received an average rating of 4.4 (SD 0.59) out of 5. The average examination completion time ranged from 35 to 110 seconds. In addition, the study on CXR showed low sensitivity (16.3%-28.2%) but high specificity (91.1%-98.2%) in the assessment of the consensus case definition of pediatric TB using the platform. The CXR finding having a stronger association with the initial diagnostic classification was air space opacification (χ21>20.38, P<.001). The study found varying levels of interreader agreement, with moderate/substantial agreement for air space opacification (κ=0.54-0.67) and pleural effusion (κ=0.43-0.72). Conclusions: Our findings support the promising role of telemedicine platforms such as BITScreen PTB in enhancing pediatric TB diagnosis access, particularly in resource-limited settings. Additionally, these platforms could facilitate the multireader and systematic assessment of CXR in pediatric TB clinical studies. %M 38949860 %R 10.2196/51743 %U https://pediatrics.jmir.org/2024/1/e51743 %U https://doi.org/10.2196/51743 %U http://www.ncbi.nlm.nih.gov/pubmed/38949860 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e56196 %T Implementing Systematic Patient-Reported Measures for Chronic Conditions Through the Naveta Value-Based Telemedicine Initiative: Observational Retrospective Multicenter Study %A Mercadal-Orfila,Gabriel %A Herrera-Pérez,Salvador %A Piqué,Núria %A Mateu-Amengual,Francesc %A Ventayol-Bosch,Pedro %A Maestre-Fullana,María Antonia %A Serrano-López de las Hazas,Joaquín Ignacio %A Fernández-Cortés,Francisco %A Barceló-Sansó,Francesc %A Rios,Santiago %+ Microbiology Section, Department of Biology, Healthcare and Environment, Faculty of Pharmacy and Food Sciences, Universitat de Barcelona, Diagonal Sud, Facultat de Farmàcia, Edifici A, Av Joan XXIII, 27-31, Barcelona, 08028, Spain, 34 934024496, npique@gmail.com %K chronic conditions %K eHealth %K value-based care %K patient-reported outcome measures %K patient-reported experience measures %K questionnaires %K response rate %K telemedicine platform %D 2024 %7 28.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Patient-reported outcome and experience measures can play a critical role in providing patient-centered and value-based health care to a growing population of patients who are chronically ill. Value-based telemedicine platforms such as the Naveta initiative may facilitate the effective integration of these tools into health care systems. Objective: This study aims to evaluate the response rate to electronic patient-reported outcome measures (ePROMs) and electronic patient-reported experience measures (ePREMs) among patients participating in the Naveta telemedicine initiative and its correlations with sociodemographic and clinical characteristics, as well as the evolution of the response rates over time. Methods: Between January 1, 2021, and June 30, 2023, a total of 53,364 ePREMs and ePROMs for 20 chronic conditions were administered through the Naveta-Phemium platform. Descriptive statistics were used to summarize continuous and categorical variables. Differences in response rates within each sociodemographic variable were analyzed using logistic regression models, with significance assessed via chi-square and post hoc Tukey tests. Two-way ANOVA was used to examine the interaction between time interval and disease type on response rate evolution. Results: A total of 3372 patients with severe chronic diseases from 64 public hospitals in Spain participated in the Naveta health questionnaire project. The overall response rate to ePROMs and ePREMs during the first 2.5 years of the Naveta initiative was 46.12% (24,704/53,364), with a baseline rate of 53.33% (7198/13,496). Several sociodemographic factors correlated with lower response rates, including male gender, older age, lower education level, frequent alcohol use, being a student, and not being physically active. There were also significant variations in response rates among different types of chronic conditions (P<.001), with the highest rates being for respiratory (433/606, 71.5%), oncologic (200/319, 62.7%), digestive (2247/3601, 62.4%), and rheumatic diseases (7506/12,982, 57.82%) and the lowest being for HIV infection (7473/22,695, 32.93%). During the first 6 months of follow-up, the response rates decreased in all disease types, except in the case of the group of patients with oncologic disease, among whom the response rate increased up to 100% (6/6). Subsequently, the overall response rate approached baseline levels. Conclusions: Recognizing the influence of sociodemographic factors on response rates is critical to identifying barriers to participation in telemonitoring programs and ensuring inclusiveness in patient-centered health care practices. The observed decline in response rates at follow-up may be due to survey fatigue, highlighting the need for strategies to mitigate this effect. In addition, the variation in response rates across chronic conditions emphasizes the importance of tailoring telemonitoring approaches to specific patient populations. %M 38545697 %R 10.2196/56196 %U https://mhealth.jmir.org/2024/1/e56196 %U https://doi.org/10.2196/56196 %U http://www.ncbi.nlm.nih.gov/pubmed/38545697 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e48777 %T Detection of Mild Cognitive Impairment Through Hand Motor Function Under Digital Cognitive Test: Mixed Methods Study %A Li,Aoyu %A Li,Jingwen %A Chai,Jiali %A Wu,Wei %A Chaudhary,Suamn %A Zhao,Juanjuan %A Qiang,Yan %+ College of Computer Science and Technology (College of Data Science), Taiyuan University of Technology, No. 209, University Street, Yuji District, Shanxi Province, Jinzhong, 030024, China, 86 18635168680, qiangyan@tyut.edu.cn %K mild cognitive impairment %K movement kinetics %K digital cognitive test %K dual task %K mobile phone %D 2024 %7 26.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Early detection of cognitive impairment or dementia is essential to reduce the incidence of severe neurodegenerative diseases. However, currently available diagnostic tools for detecting mild cognitive impairment (MCI) or dementia are time-consuming, expensive, or not widely accessible. Hence, exploring more effective methods to assist clinicians in detecting MCI is necessary. Objective: In this study, we aimed to explore the feasibility and efficiency of assessing MCI through movement kinetics under tablet-based “drawing and dragging” tasks. Methods: We iteratively designed “drawing and dragging” tasks by conducting symposiums, programming, and interviews with stakeholders (neurologists, nurses, engineers, patients with MCI, healthy older adults, and caregivers). Subsequently, stroke patterns and movement kinetics were evaluated in healthy control and MCI groups by comparing 5 categories of features related to hand motor function (ie, time, stroke, frequency, score, and sequence). Finally, user experience with the overall cognitive screening system was investigated using structured questionnaires and unstructured interviews, and their suggestions were recorded. Results: The “drawing and dragging” tasks can detect MCI effectively, with an average accuracy of 85% (SD 2%). Using statistical comparison of movement kinetics, we discovered that the time- and score-based features are the most effective among all the features. Specifically, compared with the healthy control group, the MCI group showed a significant increase in the time they took for the hand to switch from one stroke to the next, with longer drawing times, slow dragging, and lower scores. In addition, patients with MCI had poorer decision-making strategies and visual perception of drawing sequence features, as evidenced by adding auxiliary information and losing more local details in the drawing. Feedback from user experience indicates that our system is user-friendly and facilitates screening for deficits in self-perception. Conclusions: The tablet-based MCI detection system quantitatively assesses hand motor function in older adults and further elucidates the cognitive and behavioral decline phenomenon in patients with MCI. This innovative approach serves to identify and measure digital biomarkers associated with MCI or Alzheimer dementia, enabling the monitoring of changes in patients’ executive function and visual perceptual abilities as the disease advances. %M 38924786 %R 10.2196/48777 %U https://mhealth.jmir.org/2024/1/e48777 %U https://doi.org/10.2196/48777 %U http://www.ncbi.nlm.nih.gov/pubmed/38924786 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e52831 %T Examining Associations Between Smartphone Use and Clinical Severity in Frontotemporal Dementia: Proof-of-Concept Study %A Paolillo,Emily W %A Casaletto,Kaitlin B %A Clark,Annie L %A Taylor,Jack C %A Heuer,Hilary W %A Wise,Amy B %A Dhanam,Sreya %A Sanderson-Cimino,Mark %A Saloner,Rowan %A Kramer,Joel H %A Kornak,John %A Kremers,Walter %A Forsberg,Leah %A Appleby,Brian %A Bayram,Ece %A Bozoki,Andrea %A Brushaber,Danielle %A Darby,R Ryan %A Day,Gregory S %A Dickerson,Bradford C %A Domoto-Reilly,Kimiko %A Elahi,Fanny %A Fields,Julie A %A Ghoshal,Nupur %A Graff-Radford,Neill %A G H Hall,Matthew %A Honig,Lawrence S %A Huey,Edward D %A Lapid,Maria I %A Litvan,Irene %A Mackenzie,Ian R %A Masdeu,Joseph C %A Mendez,Mario F %A Mester,Carly %A Miyagawa,Toji %A Naasan,Georges %A Pascual,Belen %A Pressman,Peter %A Ramos,Eliana Marisa %A Rankin,Katherine P %A Rexach,Jessica %A Rojas,Julio C %A VandeVrede,Lawren %A Wong,Bonnie %A Wszolek,Zbigniew K %A Boeve,Bradley F %A Rosen,Howard J %A Boxer,Adam L %A Staffaroni,Adam M %A , %+ Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 19094158, San Francisco, CA, 94158, United States, 1 3476615999, emily.paolillo@ucsf.edu %K digital %K technology %K remote %K monitoring %K cognition %K neuropsychology %K cognitive impairment %K neurodegenerative %K screening %K clinical trials %K mobile phone %D 2024 %7 26.6.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Frontotemporal lobar degeneration (FTLD) is a leading cause of dementia in individuals aged <65 years. Several challenges to conducting in-person evaluations in FTLD illustrate an urgent need to develop remote, accessible, and low-burden assessment techniques. Studies of unobtrusive monitoring of at-home computer use in older adults with mild cognitive impairment show that declining function is reflected in reduced computer use; however, associations with smartphone use are unknown. Objective: This study aims to characterize daily trajectories in smartphone battery use, a proxy for smartphone use, and examine relationships with clinical indicators of severity in FTLD. Methods: Participants were 231 adults (mean age 52.5, SD 14.9 years; n=94, 40.7% men; n=223, 96.5% non-Hispanic White) enrolled in the Advancing Research and Treatment of Frontotemporal Lobar Degeneration (ARTFL study) and Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects (LEFFTDS study) Longitudinal Frontotemporal Lobar Degeneration (ALLFTD) Mobile App study, including 49 (21.2%) with mild neurobehavioral changes and no functional impairment (ie, prodromal FTLD), 43 (18.6%) with neurobehavioral changes and functional impairment (ie, symptomatic FTLD), and 139 (60.2%) clinically normal adults, of whom 55 (39.6%) harbored heterozygous pathogenic or likely pathogenic variants in an autosomal dominant FTLD gene. Participants completed the Clinical Dementia Rating plus National Alzheimer’s Coordinating Center Frontotemporal Lobar Degeneration Behavior and Language Domains (CDR+NACC FTLD) scale, a neuropsychological battery; the Neuropsychiatric Inventory; and brain magnetic resonance imaging. The ALLFTD Mobile App was installed on participants’ smartphones for remote, passive, and continuous monitoring of smartphone use. Battery percentage was collected every 15 minutes over an average of 28 (SD 4.2; range 14-30) days. To determine whether temporal patterns of battery percentage varied as a function of disease severity, linear mixed effects models examined linear, quadratic, and cubic effects of the time of day and their interactions with each measure of disease severity on battery percentage. Models covaried for age, sex, smartphone type, and estimated smartphone age. Results: The CDR+NACC FTLD global score interacted with time on battery percentage such that participants with prodromal or symptomatic FTLD demonstrated less change in battery percentage throughout the day (a proxy for less smartphone use) than clinically normal participants (P<.001 in both cases). Additional models showed that worse performance in all cognitive domains assessed (ie, executive functioning, memory, language, and visuospatial skills), more neuropsychiatric symptoms, and smaller brain volumes also associated with less battery use throughout the day (P<.001 in all cases). Conclusions: These findings support a proof of concept that passively collected data about smartphone use behaviors associate with clinical impairment in FTLD. This work underscores the need for future studies to develop and validate passive digital markers sensitive to longitudinal clinical decline across neurodegenerative diseases, with potential to enhance real-world monitoring of neurobehavioral change. %M 38922667 %R 10.2196/52831 %U https://aging.jmir.org/2024/1/e52831 %U https://doi.org/10.2196/52831 %U http://www.ncbi.nlm.nih.gov/pubmed/38922667 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52248 %T User Requirements and Perceptions of a Sensor System for Early Stress Detection in People With Dementia and People With Intellectual Disability: Qualitative Study %A Adam,Esmee %A Meiland,Franka %A Frielink,Noud %A Meinders,Erwin %A Smits,Reon %A Embregts,Petri %A Smaling,Hanneke %+ Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, Netherlands, 31 071 526 84 44, e.adam@lumc.nl %K stress detection %K sensor system %K garment integrated %K wearable %K user requirements %K dementia %K intellectual disability %K intellectual disabilities %K long-term care %K perceptions %K wearables %K qualitative study %K residents %K communication impairment %K impairments %K garment sensor %D 2024 %7 21.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Timely detection of stress in people with dementia and people with an intellectual disability (ID) may reduce the occurrence of challenging behavior. However, detecting stress is often challenging as many long-term care (LTC) residents with dementia and residents with ID have communication impairments, limiting their ability to express themselves. Wearables can help detect stress but are not always accepted by users and are uncomfortable to wear for longer periods. Integrating sensors into clothing may be a more acceptable approach for users in LTC. To develop a sensor system for early stress detection that is accepted by LTC residents with dementia and residents with ID, understanding their perceptions and requirements is essential. Objective: This study aimed to (1) identify user requirements for a garment-integrated sensor system (wearable) for early stress detection in people with dementia and people with ID, (2) explore the perceptions of the users toward the sensor system, and (3) investigate the implementation requirements in LTC settings. Methods: A qualitative design with 18 focus groups and 29 interviews was used. Focus groups and interviews were conducted per setting (dementia, ID) and target group (people with dementia, people with ID, family caregivers, health care professionals). The focus groups were conducted at 3 time points within a 6-month period, where each new focus group built on the findings of previous rounds. The data from each round were used to (further) develop the sensor system. A thematic analysis with an inductive approach was used to analyze the data. Results: The study included 44 participants who expressed a positive attitude toward the idea of a garment-integrated sensor system but also identified some potential concerns. In addition to early stress detection, participants recognized other potential purposes or benefits of the sensor system, such as identifying triggers for challenging behavior, evaluating intervention effects, and diagnostic purposes. Participants emphasized the importance of meeting specific system requirements, such as washability and safety, and user requirements, such as customizability and usability, to increase user acceptance. Moreover, some participants were concerned the sensor system could contribute to the replacement of human contact by technology. Important factors for implementation included the cost of the sensor system, added value to resident and health care professionals, and education for all users. Conclusions: The idea of a garment-integrated sensor system for early stress detection in LTC for people with dementia and people with ID is perceived as positive and promising by stakeholders. To increase acceptability and implementation success, it is important to develop an easy-to-use, customizable wearable that has a clear and demonstrable added value for health care professionals and LTC residents. The next step involves pilot-testing the developed wearable with LTC residents with dementia and residents with ID in clinical practice. %R 10.2196/52248 %U https://formative.jmir.org/2024/1/e52248 %U https://doi.org/10.2196/52248 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e58565 %T Early Detection of 5 Neurodevelopmental Disorders of Children and Prevention of Postnatal Depression With a Mobile Health App: Observational Cross-Sectional Study %A Denis,Fabrice %A Le Goff,Florian %A Desbois,Madhu %A Gepner,Agnes %A Feliciano,Guillaume %A Silber,Denise %A Zeitoun,Jean-David %A Assuied,Guedalia Peretz %+ Institute for Smarthealth INeS, 64 rue de Degré, Le Mans, 72000, France, 33 0684190480, fabrice.denis.home@gmail.com %K mobile phone %K pediatric %K infant %K baby %K neonate %K newborn %K toddler %K child %K early detection %K app %K application %K screening %K algorithm %K NDD %K neurodevelopmental disorder %K autism %K ASD %K autism spectrum disorder %K attention deficit/hyperactivity disorder %K ADHD %K attention deficit %K PND %K postnatal depression %K mHealth %K mobile health %K real-world study %K smartphone %K dyspraxia %K delayed %K language %K dyslexia %K incidence %K prevalence %D 2024 %7 18.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Delay in the diagnosis of neurodevelopmental disorders (NDDs) in toddlers and postnatal depression (PND) is a major public health issue. In both cases, early intervention is crucial but too rarely implemented in practice. Objective: Our goal was to determine if a dedicated mobile app can improve screening of 5 NDDs (autism spectrum disorder [ASD], language delay, dyspraxia, dyslexia, and attention-deficit/hyperactivity disorder [ADHD]) and reduce PND incidence. Methods: We performed an observational, cross-sectional, data-based study in a population of young parents in France with at least 1 child aged <10 years at the time of inclusion and regularly using Malo, an “all-in-one” multidomain digital health record electronic patient-reported outcome (PRO) app for smartphones. We included the first 50,000 users matching the criteria and agreeing to participate between May 1, 2022, and February 8, 2024. Parents received periodic questionnaires assessing skills in neurodevelopment domains via the app. Mothers accessed a support program to prevent PND and were requested to answer regular PND questionnaires. When any PROs matched predefined criteria, an in-app recommendation was sent to book an appointment with a family physician or pediatrician. The main outcomes were the median age of the infant at the time of notification for possible NDD and the incidence of PND detection after childbirth. One secondary outcome was the relevance of the NDD notification by consultation as assessed by health professionals. Results: Among 55,618 children median age 4 months (IQR 9), 439 (0.8%) had at least 1 disorder for which consultation was critically necessary. The median ages of notification for probable ASD, language delay, dyspraxia, dyslexia, and ADHD were 32.5 (IQR 12.8), 16 (IQR 13), 36 (IQR 22.5), 80 (IQR 5), and 61 (IQR 15.5) months, respectively. The rate of probable ADHD, ASD, dyslexia, language delay, and dyspraxia in the population of children of the age included between the detection limits of each alert was 1.48%, 0.21%, 1.52%, 0.91%, and 0.37%, respectively. Sensitivity of alert notifications for suspected NDDs as assessed by the physicians was 78.6% and specificity was 98.2%. Among 8243 mothers who completed a PND questionnaire, highly probable PND was detected in 938 (11.4%), corresponding to a reduction of –31% versus our previous study without a support program. Suspected PND was detected a median 96 days (IQR 86) after childbirth. Among 130 users who filled in the satisfaction survey, 99.2% (129/130) found the app easy to use and 70% (91/130) reported that the app improved follow-up of their child. The app was rated 4.8/5 on Apple’s App Store. Conclusions: Algorithm-based early alerts suggesting NDDs were highly specific with good sensitivity as assessed by real-life practitioners. Early detection of 5 NDDs and PNDs was efficient and led to a possible 31% reduction in PND incidence. Trial Registration: ClinicalTrials.gov NCT06301087; https://www.clinicaltrials.gov/study/NCT06301087 %M 38888952 %R 10.2196/58565 %U https://publichealth.jmir.org/2024/1/e58565 %U https://doi.org/10.2196/58565 %U http://www.ncbi.nlm.nih.gov/pubmed/38888952 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53642 %T Development of a Subjective Visual Vertical Test System Using a Smartphone With Virtual Reality Goggles for Screening of Otolithic Dysfunction: Observational Study %A Umibe,Akiko %A Fushiki,Hiroaki %A Tsunoda,Reiko %A Kuroda,Tatsuaki %A Kuroda,Kazuhiro %A Tanaka,Yasuhiro %+ Department of Otorhinolaryngology, Head and Neck Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minami-Koshigaya, Koshigaya-shi, Saitama, 343-8555, Japan, 81 489651111, aumibe@dokkyomed.ac.jp %K vestibular function tests %K telemedicine %K smartphone %K virtual reality %K otolith dysfunction screening tool %K vestibular evoked myogenic potential %K iPhone %K mobile phone %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The subjective visual vertical (SVV) test can evaluate otolith function and spatial awareness and is performed in dedicated vertigo centers using specialized equipment; however, it is not otherwise widely used because of the specific equipment and space requirements. An SVV test smartphone app was developed to easily perform assessments in outpatient facilities. Objective: This study aimed to verify whether the SVV test smartphone app with commercially available virtual reality goggles can be used in a clinical setting. Methods: The reference range was calculated for 15 healthy participants. We included 14 adult patients with unilateral vestibular neuritis, sudden sensorineural hearing loss with vertigo, and Meniere disease and investigated the correlation between the SVV test results and vestibular evoked myogenic potential (VEMP) results. Results: The SVV reference range of healthy participants for the sitting front-facing position was small, ranging from –2.6º to 2.3º. Among the 14 patients, 6 (43%) exceeded the reference range for healthy participants. The SVV of patients with vestibular neuritis and sudden sensorineural hearing loss tended to deviate to the affected side. A total of 9 (64%) had abnormal cervical VEMP (cVEMP) values and 6 (43%) had abnormal ocular VEMP (oVEMP) values. No significant difference was found between the presence or absence of abnormal SVV values and the presence or absence of abnormal cVEMP and oVEMP values; however, the odds ratios (ORs) suggested a higher likelihood of abnormal SVV values among those with abnormal cVEMP and oVEMP responses (OR 2.40, 95% CI 0.18-32.88; P>.99; and OR 2, 95% CI 0.90-4.45; P=.46, respectively). Conclusions: The SVV app can be used anywhere and in a short period while reducing directional bias by using virtual reality goggles, thus making it highly versatile and useful as a practical otolith dysfunction screening tool. %M 38833295 %R 10.2196/53642 %U https://formative.jmir.org/2024/1/e53642 %U https://doi.org/10.2196/53642 %U http://www.ncbi.nlm.nih.gov/pubmed/38833295 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57292 %T Evaluation of Artificial Intelligence Algorithms for Diabetic Retinopathy Detection: Protocol for a Systematic Review and Meta-Analysis %A Sesgundo III,Jaime Angeles %A Maeng,David Collin %A Tukay,Jumelle Aubrey %A Ascano,Maria Patricia %A Suba-Cohen,Justine %A Sampang,Virginia %+ Office of Medical Research, University of Nevada, Reno School of Medicine, 1664 N. Virginia St, Reno, NV, 89557, United States, 1 7757841110, jsesgundo@med.unr.edu %K artificial intelligence %K diabetic retinopathy %K deep learning %K ophthalmology %K accuracy %K imaging %K AI %K DR %K complication %K retinopathy %K Optha %K AI algorithms %K detection %K management %K ophthalmologists %K early detection %K screening %K meta-analysis %K diabetes mellitus %K DM %K diabetes %K systematic review %D 2024 %7 27.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Diabetic retinopathy (DR) is one of the most common complications of diabetes mellitus. The global burden is immense with a worldwide prevalence of 8.5%. Recent advancements in artificial intelligence (AI) have demonstrated the potential to transform the landscape of ophthalmology with earlier detection and management of DR. Objective: This study seeks to provide an update and evaluate the accuracy and current diagnostic ability of AI in detecting DR versus ophthalmologists. Additionally, this review will highlight the potential of AI integration to enhance DR screening, management, and disease progression. Methods: A systematic review of the current landscape of AI’s role in DR will be undertaken, guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) model. Relevant peer-reviewed papers published in English will be identified by searching 4 international databases: PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. Eligible studies will include randomized controlled trials, observational studies, and cohort studies published on or after 2022 that evaluate AI’s performance in retinal imaging detection of DR in diverse adult populations. Studies that focus on specific comorbid conditions, nonimage-based applications of AI, or those lacking a direct comparison group or clear methodology will be excluded. Selected papers will be independently assessed for bias by 2 review authors (JS and DM) using the Quality Assessment of Diagnostic Accuracy Studies tool for systematic reviews. Upon systematic review completion, if it is determined that there are sufficient data, a meta-analysis will be performed. Data synthesis will use a quantitative model. Statistical software such as RevMan and STATA will be used to produce a random-effects meta-regression model to pool data from selected studies. Results: Using selected search queries across multiple databases, we accumulated 3494 studies regarding our topic of interest, of which 1588 were duplicates, leaving 1906 unique research papers to review and analyze. Conclusions: This systematic review and meta-analysis protocol outlines a comprehensive evaluation of AI for DR detection. This active study is anticipated to assess the current accuracy of AI methods in detecting DR. International Registered Report Identifier (IRRID): DERR1-10.2196/57292 %M 38801771 %R 10.2196/57292 %U https://www.researchprotocols.org/2024/1/e57292 %U https://doi.org/10.2196/57292 %U http://www.ncbi.nlm.nih.gov/pubmed/38801771 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56607 %T Impact of an Automated Population-Level Cirrhosis Screening Program Using Common Pathology Tests on Rates of Cirrhosis Diagnosis and Linkage to Specialist Care (CAPRISE): Protocol for a Pilot Prospective Single-Arm Intervention Study %A Flores,Joan Ericka %A Trambas,Christina %A Jovanovic,Natasha %A Thompson,Alexander J %A Howell,Jessica %+ Department of Gastroenterology, St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy VIC 3065, Fitzroy, 3065, Australia, 61 0392312211, ericka.flores@svha.org.au %K noninvasive tests %K cirrhosis %K population health %K screening %K liver cirrhosis %K liver %K compensated %K risk factor %K pathology %K population based %K liver screening %K prevalence %K hepatocellular carcinoma %K transient elastography %K FibroScan %D 2024 %7 22.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: People with compensated cirrhosis receive the greatest benefit from risk factor modification and prevention programs to reduce liver decompensation and improve early liver cancer detection. Blood-based liver fibrosis algorithms such as the Aspartate Transaminase–to-Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) index are calculated using routinely ordered blood tests and are effective screening tests to exclude cirrhosis in people with chronic liver disease, triaging the need for further investigations to confirm cirrhosis and linkage to specialist care. Objective: This pilot study aims to evaluate the impact of a population screening program for liver cirrhosis (CAPRISE [Cirrhosis Automated APRI and FIB-4 Screening Evaluation]), which uses automated APRI and FIB-4 calculation and reporting on routinely ordered blood tests, on monthly rates of referral for transient elastography, cirrhosis diagnosis, and linkage to specialist care. Methods: We have partnered with a large pathology service in Victoria, Australia, to pilot a population-level liver cirrhosis screening package, which comprises (1) automated calculation and reporting of APRI and FIB-4 on routinely ordered blood tests; (2) provision of brief information about liver cirrhosis; and (3) a web link for transient elastography referral. APRI and FIB-4 will be prospectively calculated on all community-ordered pathology results in adults attending a single pathology service. This single-center, prospective, single-arm, pre-post study will compare the monthly rates of transient elastography (FibroScan) referral, liver cirrhosis diagnosis, and the proportion linked to specialist care in the 6 months after intervention to the 6 months prior to the intervention. Results: As of January 2024, in the preintervention phase of this study, a total of 120,972 tests were performed by the laboratory. Of these tests, 78,947 (65.3%) tests were excluded, with the remaining 42,025 (34.7%) tests on 37,872 individuals meeting inclusion criteria with APRI and FIB-4 being able to be calculated. Of these 42,025 tests, 1.3% (n=531) had elevated APRI>1 occurring in 446 individuals, and 2.3% (n=985) had elevated FIB-4>2.67 occurring in 816 individuals. Linking these data with FibroScan referral and appointment attendance is ongoing and will continue during the intervention phase, which is expected to commence on February 1, 2024. Conclusions: We will determine the feasibility and effectiveness of automated APRI and FIB-4 reporting on the monthly rate of transient elastography referrals, liver cirrhosis diagnosis, and linkage to specialist care. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12623000295640; https://tinyurl.com/58dv9ypp International Registered Report Identifier (IRRID): DERR1-10.2196/56607 %M 38776541 %R 10.2196/56607 %U https://www.researchprotocols.org/2024/1/e56607 %U https://doi.org/10.2196/56607 %U http://www.ncbi.nlm.nih.gov/pubmed/38776541 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55064 %T Dashboards to Support Implementation of the Quebec Alzheimer Plan: Evaluation Study With Regional and Professional Considerations %A Arsenault-Lapierre,Genevieve %A Lemay-Compagnat,Alexandra %A Guillette,Maxime %A Couturier,Yves %A Massamba,Victoria %A Dufour,Isabelle %A Maubert,Eric %A Fournier,Christine %A Denis,Julie %A Morin,Caroline %A Vedel,Isabelle %+ Center for Research and Expertise in Social Gerontology, Centre intégré universitaire de santé et de services sociaux du Centre-Ouest de l'Ile de Montréal, 5800 Boulevard Cavendish suite 600, Côte Saint-Luc, QC, H4W 2T5, Canada, 1 514 484 7878 ext 61553, genevieve.arsenault-lapierre@mail.mcgill.ca %K dashboard %K learning health system %K health policy %K dementia care %K health care regionalization %K dementia %K Alzheimer disease %K qualitative %K collaborative %K focus group %K primary care %K implementation %K attitude %K opinion %K perception %K perspective %K service %K health care management %D 2024 %7 8.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Health organizations face the critical task of executing and overseeing comprehensive health care. To address the challenges associated with this task, evidence-based dashboards have emerged as valuable tools. Since 2016, the regional health organizations of Quebec, Canada, have been responsible for ensuring implementation of the Quebec Alzheimer Plan (QAP), a provincial plan that aims to reinforce the capacity of primary care services to detect, diagnose, and treat persons with dementia. Despite the provincial scope of the QAP, the diverse material and human resources across regions introduce variability in the interest, utility, and specific needs associated with these dashboards. Objective: The aim of this study was to assess the interest and utility of dashboards to support the QAP implementation, as well as to determine the needs for improving these aspects according to the perspectives of various types of professionals involved across regions. Methods: An evaluative study using qualitative methods was conducted within a collaborative research approach involving different stakeholders, including the ministerial advisor and the four project managers responsible for supporting the implementation of the QAP, as well as researchers/scientific advisors. To support these organizations, we developed tailored, 2-page paper dashboards, detailing quantitative data on the prevalence of dementia, the use of health services by persons with dementia, and achievements and challenges of the QAP implementation in each organization’s jurisdiction. We then conducted 23 focus groups with the managers and leading clinicians involved in the implementation of the QAP of each regional health organization. Real-time notes were taken using a structured observation grid. Content analysis was conducted according to different regions (organizations with university mandates or nearby organizations, labeled “university/peripheral”; organizations for which only part of the territory is in rural areas, labeled “mixed”; and organizations in remote or isolated areas, labeled “remote/isolated”) and according to different types of participants (managers, leading clinicians, and other participants). Results: Participants from organizations in all regions expressed interest in these dashboards and found them useful in several ways. However, they highlighted the need for indicators on orphan patients and other health care providers. Differences between regions were observed, particularly in the interest in continuity of care in university/peripheral regions and the need for diagnostic tools adapted to the culture in remote/isolated regions. Conclusions: These dashboards support the implementation of an Alzheimer Plan and contribute to the emergence of a learning health care system culture. This project allows each region to increase its monitoring capacity for the implementation of the QAP and facilitates reflection among individuals locally carrying out the implementation. The perspectives expressed will guide the preparation of the next iteration of the dashboards. %M 38717803 %R 10.2196/55064 %U https://formative.jmir.org/2024/1/e55064 %U https://doi.org/10.2196/55064 %U http://www.ncbi.nlm.nih.gov/pubmed/38717803 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e54622 %T Harnessing Consumer Wearable Digital Biomarkers for Individualized Recognition of Postpartum Depression Using the All of Us Research Program Data Set: Cross-Sectional Study %A Hurwitz,Eric %A Butzin-Dozier,Zachary %A Master,Hiral %A O'Neil,Shawn T %A Walden,Anita %A Holko,Michelle %A Patel,Rena C %A Haendel,Melissa A %+ Department of Genetics, University of North Carolina at Chapel Hill, 120 Mason Farm Road, Chapel Hill, NC, 27599, United States, 1 9198436475, eric_hurwitz@med.unc.edu %K wearable device %K All of Us %K postpartum depression %K machine learning %K Fitbit %K mobile phone %D 2024 %7 2.5.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Postpartum depression (PPD) poses a significant maternal health challenge. The current approach to detecting PPD relies on in-person postpartum visits, which contributes to underdiagnosis. Furthermore, recognizing PPD symptoms can be challenging. Therefore, we explored the potential of using digital biomarkers from consumer wearables for PPD recognition. Objective: The main goal of this study was to showcase the viability of using machine learning (ML) and digital biomarkers related to heart rate, physical activity, and energy expenditure derived from consumer-grade wearables for the recognition of PPD. Methods: Using the All of Us Research Program Registered Tier v6 data set, we performed computational phenotyping of women with and without PPD following childbirth. Intraindividual ML models were developed using digital biomarkers from Fitbit to discern between prepregnancy, pregnancy, postpartum without depression, and postpartum with depression (ie, PPD diagnosis) periods. Models were built using generalized linear models, random forest, support vector machine, and k-nearest neighbor algorithms and evaluated using the κ statistic and multiclass area under the receiver operating characteristic curve (mAUC) to determine the algorithm with the best performance. The specificity of our individualized ML approach was confirmed in a cohort of women who gave birth and did not experience PPD. Moreover, we assessed the impact of a previous history of depression on model performance. We determined the variable importance for predicting the PPD period using Shapley additive explanations and confirmed the results using a permutation approach. Finally, we compared our individualized ML methodology against a traditional cohort-based ML model for PPD recognition and compared model performance using sensitivity, specificity, precision, recall, and F1-score. Results: Patient cohorts of women with valid Fitbit data who gave birth included <20 with PPD and 39 without PPD. Our results demonstrated that intraindividual models using digital biomarkers discerned among prepregnancy, pregnancy, postpartum without depression, and postpartum with depression (ie, PPD diagnosis) periods, with random forest (mAUC=0.85; κ=0.80) models outperforming generalized linear models (mAUC=0.82; κ=0.74), support vector machine (mAUC=0.75; κ=0.72), and k-nearest neighbor (mAUC=0.74; κ=0.62). Model performance decreased in women without PPD, illustrating the method’s specificity. Previous depression history did not impact the efficacy of the model for PPD recognition. Moreover, we found that the most predictive biomarker of PPD was calories burned during the basal metabolic rate. Finally, individualized models surpassed the performance of a conventional cohort-based model for PPD detection. Conclusions: This research establishes consumer wearables as a promising tool for PPD identification and highlights personalized ML approaches, which could transform early disease detection strategies. %M 38696234 %R 10.2196/54622 %U https://mhealth.jmir.org/2024/1/e54622 %U https://doi.org/10.2196/54622 %U http://www.ncbi.nlm.nih.gov/pubmed/38696234 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e49002 %T Implementation of Health IT for Cancer Screening in US Primary Care: Scoping Review %A Owens-Jasey,Constance %A Chen,Jinying %A Xu,Ran %A Angier,Heather %A Huebschmann,Amy G %A Ito Fukunaga,Mayuko %A Chaiyachati,Krisda H %A Rendle,Katharine A %A Robien,Kim %A DiMartino,Lisa %A Amante,Daniel J %A Faro,Jamie M %A Kepper,Maura M %A Ramsey,Alex T %A Bressman,Eric %A Gold,Rachel %+ OCHIN, Inc, PO Box 5426, Portland, OR, 97228-5426, United States, 1 503 943 2500, owensc@ochin.org %K cancer prevention %K health information technology %K implementation %K implementation strategies %K scoping review %D 2024 %7 30.4.2024 %9 Review %J JMIR Cancer %G English %X Background: A substantial percentage of the US population is not up to date on guideline-recommended cancer screenings. Identifying interventions that effectively improve screening rates would enhance the delivery of such screening. Interventions involving health IT (HIT) show promise, but much remains unknown about how HIT is optimized to support cancer screening in primary care. Objective: This scoping review aims to identify (1) HIT-based interventions that effectively support guideline concordance in breast, cervical, and colorectal cancer screening provision and follow-up in the primary care setting and (2) barriers or facilitators to the implementation of effective HIT in this setting. Methods: Following scoping review guidelines, we searched MEDLINE, CINAHL Plus, Web of Science, and IEEE Xplore databases for US-based studies from 2015 to 2021 that featured HIT targeting breast, colorectal, and cervical cancer screening in primary care. Studies were dual screened using a review criteria checklist. Data extraction was guided by the following implementation science frameworks: the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework; the Expert Recommendations for Implementing Change taxonomy; and implementation strategy reporting domains. It was also guided by the Integrated Technology Implementation Model that incorporates theories of both implementation science and technology adoption. Reporting was guided by PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Results: A total of 101 studies met the inclusion criteria. Most studies (85/101, 84.2%) involved electronic health record–based HIT interventions. The most common HIT function was clinical decision support, primarily used for panel management or at the point of care. Most studies related to HIT targeting colorectal cancer screening (83/101, 82.2%), followed by studies related to breast cancer screening (28/101, 27.7%), and cervical cancer screening (19/101, 18.8%). Improvements in cancer screening were associated with HIT-based interventions in most studies (36/54, 67% of colorectal cancer–relevant studies; 9/14, 64% of breast cancer–relevant studies; and 7/10, 70% of cervical cancer–relevant studies). Most studies (79/101, 78.2%) reported on the reach of certain interventions, while 17.8% (18/101) of the included studies reported on the adoption or maintenance. Reported barriers and facilitators to HIT adoption primarily related to inner context factors of primary care settings (eg, staffing and organizational policies that support or hinder HIT adoption). Implementation strategies for HIT adoption were reported in 23.8% (24/101) of the included studies. Conclusions: There are substantial evidence gaps regarding the effectiveness of HIT-based interventions, especially those targeting guideline-concordant breast and colorectal cancer screening in primary care. Even less is known about how to enhance the adoption of technologies that have been proven effective in supporting breast, colorectal, or cervical cancer screening. Research is needed to ensure that the potential benefits of effective HIT-based interventions equitably reach diverse primary care populations. %M 38687595 %R 10.2196/49002 %U https://cancer.jmir.org/2024/1/e49002 %U https://doi.org/10.2196/49002 %U http://www.ncbi.nlm.nih.gov/pubmed/38687595 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54934 %T The Applications of Artificial Intelligence for Assessing Fall Risk: Systematic Review %A González-Castro,Ana %A Leirós-Rodríguez,Raquel %A Prada-García,Camino %A Benítez-Andrades,José Alberto %+ Nursing and Physical Therapy Department, Universidad de León, Astorga Ave, Ponferrada, 24401, Spain, 34 987442000, agonzc28@estudiantes.unileon.es %K machine learning %K accidental falls %K public health %K patient care %K artificial intelligence %K AI %K fall risk %D 2024 %7 29.4.2024 %9 Review %J J Med Internet Res %G English %X Background: Falls and their consequences are a serious public health problem worldwide. Each year, 37.3 million falls requiring medical attention occur. Therefore, the analysis of fall risk is of great importance for prevention. Artificial intelligence (AI) represents an innovative tool for creating predictive statistical models of fall risk through data analysis. Objective: The aim of this review was to analyze the available evidence on the applications of AI in the analysis of data related to postural control and fall risk. Methods: A literature search was conducted in 6 databases with the following inclusion criteria: the articles had to be published within the last 5 years (from 2018 to 2024), they had to apply some method of AI, AI analyses had to be applied to data from samples consisting of humans, and the analyzed sample had to consist of individuals with independent walking with or without the assistance of external orthopedic devices. Results: We obtained a total of 3858 articles, of which 22 were finally selected. Data extraction for subsequent analysis varied in the different studies: 82% (18/22) of them extracted data through tests or functional assessments, and the remaining 18% (4/22) of them extracted through existing medical records. Different AI techniques were used throughout the articles. All the research included in the review obtained accuracy values of >70% in the predictive models obtained through AI. Conclusions: The use of AI proves to be a valuable tool for creating predictive models of fall risk. The use of this tool could have a significant socioeconomic impact as it enables the development of low-cost predictive models with a high level of accuracy. Trial Registration: PROSPERO CRD42023443277; https://tinyurl.com/4sb72ssv %M 38684088 %R 10.2196/54934 %U https://www.jmir.org/2024/1/e54934 %U https://doi.org/10.2196/54934 %U http://www.ncbi.nlm.nih.gov/pubmed/38684088 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56883 %T Psychometric Evaluation of a Tablet-Based Tool to Detect Mild Cognitive Impairment in Older Adults: Mixed Methods Study %A McMurray,Josephine %A Levy,AnneMarie %A Pang,Wei %A Holyoke,Paul %+ Lazaridis School of Business & Economics, Wilfrid Laurier University, 73 George St, Brantford, ON, N3T3Y3, Canada, 1 548 889 4492, jmcmurray@wlu.ca %K cognitive dysfunction %K dementia neuropsychological tests %K evaluation study %K technology %K aged %K mobile phone %D 2024 %7 19.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: With the rapid aging of the global population, the prevalence of mild cognitive impairment (MCI) and dementia is anticipated to surge worldwide. MCI serves as an intermediary stage between normal aging and dementia, necessitating more sensitive and effective screening tools for early identification and intervention. The BrainFx SCREEN is a novel digital tool designed to assess cognitive impairment. This study evaluated its efficacy as a screening tool for MCI in primary care settings, particularly in the context of an aging population and the growing integration of digital health solutions. Objective: The primary objective was to assess the validity, reliability, and applicability of the BrainFx SCREEN (hereafter, the SCREEN) for MCI screening in a primary care context. We conducted an exploratory study comparing the SCREEN with an established screening tool, the Quick Mild Cognitive Impairment (Qmci) screen. Methods: A concurrent mixed methods, prospective study using a quasi-experimental design was conducted with 147 participants from 5 primary care Family Health Teams (FHTs; characterized by multidisciplinary practice and capitated funding) across southwestern Ontario, Canada. Participants included health care practitioners, patients, and FHT administrative executives. Individuals aged ≥55 years with no history of MCI or diagnosis of dementia rostered in a participating FHT were eligible to participate. Participants were screened using both the SCREEN and Qmci. The study also incorporated the Geriatric Anxiety Scale–10 to assess general anxiety levels at each cognitive screening. The SCREEN’s scoring was compared against that of the Qmci and the clinical judgment of health care professionals. Statistical analyses included sensitivity, specificity, internal consistency, and test-retest reliability assessments. Results: The study found that the SCREEN’s longer administration time and complex scoring algorithm, which is proprietary and unavailable for independent analysis, presented challenges. Its internal consistency, indicated by a Cronbach α of 0.63, was below the acceptable threshold. The test-retest reliability also showed limitations, with moderate intraclass correlation coefficient (0.54) and inadequate κ (0.15) values. Sensitivity and specificity were consistent (63.25% and 74.07%, respectively) between cross-tabulation and discrepant analysis. In addition, the study faced limitations due to its demographic skew (96/147, 65.3% female, well-educated participants), the absence of a comprehensive gold standard for MCI diagnosis, and financial constraints limiting the inclusion of confirmatory neuropsychological testing. Conclusions: The SCREEN, in its current form, does not meet the necessary criteria for an optimal MCI screening tool in primary care settings, primarily due to its longer administration time and lower reliability. As the number of digital health technologies increases and evolves, further testing and refinement of tools such as the SCREEN are essential to ensure their efficacy and reliability in real-world clinical settings. This study advocates for continued research in this rapidly advancing field to better serve the aging population. International Registered Report Identifier (IRRID): RR2-10.2196/25520 %M 38640480 %R 10.2196/56883 %U https://www.jmir.org/2024/1/e56883 %U https://doi.org/10.2196/56883 %U http://www.ncbi.nlm.nih.gov/pubmed/38640480 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45545 %T Service Quality and Residents’ Preferences for Facilitated Self-Service Fundus Disease Screening: Cross-Sectional Study %A Lin,Senlin %A Ma,Yingyan %A Jiang,Yanwei %A Li,Wenwen %A Peng,Yajun %A Yu,Tao %A Xu,Yi %A Zhu,Jianfeng %A Lu,Lina %A Zou,Haidong %+ Shanghai Eye Diseases Prevention &Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, No 1440, Hongqqiao Road, Shanghai, 200336, China, 86 02162539696, zouhaidong@sjtu.edu.cn %K digital technology %K screening %K self-service %K eye disease %K health economics evaluation %K health technology assessment %K disease screening %K artificial intelligence %K AI %K eye %K community %K effectiveness %K screening efficiency %K safety %D 2024 %7 17.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Fundus photography is the most important examination in eye disease screening. A facilitated self-service eye screening pattern based on the fully automatic fundus camera was developed in 2022 in Shanghai, China; it may help solve the problem of insufficient human resources in primary health care institutions. However, the service quality and residents’ preference for this new pattern are unclear. Objective: This study aimed to compare the service quality and residents’ preferences between facilitated self-service eye screening and traditional manual screening and to explore the relationships between the screening service’s quality and residents’ preferences. Methods: We conducted a cross-sectional study in Shanghai, China. Residents who underwent facilitated self-service fundus disease screening at one of the screening sites were assigned to the exposure group; those who were screened with a traditional fundus camera operated by an optometrist at an adjacent site comprised the control group. The primary outcome was the screening service quality, including effectiveness (image quality and screening efficiency), physiological discomfort, safety, convenience, and trustworthiness. The secondary outcome was the participants’ preferences. Differences in service quality and the participants’ preferences between the 2 groups were compared using chi-square tests separately. Subgroup analyses for exploring the relationships between the screening service’s quality and residents’ preference were conducted using generalized logit models. Results: A total of 358 residents enrolled; among them, 176 (49.16%) were included in the exposure group and the remaining 182 (50.84%) in the control group. Residents’ basic characteristics were balanced between the 2 groups. There was no significant difference in service quality between the 2 groups (image quality pass rate: P=.79; average screening time: P=.57; no physiological discomfort rate: P=.92; safety rate: P=.78; convenience rate: P=.95; trustworthiness rate: P=.20). However, the proportion of participants who were willing to use the same technology for their next screening was significantly lower in the exposure group than in the control group (P<.001). Subgroup analyses suggest that distrust in the facilitated self-service eye screening might increase the probability of refusal to undergo screening (P=.02). Conclusions: This study confirms that the facilitated self-service fundus disease screening pattern could achieve good service quality. However, it was difficult to reverse residents’ preferences for manual screening in a short period, especially when the original manual service was already excellent. Therefore, the digital transformation of health care must be cautious. We suggest that attention be paid to the residents’ individual needs. More efficient man-machine collaboration and personalized health management solutions based on large language models are both needed. %M 38630535 %R 10.2196/45545 %U https://www.jmir.org/2024/1/e45545 %U https://doi.org/10.2196/45545 %U http://www.ncbi.nlm.nih.gov/pubmed/38630535 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45959 %T Mental Distress, Label Avoidance, and Use of a Mental Health Chatbot: Results From a US Survey %A Kosyluk,Kristin %A Baeder,Tanner %A Greene,Karah Yeona %A Tran,Jennifer T %A Bolton,Cassidy %A Loecher,Nele %A DiEva,Daniel %A Galea,Jerome T %+ Department of Mental Health Law & Policy, University of South Florida, 13301 Bruce B Downs Boulevard, MHC 2735, Tampa, FL, 33612, United States, 1 8139746019, kkosyluk@usf.edu %K chatbots %K conversational agents %K mental health %K resources %K screening %K resource referral %K stigma %K label avoidance %K survey %K training %K behavioral %K COVID-19 %K pilot test %K design %K users %K psychological distress %K symptoms %D 2024 %7 12.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: For almost two decades, researchers and clinicians have argued that certain aspects of mental health treatment can be removed from clinicians’ responsibilities and allocated to technology, preserving valuable clinician time and alleviating the burden on the behavioral health care system. The service delivery tasks that could arguably be allocated to technology without negatively impacting patient outcomes include screening, triage, and referral. Objective: We pilot-tested a chatbot for mental health screening and referral to understand the relationship between potential users’ demographics and chatbot use; the completion rate of mental health screening when delivered by a chatbot; and the acceptability of a prototype chatbot designed for mental health screening and referral. This chatbot not only screened participants for psychological distress but also referred them to appropriate resources that matched their level of distress and preferences. The goal of this study was to determine whether a mental health screening and referral chatbot would be feasible and acceptable to users. Methods: We conducted an internet-based survey among a sample of US-based adults. Our survey collected demographic data along with a battery of measures assessing behavioral health and symptoms, stigma (label avoidance and perceived stigma), attitudes toward treatment-seeking, readiness for change, and technology readiness and acceptance. Participants were then offered to engage with our chatbot. Those who engaged with the chatbot completed a mental health screening, received a distress score based on this screening, were referred to resources appropriate for their current level of distress, and were asked to rate the acceptability of the chatbot. Results: We found that mental health screening using a chatbot was feasible, with 168 (75.7%) of our 222 participants completing mental health screening within the chatbot sessions. Various demographic characteristics were associated with a willingness to use the chatbot. The participants who used the chatbot found it to be acceptable. Logistic regression produced a significant model with perceived usefulness and symptoms as significant positive predictors of chatbot use for the overall sample, and label avoidance as the only significant predictor of chatbot use for those currently experiencing distress. Conclusions: Label avoidance, the desire to avoid mental health services to avoid the stigmatized label of mental illness, is a significant negative predictor of care seeking. Therefore, our finding regarding label avoidance and chatbot use has significant public health implications in terms of facilitating access to mental health resources. Those who are high on label avoidance are not likely to seek care in a community mental health clinic, yet they are likely willing to engage with a mental health chatbot, participate in mental health screening, and receive mental health resources within the chatbot session. Chatbot technology may prove to be a way to engage those in care who have previously avoided treatment due to stigma. %M 38607665 %R 10.2196/45959 %U https://formative.jmir.org/2024/1/e45959 %U https://doi.org/10.2196/45959 %U http://www.ncbi.nlm.nih.gov/pubmed/38607665 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55270 %T Using Smartphones to Enhance Vision Screening in Rural Areas: Pilot Study %A Wang,Zheng %A Kempen,John %A Luo,Gang %+ Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, United States, 1 6179122529, gang_luo@meei.harvard.edu %K vision screening %K refractive error %K strabismus %K smartphone %K visual acuity %K vision %K visual %K eye %K eyes %K screening %K mHealth %K mobile health %K app %K apps %K application %K applications %K feasibility %K optometry %K ophthalmology %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: While it is treatable, uncorrected refractive error is the number one cause of visual impairment worldwide. This eye condition alone, or together with ocular misalignment, can also cause amblyopia, which is also treatable if detected early but still occurs in about 4% of the population. Mass vision screening is the first and most critical step to address these issues, but due to limited resources, vision screening in many rural areas remains a major challenge. Objective: We aimed to pilot-test the feasibility of using smartphone apps to enhance vision screening in areas where access to eye care is limited. Methods: A vision screening program was piggybacked on a charity summer camp program in a rural county in Sichuan, China. A total of 73 fourth and fifth graders were tested for visual acuity using a standard eye chart and were then tested for refractive error and heterophoria using 2 smartphone apps (a refraction app and a strabismus app, respectively) by nonprofessional personnel. Results: A total of 5 of 73 (6.8%, 95% CI 2.3%-15.3%) students were found to have visual acuity worse than 20/20 (logarithm of minimal angle of resolution [logMAR] 0) in at least one eye. Among the 5 students, 3 primarily had refractive error according to the refraction app. The other 2 students had manifest strabismus (one with 72–prism diopter [PD] esotropia and one with 33-PD exotropia) according to the strabismus app. Students without manifest strabismus were also measured for phoria using the strabismus app in cover/uncover mode. The median phoria was 0.0-PD (IQR 2.9-PD esophoria to 2.2-PD exophoria). Conclusions: The results from this vision screening study are consistent with findings from other population-based vision screening studies in which conventional tools were used by ophthalmic professionals. The smartphone apps are promising and have the potential to be used in mass vision screenings for identifying risk factors for amblyopia and for myopia control. The smartphone apps may have significant implications for the future of low-cost vision care, particularly in resource-constrained and geographically remote areas. %M 38573757 %R 10.2196/55270 %U https://formative.jmir.org/2024/1/e55270 %U https://doi.org/10.2196/55270 %U http://www.ncbi.nlm.nih.gov/pubmed/38573757 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47448 %T Willingness to Use Digital Health Screening and Tracking Tools for Public Health in Sexual Minority Populations in a National Probability Sample: Quantitative Intersectional Analysis %A Vincent,Wilson %+ Department of Psychology and Neuroscience, Temple University, Weiss Hall, 1701 N 13th St, Philadelphia, PA, 19122, United States, 1 404 200 0203, wilson.vincent@temple.edu %K COVID-19 %K demographics %K digital health %K disparities %K intersectionality %K mHealth %K mobile health %K psychometric properties %K sexual minority populations %D 2024 %7 8.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Little is known about sexual minority adults’ willingness to use digital health tools, such as pandemic-related tools for screening and tracking, outside of HIV prevention and intervention efforts for sexual minority men, specifically. Additionally, given the current cultural climate in the United States, heterosexual and sexual minority adults may differ in their willingness to use digital health tools, and there may be within-group differences among sexual minority adults. Objective: This study compared sexual minority and heterosexual adults’ willingness to use COVID-19–related digital health tools for public health screening and tracking and tested whether sexual minority adults differed from each other by age group, gender, and race or ethnicity. Methods: We analyzed data from a cross-sectional, national probability survey (n=2047) implemented from May 30 to June 8, 2020, in the United States during the height of the public health response to the COVID-19 pandemic. Using latent-variable modeling, heterosexual and sexual minority adults were tested for differences in their willingness to use digital health tools for public health screening and tracking. Among sexual minority adults, specifically, associations with age, gender, and race or ethnicity were assessed. Results: On average, sexual minority adults showed greater willingness to use digital health tools for screening and tracking than heterosexual adults (latent factor mean difference 0.46, 95% CI 0.15-0.77). Among sexual minority adults, there were no differences by age group, gender, or race or ethnicity. However, African American (b=0.41, 95% CI 0.19-0.62), Hispanic or Latino (b=0.36, 95% CI 0.18-0.55), and other racial or ethnic minority (b=0.54, 95% CI 0.31-0.77) heterosexual adults showed greater willingness to use digital health tools for screening and tracking than White heterosexual adults. Conclusions: In the United States, sexual minority adults were more willing to use digital health tools for screening and tracking than heterosexual adults. Sexual minority adults did not differ from each other by age, gender, or race or ethnicity in terms of their willingness to use these digital health tools, so no sexual orientation-based or intersectional disparities were identified. Furthermore, White heterosexual adults were less willing to use these tools than racial or ethnic minority heterosexual adults. Findings support the use of digital health tools with sexual minority adults, which could be important for other public health-related concerns (eg, the recent example of mpox). Additional studies are needed regarding the decision-making process of White heterosexual adults regarding the use of digital health tools to address public health crises, including pandemics or outbreaks that disproportionately affect minoritized populations. %M 38457790 %R 10.2196/47448 %U https://www.jmir.org/2024/1/e47448 %U https://doi.org/10.2196/47448 %U http://www.ncbi.nlm.nih.gov/pubmed/38457790 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e52400 %T Direct-to-Patient Mobile Teledermoscopy: Prospective Observational Study %A Fan,Winnie %A Mattson,Gunnar %A Twigg,Amanda %+ Department of Dermatology, School of Medicine, University of California San Francisco, 1701 Divisadero St, 3rd Floor, San Francisco, CA, 94115, United States, 1 415 353 7800, amanda.twigg@ucsf.edu %K mobile teledermoscopy %K teledermatology %K direct-to-patient %K full body skin exam %K diagnostic concordance %K mobile health %K mHealth %K dermoscopy %K dermatology %K dermatological %K imaging %K image %K images %K smartphone %K lesion %K lesions %K skin %K diagnostic %K diagnosis %K diagnoses %K telehealth %K telemedicine %K eHealth %D 2024 %7 12.2.2024 %9 Research Letter %J JMIR Dermatol %G English %X Direct-to-patient mobile teledermoscopy is a feasible and useful adjunct to smartphone imaging for monitoring patient-identified lesions of concern, achieving comparable diagnostic and management accuracy as in-office dermatology. %M 38345831 %R 10.2196/52400 %U https://derma.jmir.org/2024/1/e52400 %U https://doi.org/10.2196/52400 %U http://www.ncbi.nlm.nih.gov/pubmed/38345831 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54299 %T Remote Self-Administration of Cognitive Screeners for Older Adults Prior to a Primary Care Visit: Pilot Cross-Sectional Study of the Reliability and Usability of the MyCog Mobile Screening App %A Young,Stephanie Ruth %A Dworak,Elizabeth McManus %A Byrne,Greg Joseph %A Jones,Callie Madison %A Yao,Lihua %A Yoshino Benavente,Julia Noelani %A Diaz,Maria Varela %A Curtis,Laura %A Gershon,Richard %A Wolf,Michael %A Nowinski,Cindy J %+ Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 North Michigan Avenue 21st Floor, Chicago, IL, 60611-3008, United States, 1 3125033303, stephanieruth.young@northwestern.edu %K cognitive screening %K cognitive %K cognition %K psychometric %K usability %K feasibility %K early detection %K dementia %K Alzheimer’s disease, Alzheimer's %K Alzheimer’s disease and age-related dementia %K mHealth, mobile health apps %K detection %K screening %K mobile health %K mobile phone %K app %K apps %K applications %K applications %K user experience %K smartphone %K smartphones %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K aged %D 2024 %7 7.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Routine cognitive screening is essential in the early detection of dementia, but time constraints in primary care settings often limit clinicians’ ability to conduct screenings. MyCog Mobile is a newly developed cognitive screening system that patients can self-administer on their smartphones before a primary care visit, which can help save clinics’ time, encourage broader screening practices, and increase early detection of cognitive decline. Objective: The goal of this pilot study was to examine the feasibility, acceptability, and initial psychometric properties of MyCog Mobile. Research questions included (1) Can older adults complete MyCog Mobile remotely without staff support? (2) Are the internal consistency and test-retest reliability of the measures acceptable? and (3) How do participants rate the user experience of MyCog Mobile? Methods: A sample of adults aged 65 years and older (N=51) self-administered the MyCog Mobile measures remotely on their smartphones twice within a 2- to 3-week interval. The pilot version of MyCog Mobile includes 4 activities: MyFaces measures facial memory, MySorting measures executive functioning, MySequences measures working memory, and MyPictures measures episodic memory. After their first administration, participants also completed a modified version of the Simplified System Usability Scale (S-SUS) and 2 custom survey items. Results: All participants in the sample passed the practice items and completed each measure. Findings indicate that the Mobile Toolbox assessments measure the constructs well (internal consistency 0.73 to 0.91) and are stable over an approximately 2-week delay (test-retest reliability 0.61 to 0.71). Participants’ rating of the user experience (mean S-SUS score 73.17, SD 19.27) indicated that older adults found the usability of MyCog Mobile to be above average. On free-response feedback items, most participants provided positive feedback or no feedback at all, but some indicated a need for clarity in certain task instructions, concerns about participants’ abilities, desire to be able to contact a support person or use in-app technical support, and desire for additional practice items. Conclusions: Pilot evidence suggests that the MyCog Mobile cognitive screener can be reliably self-administered by older adults on their smartphones. Participants in our study generally provided positive feedback about the MyCog Mobile experience and rated the usability of the app highly. Based on participant feedback, we will conduct further usability research to improve support functionality, optimize task instructions and practice opportunities, and ensure that patients feel comfortable using MyCog Mobile. The next steps include a clinical validation study that compares MyCog Mobile to gold-standard assessments and tests the sensitivity and specificity of the measures for identifying dementia. %M 38324368 %R 10.2196/54299 %U https://formative.jmir.org/2024/1/e54299 %U https://doi.org/10.2196/54299 %U http://www.ncbi.nlm.nih.gov/pubmed/38324368 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51770 %T An Initial Validation of Community-Based Air-Conduction Audiometry in Adults With Simulated Hearing Impairment Using a New Web App, DigiBel: Validation Study %A Sienko,Anna %A Thirunavukarasu,Arun James %A Kuzmich,Tanya %A Allen,Louise %+ School of Clinical Medicine, University of Cambridge, Hills Road, Cambridge, CB2 0SP, United Kingdom, 44 1223 336700, as2866@cam.ac.uk %K audiology %K audiometry %K hearing test %K eHealth %K mobile application %K automated audiometry %K hearing loss %K hearing impairment %K web-app %K web-apps %K web-application %K digital health %K hearing %K adult %K adults %K mobile health %K mhealth %K community-based %K home-based %K assistive technology %K screening %K usability %K ears %K ear %D 2024 %7 25.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 80% of primary school children in the United States and Europe experience glue ear, which may impair hearing at a critical time for speech acquisition and social development. A web-based app, DigiBel, has been developed primarily to identify individuals with conductive hearing impairment who may benefit from the temporary use of bone-conduction assistive technology in the community. Objective: This preliminary study aims to determine the screening accuracy and usability of DigiBel self-assessed air-conduction (AC) pure tone audiometry in adult volunteers with simulated hearing impairment prior to formal clinical validation. Methods: Healthy adults, each with 1 ear plugged, underwent automated AC pure tone audiometry (reference test) and DigiBel audiometry in quiet community settings. Threshold measurements were compared across 6 tone frequencies and DigiBel test-retest reliability was calculated. The accuracy of DigiBel for detecting more than 20 dB of hearing impairment was assessed. A total of 30 adults (30 unplugged ears and 30 plugged ears) completed both audiometry tests. Results: DigiBel had 100% sensitivity (95% CI 87.23-100) and 72.73% (95% CI 54.48-86.70) specificity in detecting hearing impairment. Threshold mean bias was insignificant except at 4000 and 8000 Hz where a small but significant overestimation of threshold measurement was identified. All 24 participants completing feedback rated the DigiBel test as good or excellent and 21 (88%) participants agreed or strongly agreed that they would be able to do the test at home without help. Conclusions: This study supports the potential use of DigiBel as a screening tool for hearing impairment. The findings will be used to improve the software further prior to undertaking a formal clinical trial of AC and bone-conduction audiometry in individuals with suspected conductive hearing impairment. %M 38271088 %R 10.2196/51770 %U https://formative.jmir.org/2024/1/e51770 %U https://doi.org/10.2196/51770 %U http://www.ncbi.nlm.nih.gov/pubmed/38271088 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46402 %T Acceptance of Medical Artificial Intelligence in Skin Cancer Screening: Choice-Based Conjoint Survey %A Jagemann,Inga %A Wensing,Ole %A Stegemann,Manuel %A Hirschfeld,Gerrit %+ School of Business, University of Applied Sciences and Arts Bielefeld, Interaktion 1, Bielefeld, 33619, Germany, 49 521106 ext 70508, inga.jagemann@hsbi.de %K artificial intelligence %K skin cancer screening %K choice experiment %K melanoma %K conjoint analysis, technology acceptance %K adoption %K technology use %K dermatology %K skin cancer %K oncology %K screening %K choice based %K trust %D 2024 %7 12.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is great interest in using artificial intelligence (AI) to screen for skin cancer. This is fueled by a rising incidence of skin cancer and an increasing scarcity of trained dermatologists. AI systems capable of identifying melanoma could save lives, enable immediate access to screenings, and reduce unnecessary care and health care costs. While such AI-based systems are useful from a public health perspective, past research has shown that individual patients are very hesitant about being examined by an AI system. Objective: The aim of this study was two-fold: (1) to determine the relative importance of the provider (in-person physician, physician via teledermatology, AI, personalized AI), costs of screening (free, 10€, 25€, 40€; 1€=US $1.09), and waiting time (immediate, 1 day, 1 week, 4 weeks) as attributes contributing to patients’ choices of a particular mode of skin cancer screening; and (2) to investigate whether sociodemographic characteristics, especially age, were systematically related to participants’ individual choices. Methods: A choice-based conjoint analysis was used to examine the acceptance of medical AI for a skin cancer screening from the patient’s perspective. Participants responded to 12 choice sets, each containing three screening variants, where each variant was described through the attributes of provider, costs, and waiting time. Furthermore, the impacts of sociodemographic characteristics (age, gender, income, job status, and educational background) on the choices were assessed. Results: Among the 383 clicks on the survey link, a total of 126 (32.9%) respondents completed the online survey. The conjoint analysis showed that the three attributes had more or less equal importance in contributing to the participants’ choices, with provider being the most important attribute. Inspecting the individual part-worths of conjoint attributes showed that treatment by a physician was the most preferred modality, followed by electronic consultation with a physician and personalized AI; the lowest scores were found for the three AI levels. Concerning the relationship between sociodemographic characteristics and relative importance, only age showed a significant positive association to the importance of the attribute provider (r=0.21, P=.02), in which younger participants put less importance on the provider than older participants. All other correlations were not significant. Conclusions: This study adds to the growing body of research using choice-based experiments to investigate the acceptance of AI in health contexts. Future studies are needed to explore the reasons why AI is accepted or rejected and whether sociodemographic characteristics are associated with this decision. %M 38214959 %R 10.2196/46402 %U https://formative.jmir.org/2024/1/e46402 %U https://doi.org/10.2196/46402 %U http://www.ncbi.nlm.nih.gov/pubmed/38214959 %0 Journal Article %@ 2291-5222 %I %V 11 %N %P e53291 %T A Novel Smartphone App for Self-Monitoring of Neonatal Jaundice Among Postpartum Mothers: Qualitative Research Study %A Moosa,Aminath Shiwaza %A Ngeow,Alvin Jia Hao %A Yang,Yuhan %A Poon,Zhimin %A Ng,Ding Xuan %A Yi Ling,Eileen Koh %A Tan,Ngiap Chuan %K neonatal jaundice screening %K mobile health %K usability %K primary care %K neonatology %K neonatal %K care %K self-monitoring %K monitoring %K smartphone application %K application %K app %K mHealth app %K users %K screening %K postpartum %K postpartum mother %K usability %K utility %K data management %K applicability %K teleconsultation %K neonatal jaundice %K mHealth %D 2023 %7 22.12.2023 %9 %J JMIR Mhealth Uhealth %G English %X Background: Neonatal jaundice (NNJ) or hyperbilirubinemia is a ubiquitous condition in newborn infants. Currently, the transcutaneous bilirubinometer is used to screen for NNJ in health care facilities, where neonates need to be physically present (ie, a centralized model of care for NNJ screening). Mobile health (mHealth) apps present a low-cost, home-based, and noninvasive system that could facilitate self-monitoring of NNJ and could allow mothers the convenience of screening for NNJ remotely. However, end users’ acceptability of such mHealth apps is of fundamental importance before the incorporation of such apps into clinical practice. Objective: The study aimed to explore the perception of postpartum mothers toward self-monitoring of NNJ using a novel mHealth app. Methods: Mothers attending video consultations for early postpartum care at 2 Singapore primary care clinics watched an instructional video for a hyperbilirubinemia-screening mHealth app (HSMA). An independent researcher used a semistructured topic guide to conduct in-depth interviews with 25 mothers, assessing their views on HSMAs. All interviews were audio recorded, transcribed verbatim, and checked for accuracy before data analysis. Two researchers independently analyzed the transcripts via thematic analysis. Data were managed using NVivo qualitative data management software. Results: The identified themes were grouped under perceived usability and utility. Mothers valued the convenience and utility of HSMAs for remote monitoring of NNJ. They appreciated the objectivity the app readings provided compared to visual inspection. However, they perceived that the app’s applicability would be restricted to severe jaundice, were concerned about its accuracy and restriction to the English language, and lacked confidence in using it. Nevertheless, they were willing to use it once its accuracy was proven and when they received adequate guidance from health care professionals. They also suggested including an action plan for the measured readings and clinical signs within the app. Mothers proposed pairing teleconsultations with HSMAs to boost their confidence and enhance adoption. Conclusions: Mothers were receptive to using HSMAs but had concerns. Multiple languages, proof of accuracy, and resources to guide users should be incorporated into the app in the next phase to increase its successful adoption. Complementing such apps with a teleconsultation service presents a plausible and pragmatic NNJ care delivery model in general practice. %R 10.2196/53291 %U https://mhealth.jmir.org/2023/1/e53291 %U https://doi.org/10.2196/53291 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 7 %N %P e50813 %T Guideline-Based Cardiovascular Risk Assessment Delivered by an mHealth App: Development Study %A Starnecker,Fabian %A Reimer,Lara Marie %A Nissen,Leon %A Jovanović,Marko %A Kapsecker,Maximilian %A Rospleszcz,Susanne %A von Scheidt,Moritz %A Krefting,Johannes %A Krüger,Nils %A Perl,Benedikt %A Wiehler,Jens %A Sun,Ruoyu %A Jonas,Stephan %A Schunkert,Heribert %+ Department of Cardiology, German Heart Center Munich, Technical University of Munich, Lazarettstr. 36, Munich, 80636, Germany, 49 89 1218 2751, fabian.starnecker@tum.de %K cardiovascular disease %K cardiovascular risk assessment %K HerzFit %K mobile health app %K mHealth app %K public information campaigns %K prevention %K risk calculator %K mobile phone %D 2023 %7 8.12.2023 %9 Original Paper %J JMIR Cardio %G English %X Background: Identifying high-risk individuals is crucial for preventing cardiovascular diseases (CVDs). Currently, risk assessment is mostly performed by physicians. Mobile health apps could help decouple the determination of risk from medical resources by allowing unrestricted self-assessment. The respective test results need to be interpretable for laypersons. Objective: Together with a patient organization, we aimed to design a digital risk calculator that allows people to individually assess and optimize their CVD risk. The risk calculator was integrated into the mobile health app HerzFit, which provides the respective background information. Methods: To cover a broad spectrum of individuals for both primary and secondary prevention, we integrated the respective scores (Framingham 10-year CVD, Systematic Coronary Risk Evaluation 2, Systematic Coronary Risk Evaluation 2 in Older Persons, and Secondary Manifestations Of Arterial Disease) into a single risk calculator that was recalibrated for the German population. In primary prevention, an individual’s heart age is estimated, which gives the user an easy-to-understand metric for assessing cardiac health. For secondary prevention, the risk of recurrence was assessed. In addition, a comparison of expected to mean and optimal risk levels was determined. The risk calculator is available free of charge. Data safety is ensured by processing the data locally on the users’ smartphones. Results: Offering a risk calculator to the general population requires the use of multiple instruments, as each provides only a limited spectrum in terms of age and risk distribution. The integration of 4 internationally recommended scores allows risk calculation in individuals aged 30 to 90 years with and without CVD. Such integration requires recalibration and harmonization to provide consistent and plausible estimates. In the first 14 months after the launch, the HerzFit calculator was downloaded more than 96,000 times, indicating great demand. Public information campaigns proved effective in publicizing the risk calculator and contributed significantly to download numbers. Conclusions: The HerzFit calculator provides CVD risk assessment for the general population. The public demonstrated great demand for such a risk calculator as it was downloaded up to 10,000 times per month, depending on campaigns creating awareness for the instrument. %M 38064248 %R 10.2196/50813 %U https://cardio.jmir.org/2023/1/e50813 %U https://doi.org/10.2196/50813 %U http://www.ncbi.nlm.nih.gov/pubmed/38064248 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e46718 %T Assessment of a Digital Symptom Checker Tool's Accuracy in Suggesting Reproductive Health Conditions: Clinical Vignettes Study %A Peven,Kimberly %A Wickham,Aidan P %A Wilks,Octavia %A Kaplan,Yusuf C %A Marhol,Andrei %A Ahmed,Saddif %A Bamford,Ryan %A Cunningham,Adam C %A Prentice,Carley %A Meczner,András %A Fenech,Matthew %A Gilbert,Stephen %A Klepchukova,Anna %A Ponzo,Sonia %A Zhaunova,Liudmila %+ Flo Health UK Limited, 27 Old Gloucester Street, London, WC1N 3AX, United Kingdom, 44 60396823, a_wickham@flo.health %K women's health %K symptom checkers %K symptom checker %K digital health %K chatbot %K accuracy %K eHealth apps %K mobile phone %K mobile health %K mHealth %K mobile health app %K polycystic ovary syndrome %K gynecology %K digital health tool %K endometriosis %K uterus %K uterine %K uterine fibroids %K vignettes %K clinical vignettes %D 2023 %7 5.12.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Reproductive health conditions such as endometriosis, uterine fibroids, and polycystic ovary syndrome (PCOS) affect a large proportion of women and people who menstruate worldwide. Prevalence estimates for these conditions range from 5% to 40% of women of reproductive age. Long diagnostic delays, up to 12 years, are common and contribute to health complications and increased health care costs. Symptom checker apps provide users with information and tools to better understand their symptoms and thus have the potential to reduce the time to diagnosis for reproductive health conditions. Objective: This study aimed to evaluate the agreement between clinicians and 3 symptom checkers (developed by Flo Health UK Limited) in assessing symptoms of endometriosis, uterine fibroids, and PCOS using vignettes. We also aimed to present a robust example of vignette case creation, review, and classification in the context of predeployment testing and validation of digital health symptom checker tools. Methods: Independent general practitioners were recruited to create clinical case vignettes of simulated users for the purpose of testing each condition symptom checker; vignettes created for each condition contained a mixture of condition-positive and condition-negative outcomes. A second panel of general practitioners then reviewed, approved, and modified (if necessary) each vignette. A third group of general practitioners reviewed each vignette case and designated a final classification. Vignettes were then entered into the symptom checkers by a fourth, different group of general practitioners. The outcomes of each symptom checker were then compared with the final classification of each vignette to produce accuracy metrics including percent agreement, sensitivity, specificity, positive predictive value, and negative predictive value. Results: A total of 24 cases were created per condition. Overall, exact matches between the vignette general practitioner classification and the symptom checker outcome were 83% (n=20) for endometriosis, 83% (n=20) for uterine fibroids, and 88% (n=21) for PCOS. For each symptom checker, sensitivity was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, and 100% for PCOS; specificity was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 75% for PCOS; positive predictive value was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, 80% for PCOS; and negative predictive value was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 100% for PCOS. Conclusions: The single-condition symptom checkers have high levels of agreement with general practitioner classification for endometriosis, uterine fibroids, and PCOS. Given long delays in diagnosis for many reproductive health conditions, which lead to increased medical costs and potential health complications for individuals and health care providers, innovative health apps and symptom checkers hold the potential to improve care pathways. %M 38051574 %R 10.2196/46718 %U https://mhealth.jmir.org/2023/1/e46718 %U https://doi.org/10.2196/46718 %U http://www.ncbi.nlm.nih.gov/pubmed/38051574 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 7 %N %P e45137 %T Accuracy, Usability, and Adherence of Smartwatches for Atrial Fibrillation Detection in Older Adults After Stroke: Randomized Controlled Trial %A Ding,Eric Y %A Tran,Khanh-Van %A Lessard,Darleen %A Wang,Ziyue %A Han,Dong %A Mohagheghian,Fahimeh %A Mensah Otabil,Edith %A Noorishirazi,Kamran %A Mehawej,Jordy %A Filippaios,Andreas %A Naeem,Syed %A Gottbrecht,Matthew F %A Fitzgibbons,Timothy P %A Saczynski,Jane S %A Barton,Bruce %A Chon,Ki %A McManus,David D %+ Department of Medicine, University of Massachusetts Chan Medical School, 55 N Lake Ave, Worcester, MA, 01605, United States, 1 774 455 6571, eric_ding@brown.edu %K accuracy %K atrial fibrillation %K cardiac arrhythmia %K design %K detection %K diagnosis %K electrocardiography %K monitoring %K older adults %K photoplethysmography %K prevention %K remote monitoring %K smartwatch %K stroke %K usability %D 2023 %7 28.11.2023 %9 Original Paper %J JMIR Cardio %G English %X Background: Atrial fibrillation (AF) is a common cause of stroke, and timely diagnosis is critical for secondary prevention. Little is known about smartwatches for AF detection among stroke survivors. We aimed to examine accuracy, usability, and adherence to a smartwatch-based AF monitoring system designed by older stroke survivors and their caregivers. Objective: This study aims to examine the feasibility of smartwatches for AF detection in older stroke survivors. Methods: Pulsewatch is a randomized controlled trial (RCT) in which stroke survivors received either a smartwatch-smartphone dyad for AF detection (Pulsewatch system) plus an electrocardiogram patch or the patch alone for 14 days to assess the accuracy and usability of the system (phase 1). Participants were subsequently rerandomized to potentially 30 additional days of system use to examine adherence to watch wear (phase 2). Participants were aged 50 years or older, had survived an ischemic stroke, and had no major contraindications to oral anticoagulants. The accuracy for AF detection was determined by comparing it to cardiologist-overread electrocardiogram patch, and the usability was assessed with the System Usability Scale (SUS). Adherence was operationalized as daily watch wear time over the 30-day monitoring period. Results: A total of 120 participants were enrolled (mean age 65 years; 50/120, 41% female; 106/120, 88% White). The Pulsewatch system demonstrated 92.9% (95% CI 85.3%-97.4%) accuracy for AF detection. Mean usability score was 65 out of 100, and on average, participants wore the watch for 21.2 (SD 8.3) of the 30 days. Conclusions: Our findings demonstrate that a smartwatch system designed by and for stroke survivors is a viable option for long-term arrhythmia detection among older adults at risk for AF, though it may benefit from strategies to enhance adherence to watch wear. Trial Registration: ClinicalTrials.gov NCT03761394; https://clinicaltrials.gov/study/NCT03761394 International Registered Report Identifier (IRRID): RR2-10.1016/j.cvdhj.2021.07.002 %M 38015598 %R 10.2196/45137 %U https://cardio.jmir.org/2023/1/e45137 %U https://doi.org/10.2196/45137 %U http://www.ncbi.nlm.nih.gov/pubmed/38015598 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e52377 %T App Characteristics and Accuracy Metrics of Available Digital Biomarkers for Autism: Scoping Review %A Ponzo,Sonia %A May,Merle %A Tamayo-Elizalde,Miren %A Bailey,Kerri %A Shand,Alanna J %A Bamford,Ryan %A Multmeier,Jan %A Griessel,Ivan %A Szulyovszky,Benedek %A Blakey,William %A Valentine,Sophie %A Plans,David %+ Healios Limited, 4A Tileyard, Tileyard Rd, London, N7 9AH, United Kingdom, 44 0330 124 4222, sonia.ponzo@healios.org.uk %K autism %K diagnostics %K digital biomarkers %K digital health %K mobile apps %K neurodevelopmental conditions %D 2023 %7 17.11.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Diagnostic delays in autism are common, with the time to diagnosis being up to 3 years from the onset of symptoms. Such delays have a proven detrimental effect on individuals and families going through the process. Digital health products, such as mobile apps, can help close this gap due to their scalability and ease of access. Further, mobile apps offer the opportunity to make the diagnostic process faster and more accurate by providing additional and timely information to clinicians undergoing autism assessments. Objective: The aim of this scoping review was to synthesize the available evidence about digital biomarker tools to aid clinicians, researchers in the autism field, and end users in making decisions as to their adoption within clinical and research settings. Methods: We conducted a structured literature search on databases and search engines to identify peer-reviewed studies and regulatory submissions that describe app characteristics, validation study details, and accuracy and validity metrics of commercial and research digital biomarker apps aimed at aiding the diagnosis of autism. Results: We identified 4 studies evaluating 4 products: 1 commercial and 3 research apps. The accuracy of the identified apps varied between 28% and 80.6%. Sensitivity and specificity also varied, ranging from 51.6% to 81.6% and 18.5% to 80.5%, respectively. Positive predictive value ranged from 20.3% to 76.6%, and negative predictive value fluctuated between 48.7% and 97.4%. Further, we found a lack of details around participants’ demographics and, where these were reported, important imbalances in sex and ethnicity in the studies evaluating such products. Finally, evaluation methods as well as accuracy and validity metrics of available tools were not clearly reported in some cases and varied greatly across studies. Different comparators were also used, with some studies validating their tools against the Diagnostic and Statistical Manual of Mental Disorders criteria and others through self-reported measures. Further, while in most cases, 2 classes were used for algorithm validation purposes, 1 of the studies reported a third category (indeterminate). These discrepancies substantially impact the comparability and generalizability of the results, thus highlighting the need for standardized validation processes and the reporting of findings. Conclusions: Despite their popularity, systematic evaluations and syntheses of the current state of the art of digital health products are lacking. Standardized and transparent evaluations of digital health tools in diverse populations are needed to assess their real-world usability and validity, as well as help researchers, clinicians, and end users safely adopt novel tools within clinical and research practices. %M 37976084 %R 10.2196/52377 %U https://mhealth.jmir.org/2023/1/e52377 %U https://doi.org/10.2196/52377 %U http://www.ncbi.nlm.nih.gov/pubmed/37976084 %0 Journal Article %@ 2291-5222 %I %V 11 %N %P e44703 %T App-Based Hearing Screenings in Preschool Children With Different Types of Headphones: Diagnostic Study %A Tananuchittikul,Pornsek %A Yimtae,Kwanchanok %A Chayaopas,Nichtima %A Thanawirattananit,Panida %A Kasemsiri,Pornthep %A Piromchai,Patorn %K hearing screening %K mobile application %K mobile app %K headphones %K mobile health %K mHealth %K hearing %K headphone %K pediatric %K child %K preschool %K audiology %K audiometry %K audiologist %K screening %D 2023 %7 3.11.2023 %9 %J JMIR Mhealth Uhealth %G English %X Background: Hearing disability in preschool children can delay or impact oral communication and social skills. Provision of hearing screening tests by standard audiometry in low- to middle-income countries is problematic due to a lack of pediatric audiologists, standard hearing equipment, and standard soundproof rooms. Therefore, an innovative hearing screening tool that is easily accessible and inexpensive such as a mobile app should be considered. Headphones have been a crucial part of hearing screenings. Audiometric headphones, which serve as the reference standard, have been used in most studies. However, since audiometric headphones are not accessible in rural areas, we hypothesized that generic headphones can also be used in hearing screenings. Objective: This study aimed to determine the sensitivity, specificity, κ coefficiency, and time consumption of the PASS-Pro (Preschool Audiometry Screening System–Pro) app when using TDH39 headphones, Beyerdynamic DT 770 PRO headphones, and generic earmuff headphones compared to standard conditioned play audiometry. Methods: We recruited preschool children aged 4 to 5 years to participate in this study. The children received 3 PASS-Pro screening tests using different types of headphones in a quiet room and 1 standard conditioned play audiometry in a soundproof room. All tests were administered in random order. The agreement coefficient, sensitivity, specificity, and mean test duration were determined. Results: A total of 44 children participated in this study. For mild hearing loss screening, the κ coefficients between standard conditioned play audiometry and the PASS-Pro app using TDH39 headphones, Beyerdynamic DT 770 PRO headphones, and generic earmuff headphones were 0.195, 0.290, and 0.261 (P=.02, P=.002, and P=.004), respectively. The sensitivity for all headphones was 50% and the specificity was more than 88%. For moderate hearing loss screening, the κ coefficients were 0.206, 0.272, and 0.235 (all Ps=.001), respectively. The sensitivity for all headphones was 100% and the specificity was more than 92%. There were no statistical differences in sensitivity and specificity between the reference headphone (TDH39), Beyerdynamic DT 770 PRO headphone, and generic earmuff headphones (all Ps >.05). The PASS-Pro app used significantly less time to carry out hearing tests than conditioned play audiometry (P<.001). Conclusions: The PASS-Pro app, used with generic headphones, is effective for conducting hearing screening tests in preschool children with high sensitivity and specificity. Trial Registration: Thai Clinical Trials Registry TCTR20201229002; www.thaiclinicaltrials.org/show/TCTR20201229002 %R 10.2196/44703 %U https://mhealth.jmir.org/2023/1/e44703 %U https://doi.org/10.2196/44703 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 7 %N %P e47292 %T Characterizing Real-World Implementation of Consumer Wearables for the Detection of Undiagnosed Atrial Fibrillation in Clinical Practice: Targeted Literature Review %A Simonson,Julie K %A Anderson,Misty %A Polacek,Cate %A Klump,Erika %A Haque,Saira N %+ Pfizer Inc, 66 Hudson Blvd E, New York City, NY, 10001, United States, 1 718 208 6842, julie.simonson@pfizer.com %K arrhythmias %K atrial fibrillation %K clinical workflow %K consumer wearable devices %K smartwatches %K wearables %K remote patient monitoring %K virtual care %K mobile phone %D 2023 %7 3.11.2023 %9 Review %J JMIR Cardio %G English %X Background: Atrial fibrillation (AF), the most common cardiac arrhythmia, is often undiagnosed because of lack of awareness and frequent asymptomatic presentation. As AF is associated with increased risk of stroke, early detection is clinically relevant. Several consumer wearable devices (CWDs) have been cleared by the US Food and Drug Administration for irregular heart rhythm detection suggestive of AF. However, recommendations for the use of CWDs for AF detection in clinical practice, especially with regard to pathways for workflows and clinical decisions, remain lacking. Objective: We conducted a targeted literature review to identify articles on CWDs characterizing the current state of wearable technology for AF detection, identifying approaches to implementing CWDs into the clinical workflow, and characterizing provider and patient perspectives on CWDs for patients at risk of AF. Methods: PubMed, ClinicalTrials.gov, UpToDate Clinical Reference, and DynaMed were searched for articles in English published between January 2016 and July 2023. The searches used predefined Medical Subject Headings (MeSH) terms, keywords, and search strings. Articles of interest were specifically on CWDs; articles on ambulatory monitoring tools, tools available by prescription, or handheld devices were excluded. Search results were reviewed for relevancy and discussed among the authors for inclusion. A qualitative analysis was conducted and themes relevant to our study objectives were identified. Results: A total of 31 articles met inclusion criteria: 7 (23%) medical society reports or guidelines, 4 (13%) general reviews, 5 (16%) systematic reviews, 5 (16%) health care provider surveys, 7 (23%) consumer or patient surveys or interviews, and 3 (10%) analytical reports. Despite recognition of CWDs by medical societies, detailed guidelines regarding CWDs for AF detection were limited, as was the availability of clinical tools. A main theme was the lack of pragmatic studies assessing real-world implementation of CWDs for AF detection. Clinicians expressed concerns about data overload; potential for false positives; reimbursement issues; and the need for clinical tools such as care pathways and guidelines, preferably developed or endorsed by professional organizations. Patient-facing challenges included device costs and variability in digital literacy or technology acceptance. Conclusions: This targeted literature review highlights the lack of a comprehensive body of literature guiding real-world implementation of CWDs for AF detection and provides insights for informing additional research and developing appropriate tools and resources for incorporating these devices into clinical practice. The results should also provide an impetus for the active involvement of medical societies and other health care stakeholders in developing appropriate tools and resources for guiding the real-world use of CWDs for AF detection. These resources should target clinicians, patients, and health care systems with the goal of facilitating clinician or patient engagement and using an evidence-based approach for establishing guidelines or frameworks for administrative workflows and patient care pathways. %M 37921865 %R 10.2196/47292 %U https://cardio.jmir.org/2023/1/e47292 %U https://doi.org/10.2196/47292 %U http://www.ncbi.nlm.nih.gov/pubmed/37921865 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e49995 %T Comparison of Diagnostic and Triage Accuracy of Ada Health and WebMD Symptom Checkers, ChatGPT, and Physicians for Patients in an Emergency Department: Clinical Data Analysis Study %A Fraser,Hamish %A Crossland,Daven %A Bacher,Ian %A Ranney,Megan %A Madsen,Tracy %A Hilliard,Ross %+ Brown Center for Biomedical Informatics, The Warren Alpert Medical School of Brown University, 233 Richmond Street, Providence, RI, 02912, United States, 1 401863 1815, hamish_fraser@brown.edu %K diagnosis %K triage %K symptom checker %K emergency patient %K ChatGPT %K LLM %K diagnose %K self-diagnose %K self-diagnosis %K app %K application %K language model %K accuracy %K ChatGPT-3.5 %K ChatGPT-4.0 %K emergency %K machine learning %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Diagnosis is a core component of effective health care, but misdiagnosis is common and can put patients at risk. Diagnostic decision support systems can play a role in improving diagnosis by physicians and other health care workers. Symptom checkers (SCs) have been designed to improve diagnosis and triage (ie, which level of care to seek) by patients. Objective: The aim of this study was to evaluate the performance of the new large language model ChatGPT (versions 3.5 and 4.0), the widely used WebMD SC, and an SC developed by Ada Health in the diagnosis and triage of patients with urgent or emergent clinical problems compared with the final emergency department (ED) diagnoses and physician reviews. Methods: We used previously collected, deidentified, self-report data from 40 patients presenting to an ED for care who used the Ada SC to record their symptoms prior to seeing the ED physician. Deidentified data were entered into ChatGPT versions 3.5 and 4.0 and WebMD by a research assistant blinded to diagnoses and triage. Diagnoses from all 4 systems were compared with the previously abstracted final diagnoses in the ED as well as with diagnoses and triage recommendations from three independent board-certified ED physicians who had blindly reviewed the self-report clinical data from Ada. Diagnostic accuracy was calculated as the proportion of the diagnoses from ChatGPT, Ada SC, WebMD SC, and the independent physicians that matched at least one ED diagnosis (stratified as top 1 or top 3). Triage accuracy was calculated as the number of recommendations from ChatGPT, WebMD, or Ada that agreed with at least 2 of the independent physicians or were rated “unsafe” or “too cautious.” Results: Overall, 30 and 37 cases had sufficient data for diagnostic and triage analysis, respectively. The rate of top-1 diagnosis matches for Ada, ChatGPT 3.5, ChatGPT 4.0, and WebMD was 9 (30%), 12 (40%), 10 (33%), and 12 (40%), respectively, with a mean rate of 47% for the physicians. The rate of top-3 diagnostic matches for Ada, ChatGPT 3.5, ChatGPT 4.0, and WebMD was 19 (63%), 19 (63%), 15 (50%), and 17 (57%), respectively, with a mean rate of 69% for physicians. The distribution of triage results for Ada was 62% (n=23) agree, 14% unsafe (n=5), and 24% (n=9) too cautious; that for ChatGPT 3.5 was 59% (n=22) agree, 41% (n=15) unsafe, and 0% (n=0) too cautious; that for ChatGPT 4.0 was 76% (n=28) agree, 22% (n=8) unsafe, and 3% (n=1) too cautious; and that for WebMD was 70% (n=26) agree, 19% (n=7) unsafe, and 11% (n=4) too cautious. The unsafe triage rate for ChatGPT 3.5 (41%) was significantly higher (P=.009) than that of Ada (14%). Conclusions: ChatGPT 3.5 had high diagnostic accuracy but a high unsafe triage rate. ChatGPT 4.0 had the poorest diagnostic accuracy, but a lower unsafe triage rate and the highest triage agreement with the physicians. The Ada and WebMD SCs performed better overall than ChatGPT. Unsupervised patient use of ChatGPT for diagnosis and triage is not recommended without improvements to triage accuracy and extensive clinical evaluation. %M 37788063 %R 10.2196/49995 %U https://mhealth.jmir.org/2023/1/e49995 %U https://doi.org/10.2196/49995 %U http://www.ncbi.nlm.nih.gov/pubmed/37788063 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e46738 %T Co-Creating a Digital Life-Integrated Self-Assessment for Older Adults: User Experience Study %A Böttinger,Melissa J %A Litz,Elena %A Gordt-Oesterwind,Katharina %A Jansen,Carl-Philipp %A Memmer,Nicole %A Mychajliw,Christian %A Radeck,Leon %A Bauer,Jürgen M %A Becker,Clemens %+ Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Bergheimer Str. 20, Heidelberg, 69115, Germany, 49 6221 54 8146, boettinger@nar.uni-heidelberg.de %K aged %K self-assessment %K mobile apps %K mobile health %K mHealth %K community-based participatory research %K co-creation %K comprehensive geriatric assessment %K mobile phone %D 2023 %7 26.9.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Older adults are at increased risk of developing health disorders and functional decline. However, owing to time constraints and considerable effort, physicians rarely conduct comprehensive assessments to detect early signs of negative trajectories. If designed properly, digital technologies could identify health risks already at a preclinical stage, thereby facilitating preventive efforts and targeted intervention. For this purpose, a Life-integrated Self-Assessment (LiSA) tablet system will be developed through a structured co-creation process. Objective: This study aims to investigate older adults’ perceptions of different self-assessment domains, components affecting user experience, risks and benefits associated with LiSA, characteristics of potential LiSA users, and the LiSA concept in general. Methods: A total of 10 community-dwelling older adults aged ≥70 years were recruited. In total, 6 co-creation workshops were held and started with expert input followed by semistructured discussion rounds. Participants performed hands-on activities with a tablet, including testing of preinstalled self-assessment apps. All workshops were audio recorded and additionally documented by the researchers using flipcharts, notes, and photos. Qualitative content analysis was used to analyze the data following a deductive-inductive approach guided by the Optimized Honeycomb Model for user experience. Results: The group (mean age 77.8, SD 5.1 years) was heterogeneous in terms of previous technology experience and health status. The mean workshop duration was 2 hours (122.5, SD 4.43 min), and an average of 8 (SD 1.15) participants attended each workshop. A total of 11 thematic categories were identified, covering results on all research questions. Participants emphasized a strong interest in conducting a digital self-assessment of physical activity and function and sensory and cognitive functions and requested additional features such as recommendations for actions or reminders. LiSA was perceived as empowering and a motivator to engage in active health care planning as well as enabling shared and informed decision-making. Concerns and barriers included the lack of technical competence, feelings of frustration, and fear of being left alone, with negative assessment results. In essence, participants expressed a positive attitude toward using LiSA repeatedly and identified it as an option to increase the chances of maintaining independence when growing older. Conclusions: The co-creation participants supported the LiSA approach and were interested in performing regular self-assessments on a long-term basis. In their opinion, LiSA should include relevant assessments capturing physical activity and function and sensory and cognitive functions as well as recommendations for actions. It should be customizable to individual needs. These results will form the basis for a prototype. Iterative development and validation will aim to make LiSA accessible in the public domain as a reliable tablet-based system for self-assessment. %M 37751274 %R 10.2196/46738 %U https://aging.jmir.org/2023/1/e46738 %U https://doi.org/10.2196/46738 %U http://www.ncbi.nlm.nih.gov/pubmed/37751274 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45760 %T Diagnostic Value of a Wearable Continuous Electrocardiogram Monitoring Device (AT-Patch) for New-Onset Atrial Fibrillation in High-Risk Patients: Prospective Cohort Study %A Kwun,Ju-Seung %A Lee,Jang Hoon %A Park,Bo Eun %A Park,Jong Sung %A Kim,Hyeon Jeong %A Kim,Sun-Hwa %A Jeon,Ki-Hyun %A Cho,Hyoung-won %A Kang,Si-Hyuck %A Lee,Wonjae %A Youn,Tae-Jin %A Chae,In-Ho %A Yoon,Chang-Hwan %+ Cardiovascular Center, Seoul National University Bundang Hospital, 82, Gumi-Ro 173, Bundang-Gu, Seongnam-si, 13620, Republic of Korea, 82 317877052, kunson2@snu.ac.kr %K arrhythmias %K atrial fibrillation %K wearable electronic device %K patch electrocardiogram monitor %K electrocardiogram %K adult %K AT-Patch %K heart failure %K mobile phone %D 2023 %7 18.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: While conventional electrocardiogram monitoring devices are useful for detecting atrial fibrillation, they have considerable drawbacks, including a short monitoring duration and invasive device implantation. The use of patch-type devices circumvents these drawbacks and has shown comparable diagnostic capability for the early detection of atrial fibrillation. Objective: We aimed to determine whether a patch-type device (AT-Patch) applied to patients with a high risk of new-onset atrial fibrillation defined by the congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke, vascular disease, age 65-74 years, sex scale (CHA2DS2-VASc) score had increased detection rates. Methods: In this nonrandomized multicenter prospective cohort study, we enrolled 320 adults aged ≥19 years who had never experienced atrial fibrillation and whose CHA2DS2-VASc score was ≥2. The AT-Patch was attached to each individual for 11 days, and the data were analyzed for arrhythmic events by 2 independent cardiologists. Results: Atrial fibrillation was detected by the AT-Patch in 3.4% (11/320) of patients, as diagnosed by both cardiologists. Interestingly, when participants with or without atrial fibrillation were compared, a previous history of heart failure was significantly more common in the atrial fibrillation group (n=4/11, 36.4% vs n=16/309, 5.2%, respectively; P=.003). When a CHA2DS2-VASc score ≥4 was combined with previous heart failure, the detection rate was significantly increased to 24.4%. Comparison of the recorded electrocardiogram data revealed that supraventricular and ventricular ectopic rhythms were significantly more frequent in the new-onset atrial fibrillation group compared with nonatrial fibrillation group (3.4% vs 0.4%; P=.001 and 5.2% vs 1.2%; P<.001), respectively. Conclusions: This study detected a moderate number of new-onset atrial fibrillations in high-risk patients using the AT-Patch device. Further studies will aim to investigate the value of early detection of atrial fibrillation, particularly in patients with heart failure as a means of reducing adverse clinical outcomes of atrial fibrillation. Trial Registration: ClinicalTrials.gov NCT04857268; https://classic.clinicaltrials.gov/ct2/show/NCT04857268 %M 37721791 %R 10.2196/45760 %U https://www.jmir.org/2023/1/e45760 %U https://doi.org/10.2196/45760 %U http://www.ncbi.nlm.nih.gov/pubmed/37721791 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46571 %T Evaluation of the Rosa Chatbot Providing Genetic Information to Patients at Risk of Hereditary Breast and Ovarian Cancer: Qualitative Interview Study %A Siglen,Elen %A Vetti,Hildegunn Høberg %A Augestad,Mirjam %A Steen,Vidar M %A Lunde,Åshild %A Bjorvatn,Cathrine %+ Western Norway Familial Cancer Center, Department of Medical Genetics, Haukeland University Hospital, Jonas Lies veg 61, Bergen, 5021, Norway, 47 99569845, elen.siglen@helse-bergen.no %K chatbot %K chatbots %K genetic %K trust %K acceptability %K perception %K perceived %K genetic counseling %K hybrid health care %K digital health tool %K digital information tool %K digital health technology %K virtual assistant %K hereditary breast and ovarian cancer %K hereditary %K genetic testing %K technology %K genetic clinic %K digital tool %K ovarian cancer %K breast cancer %K information retrieval %K women’s health %K breast %K ovarian %K cancer %K oncology %K mobile phone %D 2023 %7 1.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Genetic testing has become an integrated part of health care for patients with breast or ovarian cancer, and the increasing demand for genetic testing is accompanied by an increasing need for easy access to reliable genetic information for patients. Therefore, we developed a chatbot app (Rosa) that is able to perform humanlike digital conversations about genetic BRCA testing. Objective: Before implementing this new information service in daily clinical practice, we wanted to explore 2 aspects of chatbot use: the perceived utility and trust in chatbot technology among healthy patients at risk of hereditary cancer and how interaction with a chatbot regarding sensitive information about hereditary cancer influences patients. Methods: Overall, 175 healthy individuals at risk of hereditary breast and ovarian cancer were invited to test the chatbot, Rosa, before and after genetic counseling. To secure a varied sample, participants were recruited from all cancer genetic clinics in Norway, and the selection was based on age, gender, and risk of having a BRCA pathogenic variant. Among the 34.9% (61/175) of participants who consented for individual interview, a selected subgroup (16/61, 26%) shared their experience through in-depth interviews via video. The semistructured interviews covered the following topics: usability, perceived usefulness, trust in the information received via the chatbot, how Rosa influenced the user, and thoughts about future use of digital tools in health care. The transcripts were analyzed using the stepwise-deductive inductive approach. Results: The overall finding was that the chatbot was very welcomed by the participants. They appreciated the 24/7 availability wherever they were and the possibility to use it to prepare for genetic counseling and to repeat and ask questions about what had been said afterward. As Rosa was created by health care professionals, they also valued the information they received as being medically correct. Rosa was referred to as being better than Google because it provided specific and reliable answers to their questions. The findings were summed up in 3 concepts: “Anytime, anywhere”; “In addition, not instead”; and “Trustworthy and true.” All participants (16/16) denied increased worry after reading about genetic testing and hereditary breast and ovarian cancer in Rosa. Conclusions: Our results indicate that a genetic information chatbot has the potential to contribute to easy access to uniform information for patients at risk of hereditary breast and ovarian cancer, regardless of geographical location. The 24/7 availability of quality-assured information, tailored to the specific situation, had a reassuring effect on our participants. It was consistent across concepts that Rosa was a tool for preparation and repetition; however, none of the participants (0/16) supported that Rosa could replace genetic counseling if hereditary cancer was confirmed. This indicates that a chatbot can be a well-suited digital companion to genetic counseling. %M 37656502 %R 10.2196/46571 %U https://www.jmir.org/2023/1/e46571 %U https://doi.org/10.2196/46571 %U http://www.ncbi.nlm.nih.gov/pubmed/37656502 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45693 %T Using Continuous Passive Assessment Technology to Describe Health and Behavior Patterns Preceding and Following a Cancer Diagnosis in Older Adults: Proof-of-Concept Case Series Study %A Wu,Chao-Yi %A Tibbitts,Deanne %A Beattie,Zachary %A Dodge,Hiroko %A Shannon,Jackilen %A Kaye,Jeffrey %A Winters-Stone,Kerri %+ Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, 10-003C, Charlestown, MA, 02129, United States, 1 617 724 2428, chwu3@mgh.harvard.edu %K sensor %K quality of life %K physical activity %K medication %K monitoring %K function %K mobile phone %D 2023 %7 10.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Describing changes in health and behavior that precede and follow a sentinel health event, such as a cancer diagnosis, is challenging because of the lack of longitudinal, objective measurements that are collected frequently enough to capture varying trajectories of change leading up to and following the event. A continuous passive assessment system that continuously monitors older adults’ physical activity, weight, medication-taking behavior, pain, health events, and mood could enable the identification of more specific health and behavior patterns leading up to a cancer diagnosis and whether and how patterns change thereafter. Objective: In this study, we conducted a proof-of-concept retrospective analysis, in which we identified new cancer diagnoses in older adults and compared trajectories of change in health and behaviors before and after cancer diagnosis. Methods: Participants were 10 older adults (mean age 71.8, SD 4.9 years; 3/10, 30% female) with various self-reported cancer types from a larger prospective cohort study of older adults. A technology-agnostic assessment platform using multiple devices provided continuous data on daily physical activity via wearable sensors (actigraphy); weight via a Wi-Fi–enabled digital scale; daily medication-taking behavior using electronic Bluetooth-enabled pillboxes; and weekly pain, health events, and mood with online, self-report surveys. Results: Longitudinal linear mixed-effects models revealed significant differences in the pre- and postcancer trajectories of step counts (P<.001), step count variability (P=.004), weight (P<.001), pain severity (P<.001), hospitalization or emergency room visits (P=.03), days away from home overnight (P=.01), and the number of pillbox door openings (P<.001). Over the year preceding a cancer diagnosis, there were gradual reductions in step counts and weight and gradual increases in pain severity, step count variability, hospitalization or emergency room visits, and days away from home overnight compared with 1 year after the cancer diagnosis. Across the year after the cancer diagnosis, there was a gradual increase in the number of pillbox door openings compared with 1 year before the cancer diagnosis. There was no significant trajectory change from the pre– to post–cancer diagnosis period in terms of low mood (P=.60) and loneliness (P=.22). Conclusions: A home-based, technology-agnostic, and multidomain assessment platform could provide a unique approach to monitoring different types of behavior and health markers in parallel before and after a life-changing health event. Continuous passive monitoring that is ecologically valid, less prone to bias, and limits participant burden could greatly enhance research that aims to improve early detection efforts, clinical care, and outcomes for people with cancer. %M 37561574 %R 10.2196/45693 %U https://formative.jmir.org/2023/1/e45693 %U https://doi.org/10.2196/45693 %U http://www.ncbi.nlm.nih.gov/pubmed/37561574 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 6 %N %P e48357 %T Improving Skin Cancer Diagnostics Through a Mobile App With a Large Interactive Image Repository: Randomized Controlled Trial %A Nervil,Gustav Gede %A Ternov,Niels Kvorning %A Vestergaard,Tine %A Sølvsten,Henrik %A Chakera,Annette Hougaard %A Tolsgaard,Martin Grønnebæk %A Hölmich,Lisbet Rosenkrantz %+ Department of Plastic Surgery, Herlev-Gentofte Hospital, Borgmester Ib Juuls vej 5, Opgang 3, 4. etage, E7, Herlev, 2730, Denmark, 45 38689467, gustavnervil@gmail.com %K dermoscopy %K nevi %K skin neoplasms %K benign skin tumors %K melanoma %K skin cancer %K medical education %K eLearning %K digital learning %K diagnostic test %K mHealth %K mobile app %K recognition training %K skin lesions %D 2023 %7 9.8.2023 %9 Original Paper %J JMIR Dermatol %G English %X Background: Skin cancer diagnostics is challenging, and mastery requires extended periods of dedicated practice. Objective: The aim of the study was to determine if self-paced pattern recognition training in skin cancer diagnostics with clinical and dermoscopic images of skin lesions using a large-scale interactive image repository (LIIR) with patient cases improves primary care physicians’ (PCPs’) diagnostic skills and confidence. Methods: A total of 115 PCPs were randomized (allocation ratio 3:1) to receive or not receive self-paced pattern recognition training in skin cancer diagnostics using an LIIR with patient cases through a quiz-based smartphone app during an 8-day period. The participants’ ability to diagnose skin cancer was evaluated using a 12-item multiple-choice questionnaire prior to and 8 days after the educational intervention period. Their thoughts on the use of dermoscopy were assessed using a study-specific questionnaire. A learning curve was calculated through the analysis of data from the mobile app. Results: On average, participants in the intervention group spent 2 hours 26 minutes quizzing digital patient cases and 41 minutes reading the educational material. They had an average preintervention multiple choice questionnaire score of 52.0% of correct answers, which increased to 66.4% on the postintervention test; a statistically significant improvement of 14.3 percentage points (P<.001; 95% CI 9.8-18.9) with intention-to-treat analysis. Analysis of participants who received the intervention as per protocol (500 patient cases in 8 days) showed an average increase of 16.7 percentage points (P<.001; 95% CI 11.3-22.0) from 53.9% to 70.5%. Their overall ability to correctly recognize malignant lesions in the LIIR patient cases improved over the intervention period by 6.6 percentage points from 67.1% (95% CI 65.2-69.3) to 73.7% (95% CI 72.5-75.0) and their ability to set the correct diagnosis improved by 10.5 percentage points from 42.5% (95% CI 40.2%-44.8%) to 53.0% (95% CI 51.3-54.9). The diagnostic confidence of participants in the intervention group increased on a scale from 1 to 4 by 32.9% from 1.6 to 2.1 (P<.001). Participants in the control group did not increase their postintervention score or their diagnostic confidence during the same period. Conclusions: Self-paced pattern recognition training in skin cancer diagnostics through the use of a digital LIIR with patient cases delivered by a quiz-based mobile app improves the diagnostic accuracy of PCPs. Trial Registration: ClinicalTrials.gov NCT05661370; https://classic.clinicaltrials.gov/ct2/show/NCT05661370 %M 37624707 %R 10.2196/48357 %U https://derma.jmir.org/2023/1/e48357 %U https://doi.org/10.2196/48357 %U http://www.ncbi.nlm.nih.gov/pubmed/37624707 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e37136 %T Effects of the Pregnancy and Newborn Diagnostic Assessment (PANDA) App on Antenatal Care Quality in Burkina Faso: Protocol for a Cluster Randomized Controlled Trial %A Coulibaly,Abou %A Kouanda,Séni %+ Département Biomédical et Santé Publique, Institut de Recherche en Sciences de la Santé, Ouagadougou, Ouagadougou, BP 7047, Burkina Faso, 226 71407789, samsoncoul@gmail.com %K telemedicine %K PANDA %K pregnancy and newborn diagnostic assessment %K quality %K antenatal care %K Burkina Faso %K trial %K pregnancy %K pregnant %K newborn %K diagnostic %K mobile app %K prenatal care %K randomized trial %K first trimester %K postpartum %K qualitative research %K maternity %K prenatal %K antenatal %K mobile phone %D 2023 %7 9.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The Pregnancy and Newborn Diagnostic Assessment (PANDA) system is a digital clinical decision support tool that can facilitate diagnosis and decision-making by health care personnel in antenatal care (ANC). Studies conducted in Madagascar and Burkina Faso showed that PANDA is a feasible system acceptable to various stakeholders. Objective: This study primarily aims to evaluate the effects of the PANDA system on ANC quality at rural health facilities in Burkina Faso. The secondary objectives of this study are to test the effects of the PANDA system on women’s satisfaction, women’s knowledge on birth preparedness and complication readiness, maternal and child health service use, men’s involvement in maternal health service utilization, and women’s contraception use at 6 weeks postpartum. Further, we will identify the factors that hinder or promote such an app and contribute to cost-effectiveness analysis. Methods: This is a randomized controlled trial implementing the PANDA system in 2 groups of health facilities (intervention and comparison groups) randomized using a matched-pair method. We included pregnant women who were <20 weeks pregnant during their first antenatal consultation in health facilities, and we followed up with them until their sixth week postpartum. Thirteen health centers were included, and 423 and 272 women were enrolled in the intervention and comparison groups, respectively. The primary outcome is a binary variable derived from the quality score, coded 1 (yes) for women with at least 75% of the total score and 0 if not. Data were collected electronically using tablets by directly interviewing the women and by extracting data from ANC registers, delivery registers, ANC cards, and health care records. The study procedures were standardized across all sites. We will compare unadjusted and adjusted primary outcome results (ANC quality scores) between the 2 study arms. We added a qualitative evaluation of the implementation of the PANDA system to identify barriers and catalysts. We also included an economic evaluation to determine whether the PANDA strategy is more cost-effective than the usual ANC strategy. Results: The enrollment ran from July 2020 to January 2021 due to the COVID-19 pandemic. Data collection ended in September 2022. Data analyses started in January 2023, ended in June 2023, and the results are expected to be published in February 2024. Conclusions: The PANDA system is one of the most comprehensive apps for ANC because it has many features. However, the use of computerized systems for ANC is limited. Therefore, our trial will be beneficial for evaluating the intrinsic capacity of the PANDA system to improve the quality of care. By including qualitative research and economic evaluation, our findings will be significant because electronic consultation registries are expected to be used for maternal health care in the future in Burkina Faso. Trial Registration: Pan-African Clinical Trials Registry (PACTR) PACTR202009861550402; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=12374 International Registered Report Identifier (IRRID): DERR1-10.2196/37136 %M 37556195 %R 10.2196/37136 %U https://www.researchprotocols.org/2023/1/e37136 %U https://doi.org/10.2196/37136 %U http://www.ncbi.nlm.nih.gov/pubmed/37556195 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45541 %T Usability and Satisfaction Testing of Game-Based Learning Avatar-Navigated Mobile (GLAm), an App for Cervical Cancer Screening: Mixed Methods Study %A Wanberg,Lindsey J %A Kim,Angela %A Vogel,Rachel I %A Sadak,Karim Thomas %A Teoh,Deanna %+ Division of Gynecologic Oncology, Masonic Cancer Center, University of Minnesota, 420 Delaware Street SE, MMC 395, Minneapolis, MN, 55455, United States, 1 612 625 6503, dkteoh@umn.edu %K cancer screening %K cervical cancer screening %K cervical cancer %K Game-based Learning Avatar-navigated mobile %K health care app %K mixed methods study %K mobile health %K mobile technology %K Pap test %K usability testing %K young adult health care %D 2023 %7 8.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Barriers to cervical cancer screening in young adults include a lack of knowledge and negative perceptions of testing. Evidence shows that mobile technology reduces these barriers; thus, we developed a web app, Game-based Learning Avatar-navigated mobile (GLAm), to educate and motivate cervical cancer screening using the Fogg Behavioral Model as a theoretic guide. Users create avatars to navigate the app, answer short quizzes with education about cervical cancer and screening, watch videos of the screening process, and earn digital trophies. Objective: We tested ease of use, usefulness, and satisfaction with the GLAm app among young adults. Methods: This mixed methods study comprised a qualitative think-aloud play interview session and a quantitative survey study. Participants were cervical cancer screening–eligible US residents aged 21 to 29 years recruited through social media. Qualitative study participants explored the app in a think-aloud play session conducted through videoconference. Data were analyzed using directed content analysis to identify themes of ease of use, usefulness, and content satisfaction. Qualitative study participants and additional participants then used the app independently for 1 week and completed a web-based survey (the quantitative study). Ease of use, usefulness, and satisfaction were assessed using the validated Technology Acceptance Model and Computer System Usability Questionnaire adapted to use of an app. Mean (SD) scores (range 1-7) are presented. Results: A total of 23 individuals participated in one or both study components. The mean age was 25.6 years. A majority were cisgender women (21/23, 91%) and White (18/23, 78%), and 83% (19/23) had at least some secondary education. Nine participants completed the think-aloud play session. Direct content analysis showed desire for content that is concise, eases anxiety around screenings, and uses game features (avatars and rewards). Twenty-three individuals completed the quantitative survey study. Mean scores showed the app was perceived to be easy to use (mean score 6.17, SD 0.27) and moderately useful to increase cervical cancer screening knowledge and uptake (mean score 4.94, SD 0.27). Participants were highly satisfied with the app (mean score 6.21, SD 1.20). Conclusions: Survey results showed participants were satisfied with the app format and found it easy to use. The app was perceived to be moderately useful to inform and motivate cervical cancer screening; notably, the screening reminder function was not tested in this study. Qualitative study results demonstrated the app’s ability to ease anxiety about screening through demonstration of the screening process, and brevity of app components was favored. Interpretation of results is limited by the predominantly cisgender, White, and educated study population; additional testing in populations which historically have lower cervical cancer screening uptake is needed. A modified version of the app is undergoing efficacy testing in a randomized clinical trial. %M 37552527 %R 10.2196/45541 %U https://formative.jmir.org/2023/1/e45541 %U https://doi.org/10.2196/45541 %U http://www.ncbi.nlm.nih.gov/pubmed/37552527 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42638 %T Smartphone App–Based and Paper-Based Patient-Reported Outcomes Using a Disease-Specific Questionnaire for Dry Eye Disease: Randomized Crossover Equivalence Study %A Nagino,Ken %A Okumura,Yuichi %A Akasaki,Yasutsugu %A Fujio,Kenta %A Huang,Tianxiang %A Sung,Jaemyoung %A Midorikawa-Inomata,Akie %A Fujimoto,Keiichi %A Eguchi,Atsuko %A Hurramhon,Shokirova %A Yee,Alan %A Miura,Maria %A Ohno,Mizu %A Hirosawa,Kunihiko %A Morooka,Yuki %A Murakami,Akira %A Kobayashi,Hiroyuki %A Inomata,Takenori %+ Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan, 81 338133111, tinoma@juntendo.ac.jp %K dry eye syndrome %K mobile app %K equivalence trial %K Ocular Surface Disease Index %K patient-reported outcome measures %K mobile health %K reliability %K validity %K telemedicine %K precision medicine %D 2023 %7 3.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Using traditional patient-reported outcomes (PROs), such as paper-based questionnaires, is cumbersome in the era of web-based medical consultation and telemedicine. Electronic PROs may reduce the burden on patients if implemented widely. Considering promising reports of DryEyeRhythm, our in-house mHealth smartphone app for investigating dry eye disease (DED) and the electronic and paper-based Ocular Surface Disease Index (OSDI) should be evaluated and compared to determine their equivalency. Objective: The purpose of this study is to assess the equivalence between smartphone app–based and paper-based questionnaires for DED. Methods: This prospective, nonblinded, randomized crossover study enrolled 34 participants between April 2022 and June 2022 at a university hospital in Japan. The participants were allocated randomly into 2 groups in a 1:1 ratio. The paper-app group initially responded to the paper-based Japanese version of the OSDI (J-OSDI), followed by the app-based J-OSDI. The app-paper group responded to similar questionnaires but in reverse order. We performed an equivalence test based on minimal clinically important differences to assess the equivalence of the J-OSDI total scores between the 2 platforms (paper-based vs app-based). A 95% CI of the mean difference between the J-OSDI total scores within the ±7.0 range between the 2 platforms indicated equivalence. The internal consistency and agreement of the app-based J-OSDI were assessed with Cronbach α coefficients and intraclass correlation coefficient values. Results: A total of 33 participants were included in this study. The total scores for the app- and paper-based J-OSDI indicated satisfactory equivalence per our study definition (mean difference 1.8, 95% CI –1.4 to 5.0). Moreover, the app-based J-OSDI total score demonstrated good internal consistency and agreement (Cronbach α=.958; intraclass correlation=0.919; 95% CI 0.842 to 0.959) and was significantly correlated with its paper-based counterpart (Pearson correlation=0.932, P<.001). Conclusions: This study demonstrated the equivalence of PROs between the app- and paper-based J-OSDI. Implementing the app-based J-OSDI in various scenarios, including telehealth, may have implications for the early diagnosis of DED and longitudinal monitoring of PROs. %M 37535409 %R 10.2196/42638 %U https://www.jmir.org/2023/1/e42638 %U https://doi.org/10.2196/42638 %U http://www.ncbi.nlm.nih.gov/pubmed/37535409 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42017 %T Assessment of Frailty by the French Version of the Vulnerable Elders Survey-13 on Digital Tablet: Validation Study %A Zolnowski-Kolp,Victoria %A Um Din,Nathavy %A Havreng-Théry,Charlotte %A Pariel,Sylvie %A Veyron,Jacques-Henri %A Lafuente-Lafuente,Carmelo %A Belmin,Joel %+ LivingLab Pratiques en santé dans le grand âge, Hôpital Charles Foix, 7 avenue de la République, Ivry-sur-Seine, 94200, France, 33 0149594565, j.belmin@aphp.fr %K frailty %K Vulnerable Elders Survey-13 (VES-13) %K elderly %K older people %K family caregivers %K French version %K electronic assessment %K digital technology %K digital health %K eHealth %K tablet %K validity %D 2023 %7 2.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Frailty assessment is a major issue in geriatric medicine. The Vulnerable Elders Survey-13 (VES-13) is a simple and practical tool that identifies frailty through a 13-item questionnaire completed by older adults or their family caregivers by self-administration (pencil and paper) or by telephone interview. The VES-13 provides a 10-point score that is also a recognized mortality predictor. Objective: This study aims to design an electronic version of the Echelle de Vulnérabilité des Ainés-13, the French version of the VES-13 (eEVA-13) for use on a digital tablet and validate it. Methods: The scale was implemented as a web App in 3 different screens and used on an Android tablet (14.0× 25.6 cm). Participants were patients attending the outpatient clinic of a French geriatric hospital or hospitalized in a rehabilitation ward and family caregivers of geriatric patients. They completed the scale twice, once by a reference method (self-administered questionnaire or telephone interview) and once by eEVA-13 using the digital tablet. Agreement for diagnosis of frailty was assessed with the κ coefficient, and scores were compared by Bland and Altman plots and interclass correlation coefficients. User experience was assessed by a self-administered questionnaire. Results: In total, 86 participants, including 40 patients and 46 family caregivers, participated in the study. All family caregivers had previously used digital devices, while 13 (32.5%) and 10 (25%) patients had no or infrequent use of them previously. We observed no failure to complete the eEVA-13, and 70% of patients (28/40) and no family caregivers needed support to complete the eEVA-13. The agreement between the eEVA-13 and the reference method for the diagnosis of frailty was excellent (κ=0.92) with agreement in 83 cases and disagreement in 3 cases. The mean difference between the scores provided by the 2 scales was 0.081 (95% CI–1.263 to 1.426). Bland and Altman plots showed a high level of agreement between the eEVA-13 and the reference methods and interclass correlation coefficient value was 0.997 (95% CI 0.994-0.998) for the paper and tablet group and 0.977 (95% CI 0.957-0.988) for the phone and tablet groups. The tablet assessment was found to be easy to use by 77.5% (31/40) of patients and by 96% (44/46) of caregivers. Finally, 85% (39/46) of family caregivers and 50% (20/40) of patients preferred the eEVA-13 to the original version. Conclusions: The eEVA-13 is an appropriate digital tool for diagnosing frailty and can be used by older adults and their family caregivers. The scores obtained with eEVA-13 are highly correlated with those obtained with the original version. The use of health questionnaires on digital tablets is feasible in frail and very old patients, although some patients may need help to use them. %M 37531175 %R 10.2196/42017 %U https://www.jmir.org/2023/1/e42017 %U https://doi.org/10.2196/42017 %U http://www.ncbi.nlm.nih.gov/pubmed/37531175 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44362 %T A Mobile Clinical Decision Support System for High-Risk Pregnant Women in Rural India (SMARThealth Pregnancy): Pilot Cluster Randomized Controlled Trial %A Nagraj,Shobhana %A Kennedy,Stephen %A Jha,Vivekananda %A Norton,Robyn %A Hinton,Lisa %A Billot,Laurent %A Rajan,Eldho %A Mohammed Abdul,Ameer %A Phalswal,Anita %A Arora,Varun %A Praveen,Devarsetty %A Hirst,Jane %+ Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, The Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, United Kingdom, 44 1865 281231, shobhana.nagraj@ndm.ox.ac.uk %K decision support systems %K clinical %K telemedicine %K community health workers %K pregnancy %K high risk %K diabetes %K gestational %K cardiovascular diseases %D 2023 %7 20.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Cardiovascular disease (CVD) is the leading cause of death in women in India. Early identification is crucial to reducing deaths. Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) carry independent risks for future CVD, and antenatal care is a window to screen and counsel high-risk women. In rural India, community health workers (CHWs) deliver antenatal and postnatal care. We developed a complex intervention (SMARThealth Pregnancy) involving mobile clinical decision support for CHWs and evaluated it in a pilot cluster randomized controlled trial (cRCT). Objective: The aim of the study is to co-design a theory-informed intervention for CHWs to screen, refer, and counsel pregnant women at high risk of future CVD in rural India and evaluate its feasibility and acceptability. Methods: In phase 1, we used qualitative methods to explore community priorities for high-risk pregnant women in rural areas of 2 diverse states in India. In phase 2, informed by behavior change theory and human-centered design, we used these qualitative data to develop the intervention components and implementation strategies for SMARThealth Pregnancy in an iterative process with end users. In phase 3, using mixed methods, we evaluated the intervention in a cRCT with an embedded qualitative substudy across 4 primary health centres: 2 in Jhajjar district, Haryana, and 2 in Guntur district, Andhra Pradesh. Results: SMARThealth Pregnancy embedded a total of 15 behavior change techniques and included (1) community awareness programs; (2) targeted training, including point-of-care blood pressure and hemoglobin measurement; and (3) mobile clinical decision support for CHWs to screen women in their homes. The intervention focused on 3 priority conditions: anemia, HDP, and GDM. The evaluation involved a total of 200 pregnant women, equally randomized to intervention or enhanced standard care (control). Recruitment was completed within 5 months, with minimal loss to follow-up (4/200, 2%) at 6 weeks postpartum. A total of 4 primary care doctors and 54 CHWs in the intervention clusters took part in the study. Fidelity to intervention practices was 100% prepandemic. Over half the study population was affected by moderate to severe anemia at baseline. The prevalence of HDP (2.5%) and GDM (2%) was low in our study population. Results suggest a possible improvement in mean hemoglobin (anemia) in the intervention group, although an adequately powered trial is needed. The model of home-based care was feasible and acceptable for pregnant or postpartum women and CHWs, who perceived improvements in quality of care, self-efficacy, and professional recognition. Conclusions: SMARThealth Pregnancy is an innovative model of home-based care for high-risk pregnant women during the transitions between antenatal and postnatal care and adult health services. The use of theory and co-design during intervention development facilitated acceptability of the intervention and implementation strategies. Our experience has informed the decision to initiate a larger-scale cRCT. Trial Registration: ClinicalTrials.gov NCT03968952; https://clinicaltrials.gov/ct2/show/NCT03968952 International Registered Report Identifier (IRRID): RR2-10.3389/fgwh.2021.620759 %M 37471135 %R 10.2196/44362 %U https://formative.jmir.org/2023/1/e44362 %U https://doi.org/10.2196/44362 %U http://www.ncbi.nlm.nih.gov/pubmed/37471135 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46231 %T Characteristics of Users and Nonusers of Symptom Checkers in Germany: Cross-Sectional Survey Study %A Kopka,Marvin %A Scatturin,Lennart %A Napierala,Hendrik %A Fürstenau,Daniel %A Feufel,Markus A %A Balzer,Felix %A Schmieding,Malte L %+ Institute of Medical Informatics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitépl 1, Berlin, 10117, Germany, 49 30 450 581 052, marvin.kopka@charite.de %K symptom checker %K cross-sectional study %K user characteristic %K digital public health %K health information seeking %K decision support %K eHealth %K mHealth %K Germany %K mobile health %K health app %K information seeking %K technology use %K usage %K demographic %K perception %K awareness %K adoption %D 2023 %7 20.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous studies have revealed that users of symptom checkers (SCs, apps that support self-diagnosis and self-triage) are predominantly female, are younger than average, and have higher levels of formal education. Little data are available for Germany, and no study has so far compared usage patterns with people’s awareness of SCs and the perception of usefulness. Objective: We explored the sociodemographic and individual characteristics that are associated with the awareness, usage, and perceived usefulness of SCs in the German population. Methods: We conducted a cross-sectional online survey among 1084 German residents in July 2022 regarding personal characteristics and people’s awareness and usage of SCs. Using random sampling from a commercial panel, we collected participant responses stratified by gender, state of residence, income, and age to reflect the German population. We analyzed the collected data exploratively. Results: Of all respondents, 16.3% (177/1084) were aware of SCs and 6.5% (71/1084) had used them before. Those aware of SCs were younger (mean 38.8, SD 14.6 years, vs mean 48.3, SD 15.7 years), were more often female (107/177, 60.5%, vs 453/907, 49.9%), and had higher formal education levels (eg, 72/177, 40.7%, vs 238/907, 26.2%, with a university/college degree) than those unaware. The same observation applied to users compared to nonusers. It disappeared, however, when comparing users to nonusers who were aware of SCs. Among users, 40.8% (29/71) considered these tools useful. Those considering them useful reported higher self-efficacy (mean 4.21, SD 0.66, vs mean 3.63, SD 0.81, on a scale of 1-5) and a higher net household income (mean EUR 2591.63, SD EUR 1103.96 [mean US $2798.96, SD US $1192.28], vs mean EUR 1626.60, SD EUR 649.05 [mean US $1756.73, SD US $700.97]) than those who considered them not useful. More women considered SCs unhelpful (13/44, 29.5%) compared to men (4/26, 15.4%). Conclusions: Concurring with studies from other countries, our findings show associations between sociodemographic characteristics and SC usage in a German sample: users were on average younger, of higher socioeconomic status, and more commonly female compared to nonusers. However, usage cannot be explained by sociodemographic differences alone. It rather seems that sociodemographics explain who is or is not aware of the technology, but those who are aware of SCs are equally likely to use them, independently of sociodemographic differences. Although in some groups (eg, people with anxiety disorder), more participants reported to know and use SCs, they tended to perceive them as less useful. In other groups (eg, male participants), fewer respondents were aware of SCs, but those who used them perceived them to be more useful. Thus, SCs should be designed to fit specific user needs, and strategies should be developed to help reach individuals who could benefit but are not aware of SCs yet. %M 37338970 %R 10.2196/46231 %U https://www.jmir.org/2023/1/e46231 %U https://doi.org/10.2196/46231 %U http://www.ncbi.nlm.nih.gov/pubmed/37338970 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43803 %T Triage and Diagnostic Accuracy of Online Symptom Checkers: Systematic Review %A Riboli-Sasco,Eva %A El-Osta,Austen %A Alaa,Aos %A Webber,Iman %A Karki,Manisha %A El Asmar,Marie Line %A Purohit,Katie %A Painter,Annabelle %A Hayhoe,Benedict %+ Self-Care Academic Research Unit (SCARU), Department of Primary Care and Public Health, Imperial College London, 323 Reynolds Building Charing Cross Hospital, London, W6 8RF, United Kingdom, 44 207 594 7604, e.riboli-sasco@imperial.ac.uk %K systematic review %K digital triage %K diagnosis %K online symptom checker %K safety %K accuracy %K mobile phone %D 2023 %7 2.6.2023 %9 Review %J J Med Internet Res %G English %X Background: In the context of a deepening global shortage of health workers and, in particular, the COVID-19 pandemic, there is growing international interest in, and use of, online symptom checkers (OSCs). However, the evidence surrounding the triage and diagnostic accuracy of these tools remains inconclusive. Objective: This systematic review aimed to summarize the existing peer-reviewed literature evaluating the triage accuracy (directing users to appropriate services based on their presenting symptoms) and diagnostic accuracy of OSCs aimed at lay users for general health concerns. Methods: Searches were conducted in MEDLINE, Embase, CINAHL, Health Management Information Consortium (HMIC), and Web of Science, as well as the citations of the studies selected for full-text screening. We included peer-reviewed studies published in English between January 1, 2010, and February 16, 2022, with a controlled and quantitative assessment of either or both triage and diagnostic accuracy of OSCs directed at lay users. We excluded tools supporting health care professionals, as well as disease- or specialty-specific OSCs. Screening and data extraction were carried out independently by 2 reviewers for each study. We performed a descriptive narrative synthesis. Results: A total of 21,296 studies were identified, of which 14 (0.07%) were included. The included studies used clinical vignettes, medical records, or direct input by patients. Of the 14 studies, 6 (43%) reported on triage and diagnostic accuracy, 7 (50%) focused on triage accuracy, and 1 (7%) focused on diagnostic accuracy. These outcomes were assessed based on the diagnostic and triage recommendations attached to the vignette in the case of vignette studies or on those provided by nurses or general practitioners, including through face-to-face and telephone consultations. Both diagnostic accuracy and triage accuracy varied greatly among OSCs. Overall diagnostic accuracy was deemed to be low and was almost always lower than that of the comparator. Similarly, most of the studies (9/13, 69 %) showed suboptimal triage accuracy overall, with a few exceptions (4/13, 31%). The main variables affecting the levels of diagnostic and triage accuracy were the severity and urgency of the condition, the use of artificial intelligence algorithms, and demographic questions. However, the impact of each variable differed across tools and studies, making it difficult to draw any solid conclusions. All included studies had at least one area with unclear risk of bias according to the revised Quality Assessment of Diagnostic Accuracy Studies-2 tool. Conclusions: Although OSCs have potential to provide accessible and accurate health advice and triage recommendations to users, more research is needed to validate their triage and diagnostic accuracy before widescale adoption in community and health care settings. Future studies should aim to use a common methodology and agreed standard for evaluation to facilitate objective benchmarking and validation. Trial Registration: PROSPERO CRD42020215210; https://tinyurl.com/3949zw83 %M 37266983 %R 10.2196/43803 %U https://www.jmir.org/2023/1/e43803 %U https://doi.org/10.2196/43803 %U http://www.ncbi.nlm.nih.gov/pubmed/37266983 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39219 %T Impacts of Symptom Checkers for Laypersons’ Self-diagnosis on Physicians in Primary Care: Scoping Review %A Radionova,Natalia %A Ög,Eylem %A Wetzel,Anna-Jasmin %A Rieger,Monika A %A Preiser,Christine %+ Institute of Occupational Medicine, Social Medicine and Health Services Research, University Hospital Tuebingen, Wilhelmstrasse 27, Tuebingen, 72074, Germany, 49 70712984361, christine.preiser@med.uni-tuebingen.de %K mobile health %K mHealth %K symptom checkers %K artificial intelligence–based technology %K AI-based technology %K self-diagnosis %K general practice %K scoping review %K mobile phone %D 2023 %7 29.5.2023 %9 Review %J J Med Internet Res %G English %X Background: Symptom checkers (SCs) for laypersons’ self-assessment and preliminary self-diagnosis are widely used by the public. Little is known about the impact of these tools on health care professionals (HCPs) in primary care and their work. This is relevant to understanding how technological changes might affect the working world and how this is linked to work-related psychosocial demands and resources for HCPs. Objective: This scoping review aimed to systematically explore the existing publications on the impacts of SCs on HCPs in primary care and to identify knowledge gaps. Methods: We used the Arksey and O’Malley framework. We based our search string on the participant, concept, and context scheme and searched PubMed (MEDLINE) and CINAHL in January and June 2021. We performed a reference search in August 2021 and a manual search in November 2021. We included publications of peer-reviewed journals that focused on artificial intelligence- or algorithm-based self-diagnosing apps and tools for laypersons and had primary care or nonclinical settings as a relevant context. The characteristics of these studies were described numerically. We used thematic analysis to identify core themes. We followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist to report the study. Results: Of the 2729 publications identified through initial and follow-up database searches, 43 full texts were screened for eligibility, of which 9 were included. Further 8 publications were included through manual search. Two publications were excluded after receiving feedback in the peer-review process. Fifteen publications were included in the final sample, which comprised 5 (33%) commentaries or nonresearch publications, 3 (20%) literature reviews, and 7 (47%) research publications. The earliest publications stemmed from 2015. We identified 5 themes. The theme finding prediagnosis comprised the comparison between SCs and physicians. We identified the performance of the diagnosis and the relevance of human factors as topics. In the theme layperson-technology relationship, we identified potentials for laypersons’ empowerment and harm through SCs. Our analysis showed potential disruptions of the physician-patient relationship and uncontested roles of HCPs in the theme (impacts on) physician-patient relationship. In the theme impacts on HCPs’ tasks, we described the reduction or increase in HCPs’ workload. We identified potential transformations of HCPs’ work and impacts on the health care system in the theme future role of SCs in health care. Conclusions: The scoping review approach was suitable for this new field of research. The heterogeneity of technologies and wordings was challenging. We identified research gaps in the literature regarding the impact of artificial intelligence– or algorithm-based self-diagnosing apps or tools on the work of HCPs in primary care. Further empirical studies on HCPs’ lived experiences are needed, as the current literature depicts expectations rather than empirical findings. %M 37247214 %R 10.2196/39219 %U https://www.jmir.org/2023/1/e39219 %U https://doi.org/10.2196/39219 %U http://www.ncbi.nlm.nih.gov/pubmed/37247214 %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 %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44996 %T Identification of Patients With Elevated Urine Albumin–to-Creatinine Ratio Levels in a Type 2 Diabetes Mellitus Cohort Based on Data Submitted by Patients via a Smartphone App (SMART-Finder): Protocol for an Observational Study %A Mueller,Christian %A Schürks,Markus %A Neußer,Thomas %A von der Osten,Uschi %A Weihermüller,Daniela %A von Arnim,Ira %A Martin,Stephan %+ Bayer Vital GmbH, Kaiser-Wilhelm-Allee 70, Leverkusen, 51373, Germany, 49 175 3005134, christian.mueller4@bayer.com %K app-based documentation %K chronic kidney disease %K prevalence %K MyTherapy %K type 2 diabetes mellitus %K urine albumin-to-creatinine ratio screening %D 2023 %7 5.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite effective treatment options, chronic kidney disease (CKD) has become a major cause of mortality worldwide due to the ever-increasing number of patients with type 2 diabetes mellitus (T2DM). Guideline-compliant, at least, annual screening of patients with T2DM is crucial to prevent renal disease progression. However, data on the prevalence of CKD in patients with T2DM and on screening frequency are limited. SMART-Finder is the first study to exclusively use data provided directly by patients via an adherence app to collect information on the prevalence of CKD, risk factors, disease management, and quality of life of patients with T2DM in Germany. Objective: The primary objective of this study is to determine the proportion of patients with T2DM and an elevated urine albumin-to-creatinine ratio (UACR; albumin-to-creatinine ratio stage A2 and A3) at baseline and after 12 (±3) months. Secondary objectives include the proportion of patients who remain in or switch to another albumin-to-creatinine ratio classification category after 12 months, information on quality of life, disease awareness, and adherence rates, as well as the proportion of patients without any UACR-screening data. Recruitment occurs via push notification among MyTherapy app users with T2DM. Methods: This is a single-arm, retrospective/prospective, observational, digital, patient-centered cohort study, with recruitment and data documentation via a health app. Required routine laboratory data are provided by treating physicians to their patients for data entry. The study population includes adult patients with T2DM documenting their data in the MyTherapy app using their own smartphone or tablet. Study participants are provided with a specifically developed electronic case report form containing questions on demographic and general data, quality of life, disease awareness, and laboratory values including estimated glomerular filtration rate, UACR, hemoglobin 1Ac, and blood pressure. Apart from demographic and general data, all data are collected at baseline and 12 months after the last UACR assessment. An automatically generated push notification reminds participants of the second data entry. The extracted and pseudonymized data are analyzed descriptively. Results: The enrollment period for this study started in February 2023 and shall end after 12 months or after the enrollment of 5000 patients. An interim analysis is planned 3 months after the inclusion of the first patient and the final analysis after 12 months of follow-up. Conclusions: Overall, the study will contribute to minimizing the existing data gap on the prevalence of CKD in patients with T2DM in Germany, provide important insights into the current disease management of patients with T2DM in everyday clinical practice in Germany, and support guideline-based care for the participating patients. International Registered Report Identifier (IRRID): PRR1-10.2196/44996 %M 37018036 %R 10.2196/44996 %U https://www.researchprotocols.org/2023/1/e44996 %U https://doi.org/10.2196/44996 %U http://www.ncbi.nlm.nih.gov/pubmed/37018036 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38563 %T Video Consultations and Safety App Targeting Pregnant Women Exposed to Intimate Partner Violence in Denmark and Spain: Nested Cohort Intervention Study (STOP Study) %A Andreasen,Karen %A Zapata-Calvente,Antonella Ludmila %A Martín-de-las-Heras,Stella %A Bueno-Cavanillas,Aurora %A Schei,Berit %A Dokkedahl,Sarah %A de León de León,Sabina %A Fernandez Lopez,Rodrigo %A Oviedo-Gutiérrez,Alba %A Ankerstjerne,Lea Bo Sønderlund %A Megías,Jesús L %A Khan,Khalid Saeed %A Rasch,Vibeke %A Linde,Ditte S %+ Department of Gyneacology and Obstetrics, Odense University Hospital, Kloevervaenget 10, 10th floor, Odense, 5000, Denmark, 45 65414606, karen.andreasen2@rsyd.dk %K intimate partner violence %K gender-based violence %K domestic violence %K abuse %K telemedicine %K video counseling %K app %K acceptance %K safety %K feasibility %K empowerment %D 2023 %7 20.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Intimate partner violence (IPV) during pregnancy is a public health issue with wide-ranging consequences for both the mother and fetus, and interventions are needed. Therefore, the Stop Intimate Partner Violence in Pregnancy (STOP) cohort was established with the overall aim to identify pregnant women exposed to IPV through digital screening and offer women screening positive for IPV a digital supportive intervention. Objective: The aim of this study was to (1) introduce the design and profile of the STOP cohort study, (2) assess the feasibility of implementing digital IPV screening among pregnant women, and (3) assess the feasibility of implementing a digital supportive intervention targeting pregnant women exposed to IPV. Methods: Pregnant women attending antenatal care in the Region of Southern Denmark and in Andalucía, Spain were offered digital screening for IPV using validated scales (Abuse Assessment Screen and Women Abuse Screening Tool). Women who screened positive were eligible to receive a digital supportive intervention. The intervention consisted of 3-6 video consultations with an IPV counselor and a safety planning app. In Denmark, IPV counselors were antenatal care midwives trained by a psychologist specialized in IPV, whereas in Spain, the counselor was a psychologist. Results: Data collection started in February 2021 and was completed in October 2022. Across Denmark and Spain, a total of 19,442 pregnant women were invited for IPV screening and 16,068 women (82.65%) completed the screening. More women in Spain screened positive for exposure to IPV (350/2055, 17.03%) than in Denmark (1195/14,013, 8.53%). Among the women who screened positive, only 31.39% (485/1545) were eligible to receive the intervention with only 104 (21.4%) of these women ultimately receiving it. Conclusions: Digital screening for IPV among pregnant women is feasible in an antenatal care context in Denmark and Spain; however, a digital supportive intervention during pregnancy appears to have limited feasibility as only a minor subgroup of women who screened positive for eligibility received the intervention. More research is needed on how to best support pregnant women exposed to IPV if universal IPV screening is to be implemented in antenatal care. %M 36939835 %R 10.2196/38563 %U https://formative.jmir.org/2023/1/e38563 %U https://doi.org/10.2196/38563 %U http://www.ncbi.nlm.nih.gov/pubmed/36939835 %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 %@ 2561-6722 %I JMIR Publications %V 6 %N %P e40463 %T Iterative Development, Validation, and Certification of a Smartphone System to Assess Neonatal Jaundice: Development and Usability Study %A Aune,Anders %A Vartdal,Gunnar %A Jimenez Diaz,Gabriela %A Gierman,Lobke Marijn %A Bergseng,Håkon %A Darj,Elisabeth %+ Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Olav Kyrres gate 9, Trondheim, 7030, Norway, 47 95034601, a.aune@ntnu.no %K neonatal jaundice %K neonatal hyperbilirubinemia %K newborns %K mobile app %K design %K validation %K regulatory processes %K mobile health %K mHealth %K mobile phone %D 2023 %7 28.2.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Medical device development is an area facing multiple challenges, resulting in a high number of products not reaching the clinical setting. Neonatal hyperbilirubinemia, manifesting as neonatal jaundice (NNJ), is an important cause of newborn morbidity and mortality. It is important to identify infants with neonatal hyperbilirubinemia at an early stage, but currently there is a lack of tools that are both accurate and affordable. Objective: This study aimed to develop a novel system to assess the presence of NNJ. The device should provide accurate results, be approved as a medical device, be easy to use, and be produced at a price that is affordable even in low-resource settings. Methods: We used an iterative approach to develop a smartphone-based system to detect the presence of NNJ. We performed technical development, followed by clinical and usability testing in parallel, after which we initiated the regulatory processes for certification. We updated the system in each iteration, and the final version underwent a clinical validation study on healthy term newborns aged 1 to 15 days before all documentation was submitted for conformity assessment to obtain Conformité Européenne (CE) certification. We developed a system that incorporates a smartphone app, a color calibration card, and a server. Results: Three iterations of the smartphone-based system were developed; the final version was approved as a medical device after complying with Medical Device Regulation guidelines. A total of 201 infants were included in the validation study. Bilirubin values using the system highly correlated with total serum or plasma bilirubin levels (r=0.84). The system had a high sensitivity (94%) to detect severe jaundice, defined as total serum or plasma bilirubin >250 µmol/L, and maintained a high specificity (71%). Conclusions: Our smartphone-based system has a high potential as a tool for identifying NNJ. An iterative approach to product development, conducted by working on different tasks in parallel, resulted in a functional and successful product. By adhering to the requirements for regulatory approval from the beginning of the project, we were able to develop a market-ready mobile health solution. %M 36853753 %R 10.2196/40463 %U https://pediatrics.jmir.org/2023/1/e40463 %U https://doi.org/10.2196/40463 %U http://www.ncbi.nlm.nih.gov/pubmed/36853753 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e41508 %T Effectiveness of Remote Fetal Monitoring on Maternal-Fetal Outcomes: Systematic Review and Meta-Analysis %A Li,Suya %A Yang,Qing %A Niu,Shuya %A Liu,Yu %+ Nursing Department, Tongji Hospital, Tongji Medical College, HuaZhong University of Science and Technology, No. 1095 Jiefang Rd, Wuhan, 430030, China, 86 13995579713, hust512@sohu.com %K remote fetal monitoring %K maternal outcomes %K fetal outcomes %K review %D 2023 %7 22.2.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: To solve the disadvantages of traditional fetal monitoring such as time-consuming, cumbersome steps and low coverage, it is paramount to develop remote fetal monitoring. Remote fetal monitoring expands time and space, which is expected to popularize fetal monitoring in remote areas with the low availability of health services. Pregnant women can transmit fetal monitoring data from remote monitoring terminals to the central monitoring station so that doctors can interpret it remotely and detect fetal hypoxia in time. Fetal monitoring involving remote technology has also been carried out, but with some conflicting results. Objective: The review aimed to (1) examine the efficacy of remote fetal monitoring in improving maternal-fetal outcomes and (2) identify research gaps in the field to make recommendations for future research. Methods: We did a systematic literature search with PubMed, Cochrane Library, Web of Science, Embase, MEDLINE, CINAHL, ProQuest Dissertations and Theses Global, ClinicalTrials.gov, and Open Grey in March 2022. Randomized controlled trials or quasi-experimental trials of remote fetal monitoring were identified. Two reviewers independently searched articles, extracted data, and assessed each study. Primary outcomes (maternal-fetal outcomes) and secondary outcomes (health care usage) were presented as relative risks or mean difference. The review was registered on PROSPERO as CRD42020165038. Results: Of the 9337 retrieved literature, 9 studies were included in the systematic review and meta-analysis (n=1128). Compared with a control group, remote fetal monitoring reduced the risk of neonatal asphyxia (risk ratio 0.66, 95% CI 0.45-0.97; P=.04), with a low heterogeneity of 24%. Other maternal-fetal outcomes did not differ significantly between remote fetal monitoring and routine fetal monitoring, such as cesarean section (P=.21; I2=0%), induced labor (P=.50; I2=0%), instrumental vaginal birth (P=.45; I2=0%), spontaneous delivery (P=.85; I2=0%), gestational weeks at delivery (P=.35; I2=0%), premature delivery (P=.47; I2=0%), and low birth weight (P=.71; I2=0%). Only 2 studies performed a cost analysis, stating that remote fetal monitoring can contribute to reductions in health care costs when compared with conventional care. In addition, remote fetal monitoring might affect the number of visits and duration in the hospital, but it was not possible to draw definite conclusions about the effects due to the limited number of studies. Conclusions: Remote fetal monitoring seems to reduce the incidence of neonatal asphyxia and health care costs compared with routine fetal monitoring. To strengthen the claims on the efficacy of remote fetal monitoring, further well-designed studies are necessary, especially in high-risk pregnant women, such as pregnant women with diabetes, pregnant women with hypertension, and so forth. %M 36811944 %R 10.2196/41508 %U https://mhealth.jmir.org/2023/1/e41508 %U https://doi.org/10.2196/41508 %U http://www.ncbi.nlm.nih.gov/pubmed/36811944 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e41861 %T Evaluating Clinician Expectations of mHealth Solutions to Increase Rapid-Screening for HIV and Hepatitis in Migrant Populations in France: Qualitative Study %A Brown,Carter %A Roucoux,Guillaume %A Dimi,Svetlane %A Fahmi,Saleh %A Jeevan,Raj-Banou %A Chassany,Olivier %A Chaplin,John %A Duracinsky,Martin %+ Patient-Reported Outcomes Unit, UMR 1123, Inserm, Université de Paris, 1 Parvis Notre Dame - Place Jean-Paul II, Paris, 75004, France, 33 0140274664, carter.brown@inserm.fr %K app development %K acceptability %K mobile health %K mHealth %K user-centered design %K communication barriers %K migrants %K HIV %K AIDS %K hepatitis %K rapid diagnostic testing %K public health %K communication tool %K screening %K language barrier %D 2023 %7 3.2.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Migrants underuse screening opportunities for HIV, hepatitis B, and hepatitis C despite elevated risk factors for contracting these infections. Language barriers are an often given as reasons for limiting access to services. Translation and communication apps increase communication and overall patient satisfaction in the patient-provider relationship. In the development and adoption of new technology, expectations play an important role. Objective: This study aimed to explore health care professionals’ opinions and attitudes regarding their screening practices with migrants and their expectations for a new communication tool that could improve migrants’ screening use. Methods: In this qualitative study, a purposive (diverse) sampling method was used to invite doctors and nurses who conduct rapid screening tests with migrants from 4 centers of the French Office of Immigration and Integration in 3 geographic regions of France. Semistructured interviews were conducted to survey their opinions on the rapid testing of migrants, the use of telephone interpreters, the concept of health literacy, and their expectations of a new communication tool that could overcome language barriers and promote rapid screening in the new migrant population. Results: In all, 20 interviews were conducted with 11 doctors and 9 nurses with a median age of 58 (range 25-67) years. Participants favored the integration of an innovative communication tool in the context of rapid screening of migrants. However, there were concerns related to the implementation and added value of the tool while migrants were already reluctant to be screened. Expectations were for a tool that would present information in simplified French or a chosen language but also supports a positive attitude toward screening. Health professionals also expressed the wish that the technology could help with the collection of health data. Conclusions: Feedback from health professionals provides a better understanding of potential formats, characteristics, functions, content, and use of an innovative, digital method to communicate with migrants with limited French proficiency. Findings contribute to the conceptual development of an electronic app and its implementation within the ApiDé study, which aims to validate a digital app to address language barriers to increase the use of screening among migrants with limited French proficiency in France. %M 36735323 %R 10.2196/41861 %U https://humanfactors.jmir.org/2023/1/e41861 %U https://doi.org/10.2196/41861 %U http://www.ncbi.nlm.nih.gov/pubmed/36735323 %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 %@ 2291-9279 %I JMIR Publications %V 10 %N 4 %P e36197 %T Impact of the Mobile Game FightHPV on Cervical Cancer Screening Attendance: Retrospective Cohort Study %A Orumaa,Madleen %A Campbell,Suzanne %A Støer,Nathalie C %A Castle,Philip E %A Sen,Sagar %A Tropé,Ameli %A Adedimeji,Adebola %A Nygård,Mari %+ Department of Research, Cancer Registry of Norway, P.O. Box 5313 Majorstuen, Oslo, N-0304, Norway, 47 22928851, mari.nygard@kreftregisteret.no %K mobile app %K gamification %K empowering %K health literacy %K cervical cancer screening %K cancer prevention %D 2022 %7 13.12.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: The wide availability of mobile phones has made it easy to disseminate health-related information and make it accessible. With gamification, mobile apps can nudge people to make informed health choices, including attending cervical cancer screening. Objective: This matched retrospective cohort study examined the association between exposure to the FightHPV mobile app gamified educational content and having a cervical exam in the following year. Methods: Women aged 20 to 69 years who signed an electronic consent form after downloading the FightHPV app in 2017 (intervention group) were matched 1:6 with women of the same age and with the same screening history (reference group) in 2015. To estimate the impact of exposure to the FightHPV app, we estimated cumulative incidence and hazard ratios (HRs) with 95% CIs. We used data from the Norwegian Cervical Cancer Screening Program database and Statistics Norway to determine screening participation and outcomes, respectively. Results: We matched 3860 women in the control group to 658 women in the intervention group; 6 months after enrollment, 29.6% (195/658) of the women in the intervention group and 15.21% (587/3860) of those in the reference group underwent a cervical exam (P<.01). Women exposed to the FightHPV app were 2 times more likely to attend screening (adjusted HR 2.3, 95% CI 2.0-2.7), during which they were 13 times more likely to be diagnosed with high-grade abnormality (adjusted HR 12.7, 95% CI 5.0-32.5) than the women in the reference group. Conclusions: Exposure to the FightHPV app significantly increased cervical cancer screening attendance across the various analyses and improved detection of women with high risk for cervical cancer. For the first time, we demonstrated the effectiveness of gamification combined with mobile technology in cancer prevention by empowering women to make active health-related decisions. Gamification can significantly improve the understanding of complicated scientific concepts behind interventions and increase the acceptance of proposed cancer control measures. %M 36512401 %R 10.2196/36197 %U https://games.jmir.org/2022/4/e36197 %U https://doi.org/10.2196/36197 %U http://www.ncbi.nlm.nih.gov/pubmed/36512401 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e40718 %T Shortening the Time Interval for the Referral of Patients With Soft Tissue Sarcoma to Expert Centers Using Mobile Health: Retrospective Study %A Nannini,Simon %A Penel,Nicolas %A Bompas,Emmanuelle %A Willaume,Thibault %A Kurtz,Jean-Emmanuel %A Gantzer,Justine %+ Department of Medical Oncology, Strasbourg-Europe Cancer Institute, 17 Rue Albert Calmette, Strasbourg, 67200, France, 33 03 68 76 67 67, s.nannini@icans.eu %K sarcoma %K apps %K mHealth %K mobile health %K health app %K mobile app %K referral %K consultation %K care coordination %K tumor %K cancer %K oncology %K soft tissue %K connective tissue %K prognosis %K communication %K interprofessional %K patient management %K physician %K doctor %K health care provider %K specialist %K general practitioner %K GP %D 2022 %7 9.11.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: According to guidelines, all patients with sarcoma must be managed from initial diagnosis at expert sarcoma centers. However, in everyday practice, the time interval to an expert center visit can be long, which delays presentation to an expert multidisciplinary tumor board and increases the risk of inappropriate management, negatively affecting local tumor control and prognosis. The advent of mobile health offers an easy way to facilitate communication and cooperation between general health care providers (eg, general practitioners and radiologists) and sarcomas experts. We developed a mobile app (Sar’Connect) based on the algorithm designed by radiologists from the French Sarcoma Group. Through a small number of easy-to-answer questions, Sar’Connect provides personalized advice for the management of patients and contact information for the closest expert center. Objective: This retrospective study is the first to assess this mobile app’s potential benefits in reducing the time interval for patient referral to an expert center according to the initial clinical characteristics of the soft tissue tumor. Methods: From May to December 2021, we extracted tumor mass data for 78 patients discussed by the multidisciplinary tumor boards at 3 centers of the French Sarcoma Group. We applied the Sar’Connect algorithm to these data and estimated the time interval between the first medical description of the soft tissue mass and the referral to expert center. We then compared this estimated time interval with the observed time interval. Results: We found that the use of Sar’Connect could potentially shorten the time interval to an expert center by approximately 7.5 months (P<.001). Moreover, for half (31/60, 52%) of the patients with a malignant soft tissue tumor, Sar’Connect could have avoided inappropriate management outside of the reference center. We did not identify a significant determinant for shortening the time interval for referral. Conclusions: Overall, promoting the use of a simple mobile app is an innovative and straightforward means to potentially accelerate both the referral and management of patients with soft tissue sarcoma at expert centers. %M 36350680 %R 10.2196/40718 %U https://mhealth.jmir.org/2022/11/e40718 %U https://doi.org/10.2196/40718 %U http://www.ncbi.nlm.nih.gov/pubmed/36350680 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 10 %P e28082 %T Validity of Chatbot Use for Mental Health Assessment: Experimental Study %A Schick,Anita %A Feine,Jasper %A Morana,Stefan %A Maedche,Alexander %A Reininghaus,Ulrich %+ Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, Mannheim, 68219, Germany, 49 62117031941, anita.schick@zi-mannheim.de %K chatbot %K distress %K monitoring %K mobile health %K social desirability %K social presence %D 2022 %7 31.10.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mental disorders in adolescence and young adulthood are major public health concerns. Digital tools such as text-based conversational agents (ie, chatbots) are a promising technology for facilitating mental health assessment. However, the human-like interaction style of chatbots may induce potential biases, such as socially desirable responding (SDR), and may require further effort to complete assessments. Objective: This study aimed to investigate the convergent and discriminant validity of chatbots for mental health assessments, the effect of assessment mode on SDR, and the effort required by participants for assessments using chatbots compared with established modes. Methods: In a counterbalanced within-subject design, we assessed 2 different constructs—psychological distress (Kessler Psychological Distress Scale and Brief Symptom Inventory-18) and problematic alcohol use (Alcohol Use Disorders Identification Test-3)—in 3 modes (chatbot, paper-and-pencil, and web-based), and examined convergent and discriminant validity. In addition, we investigated the effect of mode on SDR, controlling for perceived sensitivity of items and individuals’ tendency to respond in a socially desirable way, and we also assessed the perceived social presence of modes. Including a between-subject condition, we further investigated whether SDR is increased in chatbot assessments when applied in a self-report setting versus when human interaction may be expected. Finally, the effort (ie, complexity, difficulty, burden, and time) required to complete the assessments was investigated. Results: A total of 146 young adults (mean age 24, SD 6.42 years; n=67, 45.9% female) were recruited from a research panel for laboratory experiments. The results revealed high positive correlations (all P<.001) of measures of the same construct across different modes, indicating the convergent validity of chatbot assessments. Furthermore, there were no correlations between the distinct constructs, indicating discriminant validity. Moreover, there were no differences in SDR between modes and whether human interaction was expected, although the perceived social presence of the chatbot mode was higher than that of the established modes (P<.001). Finally, greater effort (all P<.05) and more time were needed to complete chatbot assessments than for completing the established modes (P<.001). Conclusions: Our findings suggest that chatbots may yield valid results. Furthermore, an understanding of chatbot design trade-offs in terms of potential strengths (ie, increased social presence) and limitations (ie, increased effort) when assessing mental health were established. %M 36315228 %R 10.2196/28082 %U https://mhealth.jmir.org/2022/10/e28082 %U https://doi.org/10.2196/28082 %U http://www.ncbi.nlm.nih.gov/pubmed/36315228 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 9 %P e38364 %T Evaluation of Diagnostic and Triage Accuracy and Usability of a Symptom Checker in an Emergency Department: Observational Study %A Fraser,Hamish S F %A Cohan,Gregory %A Koehler,Christopher %A Anderson,Jared %A Lawrence,Alexis %A Pateña,John %A Bacher,Ian %A Ranney,Megan L %+ Brown Center for Biomedical Informatics, Warren Alpert Medical School, Brown University, 233 Richmond Street, Providence, RI, 02912, United States, 1 401 863 1815, hamish_fraser@brown.edu %K mobile health %K mHealth %K symptom checker %K diagnosis %K user experience %D 2022 %7 19.9.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Symptom checkers are clinical decision support apps for patients, used by tens of millions of people annually. They are designed to provide diagnostic and triage advice and assist users in seeking the appropriate level of care. Little evidence is available regarding their diagnostic and triage accuracy with direct use by patients for urgent conditions. Objective: The aim of this study is to determine the diagnostic and triage accuracy and usability of a symptom checker in use by patients presenting to an emergency department (ED). Methods: We recruited a convenience sample of English-speaking patients presenting for care in an urban ED. Each consenting patient used a leading symptom checker from Ada Health before the ED evaluation. Diagnostic accuracy was evaluated by comparing the symptom checker’s diagnoses and those of 3 independent emergency physicians viewing the patient-entered symptom data, with the final diagnoses from the ED evaluation. The Ada diagnoses and triage were also critiqued by the independent physicians. The patients completed a usability survey based on the Technology Acceptance Model. Results: A total of 40 (80%) of the 50 participants approached completed the symptom checker assessment and usability survey. Their mean age was 39.3 (SD 15.9; range 18-76) years, and they were 65% (26/40) female, 68% (27/40) White, 48% (19/40) Hispanic or Latino, and 13% (5/40) Black or African American. Some cases had missing data or a lack of a clear ED diagnosis; 75% (30/40) were included in the analysis of diagnosis, and 93% (37/40) for triage. The sensitivity for at least one of the final ED diagnoses by Ada (based on its top 5 diagnoses) was 70% (95% CI 54%-86%), close to the mean sensitivity for the 3 physicians (on their top 3 diagnoses) of 68.9%. The physicians rated the Ada triage decisions as 62% (23/37) fully agree and 24% (9/37) safe but too cautious. It was rated as unsafe and too risky in 22% (8/37) of cases by at least one physician, in 14% (5/37) of cases by at least two physicians, and in 5% (2/37) of cases by all 3 physicians. Usability was rated highly; participants agreed or strongly agreed with the 7 Technology Acceptance Model usability questions with a mean score of 84.6%, although “satisfaction” and “enjoyment” were rated low. Conclusions: This study provides preliminary evidence that a symptom checker can provide acceptable usability and diagnostic accuracy for patients with various urgent conditions. A total of 14% (5/37) of symptom checker triage recommendations were deemed unsafe and too risky by at least two physicians based on the symptoms recorded, similar to the results of studies on telephone and nurse triage. Larger studies are needed of diagnosis and triage performance with direct patient use in different clinical environments. %M 36121688 %R 10.2196/38364 %U https://mhealth.jmir.org/2022/9/e38364 %U https://doi.org/10.2196/38364 %U http://www.ncbi.nlm.nih.gov/pubmed/36121688 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e36316 %T mHealth Interventions to Improve Cancer Screening and Early Detection: Scoping Review of Reviews %A Schliemann,Désirée %A Tan,Min Min %A Hoe,Wilfred Mok Kok %A Mohan,Devi %A Taib,Nur Aishah %A Donnelly,Michael %A Su,Tin Tin %+ Centre for Public Health, Queen’s University Belfast, Institute of Clinical Science, Block B, Royal Victoria Hospital, Belfast, BT12 6BA, United Kingdom, 44 02890245133, d.schliemann@qub.ac.uk %K mobile health %K mHealth %K cancer screening %K scoping review of reviews %K cancer %K cancer detection %K oncology %K digital health %K scoping review %K review %K mobile phone %D 2022 %7 15.8.2022 %9 Review %J J Med Internet Res %G English %X Background: Cancer screening provision in resource-constrained settings tends to be opportunistic, and uptake tends to be low, leading to delayed presentation and treatment and poor survival. Objective: The aim of this study was to identify, review, map, and summarize findings from different types of literature reviews on the use of mobile health (mHealth) technologies to improve the uptake of cancer screening. Methods: The review methodology was guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Ovid MEDLINE, PyscINFO, and Embase were searched from inception to May 2021. The eligible criteria included reviews that focused on studies of interventions that used mobile phone devices to promote and deliver cancer screening and described the effectiveness or implementation of mHealth intervention outcomes. Key data fields such as study aims, types of cancer, mHealth formats, and outcomes were extracted, and the data were analyzed to address the objective of the review. Results: Our initial search identified 1981 titles, of which 12 (0.61%) reviews met the inclusion criteria (systematic reviews: n=6, 50%; scoping reviews: n=4, 33%; rapid reviews: n=1, 8%; narrative reviews: n=1, 8%). Most (57/67, 85%) of the interventions targeted breast and cervical cancer awareness and screening uptake. The most commonly used mHealth technologies for increasing cancer screening uptake were SMS text messages and telephone calls. Overall, mHealth interventions increased knowledge about screening and had high acceptance among participants. The likelihood of achieving improved uptake-related outcomes increased when interventions used >1 mode of communication (telephone reminders, physical invitation letters, and educational pamphlets) together with mHealth. Conclusions: mHealth interventions increase cancer screening uptake, although multiple modes used in combination seem to be more effective. %M 35969450 %R 10.2196/36316 %U https://www.jmir.org/2022/8/e36316 %U https://doi.org/10.2196/36316 %U http://www.ncbi.nlm.nih.gov/pubmed/35969450 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e36425 %T Cost-Effectiveness of Lung Cancer Screening Using Low-Dose Computed Tomography Based on Start Age and Interval in China: Modeling Study %A Zhao,Zixuan %A Du,Lingbin %A Li,Yuanyuan %A Wang,Le %A Wang,Youqing %A Yang,Yi %A Dong,Hengjin %+ Department of Science and Education of the Fourth Affiliated Hospital, Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, No. 866 Yuhangtang Road, Xihu District, Hangzhou, 310058, China, 86 13221076129, donghj@zju.edu.cn %K cost-effectiveness analysis %K low-dose computed tomography %K screening %K lung cancer %K China %D 2022 %7 6.7.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death in China. The effectiveness of screening for lung cancer has been reported to reduce lung cancer–specific and overall mortality, although the cost-effectiveness, optimal start age, and screening interval remain unclear. Objective: This study aimed to assess the cost-effectiveness of lung cancer screening among heavy smokers in China by incorporating start age and screening interval. Methods: A Markov state-transition model was used to assess the cost-effectiveness of a lung cancer screening program in China. The evaluated screening strategies were based on a screening start age of 50-74 years and a screening interval of once or annually. Transition probabilities were obtained from the literature and validated, while cost parameters were derived from databases of local medical insurance bureaus. A societal perspective was adopted. The outputs of the model included costs, quality-adjusted life years (QALYs), and lung cancer–specific mortality, with future costs and outcomes discounted by 5%. A currency exchange rate of 1 CNY=0.1557 USD is applicable. The incremental cost-effectiveness ratio (ICER) was calculated for different screening strategies relative to nonscreening. Results: The proposed model suggested that screening led to a gain of 0.001-0.042 QALYs per person as compared with the findings in the nonscreening cohort. Meanwhile, one-time and annual screenings were associated with reductions in lung cancer–related mortality of 0.004%-1.171% and 6.189%-15.819%, respectively. The ICER ranged from 119,974.08 to 614,167.75 CNY per QALY gained relative to nonscreening. Using the World Health Organization threshold of 212,676 CNY per QALY gained, annual screening from a start age of 55 years and one-time screening from the age of 65 years can be considered as cost-effective in China. Deterministic and probabilistic sensitivity analyses were conducted. Conclusions: This economic evaluation revealed that a population-based lung cancer screening program in China for heavy smokers using low-dose computed tomography was cost-effective for annual screening of smokers aged 55-74 years and one-time screening of those aged 65-74 years. Moreover, annual lung cancer screening should be promoted in China to realize the benefits of a guideline-recommended screening program. %M 35793127 %R 10.2196/36425 %U https://publichealth.jmir.org/2022/7/e36425 %U https://doi.org/10.2196/36425 %U http://www.ncbi.nlm.nih.gov/pubmed/35793127 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e34685 %T Health Consumer Engagement, Enablement, and Empowerment in Smartphone-Enabled Home-Based Diagnostic Testing for Viral Infections: Mixed Methods Study %A LeRouge,Cynthia %A Durneva,Polina %A Lyon,Victoria %A Thompson,Matthew %+ Department of Information Systems and Business Analytics, College of Business, Florida International University, 11200 S.W. 8th St., RB 206B, Miami, FL, 33199, United States, 1 305 348 4709, clerouge@fiu.edu %K smart HT %K mHealth %K patient engagement %K patient enablement %K patient empowerment %K diagnostic testing %K viral infection %K patient activation %K consumer health informatics %K influenza %K home testing %K mobile phone %D 2022 %7 30.6.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health consumers are increasingly taking a more substantial role in decision-making and self-care regarding their health. A range of digital technologies is available for laypeople to find, share, and generate health-related information that supports their health care processes. There is also innovation and interest in home testing enabled by smartphone technology (smartphone-supported home testing [smart HT]). However, few studies have focused on the process from initial engagement to acting on the test results, which involves multiple decisions. Objective: This study aimed to identify and model the key factors leading to health consumers’ engagement and enablement associated with smart HT. We also explored multiple levels of health care choices resulting from health consumer empowerment and activation from smart HT use. Understanding the factors and choices associated with engagement, enablement, empowerment, and activation helps both research and practice to support the intended and optimal use of smart HT. Methods: This study reports the findings from 2 phases of a more extensive pilot study of smart HT for viral infection. In these 2 phases, we used mixed methods (semistructured interviews and surveys) to shed light on the situated complexities of health consumers making autonomous decisions to engage with, perform, and act on smart HT, supporting the diagnostic aspects of their health care. Interview (n=31) and survey (n=282) participants underwent smart HT testing for influenza in earlier pilot phases. The survey also extended the viral infection context to include questions related to potential smart HT use for SARS-CoV-2 diagnosis. Results: Our resulting model revealed the smart HT engagement and enablement factors, as well as choices resulting from empowerment and activation. The model included factors leading to engagement, specifically various intrinsic and extrinsic influences. Moreover, the model included various enablement factors, including the quality of smart HT and the personal capacity to perform smart HT. The model also explores various choices resulting from empowerment and activation from the perspectives of various stakeholders (public vs private) and concerning different levels of impact (personal vs distant). Conclusions: The findings provide insight into the nuanced and complex ways health consumers make decisions to engage with and perform smart HT and how they may react to positive results in terms of public-private and personal-distant dimensions. Moreover, the study illuminates the role that providers and smart HT sources can play to better support digitally engaged health consumers in the smart HT decision process. %M 35771605 %R 10.2196/34685 %U https://mhealth.jmir.org/2022/6/e34685 %U https://doi.org/10.2196/34685 %U http://www.ncbi.nlm.nih.gov/pubmed/35771605 %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 %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e31011 %T Assessing the Risk Factors For Diagnosed Symptomatic Dry Eye Using a Smartphone App: Cross-sectional Study %A Kasetsuwan,Ngamjit %A Suwan-Apichon,Olan %A Lekhanont,Kaevalin %A Chuckpaiwong,Varintorn %A Reinprayoon,Usanee %A Chantra,Somporn %A Puangsricharern,Vilavun %A Pariyakanok,Lalida %A Prabhasawat,Pinnita %A Tesavibul,Nattaporn %A Chaidaroon,Winai %A Tananuvat,Napaporn %A Hirunpat,Chakree %A Prakairungthong,Nauljira %A Sansanayudh,Wiwan %A Chirapapaisan,Chareenun %A Phrueksaudomchai,Pakornkit %+ Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Rama 4 Rd Pathum Wan, Pathumwan District, Bangkok, 10330, Thailand, 66 22564000 ext 81875, ngamjitk@gmail.com %K blink rate %K dry eye %K smartphone application %K maximum blink interval %K prevalence %K mHealth %K epidemiology %K screening %K risk factors %K symptoms %K ophthalmology %K vision %D 2022 %7 22.6.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dry eye (DE) is a chronic inflammatory disease of the ocular surface of the eye that affects millions of people throughout the world. Smartphone use as an effective health care tool has grown exponentially. The “Dry eye or not?” app was created to evaluate the prevalence of symptomatic DE, screen for its occurrence, and provide feedback to users with symptomatic DE throughout Thailand. Objective: The purpose of this study was to compare the prevalence of symptomatic dry eye (DE), blink rate, maximum blink interval (MBI), and best spectacle-corrected visual acuity (BSCVA) between people with and without symptomatic DE and to identify risk factors for symptomatic DE in Thailand. Methods: This cross-sectional study sourced data from the “Dry eye or not?” smartphone app between November 2019 and July 2020. This app collected demographic data, Ocular Surface Disease Index (OSDI) score, blink rate, MBI, BSCVA, and visual display terminal (VDT) use data. The criterion for symptomatic DE was OSDI score ≥13. Results: The prevalence of symptomatic DE among individuals using this smartphone app in Thailand was 85.8% (8131/9482), with the Northeastern region of Thailand having the highest prevalence, followed by the Northern region. Worse BSCVA (median 0.20, IQR 0.40; P=.02), increased blink rate (median 18, IQR 16; P<.001), reduced MBI (median 8.90, IQR 10.80; P<.001), female sex (adjusted OR 1.83; 95% CI 1.59-2.09; P<.001), more than 6 hours of VDT use (adjusted OR 1.59; 95% CI 1.15-2.19; P=.004), and lower than bachelor’s degree (adjusted OR 1.30; 95% CI 1.03-1.64; P=.02) were significantly associated with symptomatic DE. An age over 50 years (adjusted OR 0.77; 95% CI 0.60-0.99) was significantly less associated with symptomatic DE (P=.04). Conclusions: This smartphone DE app showed that the prevalence of symptomatic DE in Thailand was 85.8%. Signs and risk factors could be also evaluated with this smartphone DE app. Screening for DE by this app may allow for the development of strategic plans for health care systems in Thailand. %M 35731569 %R 10.2196/31011 %U https://mhealth.jmir.org/2022/6/e31011 %U https://doi.org/10.2196/31011 %U http://www.ncbi.nlm.nih.gov/pubmed/35731569 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e31230 %T Continuous mHealth Patch Monitoring for the Algorithm-Based Detection of Atrial Fibrillation: Feasibility and Diagnostic Accuracy Study %A Santala,Onni E %A Lipponen,Jukka A %A Jäntti,Helena %A Rissanen,Tuomas T %A Tarvainen,Mika P %A Laitinen,Tomi P %A Laitinen,Tiina M %A Castrén,Maaret %A Väliaho,Eemu-Samuli %A Rantula,Olli A %A Naukkarinen,Noora S %A Hartikainen,Juha E K %A Halonen,Jari %A Martikainen,Tero J %+ School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1 PO BOX 1627, Kuopio, FI-70211, Finland, 358 503010879, elmeris@uef.fi %K atrial fibrillation %K heart rate variability %K HRV %K algorithm %K stroke %K mobile health %K mHealth %K Awario analysis Service, screening %K risk %K stroke risk %K heart rate %K feasibility %K reliability %K artificial intelligence %K mobile patch %K wearable %K arrhythmia %K screening %D 2022 %7 21.6.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: The detection of atrial fibrillation (AF) is a major clinical challenge as AF is often paroxysmal and asymptomatic. Novel mobile health (mHealth) technologies could provide a cost-effective and reliable solution for AF screening. However, many of these techniques have not been clinically validated. Objective: The purpose of this study is to evaluate the feasibility and reliability of artificial intelligence (AI) arrhythmia analysis for AF detection with an mHealth patch device designed for personal well-being. Methods: Patients (N=178) with an AF (n=79, 44%) or sinus rhythm (n=99, 56%) were recruited from the emergency care department. A single-lead, 24-hour, electrocardiogram-based heart rate variability (HRV) measurement was recorded with the mHealth patch device and analyzed with a novel AI arrhythmia analysis software. Simultaneously registered 3-lead electrocardiograms (Holter) served as the gold standard for the final rhythm diagnostics. Results: Of the HRV data produced by the single-lead mHealth patch, 81.5% (3099/3802 hours) were interpretable, and the subject-based median for interpretable HRV data was 99% (25th percentile=77% and 75th percentile=100%). The AI arrhythmia detection algorithm detected AF correctly in all patients in the AF group and suggested the presence of AF in 5 patients in the control group, resulting in a subject-based AF detection accuracy of 97.2%, a sensitivity of 100%, and a specificity of 94.9%. The time-based AF detection accuracy, sensitivity, and specificity of the AI arrhythmia detection algorithm were 98.7%, 99.6%, and 98.0%, respectively. Conclusions: The 24-hour HRV monitoring by the mHealth patch device enabled accurate automatic AF detection. Thus, the wearable mHealth patch device with AI arrhythmia analysis is a novel method for AF screening. Trial Registration: ClinicalTrials.gov NCT03507335; https://clinicaltrials.gov/ct2/show/NCT03507335 %M 35727618 %R 10.2196/31230 %U https://cardio.jmir.org/2022/1/e31230 %U https://doi.org/10.2196/31230 %U http://www.ncbi.nlm.nih.gov/pubmed/35727618 %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 %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e37779 %T Mobile Health App for Tuberculosis Screening and Compliance to Undergo Chest X-ray Examination Among Presumptive Cases Detected by the App in Myanmar: Usability Study %A Htet,Kyaw Ko Ko %A Phyu,Aye Nyein %A Thwin,Thandar %A Chongsuvivatwong,Virasakdi %+ Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, 90110, Thailand, 66 74451165, cvirasak@medicine.psu.ac.th %K usability %K mobile app %K TB screening %K chest X-ray compliance %K mobile health %K health application %K risk score %K tuberculosis %K COVID-19 %D 2022 %7 7.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In Myanmar, the use of a mobile app for tuberculosis (TB) screening and its operational effect on seeking TB health care have not been evaluated yet. Objective: This study aims to report the usability of a simple mobile app to screen TB and comply with chest X-ray (CXR) examination of presumptive cases detected by the app. Methods: A new “TB-screen” app was developed from a Google Sheet based on a previously published algorithm. The app calculates a TB risk propensity score from an individual’s sociodemographic characteristics and TB clinical history and suggests whether the individual should undergo a CXR. The screening program was launched in urban slum areas soon after the COVID-19 outbreak subsided. A standard questionnaire was used to assess the app’s usability rated by presumptive cases. Compliance to undergo CXR was confirmed by scanning the referral quick response (QR) code via the app. Results: Raters were 453 presumptive cases detected by the app. The mean usability rating score was 4.1 out of 5. Compliance to undergo CXR examination was 71.1% (n=322). Active TB case detection among CXR compliances was 7.5% (n=24). One standard deviation (SD) increase in the app usability score was significantly associated with a 59% increase in the odds to comply with CXR (β=.464) after adjusting for other variables (P<.001). Conclusions: This simple mobile app got a high usability score rated by 453 users. The mobile app usability score successfully predicted compliance to undergo CXR examination. Eventually, 24 (7.5%) of 322 users who were suspected of having TB by the mobile app were detected as active TB cases by CXR. The system should be upscaled for a large trial. %M 35623000 %R 10.2196/37779 %U https://formative.jmir.org/2022/6/e37779 %U https://doi.org/10.2196/37779 %U http://www.ncbi.nlm.nih.gov/pubmed/35623000 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e36065 %T Monitoring Symptoms of COVID-19: Review of Mobile Apps %A Schmeelk,Suzanna %A Davis,Alison %A Li,Qiaozheng %A Shippey,Caroline %A Utah,Michelle %A Myers,Annie %A Reading Turchioe,Meghan %A Masterson Creber,Ruth %+ Weill Cornell Medicine, 425 E 61st Street, New York, NY, 10065, United States, 1 9144340731, rmc2009@med.cornell.edu %K COVID-19 %K mobile apps %K mobile health %K mHealth %K symptom assessment %K symptom tracking %K public health %K mobile health application %K surveillance %K digital surveillance %K monitoring system %K digital health %D 2022 %7 1.6.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps have facilitated symptom monitoring of COVID-19 symptoms globally and have been used to share data with health care professionals and support disease prediction, prevention, management, diagnostics, and improvements in treatments and patient education. Objective: The aim of this review is to evaluate the quality and functionality of COVID-19 mHealth apps that support tracking acute and long-term symptoms of COVID-19. Methods: We systematically reviewed commercially available mHealth apps for COVID-19 symptom monitoring by searching Google Play and Apple iTunes using search terms such as “COVID-19,” “Coronavirus,” and “COVID-19 and symptoms.” All apps underwent three rounds of screening. The final apps were independently assessed using the Mobile Application Rating Scale (MARS), an informatics functionality scoring system, and the Center for Disease Control and World Health Organization symptom guidelines. The MARS is a 19-item standardized tool to evaluate the quality of mHealth apps on engagement, functionality, aesthetics, and information quality. Functionality was quantified across the following criteria: inform, instruct, record (collect, share, evaluate, and intervene), display, guide, remind or alert, and communicate. Interrater reliability between the reviewers was calculated. Results: A total of 1017 mobile apps were reviewed, and 20 (2%) met the inclusion criteria. The majority of the 20 included apps (n=18, 90%) were designed to track acute COVID-19 symptoms, and only 2 (10%) addressed long-term symptoms. Overall, the apps scored high on quality, with an overall MARS rating of 3.89 out of 5, and the highest domain score for functionality (4.2). The most common functionality among all apps was the instruct function (n=19, 95%). The most common symptoms included in the apps for tracking were fever and dry cough (n=18, 90%), aches and pains (n=17, 85%), difficulty breathing (n=17, 85%), tiredness, sore throat, headache, loss of taste or smell (n=16, 80%), and diarrhea (n=15, 75%). Only 2 (10%) apps specifically tracked long-term symptoms of COVID-19. The top 4 rated apps overall were state-specific apps developed and deployed for public use. Conclusions: Overall, mHealth apps designed to monitor symptoms of COVID-19 were of high quality, but the majority of apps focused almost exclusively on acute symptoms. Future apps should also incorporate monitoring long-term symptoms of COVID-19 and evidence-based educational materials; they should also include a feature that would allow patients to communicate their symptoms to specific caregivers or their own health care team. App developers should also follow updated technical and clinical guidelines from the Center for Disease Control and the World Health Organization. %M 35609313 %R 10.2196/36065 %U https://mhealth.jmir.org/2022/6/e36065 %U https://doi.org/10.2196/36065 %U http://www.ncbi.nlm.nih.gov/pubmed/35609313 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 5 %P e38181 %T Early Detection of Neurodevelopmental Disorders of Toddlers and Postnatal Depression by Mobile Health App: Observational Cross-sectional Study %A Denis,Fabrice %A Maurier,Laura %A Carillo,Kevin %A Ologeanu-Taddei,Roxana %A Septans,Anne-Lise %A Gepner,Agnes %A Le Goff,Florian %A Desbois,Madhu %A Demurger,Baptiste %A Silber,Denise %A Zeitoun,Jean-David %A Assuied,Guedalia Peretz %A Bonnot,Olivier %+ Institut Inter-Regional Jean Bernard, ELSAN, 9 Rue Beauverger, Le Mans, 72000, France, 33 0684190480, f.denis@ilcgroupe.fr %K early detection %K NDD %K neurodevelopmental disorder %K ASD %K autism spectrum disorder %K PND %K postnatal depression %K mHealth %K mobile health %K real-world study %K autism %K parenting %K pediatric %K children %K mobile phone %K smartphone %K mobile health app %K digital health intervention %K digital product %K algorithm %D 2022 %7 16.5.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Delays in the diagnosis of neurodevelopmental disorders (NDDs) in toddlers and postnatal depression (PND) in mothers are major public health issues. In both cases, early intervention is crucial. Objective: We aimed to assess if a mobile app named Malo can reduce delay in the recognition of NDD and PND. Methods: We performed an observational, cross-sectional, data-based study in a population of young parents with a minimum of 1 child under 3 years of age at the time of inclusion and using Malo on a regular basis. We included the first 4000 users matching the criteria and agreeing to participate between November 11, 2021, and January 14, 2022. Parents received monthly questionnaires via the app, assessing skills on sociability, hearing, vision, motricity, language of their infants, and possible autism spectrum disorder. Mothers were also requested to answer regular questionnaires regarding PND, from 4-28 weeks after childbirth. When any patient-reported outcomes matched predefined criteria, an in-app notification was sent to the user, recommending the booking of an appointment with their family physician or pediatrician. The main outcomes were the median age of the infant at the time of notification for possible NDD and the median time of PND notifications after childbirth. One secondary outcome was the relevance of the NDD notification for a consultation as assessed by the physicians. Results: Among 4242 children assessed by 5309 questionnaires, 613 (14.5%) had at least 1 disorder requiring a consultation. The median age of notification for possible autism spectrum, vision, audition, socialization, language, or motor disorders was 11, 9, 17, 12, 22, and 4 months, respectively. The sensitivity of the alert notifications of suspected NDDs as assessed by the physicians was 100%, and the specificity was 73.5%. Among 907 mothers who completed a PND questionnaire, highly probable PND was detected in 151 (16.6%) mothers, and the median time of detection was 8-12 weeks. Conclusions: The algorithm-based alert suggesting NDD was highly sensitive with good specificity as assessed by real-life practitioners. The app was also efficient in the early detection of PND. Our results suggest that the regular use of this multidomain familial smartphone app would permit the early detection of NDD and PND. Trial Registration: ClinicalTrials.gov NCT04958174; https://clinicaltrials.gov/ct2/show/NCT04958174 %M 35576565 %R 10.2196/38181 %U https://mhealth.jmir.org/2022/5/e38181 %U https://doi.org/10.2196/38181 %U http://www.ncbi.nlm.nih.gov/pubmed/35576565 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e30218 %T Conditions for the Successful Integration of an eHealth Tool "StopBlues" Into Community-Based Interventions in France: Results From a Multiple Correspondence Analysis %A Turmaine,Kathleen %A Dumas,Agnès %A Chevreul,Karine %A , %+ Université Paris Cité, ECEVE, UMR 1123, Inserm, 10 avenue de Verdun, Paris, 75010, France, 33 1 57 27 86 89, kathleen.turmaine@inserm.fr %K eHealth %K internet-based intervention %K community participation %K health promotion %K prevention %K mental health %D 2022 %7 22.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: For over a decade, digital health has held promise for enabling broader access to health information, education, and services for the general population at a lower cost. However, recent studies have shown mixed results leading to a certain disappointment regarding the benefits of eHealth technologies. In this context, community-based health promotion represents an interesting and efficient conceptual framework that could help increase the adoption of digital health solutions and facilitate their evaluation. Objective: To understand how the local implementation of the promotion of an eHealth tool, StopBlues (SB), aimed at preventing psychological distress and suicide, varied according to local contexts and if the implementation was related to the use of the tool. Methods: The study was nested within a cluster-randomized controlled trial that was conducted to evaluate the effectiveness of the promotion, with before and after observation (NCT03565562). Data from questionnaires, observations, and institutional sources were collected in 27 localities where SB was implemented. A multiple correspondence analysis was performed to assess the relations between context, type of implementation and promotion, and use of the tool. Results: Three distinct promotion patterns emerged according to the profiles of the localities that were associated with specific SB utilization rates. From highest to lowest utilization rates, they are listed as follows: the privileged urban localities, investing in health that implemented a high-intensity and digital promotion, demonstrating a greater capacity to take ownership of the project; the urban, but less privileged localities that, in spite of having relatively little experience in health policy implementation, managed to implement a traditional and high-intensity promotion; and the rural localities, with little experience in addressing health issues, that implemented low-intensity promotion but could not overcome the challenges associated with their local context. Conclusions: These findings indicate the substantial influence of local context on the reception of digital tools. The urban and socioeconomic status profiles of the localities, along with their investment and pre-existing experience in health, appear to be critical for shaping the promotion and implementation of eHealth tools in terms of intensity and use of digital communication. The more digital channels used, the higher the utilization rates, ultimately leading to the overall success of the intervention. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-04464-2 %M 35451977 %R 10.2196/30218 %U https://www.jmir.org/2022/4/e30218 %U https://doi.org/10.2196/30218 %U http://www.ncbi.nlm.nih.gov/pubmed/35451977 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e31209 %T Optimizing Existing Mental Health Screening Methods in a Dementia Screening and Risk Factor App: Observational Machine Learning Study %A Kuleindiren,Narayan %A Rifkin-Zybutz,Raphael Paul %A Johal,Monika %A Selim,Hamzah %A Palmon,Itai %A Lin,Aaron %A Yu,Yizhou %A Alim-Marvasti,Ali %A Mahmud,Mohammad %+ Mindset Technologies Ltd, 3rd Floor, 5 Chancery Lane, London, WC2A 1LG, United Kingdom, 44 02081522341, raphael.rifkinzybutz@meetmindset.com %K depression %K anxiety %K screening %K research method %K questionnaire %K precision %K dementia %K cognition %K risk factors %K machine learning %K prediction %D 2022 %7 22.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mindstep is an app that aims to improve dementia screening by assessing cognition and risk factors. It considers important clinical risk factors, including prodromal symptoms, mental health disorders, and differential diagnoses of dementia. The 9-item Patient Health Questionnaire for depression (PHQ-9) and the 7-item Generalized Anxiety Disorder Scale (GAD-7) are widely validated and commonly used scales used in screening for depression and anxiety disorders, respectively. Shortened versions of both (PHQ-2/GAD-2) have been produced. Objective: We sought to develop a method that maintained the brevity of these shorter questionnaires while maintaining the better precision of the original questionnaires. Methods: Single questions were designed to encompass symptoms covered in the original questionnaires. Answers to these questions were combined with PHQ-2/GAD-2, and anonymized risk factors were collected by Mindset4Dementia from 2235 users. Machine learning models were trained to use these single questions in combination with data already collected by the app: age, response to a joke, and reporting of functional impairment to predict binary and continuous outcomes as measured using PHQ-9/GAD-7. Our model was developed with a training data set by using 10-fold cross-validation and a holdout testing data set and compared to results from using the shorter questionnaires (PHQ-2/GAD-2) alone to benchmark performance. Results: We were able to achieve superior performance in predicting PHQ-9/GAD-7 screening cutoffs compared to PHQ-2 (difference in area under the curve 0.04, 95% CI 0.00-0.08, P=.02) but not GAD-2 (difference in area under the curve 0.00, 95% CI –0.02 to 0.03, P=.42). Regression models were able to accurately predict total questionnaire scores in PHQ-9 (R2=0.655, mean absolute error=2.267) and GAD-7 (R2=0.837, mean absolute error=1.780). Conclusions: We app-adapted PHQ-4 by adding brief summary questions about factors normally covered in the longer questionnaires. We additionally trained machine learning models that used the wide range of additional information already collected in Mindstep to make a short app-based screening tool for affective disorders, which appears to have superior or equivalent performance to well-established methods. %M 35315786 %R 10.2196/31209 %U https://formative.jmir.org/2022/3/e31209 %U https://doi.org/10.2196/31209 %U http://www.ncbi.nlm.nih.gov/pubmed/35315786 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e27501 %T Iterative Development of a Mobile Phone App to Support Community Health Volunteers During Cervical Cancer Screening in Western Kenya: Qualitative Study %A Stocks,Jacob %A Choi,Yujung %A Ibrahim,Saduma %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 mHealth %K cervical cancer screening %K Kenya %K HPV testing %K user-testing %K community health volunteers %K mobile phone %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: To achieve the World Health Organization targets for cervical cancer elimination, low- and middle-income countries will need to develop innovative strategies to provide human papillomavirus (HPV)–based screening at a population level. Although mobile health (mHealth) interventions may help realize these goals by filling gaps in electronic specimen tracking and patient education, effective implementation of mHealth interventions is dependent upon context-specific development that is acceptable and usable by the target population. Detailed feedback should be gathered at the design and development stages to yield final products that reflect the needs, desires, and capabilities of target users. Objective: The aim of this study is to develop an mHealth app (mSaada) to support HPV-based screening in partnership with community health volunteers (CHVs) and program planners in western Kenya. Methods: A team of student programmers developed a prototype to meet previously identified gaps in screening: patient education, protocol support, data capture, and specimen tracking. The prototype was iteratively developed through 2 waves of in-person working sessions with quantitative (survey) and qualitative (in-depth interview) feedback. Research staff engaged key stakeholders from both urban and rural locations and with varying levels of experience in delivering screening services. During the sessions, participants completed simulation exercises and role-play activities to become familiar with the platform. Once feedback was gathered and synthesized after each wave of in-person data collection, developers implemented changes to improve mSaada functionality. Results: A total of 18 CHVs and clinicians participated in the in-person sessions. Participants found mSaada useful, easy to use, and would meet the needs of CHVs to provide HPV-based cervical cancer screening (electronic data capture, client education resources, and specimen tracking). They provided key feedback to enhance user experience, workflow, and sustainability. Key changes included altering the appearance of the wireframes, adding translation in additional local languages, changing potentially insensitive figures, alphabetizing lengthy dropdown menus, adding clinically relevant logic checks when entering data, and incorporating the ability to make real time edits to client records. They also made recommendations for additional features that might enhance mSaada’s impact at the facility and health system levels, specifically the inclusion of a report-generating tool consistent with the Ministry of Health standards. Conclusions: Using a process of iterative feedback with key stakeholders and rapid response from developers, we have developed a mobile app ready for pilot testing in HPV-based screening programs led by CHVs. %M 35200151 %R 10.2196/27501 %U https://formative.jmir.org/2022/2/e27501 %U https://doi.org/10.2196/27501 %U http://www.ncbi.nlm.nih.gov/pubmed/35200151 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e26275 %T Use of Mobile Apps for Visual Acuity Assessment: Systematic Review and Meta-analysis %A Suo,Lingge %A Ke,Xianghan %A Zhang,Di %A Qin,Xuejiao %A Chen,Xuhao %A Hong,Ying %A Dai,Wanwei %A Wu,Defu %A Zhang,Chun %A Zhang,Dongsong %+ Department of Business Information Systems and Operations Management, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223-0001, United States, 1 704 687 1893, dzhang15@uncc.edu %K smartphone %K iPad %K eye screening %K visual acuity %K app %K meta-analysis %D 2022 %7 14.2.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Vision impairments (VIs) and blindness are major global public health issues. A visual acuity (VA) test is one of the most crucial standard psychophysical tests of visual function and has been widely used in a broad range of health care domains, especially in many clinical settings. In recent years, there has been increasing research on mobile app–based VA assessment designed to allow people to test their VA at any time and any location. Objective: The goal of the review was to assess the accuracy and reliability of using mobile VA measurement apps. Methods: We searched PubMed, Embase, Cochrane Library, and Google Scholar for relevant articles on mobile apps for VA assessment published between January 1, 2008, and July 1, 2020. Two researchers independently inspected and selected relevant studies. Eventually, we included 22 studies that assessed tablet or smartphone apps for VA measurement. We then analyzed sensitivity, specificity, and accuracy in the 6 papers we found through a meta-analysis. Results: Most of the 22 selected studies can be considered of high quality based on the Quality Assessment of Diagnostic Accuracy Studies–2. In a meta-analysis of 6 studies involving 24,284 participants, we categorized the studies based on the age groups of the study participants (ie, aged 3-5 years, aged 6-22 years, and aged 55 years and older), examiner (ie, professional and nonprofessional examiners), and the type of mobile devices (ie, smartphone, iPad). In the group aged 3 to 5 years, the pooled sensitivity for VA app tests versus clinical VA tests was 0.87 (95% CI 0.79-0.93; P=.39), and the pooled specificity was 0.78 (95% CI 0.70-0.85; P=.37). In the group aged 6 to 22 years, the pooled sensitivity for VA app tests versus clinical VA tests was 0.86 (95% CI 0.84-0.87; P<.001), and the pooled specificity for VA app tests versus clinical VA tests was 0.91 (95% CI 0.90-0.91; P=.27). In the group aged 55 years and older, the pooled sensitivity for VA app tests versus clinical VA tests was 0.85 (95% CI 0.55-0.98), and the pooled specificity for VA app tests versus clinical VA tests was 0.98 (95% CI 0.95-0.99). We found that the nonprofessional examiner group (AUC 0.93) had higher accuracy than the professional examiner group (AUC 0.87). In the iPad-based group, the pooled sensitivity for VA app tests versus clinical VA tests was 0.86, and the pooled specificity was 0.79. In the smartphone-based group, the pooled sensitivity for VA app tests versus clinical VA tests was 0.86 (P<.001), and the pooled specificity for VA app tests versus clinical VA tests was 0.91 (P<.001). Conclusions: In this study, we conducted a comprehensive review of the research on existing mobile apps for VA tests to investigate their diagnostic value and limitations. Evidence gained from this study suggests that mobile app–based VA tests can be useful for on-demand VI detection. %M 35156935 %R 10.2196/26275 %U https://mhealth.jmir.org/2022/2/e26275 %U https://doi.org/10.2196/26275 %U http://www.ncbi.nlm.nih.gov/pubmed/35156935 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e30724 %T mHealth Solutions for Perinatal Mental Health: Scoping Review and Appraisal Following the mHealth Index and Navigation Database Framework %A Spadaro,Benedetta %A Martin-Key,Nayra A %A Funnell,Erin %A Bahn,Sabine %+ Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, United Kingdom, 44 1223 334151, sb209@cam.ac.uk %K digital mental health %K perinatal mental health %K pregnancy %K MIND %K mobile phone %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The ever-increasing pressure on health care systems has resulted in the underrecognition of perinatal mental disorders. Digital mental health tools such as apps could provide an option for accessible perinatal mental health screening and assessment. However, there is a lack of information regarding the availability and features of perinatal app options. Objective: This study aims to evaluate the current state of diagnostic and screening apps for perinatal mental health available on the Google Play Store (Android) and Apple App Store (iOS) and to review their features following the mHealth Index and Navigation Database framework. Methods: Following a scoping review approach, the Apple App Store and Google Play Store were systematically searched to identify perinatal mental health assessment apps. A total of 14 apps that met the inclusion criteria were downloaded and reviewed in a standardized manner using the mHealth Index and Navigation Database framework. The framework comprised 107 questions, allowing for a comprehensive assessment of app origin, functionality, engagement features, security, and clinical use. Results: Most apps were developed by for-profit companies (n=10), followed by private individuals (n=2) and trusted health care companies (n=2). Out of the 14 apps, 3 were available only on Android devices, 4 were available only on iOS devices, and 7 were available on both platforms. Approximately one-third of the apps (n=5) had been updated within the last 180 days. A total of 12 apps offered the Edinburgh Postnatal Depression Scale in its original version or in rephrased versions. Engagement, input, and output features included reminder notifications, connections to therapists, and free writing features. A total of 6 apps offered psychoeducational information and references. Privacy policies were available for 11 of the 14 apps, with a median Flesch-Kincaid reading grade level of 12.3. One app claimed to be compliant with the Health Insurance Portability and Accountability Act standards and 2 apps claimed to be compliant with General Data Protection Regulation. Of the apps that could be accessed in full (n=10), all appeared to fulfill the claims stated in their description. Only 1 app referenced a relevant peer-reviewed study. All the apps provided a warning for use, highlighting that the mental health assessment result should not be interpreted as a diagnosis or as a substitute for medical care. Only 3 apps allowed users to export or email their mental health test results. Conclusions: These results indicate that there are opportunities to improve perinatal mental health assessment apps. To this end, we recommend focusing on the development and validation of more comprehensive assessment tools, ensuring data protection and safety features are adequate for the intended app use, and improving data sharing features between users and health care professionals for timely support. %M 35037894 %R 10.2196/30724 %U https://mhealth.jmir.org/2022/1/e30724 %U https://doi.org/10.2196/30724 %U http://www.ncbi.nlm.nih.gov/pubmed/35037894 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e28709 %T Development of a Credible Virtual Clinician Promoting Colorectal Cancer Screening via Telehealth Apps for and by Black Men: Qualitative Study %A Wilson-Howard,Danyell %A Vilaro,Melissa J %A Neil,Jordan M %A Cooks,Eric J %A Griffin,Lauren N %A Ashley,Taylor T %A Tavassoli,Fatemeh %A Zalake,Mohan S %A Lok,Benjamin C %A Odedina,Folakemi T %A Modave,Francois %A Carek,Peter J %A George,Thomas J %A Krieger,Janice L %+ Department of Natural Sciences, Bethune Cookman University, 640 Mary McLeod Blvd., Daytona, FL, 32114, United States, 1 3864812687, wilsonda@cookman.edu %K telehealth %K digital health %K eHealth %K colorectal cancer %K Black men %K virtual human %K technology %K cancer screening %K app %K cancer %K prevention %K development %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Traditionally, promotion of colorectal cancer (CRC) screening among Black men was delivered by community health workers, patient navigators, and decision aids (printed text or video media) at clinics and in the community setting. A novel approach to increase CRC screening of Black men includes developing and utilizing a patient-centered, tailored message delivered via virtual human technology in the privacy of one’s home. Objective: The objective of this study was to incorporate the perceptions of Black men in the development of a virtual clinician (VC) designed to deliver precision messages promoting the fecal immunochemical test (FIT) kit for CRC screening among Black men in a future clinical trial. Methods: Focus groups of Black men were recruited to understand their perceptions of a Black male VC. Specifically, these men identified source characteristics that would enhance the credibility of the VC. The modality, agency, interactivity, and navigability (MAIN) model, which examines how interface features affect the user’s psychology through four affordances (modality, agency, interactivity, and navigability), was used to assess the presumed credibility of the VC and likability of the app from the focus group transcripts. Each affordance triggers heuristic cues that stimulate a positive or a negative perception of trustworthiness, believability, and understandability, thereby increasing source credibility. Results: In total, 25 Black men were recruited from the community and contributed to the development of 3 iterations of a Black male VC over an 18-month time span. Feedback from the men enhanced the visual appearance of the VC, including its movement, clothing, facial expressions, and environmental surroundings. Heuristics, including social presence, novelty, and authority, were all recognized by the final version of the VC, and creditably was established. The VC was named Agent Leveraging Empathy for eXams (ALEX) and referred to as “brother-doctor,” and participants stated “wanting to interact with ALEX over their regular doctor.” Conclusions: Involving Black men in the development of a digital health care intervention is critical. This population is burdened by cancer health disparities, and incorporating their perceptions in telehealth interventions will create awareness of the need to develop targeted messages for Black men. %M 34780346 %R 10.2196/28709 %U https://formative.jmir.org/2021/12/e28709 %U https://doi.org/10.2196/28709 %U http://www.ncbi.nlm.nih.gov/pubmed/34780346 %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 %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e27521 %T An Early Warning Mobile Health Screening and Risk Scoring App for Preventing In-Hospital Transmission of COVID-19 by Health Care Workers: Development and Feasibility Study %A Mbiine,Ronald %A Nakanwagi,Cephas %A Lekuya,Herve Monka %A Aine,Joan %A Hakim,Kawesi %A Nabunya,Lilian %A Tomusange,Henry %+ Makerere University College of Health Sciences, Mulago Hill Road, Kampala, 7072, Uganda, 256 774338585, mbiineron@gmail.com %K mHealth %K risk score for Covid-19 %K Africa %K mobile health %K digital health %K pandemic %K COVID-19 %K COVID %K screening tool %K healthcare workers %K transmission %K warning system %D 2021 %7 17.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Hospitals have been identified as very high-risk places for COVID-19 transmission between health care workers and patients who do not have COVID-19. Health care workers are the most at-risk population to contract and transmit the infection, especially to already vulnerable patients who do not have COVID-19. In low-income countries, routine testing is not feasible due to the high cost of testing; therefore, presenting the risk of uncontrolled transmission within non–COVID-19 treatment wards. This challenge necessitated the development of an affordable intermediary screening tool that would enable early identification of potentially infected health care workers and for early real time DNA–polymerase chain reaction testing prioritization. This would limit the contact time of potentially infected health care workers with the patients but also enable efficient use of the limited testing kits. Objective: The aims of this study are to describe an early warning in-hospital mobile risk analysis app for screening COVID-19 and to determine the feasibility and user-friendliness of the app among health care workers. Methods: The primary result of this research project was the development of a mobile-based daily early warning system for in-hospital transmission of COVID-19. Overall, the Early Warning System for In-Hospital Transmission of COVID-19 (EWAS) mobile app was found to be feasible, with over 69% of the health care workers having logged more than 67% of the required times. Over 93% of the participants reported that the tool was easy to use. Results: The primary result of this research project was the development of a mobile-based daily early warning system for in-hospital transmission of COVID-19. Overall, the Early Warning System for In-Hospital Transmission of COVID-19 (EWAS) mobile app was found to be feasible, with 69% of the health care workers (69/100) having logged more than 67% of the required times. Of the 100 participants, 93 reported that the tool was easy to use. Conclusions: The EWAS mobile app is a feasible and user-friendly daily risk scoring tool for preventing in-hospital transmission of COVID-19. Although it was not designed to be a diagnostic tool but rather a screening tool, there is a need to evaluate its sensitivity in predicting persons likely to have contracted COVID-19. %M 34793321 %R 10.2196/27521 %U https://formative.jmir.org/2021/12/e27521 %U https://doi.org/10.2196/27521 %U http://www.ncbi.nlm.nih.gov/pubmed/34793321 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e31541 %T Validation of a Musculoskeletal Digital Assessment Routing Tool: Protocol for a Pilot Randomized Crossover Noninferiority Trial %A Lowe,Cabella %A Hanuman Sing,Harry %A Marsh,William %A Morrissey,Dylan %+ Centre for Sports & Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, Bancroft Road, London, E1 4DG, United Kingdom, 44 07976315105, c.lowe@qmul.ac.uk %K mHealth %K mobile health %K eHealth %K digital health %K digital technology %K musculoskeletal %K triage %K physiotherapy triage %K validation %K mobile phone %D 2021 %7 13.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Musculoskeletal conditions account for 16% of global disability, resulting in a negative effect on millions of patients and an increasing demand for health care use. Digital technologies to improve health care outcomes and efficiency are considered a priority; however, innovations are rarely tested with sufficient rigor in clinical trials, which is the gold standard for clinical proof of safety and efficacy. We have developed a new musculoskeletal digital assessment routing tool (DART) that allows users to self-assess and be directed to the right care. DART requires validation in a real-world setting before implementation. Objective: This pilot study aims to assess the feasibility of a future trial by exploring the key aspects of trial methodology, assessing the procedures, and collecting exploratory data to inform the design of a definitive randomized crossover noninferiority trial to assess DART safety and effectiveness. Methods: We will collect data from 76 adults with a musculoskeletal condition presenting to general practitioners within a National Health Service (NHS) in England. Participants will complete both a DART assessment and a physiotherapist-led triage, with the order determined by randomization. The primary analysis will involve an absolute agreement intraclass correlation (A,1) estimate with 95% CI between DART and the clinician for assessment outcomes signposting to condition management pathways. Data will be collected to allow the analysis of participant recruitment and retention, randomization, allocation concealment, blinding, data collection process, and bias. In addition, the impact of trial burden and potential barriers to intervention delivery will be considered. The DART user satisfaction will be measured using the system usability scale. Results: A UK NHS ethics submission was done during June 2021 and is pending approval; recruitment will commence in early 2022, with data collection anticipated to last for 3 months. The results will be reported in a follow-up paper in 2022. Conclusions: This study will inform the design of a randomized controlled crossover noninferiority study that will provide evidence concerning mobile health DART system clinical signposting in an NHS setting before real-world implementation. Success should produce evidence of a safe, effective system with good usability, potentially facilitating quicker and easier patient access to appropriate care while reducing the burden on primary and secondary care musculoskeletal services. This rigorous approach to mobile health system testing could be used as a guide for other developers of similar applications. Trial Registration: ClinicalTrials.gov NCT04904029; http://clinicaltrials.gov/ct2/show/NCT04904029 International Registered Report Identifier (IRRID): PRR1-10.2196/31541 %M 34898461 %R 10.2196/31541 %U https://www.researchprotocols.org/2021/12/e31541 %U https://doi.org/10.2196/31541 %U http://www.ncbi.nlm.nih.gov/pubmed/34898461 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e28040 %T Test-Retest Reliability of Home-Based Fitness Assessments Using a Mobile App (R Plus Health) in Healthy Adults: Prospective Quantitative Study %A Lin,I-I %A Chen,You-Lin %A Chuang,Li-Ling %+ School of Physical Therapy & Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, No. 259 Wen-hua 1st Rd, Guishan Dist, Taoyuan, 33302, Taiwan, 886 3 2118800 ext 3177, lchuang@gap.cgu.edu.tw %K mobile health app %K reliability %K home-based fitness assessments %K healthy adults %K mobile phone %K digital health %D 2021 %7 8.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor physical fitness has a negative impact on overall health status. An increasing number of health-related mobile apps have emerged to reduce the burden of medical care and the inconvenience of long-distance travel. However, few studies have been conducted on home-based fitness tests using apps. Insufficient monitoring of physiological signals during fitness assessments have been noted. Therefore, we developed R Plus Health, a digital health app that incorporates all the components of a fitness assessment with concomitant physiological signal monitoring. Objective: The aim of this study is to investigate the test-retest reliability of home-based fitness assessments using the R Plus Health app in healthy adults. Methods: A total of 31 healthy young adults self-executed 2 fitness assessments using the R Plus Health app, with a 2- to 3-day interval between assessments. The fitness assessments included cardiorespiratory endurance, strength, flexibility, mobility, and balance tests. The intraclass correlation coefficient was computed as a measure of the relative reliability of the fitness assessments and determined their consistency. The SE of measurement, smallest real difference at a 90% CI, and Bland–Altman analyses were used to assess agreement, sensitivity to real change, and systematic bias detection, respectively. Results: The relative reliability of the fitness assessments using R Plus Health was moderate to good (intraclass correlation coefficient 0.8-0.99 for raw scores, 0.69-0.99 for converted scores). The SE of measurement and smallest real difference at a 90% CI were 1.44-6.91 and 3.36-16.11, respectively, in all fitness assessments. The 95% CI of the mean difference indicated no significant systematic error between the assessments for the strength and balance tests. The Bland–Altman analyses revealed no significant systematic bias between the assessments for all tests, with a few outliers. The Bland–Altman plots illustrated narrow limits of agreement for upper extremity strength, abdominal strength, and right leg stance tests, indicating good agreement between the 2 assessments. Conclusions: Home-based fitness assessments using the R Plus Health app were reliable and feasible in young, healthy adults. The results of the fitness assessments can offer a comprehensive understanding of general health status and help prescribe safe and suitable exercise training regimens. In future work, the app will be tested in different populations (eg, patients with chronic diseases or users with poor fitness), and the results will be compared with clinical test results. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000030905; http://www.chictr.org.cn/showproj.aspx?proj=50229 %M 34657835 %R 10.2196/28040 %U https://formative.jmir.org/2021/12/e28040 %U https://doi.org/10.2196/28040 %U http://www.ncbi.nlm.nih.gov/pubmed/34657835 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e11055 %T Reliability and Confirmatory Factor Analysis (CFA) of a Paper- Versus App-Administered Resilience Scale in Scottish Youths: Comparative Study %A Mcgeough,Julienne %A Gallagher-Mitchell,Thomas %A Clark,Dan Philip Andrew %A Harrison,Neil %+ Department of Psychology, Liverpool Hope University, Hope Park, Liverpool, L16 9JD, United Kingdom, 44 1512913073, mcgeouj@hope.ac.uk %K resilience %K psychometrics %K app administration %K cyberpsychology %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adequately measuring resilience is important to support young people and children who may need to access resources through social work or educational settings. A widely accepted measure of youth resilience has been developed previously and has been shown to be suitable for vulnerable youth. While the measure is completed by the young person on paper, it has been designed to be worked through with a teacher or social worker in case further clarification is required. However, this method is time consuming and, when faced with large groups of pupils who need assessment, can be overwhelming for schools and practitioners. This study assesses app software with a built-in avatar that can guide young persons through the assessment and its interpretation. Objective: Our primary objective is to compare the reliability and psychometric properties of a mobile software app to a paper version of the Child and Youth Resilience measure (CYRM-28). Second, this study assesses the use of the CYRM-28 in a Scottish youth population (aged 11-18 years). Methods: Following focus groups and discussion with teachers, social workers, and young people, an avatar was developed by a software company and integrated into an android smartphone app designed to ask questions via the device’s inbuilt text-to-voice engine. In total, 714 students from 2 schools in North East Scotland completed either a paper version or app version of the CYRM-28. A cross-sectional design was used, and students completed their allocated version twice, with a 2-week period in between each testing. All participants could request clarification either from a guidance teacher (paper version) or from the in-built software glossary (app version). Results: Test and retest correlations showed that the app version performed better than the paper version of the questionnaire (paper version: r303=0.81; P<.001; 95% CI 0.77-0.85; app version: r413=0.84; P<.001; 95% CI 0.79-0.89). Fisher r to z transformation revealed a significant difference in the correlations (Z=–2.97, P<.01). Similarly, Cronbach α in both conditions was very high (app version: α=.92; paper version: α=.87), suggesting item redundancy. Ordinarily, this would lead to a possible removal of highly correlated items; however, our primary objective was to compare app delivery methods over a pen-and-paper mode and was hence beyond the scope of the study. Fisher r to z transformation revealed a significant difference in the correlations (Z=–3.69, P<.01). A confirmatory factor analysis supported the 3-factor solution (individual, relational, and contextual) and reported a good model fit (χ215=27.6 [n=541], P=.24). Conclusions: ALEX, an avatar with an integrated voice guide, had higher reliability when measuring resilience than a paper version with teacher assistance. The CFA reports similar structure using the avatar when compared against the original validation. %M 34878995 %R 10.2196/11055 %U https://mhealth.jmir.org/2021/12/e11055 %U https://doi.org/10.2196/11055 %U http://www.ncbi.nlm.nih.gov/pubmed/34878995 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e30439 %T Language, Speech, and Facial Expression Features for Artificial Intelligence–Based Detection of Cancer Survivors’ Depression: Scoping Meta-Review %A Smrke,Urška %A Mlakar,Izidor %A Lin,Simon %A Musil,Bojan %A Plohl,Nejc %+ Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroška cesta 46, Maribor, 2000, Slovenia, 386 31262861, urska.smrke@um.si %K artificial intelligence %K cancer %K depression %K facial expression %K language %K oncology %K review %K screening %K speech %K symptom %D 2021 %7 6.12.2021 %9 Review %J JMIR Ment Health %G English %X Background: Cancer survivors often experience disorders from the depressive spectrum that remain largely unrecognized and overlooked. Even though screening for depression is recognized as essential, several barriers prevent its successful implementation. It is possible that better screening options can be developed. New possibilities have been opening up with advances in artificial intelligence and increasing knowledge on the connection of observable cues and psychological states. Objective: The aim of this scoping meta-review was to identify observable features of depression that can be intercepted using artificial intelligence in order to provide a stepping stone toward better recognition of depression among cancer survivors. Methods: We followed a methodological framework for scoping reviews. We searched SCOPUS and Web of Science for relevant papers on the topic, and data were extracted from the papers that met inclusion criteria. We used thematic analysis within 3 predefined categories of depression cues (ie, language, speech, and facial expression cues) to analyze the papers. Results: The search yielded 1023 papers, of which 9 met the inclusion criteria. Analysis of their findings resulted in several well-supported cues of depression in language, speech, and facial expression domains, which provides a comprehensive list of observable features that are potentially suited to be intercepted by artificial intelligence for early detection of depression. Conclusions: This review provides a synthesis of behavioral features of depression while translating this knowledge into the context of artificial intelligence–supported screening for depression in cancer survivors. %M 34874883 %R 10.2196/30439 %U https://mental.jmir.org/2021/12/e30439 %U https://doi.org/10.2196/30439 %U http://www.ncbi.nlm.nih.gov/pubmed/34874883 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e30919 %T A Virtual Supermarket Program for the Screening of Mild Cognitive Impairment in Older Adults: Diagnostic Accuracy Study %A Yan,Mingli %A Yin,Huiru %A Meng,Qiuyan %A Wang,Shuo %A Ding,Yiwen %A Li,Guichen %A Wang,Chunyan %A Chen,Li %+ School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130021, China, 86 043185619366, chen_care@126.com %K virtual reality %K mild cognitive impairment %K dementia %K ambient intelligence %K digital health %K elderly population %K aging %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Mild cognitive impairment (MCI) is often a precursor of dementia, and patients with MCI develop dementia at a higher rate than healthy older adults. Early detection of cognitive decline at the MCI stage supports better planning of care and interventions. At present, the use of virtual reality (VR) in screening for MCI in older adults is promising, but there is little evidence regarding the use of virtual supermarkets to screen for MCI. Objective: The objectives of this study are to validate a VR game–based test, namely, the Virtual Supermarket Program (VSP), for differentiating patients with MCI and healthy controls and to identify cutoff scores for different age levels. Methods: Subjects were recruited from several nursing homes and communities in Changchun, China. They were divided into a healthy control group (n=64) and an MCI group (n=62). All subjects were administered the VSP and a series of neuropsychological examinations. The study determined the optimal cutoff, discriminating validity, concurrent validity, and retest reliability of the VSP. We used the area under the receiver operating characteristic curve (AUC) to evaluate the discriminating validity and obtain the optimal cutoff values. Pearson correlation analysis and the intraclass correlation coefficient were used to evaluate the concurrent validity and retest reliability, respectively. Results: A cutoff score of 46.4 was optimal for the entire sample, yielding a sensitivity of 85.9% and specificity of 79.0% for differentiating individuals with MCI and healthy controls, and the AUC was 0.870 (95% CI 0.799-0.924). The median index of VSP score was 51.1 (range 42.6-60.0). There was a moderate positive correlation between the VSP total score and Mini-Mental State Examination score (r=0.429, P<.001). There was a strong positive correlation between VSP total score and Montreal Cognitive Assessment score (r=0.645, P<.001). The retest reliability of the VSP was feasible (r=0.588, P=.048). Conclusions: The VSP is interesting and feasible for subjects. It shows high sensitivity and specificity for the identification of MCI in older adults, which makes it a promising screening method. The VSP may be generalized to older adults in other countries, although some cultural adaptation may be necessary. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000040074; https://www.chictr.org.cn/showprojen.aspx?proj=64639 %M 34870610 %R 10.2196/30919 %U https://games.jmir.org/2021/4/e30919 %U https://doi.org/10.2196/30919 %U http://www.ncbi.nlm.nih.gov/pubmed/34870610 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e30304 %T Utility of a Machine-Guided Tool for Assessing Risk Behavior Associated With Contracting HIV in Three Sites in South Africa: Protocol for an In-Field Evaluation %A Majam,Mohammed %A Phatsoane,Mothepane %A Hanna,Keith %A Faul,Charles %A Arora,Lovkesh %A Makthal,Sarvesh %A Kumar,Akhil %A Jois,Kashyap %A Lalla-Edward,Samanta Tresha %+ Ezintsha, Faculty of Health Sciences, University of Witswatersrand, Sunnyside Office Park, 31 Princess of Wales Terrace, Johannesburg, 2193, South Africa, 27 826172490, slallaedward@ezintsha.org %K machine learning %K predictive risk %K modeling %K algorithm %K HIV status %K HIV %K risk assessment %K South Africa %D 2021 %7 2.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mobile technology has helped to advance health programs, and studies have shown that an automated risk prediction model can successfully be used to identify patients who exhibit a high probable risk of contracting human immunodeficiency virus (HIV). A machine-guided tool is an algorithm that takes a set of subjective and objective answers from a simple questionnaire and computes an HIV risk assessment score. Objective: The primary objective of this study is to establish that machine learning can be used to develop machine-guided tools and give us a deeper statistical understanding of the correlation between certain behavioral patterns and HIV. Methods: In total, 200 HIV-negative adult individuals across three South African study sites each (two semirural and one urban) will be recruited. Study processes will include (1) completing a series of questions (demographic, sexual behavior and history, personal, lifestyle, and symptoms) on an application system, unaided (assistance will only be provided upon user request); (2) two HIV tests (one per study visit) being performed by a nurse/counselor according to South African national guidelines (to evaluate the prediction accuracy of the tool); and (3) communicating test results and completing a user experience survey questionnaire. The output metrics for this study will be computed by using the participants’ risk assessment scores as “predictions” and the test results as the “ground truth.” Analyses will be completed after visit 1 and then again after visit 2. All risk assessment scores will be used to calculate the reliability of the machine-guided tool. Results: Ethical approval was received from the University of Witwatersrand Human Research Ethics Committee (HREC; ethics reference no. 200312) on August 20, 2020. This study is ongoing. Data collection has commenced and is expected to be completed in the second half of 2021. We will report on the machine-guided tool’s performance and usability, together with user satisfaction and recommendations for improvement. Conclusions: Machine-guided risk assessment tools can provide a cost-effective alternative to large-scale HIV screening and help in providing targeted counseling and testing to prevent the spread of HIV. Trial Registration: South African National Clinical Trial Registry DOH-27-042021-679; https://sanctr.samrc.ac.za/TrialDisplay.aspx?TrialID=5545 International Registered Report Identifier (IRRID): DERR1-10.2196/30304 %M 34860679 %R 10.2196/30304 %U https://www.researchprotocols.org/2021/12/e30304 %U https://doi.org/10.2196/30304 %U http://www.ncbi.nlm.nih.gov/pubmed/34860679 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e30479 %T Implementing the Routine Use of Electronic Mental Health Screening for Youth in Primary Care: Systematic Review %A Martel,Rhiannon %A Shepherd,Matthew %A Goodyear-Smith,Felicity %+ Department of General Practice & Primary Health Care, Faculty of Medical & Health Science, University of Auckland, 22 Park Road, Grafton, Auckland, 1142, New Zealand, 64 99232357, f.goodyear-smith@auckland.ac.nz %K adolescent %K mental health %K risk behavior %K screening %K primary care %D 2021 %7 19.11.2021 %9 Review %J JMIR Ment Health %G English %X Background: Adolescents often present at primary care clinics with nonspecific physical symptoms when, in fact, they have at least 1 mental health or risk behavior (psychosocial) issue with which they would like help but do not disclose to their care provider. Despite global recommendations, over 50% of youths are not screened for mental health and risk behavior issues in primary care. Objective: This review aimed to examine the implementation, acceptability, feasibility, benefits, and barriers of e-screening tools for mental health and risk behaviors among youth in primary care settings. Methods: Electronic databases—MEDLINE, CINAHL, Scopus, and the Cochrane Database of Systematic Reviews—were searched for studies on the routine screening of youth in primary care settings. Screening tools needed to be electronic and screen for at least 1 mental health or risk behavior issue. A total of 11 studies that were reported in 12 articles, of which all were from high-income countries, were reviewed. Results: e-Screening was largely proven to be feasible and acceptable to youth and their primary care providers. Preconsultation e-screening facilitated discussions about sensitive issues and increased disclosure by youth. However, barriers such as the lack of time, training, and discomfort in raising sensitive issues with youth continued to be reported. Conclusions: To implement e-screening, clinicians need to change their behaviors, and e-screening processes must become normalized into their workflows. Co-designing and tailoring screening implementation frameworks to meet the needs of specific contexts may be required to ensure that clinicians overcome initial resistances and perceived barriers and adopt the required processes in their work. %M 34807833 %R 10.2196/30479 %U https://mental.jmir.org/2021/11/e30479 %U https://doi.org/10.2196/30479 %U http://www.ncbi.nlm.nih.gov/pubmed/34807833 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e25730 %T The Use of Cannabinoids for Insomnia in Daily Life: Naturalistic Study %A Kuhathasan,Nirushi %A Minuzzi,Luciano %A MacKillop,James %A Frey,Benicio N %+ Mood Disorders Program and Women’s Health Concerns Clinic, St. Joseph’s Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada, 1 905 522 1155, freybn@mcmaster.ca %K medicinal cannabis %K insomnia %K symptom management %K linear mixed-effects %D 2021 %7 27.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Insomnia is a prevalent condition that presents itself at both the symptom and diagnostic levels. Although insomnia is one of the main reasons individuals seek medicinal cannabis, little is known about the profile of cannabinoid use or the perceived benefit of the use of cannabinoids in daily life. Objective: We conducted a retrospective study of medicinal cannabis users to investigate the use profile and perceived efficacy of cannabinoids for the management of insomnia. Methods: Data were collected using the Strainprint app, which allows medicinal cannabis users to log conditions and symptoms, track cannabis use, and monitor symptom severity pre- and postcannabis use. Our analyses examined 991 medicinal cannabis users with insomnia across 24,189 tracked cannabis use sessions. Sessions were analyzed, and both descriptive statistics and linear mixed-effects modeling were completed to examine use patterns and perceived efficacy. Results: Overall, cannabinoids were perceived to be efficacious across all genders and ages, and no significant differences were found among product forms, ingestion methods, or gender groups. Although all strain categories were perceived as efficacious, predominant indica strains were found to reduce insomnia symptomology more than cannabidiol (CBD) strains (estimated mean difference 0.59, SE 0.11; 95% CI 0.36-0.81; adjusted P<.001) and predominant sativa strains (estimated mean difference 0.74, SE 0.16; 95% CI 0.43-1.06; adjusted P<.001). Indica hybrid strains also presented a greater reduction in insomnia symptomology than CBD strains (mean difference 0.52, SE 0.12; 95% CI 0.29-0.74; adjusted P<.001) and predominant sativa strains (mean difference 0.67, SE 0.16; 95% CI 0.34-1.00; adjusted P=.002). Conclusions: Medicinal cannabis users perceive a significant improvement in insomnia with cannabinoid use, and this study suggests a possible advantage with the use of predominant indica strains compared with predominant sativa strains and exclusively CBD in this population. This study emphasizes the need for randomized placebo-controlled trials assessing the efficacy and safety profile of cannabinoids for the treatment of insomnia. %M 34704957 %R 10.2196/25730 %U https://www.jmir.org/2021/10/e25730 %U https://doi.org/10.2196/25730 %U http://www.ncbi.nlm.nih.gov/pubmed/34704957 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e32345 %T Assessment of an Innovative Mobile Dentistry eHygiene Model Amid the COVID-19 Pandemic in the National Dental Practice–Based Research Network: Protocol for Design, Implementation, and Usability Testing %A Xiao,Jin %A Meyerowitz,Cyril %A Ragusa,Patricia %A Funkhouser,Kimberly %A Lischka,Tamara R %A Mendez Chagoya,Luis Alberto %A Al Jallad,Nisreen %A Wu,Tong Tong %A Fiscella,Kevin %A Ivie,Eden %A Strange,Michelle %A Collins,Jamie %A Kopycka-Kedzierawski,Dorota T %A , %+ Eastman Institute for Oral Health, University of Rochester Medical Center, 625 Elmwood Ave, Rochester, NY, 14620, United States, 1 585 275 0706, Dorota_KopyckaKedzierawski@URMC.Rochester.edu %K teledentistry %K mDentistry %K oral diseases %K virtual visit %K intraoral camera %K pandemic response %K COVID-19 %K mHealth %D 2021 %7 26.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Amid COVID-19, and other possible future infectious disease pandemics, dentistry needs to consider modified dental examination regimens that render quality care, are cost effective, and ensure the safety of patients and dental health care personnel (DHCP). Traditional dental examinations, which number more than 300 million per year in the United States, rely on person-to-person tactile examinations, pose challenges to infection control, and consume large quantities of advanced-level personal protective equipment (PPE). Therefore, our long-term goal is to develop an innovative mobile dentistry (mDent) model that takes these issues into account. This model supplements the traditional dental practice with virtual visits, supported by mobile devices such as mobile telephones, tablets, and wireless infrastructure. The mDent model leverages the advantages of digital mobile health (mHealth) tools such as intraoral cameras to deliver virtual oral examinations, treatment planning, and interactive oral health management, on a broad population basis. Conversion of the traditional dental examinations to mDent virtual examinations builds upon (1) the reliability of teledentistry, which uses intraoral photos and live videos to make diagnostic decisions, and (2) rapid advancement in mHealth tool utilization. Objective: In this pilot project, we designed a 2-stage implementation study to assess 2 critical components of the mDent model: virtual hygiene examination (eHygiene) and patient self-taken intraoral photos (SELFIE). Our specific aims are to (1) assess the acceptance and barriers of mDent eHygiene among patients and DHCP, (2) assess the economic impact of mDent eHygiene, and (3) assess the patient’s capability to generate intraoral photos using mHealth tools (exploratory aim, SELFIE). Methods: This study will access the rich resources of the National Dental Practice-Based Research Network to recruit 12 dentists, 12 hygienists, and 144 patients from 12 practices. For aims 1 and 2, we will use role-specific questionnaires to collect quantitative data on eHygiene acceptance and economic impact. The questionnaire components include participant characteristics, the System Usability Scale, a dentist-patient communication scale, practice operation cost, and patient opportunity cost. We will further conduct a series of iterative qualitative research activities using individual interviews to further elicit feedback and suggestion for changes to the mDent eHygiene model. For aim 3, we will use mixed methods (quantitative and qualitative) to assess the patient’s capability of taking intraoral photos, by analyzing obtained photos and recorded videos. Results: The study is supported by the US National Institute of Dental and Craniofacial Research. This study received “single” institutional review board approval in August 2021. Data collection and analysis are expected to conclude by December 2021 and March 2022, respectively. Conclusions: The study results will inform the logistics of conducting virtual dental examinations and empowering patients with mHealth tools, providing better safety and preserving PPE amid the COVID-19 and possible future pandemics. International Registered Report Identifier (IRRID): PRR1-10.2196/32345 %M 34597259 %R 10.2196/32345 %U https://www.researchprotocols.org/2021/10/e32345 %U https://doi.org/10.2196/32345 %U http://www.ncbi.nlm.nih.gov/pubmed/34597259 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e30404 %T Characteristics and Quality of Mobile Apps Containing Prenatal Genetic Testing Information: Systematic App Store Search and Assessment %A Wu,Ko-Lin %A Alegria,Rebeca %A Gonzalez,Jazzlyn %A Hu,Harrison %A Wang,Haocen %A Page,Robin %A Robbins-Furman,Patricia %A Ma,Ping %A Tseng,Tung-Sung %A Chen,Lei-Shih %+ Department of Health and Kinesiology, Texas A&M University, 4243 TAMU, College Station, TX, 77840, United States, 1 979 862 2912, lacechen@tamu.edu %K mobile applications %K prenatal genetic testing %K pregnancy %K review %K evaluation %D 2021 %7 14.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Prenatal genetic testing is an essential part of routine prenatal care. Yet, obstetricians often lack the time to provide comprehensive prenatal genetic testing education to their patients. Pregnant women lack prenatal genetic testing knowledge, which may hinder informed decision-making during their pregnancies. Due to the rapid growth of technology, mobile apps are a potentially valuable educational tool through which pregnant women can learn about prenatal genetic testing and improve the quality of their communication with obstetricians. The characteristics, quality, and number of available apps containing prenatal genetic testing information are, however, unknown. Objective: This study aims to conduct a firstreview to identify, evaluate, and summarize currently available mobile apps that contain prenatal genetic testing information using a systematic approach. Methods: We searched both the Apple App Store and Google Play for mobile apps containing prenatal genetic testing information. The quality of apps was assessed based on the criteria adopted from two commonly used and validated mobile app scoring systems, including the Mobile Application Rating Scale (MARS) and the APPLICATIONS evaluation criteria. Results: A total of 64 mobile apps were identified. Of these, only 2 apps were developed for a specific prenatal genetic test. All others were either pregnancy-related (61/64, 95%) or genetics-related (1/64, 2%) apps that provided prenatal genetic testing information. The majority of the apps (49/64, 77%) were developed by commercial companies. The mean quality assessment score of the included apps was 13.5 (SD 2.9), which was equal to the average of possible theoretical score. Overall, the main weaknesses of mobile apps in this review included the limited number of prenatal genetic tests mentioned; incomprehensiveness of testing information; unreliable and missing information sources; absence of developmental testing with users (not evidence based); high level of readability; and the lack of visual information, customization, and a text search field. Conclusions: Our findings suggest that the quality of mobile apps with prenatal genetic testing information must be improved and that pregnant women should be cautious when using these apps for prenatal genetic testing information. Obstetricians should carefully examine mobile apps before referring any of them to their patients for use as an educational tool. Both improving the quality of existing mobile apps, and developing new, evidence-based, high-quality mobile apps targeting all prenatal genetic tests should be the focus of mobile app developers going forward. %M 34647898 %R 10.2196/30404 %U https://mhealth.jmir.org/2021/10/e30404 %U https://doi.org/10.2196/30404 %U http://www.ncbi.nlm.nih.gov/pubmed/34647898 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e23663 %T A Mobile App (FallSA) to Identify Fall Risk Among Malaysian Community-Dwelling Older Persons: Development and Validation Study %A Singh,Devinder Kaur Ajit %A Goh,Jing Wen %A Shaharudin,Muhammad Iqbal %A Shahar,Suzana %+ Center for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, 50300, Malaysia, 60 392897000, devinder@ukm.edu.my %K fall risk %K self-screening %K mobile app %K older person %D 2021 %7 12.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Recent falls prevention guidelines recommend early routine fall risk assessment among older persons. Objective: The purpose of this study was to develop a Falls Screening Mobile App (FallSA), determine its acceptance, concurrent validity, test-retest reliability, discriminative ability, and predictive validity as a self-screening tool to identify fall risk among Malaysian older persons. Methods: FallSA acceptance was tested among 15 participants (mean age 65.93 [SD 7.42] years); its validity and reliability among 91 participants (mean age 67.34 [SD 5.97] years); discriminative ability and predictive validity among 610 participants (mean age 71.78 [SD 4.70] years). Acceptance of FallSA was assessed using a questionnaire, and it was validated against a comprehensive fall risk assessment tool, the Physiological Profile Assessment (PPA). Participants used FallSA to test their fall risk repeatedly twice within an hour. Its discriminative ability and predictive validity were determined by comparing participant fall risk scores between fallers and nonfallers and prospectively through a 6-month follow-up, respectively. Results: The findings of our study showed that FallSA had a high acceptance level with 80% (12/15) of older persons agreeing on its suitability as a falls self-screening tool. Concurrent validity test demonstrated a significant moderate correlation (r=.518, P<.001) and agreement (k=.516, P<.001) with acceptable sensitivity (80.4%) and specificity (71.1%). FallSA also had good reliability (intraclass correlation .948; 95% CI .921-.966) and an internal consistency (α=.948, P<.001). FallSA score demonstrated a moderate to strong discriminative ability in classifying fallers and nonfallers. FallSA had a predictive validity of falls with positive likelihood ratio of 2.27, pooled sensitivity of 82% and specificity of 64%, and area under the curve of 0.802. Conclusions: These results suggest that FallSA is a valid and reliable fall risk self-screening tool. Further studies are required to empower and engage older persons or care givers in the use of FallSA to self-screen for falls and thereafter to seek early prevention intervention. %M 34636740 %R 10.2196/23663 %U https://mhealth.jmir.org/2021/10/e23663 %U https://doi.org/10.2196/23663 %U http://www.ncbi.nlm.nih.gov/pubmed/34636740 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e30871 %T Post-COVID Public Health Surveillance and Privacy Expectations in the United States: Scenario-Based Interview Study %A Seberger,John S %A Patil,Sameer %+ College of Communication Arts & Sciences, Michigan State University, 404 Wilson Rd, East Lansing, MI, 48824, United States, 1 (517) 416 0743, seberge1@msu.edu %K COVID-19 %K pandemic-tracking apps %K privacy concerns %K infrastructure %K health surveillance %K scenario %K interview %K thematic analysis %D 2021 %7 5.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone-based apps designed and deployed to mitigate the COVID-19 pandemic may become infrastructure for postpandemic public health surveillance in the United States. Through the lenses of privacy concerns and user expectations of digital pandemic mitigation techniques, we identified possible long-term sociotechnical implications of such an infrastructure. Objective: We explored how people in the United States perceive the possible routinization of pandemic tracking apps for public health surveillance in general. Our interdisciplinary analysis focused on the interplay between privacy concerns, data practices of surveillance capitalism, and trust in health care providers. We conducted this analysis to achieve a richer understanding of the sociotechnical issues raised by the deployment and use of technology for pandemic mitigation. Methods: We conducted scenario-based, semistructured interviews (n=19) with adults in the United States. The interviews focused on how people perceive the short- and long-term privacy concerns associated with a fictional smart thermometer app deployed to mitigate the “outbreak of a contagious disease.” In order to elicit future-oriented discussions, the scenario indicated that the app would continue functioning “after the disease outbreak has dissipated.” We analyzed interview transcripts using reflexive thematic analysis. Results: In the context of pandemic mitigation technology, including app-based tracking, people perceive a core trade-off between public health and personal privacy. People tend to rationalize this trade-off by invoking the concept of “the greater good.” The interplay between the trade-off and rationalization forms the core of sociotechnical issues that pandemic mitigation technologies raise. Participants routinely expected that data collected through apps related to public health would be shared with unknown third parties for the financial gain of the app makers. This expectation suggests a perceived alignment between an app-based infrastructure for public health surveillance and the broader economics of surveillance capitalism. Our results highlight unintended and unexpected sociotechnical impacts of routinizing app-based tracking on postpandemic life, which are rationalized by invoking a nebulous concept of the greater good. Conclusions: While technologies such as app-based tracking could be useful for pandemic mitigation and preparedness, the routinization of such apps as a form of public health surveillance may have broader, unintentional sociotechnical implications for individuals and the societies in which they live. Although technology has the potential to increase the efficacy of pandemic mitigation, it exists within a broader network of sociotechnical concerns. Therefore, it is necessary to consider the long-term implications of pandemic mitigation technologies beyond the immediate needs of addressing the COVID-19 pandemic. Potential negative consequences include the erosion of patient trust in health care systems and providers, grounded in concerns about privacy violations and overly broad surveillance. %M 34519667 %R 10.2196/30871 %U https://mhealth.jmir.org/2021/10/e30871 %U https://doi.org/10.2196/30871 %U http://www.ncbi.nlm.nih.gov/pubmed/34519667 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e26602 %T Acceptance of a Smartphone-Based Visual Field Screening Platform for Glaucoma: Pre-Post Study %A Nida,Esmael Kedir %A Bekele,Sisay %A Geurts,Luc %A Vanden Abeele,Vero %+ e-Media Lab, KU Leuven, Vesaliusstraat 13, Leuven, 3000, Belgium, 32 16 30 10 3, isma.kedir@gmail.com %K mHealth acceptance %K UTAUT %K glaucoma screening %K mhealth for eye care %K mhealth %K glaucoma %K visual %K eye %K ophthalmology %K ophthalmic %K mobile phone %D 2021 %7 17.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Glaucoma, the silent thief of sight, is a major cause of blindness worldwide. It is a burden for people in low-income countries, specifically countries where glaucoma-induced blindness accounts for 15% of the total incidence of blindness. More than half the people living with glaucoma in low-income countries are unaware of the disease until it progresses to an advanced stage, resulting in permanent visual impairment. Objective: This study aims to evaluate the acceptability of the Glaucoma Easy Screener (GES), a low-cost and portable visual field screening platform comprising a smartphone, a stereoscopic virtual reality headset, and a gaming joystick. Methods: A mixed methods study that included 24 eye care professionals from 4 hospitals in Southwest Ethiopia was conducted to evaluate the acceptability of GES. A pre-post design was used to collect perspectives before and after using the GES by using questionnaires and semistructured interviews. A Wilcoxon signed-rank test was used to determine the significance of any change in the scores of the questionnaire items (two-tailed, 95% CI; α=.05). The questionnaire and interview questions were guided by the Unified Theory of Acceptance and Use of Technology. Results: Positive results were obtained both before and after use, suggesting the acceptance of mobile health solutions for conducting glaucoma screening by using a low-cost headset with a smartphone and a game controller. There was a significant increase (two-tailed, 95% CI; α=.05) in the average scores of 86% (19/22) of postuse questionnaire items compared with those of preuse questionnaire items. Ophthalmic professionals perceived GES as easy to use and as a tool that enabled the conduct of glaucoma screening tests, especially during outreach to rural areas. However, positive evaluations are contingent on the accuracy of the tool. Moreover, ophthalmologists voiced the need to limit the tool to screening only (ie, not for making diagnoses). Conclusions: This study supports the feasibility of using a mobile device in combination with a low-cost virtual reality headset and classic controller for glaucoma screening in rural areas. GES has the potential to reduce the burden of irreversible blindness caused by glaucoma. However, further assessment of its sensitivity and specificity is required. %M 34533462 %R 10.2196/26602 %U https://formative.jmir.org/2021/9/e26602 %U https://doi.org/10.2196/26602 %U http://www.ncbi.nlm.nih.gov/pubmed/34533462 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e24352 %T Using Acoustic Speech Patterns From Smartphones to Investigate Mood Disorders: Scoping Review %A Flanagan,Olivia %A Chan,Amy %A Roop,Partha %A Sundram,Frederick %+ Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Building 507, Level 3, 28 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 9 923 7521, f.sundram@auckland.ac.nz %K smartphone %K data science %K speech patterns %K mood disorders %K diagnosis %K monitoring %D 2021 %7 17.9.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mood disorders are commonly underrecognized and undertreated, as diagnosis is reliant on self-reporting and clinical assessments that are often not timely. Speech characteristics of those with mood disorders differs from healthy individuals. With the wide use of smartphones, and the emergence of machine learning approaches, smartphones can be used to monitor speech patterns to help the diagnosis and monitoring of mood disorders. Objective: The aim of this review is to synthesize research on using speech patterns from smartphones to diagnose and monitor mood disorders. Methods: Literature searches of major databases, Medline, PsycInfo, EMBASE, and CINAHL, initially identified 832 relevant articles using the search terms “mood disorders”, “smartphone”, “voice analysis”, and their variants. Only 13 studies met inclusion criteria: use of a smartphone for capturing voice data, focus on diagnosing or monitoring a mood disorder(s), clinical populations recruited prospectively, and in the English language only. Articles were assessed by 2 reviewers, and data extracted included data type, classifiers used, methods of capture, and study results. Studies were analyzed using a narrative synthesis approach. Results: Studies showed that voice data alone had reasonable accuracy in predicting mood states and mood fluctuations based on objectively monitored speech patterns. While a fusion of different sensor modalities revealed the highest accuracy (97.4%), nearly 80% of included studies were pilot trials or feasibility studies without control groups and had small sample sizes ranging from 1 to 73 participants. Studies were also carried out over short or varying timeframes and had significant heterogeneity of methods in terms of the types of audio data captured, environmental contexts, classifiers, and measures to control for privacy and ambient noise. Conclusions: Approaches that allow smartphone-based monitoring of speech patterns in mood disorders are rapidly growing. The current body of evidence supports the value of speech patterns to monitor, classify, and predict mood states in real time. However, many challenges remain around the robustness, cost-effectiveness, and acceptability of such an approach and further work is required to build on current research and reduce heterogeneity of methodologies as well as clinical evaluation of the benefits and risks of such approaches. %M 34533465 %R 10.2196/24352 %U https://mhealth.jmir.org/2021/9/e24352 %U https://doi.org/10.2196/24352 %U http://www.ncbi.nlm.nih.gov/pubmed/34533465 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28369 %T Mental Health Screening in General Practices as a Means for Enhancing Uptake of Digital Mental Health Interventions: Observational Cohort Study %A Whitton,Alexis E %A Hardy,Rebecca %A Cope,Kate %A Gieng,Chilin %A Gow,Leanne %A MacKinnon,Andrew %A Gale,Nyree %A O'Moore,Kathleen %A Anderson,Josephine %A Proudfoot,Judith %A Cockayne,Nicole %A O'Dea,Bridianne %A Christensen,Helen %A Newby,Jill Maree %+ Black Dog Institute, Hospital Road, Randwick, 2031, Australia, 61 293828507, a.whitton@unsw.edu.au %K depression %K anxiety %K general practice %K screening %K digital mental health %D 2021 %7 16.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital mental health interventions stand to play a critical role in managing the mental health impact of the COVID-19 pandemic. Thus, enhancing their uptake is a key priority. General practitioners (GPs) are well positioned to facilitate access to digital interventions, but tools that assist GPs in identifying suitable patients are lacking. Objective: This study aims to evaluate the suitability of a web-based mental health screening and treatment recommendation tool (StepCare) for improving the identification of anxiety and depression in general practice and, subsequently, uptake of digital mental health interventions. Methods: StepCare screens patients for symptoms of depression (9-item Patient Health Questionnaire) and anxiety (7-item Generalized Anxiety Disorder scale) in the GP waiting room. It provides GPs with stepped treatment recommendations that include digital mental health interventions for patients with mild to moderate symptoms. Patients (N=5138) from 85 general practices across Australia were invited to participate in screening. Results: Screening identified depressive or anxious symptoms in 43.09% (1428/3314) of patients (one-quarter were previously unidentified or untreated). The majority (300/335, 89.6%) of previously unidentified or untreated patients had mild to moderate symptoms and were candidates for digital mental health interventions. Although less than half were prescribed a digital intervention by their GP, when a digital intervention was prescribed, more than two-thirds of patients reported using it. Conclusions: Implementing web-based mental health screening in general practices can provide important opportunities for GPs to improve the identification of symptoms of mental illness and increase patient access to digital mental health interventions. Although GPs prescribed digital interventions less frequently than in-person psychotherapy or medication, the promising rates of uptake by GP-referred patients suggest that GPs can play a critical role in championing digital interventions and maximizing the associated benefits. %M 34528896 %R 10.2196/28369 %U https://www.jmir.org/2021/9/e28369 %U https://doi.org/10.2196/28369 %U http://www.ncbi.nlm.nih.gov/pubmed/34528896 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e28378 %T Diagnostic Accuracy of Smartphone-Based Audiometry for Hearing Loss Detection: Meta-analysis %A Chen,Chih-Hao %A Lin,Heng-Yu Haley %A Wang,Mao-Che %A Chu,Yuan-Chia %A Chang,Chun-Yu %A Huang,Chii-Yuan %A Cheng,Yen-Fu %+ Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taiwan, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 11217, Taiwan, 886 2 2871 2121 ext 1292, yfcheng2@vghtpe.gov.tw %K audiometry %K hearing loss %K hearing test %K mhealth %K mobile health %K digital health %K meta-analysis %K mobile phone %K smartphone diagnostic test accuracy %D 2021 %7 10.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hearing loss is one of the most common disabilities worldwide and affects both individual and public health. Pure tone audiometry (PTA) is the gold standard for hearing assessment, but it is often not available in many settings, given its high cost and demand for human resources. Smartphone-based audiometry may be equally effective and can improve access to adequate hearing evaluations. Objective: The aim of this systematic review is to synthesize the current evidence of the role of smartphone-based audiometry in hearing assessments and further explore the factors that influence its diagnostic accuracy. Methods: Five databases—PubMed, Embase, Cochrane Library, Web of Science, and Scopus—were queried to identify original studies that examined the diagnostic accuracy of hearing loss measurement using smartphone-based devices with conventional PTA as a reference test. A bivariate random-effects meta-analysis was performed to estimate the pooled sensitivity and specificity. The factors associated with diagnostic accuracy were identified using a bivariate meta-regression model. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Results: In all, 25 studies with a total of 4470 patients were included in the meta-analysis. The overall sensitivity, specificity, and area under the receiver operating characteristic curve for smartphone-based audiometry were 89% (95% CI 83%-93%), 93% (95% CI 87%-97%), and 0.96 (95% CI 0.93-0.97), respectively; the corresponding values for the smartphone-based speech recognition test were 91% (95% CI 86%-94%), 88% (95% CI 75%-94%), and 0.93 (95% CI 0.90-0.95), respectively. Meta-regression analysis revealed that patient age, equipment used, and the presence of soundproof booths were significantly related to diagnostic accuracy. Conclusions: We have presented comprehensive evidence regarding the effectiveness of smartphone-based tests in diagnosing hearing loss. Smartphone-based audiometry may serve as an accurate and accessible approach to hearing evaluations, especially in settings where conventional PTA is unavailable. %M 34515644 %R 10.2196/28378 %U https://mhealth.jmir.org/2021/9/e28378/ %U https://doi.org/10.2196/28378 %U http://www.ncbi.nlm.nih.gov/pubmed/34515644 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e25660 %T Tablet-Based Cognitive Impairment Screening for Adults With HIV Seeking Clinical Care: Observational Study %A Rubin,Leah H %A Severson,Joan %A Marcotte,Thomas D %A Savin,Micah J %A Best,Allen %A Johnson,Shane %A Cosman,Joshua %A Merickel,Michael %A Buchholz,Alison %A Del Bene,Victor A %A Eldred,Lois %A Sacktor,Ned C %A Fuchs,Joelle-Beverlie %A Althoff,Keri N %A Moore,Richard D %+ Johns Hopkins University, 600 N Wolfe St, Meyer 6-113a, Baltimore, MD, 21287-7613, United States, 1 3128024802, lrubin@jhu.edu %K cognitive complications %K people with HIV %K digital assessment %K HIV %K tablet %K screening %D 2021 %7 9.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Neurological complications including cognitive impairment persist among people with HIV on antiretrovirals; however, cognitive screening is not routinely conducted in HIV clinics. Objective: Our objective for this study was 3-fold: (1) to determine the feasibility of implementing an iPad-based cognitive impairment screener among adults seeking HIV care, (2) to examine the psychometric properties of the tool, and (3) to examine predictors of cognitive impairment using the tool. Methods: A convenience sample of participants completed Brain Baseline Assessment of Cognition and Everyday Functioning (BRACE), which included (1) Trail Making Test Part A, measuring psychomotor speed; (2) Trail Making Test Part B, measuring set-shifting; (3) Stroop Color, measuring processing speed; and (4) the Visual–Spatial Learning Test. Global neuropsychological function was estimated as mean T score performance on the 4 outcomes. Impairment on each test or for the global mean was defined as a T score ≤40. Subgroups of participants repeated the tests 4 weeks or >6 months after completing the first test to evaluate intraperson test–retest reliability and practice effects (improvements in performance due to repeated test exposure). An additional subgroup completed a lengthier cognitive battery concurrently to assess validity. Relevant factors were abstracted from electronic medical records to examine predictors of global neuropsychological function. Results: The study population consisted of 404 people with HIV (age: mean 53.6 years; race: 332/404, 82% Black; 34/404, 8% White, 10/404, 2% American Indian/Alaskan Native; 28/404, 7% other and 230/404, 58% male; 174/404, 42% female) of whom 99% (402/404) were on antiretroviral therapy. Participants completed BRACE in a mean of 12 minutes (SD 3.2), and impairment was demonstrated by 34% (136/404) on Trail Making Test A, 44% (177/404) on Trail Making Test B, 40% (161/404) on Stroop Color, and 17% (67/404) on Visual-Spatial Learning Test. Global impairment was demonstrated by 103 out of 404 (25%). Test–retest reliability for the subset of participants (n=26) repeating the measure at 4 weeks was 0.81 and for the subset of participants (n=67) repeating the measure almost 1 year later (days: median 294, IQR 50) was 0.63. There were no significant practice effects at either time point (P=.20 and P=.68, respectively). With respect for validity, the correlation between global impairment on the lengthier cognitive battery and BRACE was 0.63 (n=61; P<.001), with 84% sensitivity and 94% specificity to impairment on the lengthier cognitive battery. Conclusions: We were able to successfully implement BRACE and estimate cognitive impairment burden in the context of routine clinic care. BRACE was also shown to have good psychometric properties. This easy-to-use tool in clinical settings may facilitate the care needs of people with HIV as cognitive impairment continues to remain a concern in people with HIV. %M 34499048 %R 10.2196/25660 %U https://mental.jmir.org/2021/9/e25660 %U https://doi.org/10.2196/25660 %U http://www.ncbi.nlm.nih.gov/pubmed/34499048 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e28974 %T Diagnostic Accuracy of Smartwatches for the Detection of Cardiac Arrhythmia: Systematic Review and Meta-analysis %A Nazarian,Scarlet %A Lam,Kyle %A Darzi,Ara %A Ashrafian,Hutan %+ Imperial College London, 10th Floor QEQM Building, St Mary’s Hospital, Praed Street, London, W2 1NY, United Kingdom, 44 7799 871 597, hutan@researchtrials.net %K wearables %K smartwatch %K cardiac arrhythmia %K atrial fibrillation %K cardiology %K mHealth %K wearable devices %K screening %K diagnostics %K accuracy %D 2021 %7 27.8.2021 %9 Review %J J Med Internet Res %G English %X Background: Significant morbidity, mortality, and financial burden are associated with cardiac rhythm abnormalities. Conventional investigative tools are often unsuccessful in detecting cardiac arrhythmias because of their episodic nature. Smartwatches have gained popularity in recent years as a health tool for the detection of cardiac rhythms. Objective: This study aims to systematically review and meta-analyze the diagnostic accuracy of smartwatches in the detection of cardiac arrhythmias. Methods: A systematic literature search of the Embase, MEDLINE, and Cochrane Library databases was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify studies reporting the use of a smartwatch for the detection of cardiac arrhythmia. Summary estimates of sensitivity, specificity, and area under the curve were attempted using a bivariate model for the diagnostic meta-analysis. Studies were examined for quality using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Results: A total of 18 studies examining atrial fibrillation detection, bradyarrhythmias and tachyarrhythmias, and premature contractions were analyzed, measuring diagnostic accuracy in 424,371 subjects in total. The signals analyzed by smartwatches were based on photoplethysmography. The overall sensitivity, specificity, and accuracy of smartwatches for detecting cardiac arrhythmias were 100% (95% CI 0.99-1.00), 95% (95% CI 0.93-0.97), and 97% (95% CI 0.96-0.99), respectively. The pooled positive predictive value and negative predictive value for detecting cardiac arrhythmias were 85% (95% CI 0.79-0.90) and 100% (95% CI 1.0-1.0), respectively. Conclusions: This review demonstrates the evolving field of digital disease detection. The current diagnostic accuracy of smartwatch technology for the detection of cardiac arrhythmias is high. Although the innovative drive of digital devices in health care will continue to gain momentum toward screening, the process of accurate evidence accrual and regulatory standards ready to accept their introduction is strongly needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020213237; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=213237. %M 34448706 %R 10.2196/28974 %U https://www.jmir.org/2021/8/e28974 %U https://doi.org/10.2196/28974 %U http://www.ncbi.nlm.nih.gov/pubmed/34448706 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e23425 %T Enhancing Healthcare Access–Smartphone Apps in Arrhythmia Screening: Viewpoint %A Książczyk,Marcin %A Dębska-Kozłowska,Agnieszka %A Warchoł,Izabela %A Lubiński,Andrzej %+ Department of Interventional Cardiology and Cardiac Arrhythmias, Medical University of Lodz, Ul. Żeromskiego 113, Łódź, 90-549, Poland, 48 42 639 35 63, marcin_ksiazczyk@interia.pl %K arrhythmia screening %K atrial fibrillation %K mobile electrocardiography %K mobile health %K phonocardiography %K photoplethysmography %K seismocardiography %K stroke prevention %D 2021 %7 27.8.2021 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Atrial fibrillation is the most commonly reported arrhythmia and, if undiagnosed or untreated, may lead to thromboembolic events. It is therefore desirable to provide screening to patients in order to detect atrial arrhythmias. Specific mobile apps and accessory devices, such as smartphones and smartwatches, may play a significant role in monitoring heart rhythm in populations at high risk of arrhythmia. These apps are becoming increasingly common among patients and professionals as a part of mobile health. The rapid development of mobile health solutions may revolutionize approaches to arrhythmia screening. In this viewpoint paper, we assess the availability of smartphone and smartwatch apps and evaluate their efficacy for monitoring heart rhythm and arrhythmia detection. The findings obtained so far suggest they are on the right track to improving the efficacy of early detection of atrial fibrillation, thus lowering the risk of stroke and reducing the economic burden placed on public health. %M 34448723 %R 10.2196/23425 %U https://mhealth.jmir.org/2021/8/e23425 %U https://doi.org/10.2196/23425 %U http://www.ncbi.nlm.nih.gov/pubmed/34448723 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e22909 %T Digital Natives’ Preferences on Mobile Artificial Intelligence Apps for Skin Cancer Diagnostics: Survey Study %A Haggenmüller,Sarah %A Krieghoff-Henning,Eva %A Jutzi,Tanja %A Trapp,Nicole %A Kiehl,Lennard %A Utikal,Jochen Sven %A Fabian,Sascha %A Brinker,Titus Josef %+ Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg, 69120, Germany, 49 6221 32 19 304, titus.brinker@dkfz.de %K artificial intelligence %K skin cancer %K skin cancer screening %K diagnostics %K digital natives %K acceptance %K concerns %K preferences %K online survey %D 2021 %7 27.8.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Artificial intelligence (AI) has shown potential to improve diagnostics of various diseases, especially for early detection of skin cancer. Studies have yet to investigate the clear application of AI technology in clinical practice or determine the added value for younger user groups. Translation of AI-based diagnostic tools can only be successful if they are accepted by potential users. Young adults as digital natives may offer the greatest potential for successful implementation of AI into clinical practice, while at the same time, representing the future generation of skin cancer screening participants. Objective: We conducted an anonymous online survey to examine how and to what extent individuals are willing to accept AI-based mobile apps for skin cancer diagnostics. We evaluated preferences and relative influences of concerns, with a focus on younger age groups. Methods: We recruited participants below 35 years of age using three social media channels—Facebook, LinkedIn, and Xing. Descriptive analysis and statistical tests were performed to evaluate participants’ attitudes toward mobile apps for skin examination. We integrated an adaptive choice-based conjoint to assess participants’ preferences. We evaluated potential concerns using maximum difference scaling. Results: We included 728 participants in the analysis. The majority of participants (66.5%, 484/728; 95% CI 0.631-0.699) expressed a positive attitude toward the use of AI-based apps. In particular, participants residing in big cities or small towns (P=.02) and individuals that were familiar with the use of health or fitness apps (P=.02) were significantly more open to mobile diagnostic systems. Hierarchical Bayes estimation of the preferences of participants with a positive attitude (n=484) revealed that the use of mobile apps as an assistance system was preferred. Participants ruled out app versions with an accuracy of ≤65%, apps using data storage without encryption, and systems that did not provide background information about the decision-making process. However, participants did not mind their data being used anonymously for research purposes, nor did they object to the inclusion of clinical patient information in the decision-making process. Maximum difference scaling analysis for the negative-minded participant group (n=244) showed that data security, insufficient trust in the app, and lack of personal interaction represented the dominant concerns with respect to app use. Conclusions: The majority of potential future users below 35 years of age were ready to accept AI-based diagnostic solutions for early detection of skin cancer. However, for translation into clinical practice, the participants’ demands for increased transparency and explainability of AI-based tools seem to be critical. Altogether, digital natives between 18 and 24 years and between 25 and 34 years of age expressed similar preferences and concerns when compared both to each other and to results obtained by previous studies that included other age groups. %M 34448722 %R 10.2196/22909 %U https://mhealth.jmir.org/2021/8/e22909 %U https://doi.org/10.2196/22909 %U http://www.ncbi.nlm.nih.gov/pubmed/34448722 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e28918 %T Automated Screening for Social Anxiety, Generalized Anxiety, and Depression From Objective Smartphone-Collected Data: Cross-sectional Study %A Di Matteo,Daniel %A Fotinos,Kathryn %A Lokuge,Sachinthya %A Mason,Geneva %A Sternat,Tia %A Katzman,Martin A %A Rose,Jonathan %+ The Edward S Rogers Sr Department of Electrical and Computer Engineering, University of Toronto, 10 King's College Road, Toronto, ON, Canada, 1 416 978 6992, daniel.dimatteo@utoronto.ca %K mobile sensing %K passive EMA %K passive sensing %K psychiatric assessment %K mood and anxiety disorders %K mobile apps %K mhealth %K mobile phone %K digital health %K digital phenotyping %D 2021 %7 13.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The lack of access to mental health care could be addressed, in part, through the development of automated screening technologies for detecting the most common mental health disorders without the direct involvement of clinicians. Objective smartphone-collected data may contain sufficient information about individuals’ behaviors to infer their mental states and therefore screen for anxiety disorders and depression. Objective: The objective of this study is to compare how a single set of recognized and novel features, extracted from smartphone-collected data, can be used for predicting generalized anxiety disorder (GAD), social anxiety disorder (SAD), and depression. Methods: An Android app was designed, together with a centralized server system, to collect periodic measurements of objective smartphone data. The types of data included samples of ambient audio, GPS location, screen state, and light sensor data. Subjects were recruited into a 2-week observational study in which the app was run on their personal smartphones. The subjects also completed self-report severity measures of SAD, GAD, and depression. The participants were 112 Canadian adults from a nonclinical population. High-level features were extracted from the data of 84 participants, and predictive models of SAD, GAD, and depression were built and evaluated. Results: Models of SAD and depression achieved a significantly greater screening accuracy than uninformative models (area under the receiver operating characteristic means of 0.64, SD 0.13 and 0.72, SD 0.12, respectively), whereas models of GAD failed to be predictive. Investigation of the model coefficients revealed key features that were predictive of SAD and depression. Conclusions: We demonstrate the ability of a common set of features to act as predictors in the models of both SAD and depression. This suggests that the types of behaviors that can be inferred from smartphone-collected data are broad indicators of mental health, which can be used to study, assess, and track psychopathology simultaneously across multiple disorders and diagnostic boundaries. %M 34397386 %R 10.2196/28918 %U https://www.jmir.org/2021/8/e28918 %U https://doi.org/10.2196/28918 %U http://www.ncbi.nlm.nih.gov/pubmed/34397386 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e26759 %T Social Media and mHealth Technology for Cancer Screening: Systematic Review and Meta-analysis %A Ruco,Arlinda %A Dossa,Fahima %A Tinmouth,Jill %A Llovet,Diego %A Jacobson,Jenna %A Kishibe,Teruko %A Baxter,Nancy %+ Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, 3053, Australia, 61 39035551, Nancy.baxter@unimelb.edu.au %K social media %K mHealth %K cancer screening %K digital health %K mass screening %K mobile phone %D 2021 %7 30.7.2021 %9 Review %J J Med Internet Res %G English %X Background: Cancer is a leading cause of death, and although screening can reduce cancer morbidity and mortality, participation in screening remains suboptimal. Objective: This systematic review and meta-analysis aims to evaluate the effectiveness of social media and mobile health (mHealth) interventions for cancer screening. Methods: We searched for randomized controlled trials and quasi-experimental studies of social media and mHealth interventions promoting cancer screening (breast, cervical, colorectal, lung, and prostate cancers) in adults in MEDLINE, Embase, PsycINFO, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, and Communication & Mass Media Complete from January 1, 2000, to July 17, 2020. Two independent reviewers screened the titles, abstracts, and full-text articles and completed the risk of bias assessments. We pooled odds ratios for screening participation using the Mantel-Haenszel method in a random-effects model. Results: We screened 18,008 records identifying 39 studies (35 mHealth and 4 social media). The types of interventions included peer support (n=1), education or awareness (n=6), reminders (n=13), or mixed (n=19). The overall pooled odds ratio was 1.49 (95% CI 1.31-1.70), with similar effect sizes across cancer types. Conclusions: Screening programs should consider mHealth interventions because of their promising role in promoting cancer screening participation. Given the limited number of studies identified, further research is needed for social media interventions. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019139615; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=139615 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-035411 %M 34328423 %R 10.2196/26759 %U https://www.jmir.org/2021/7/e26759 %U https://doi.org/10.2196/26759 %U http://www.ncbi.nlm.nih.gov/pubmed/34328423 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 3 %P e23790 %T Email Patient-Provider Communication and Cancer Screenings Among US Adults: Cross-sectional Study %A Kindratt,Tiffany B %A Allicock,Marlyn %A Atem,Folefac %A Dallo,Florence J %A Balasubramanian,Bijal A %+ Public Health Program, Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, 500 W. Nedderman Drive, Arlington, TX, 75919, United States, 1 1 817 938 9223, tiffany.kindratt@uta.edu %K email %K patient-provider communication %K online, patient portals %K mammogram %K Pap test %K colon cancer screening %K cancer screenings %K National Health Interview Survey %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: The growth of electronic medical records and use of patient portals have allowed for patients and health care providers to communicate via email and direct messaging between health care visits. Email patient-provider communication (PPC) may enhance traditional face-to-face PPC by allowing patients to ask questions, receive clear explanations, engage in shared decision-making, and confirm their understanding between in-person visits. Despite increasing trends in the use of email PPC since the early 2000s, few studies have evaluated associations between email PPC and the uptake of preventive services. Objective: The objective of this study was to determine associations between the use of email PPC and the likelihood of undergoing breast, cervical, and colon cancer screenings among adults who have received health care in the past 12 months. Methods: Secondary, cross-sectional data from the 2011-2015 National Health Interview Survey were combined and analyzed. For each cancer screening, inclusion criteria were based on the age of screening recommendations and prior history of cancer diagnosis (n=35,912 for breast, n=48,512 for cervical, and n=45,884 for colon). The independent variable was whether adults used email PPC in the past 12 months (yes or no). The dependent variables were whether (1) women (aged ≥40 years) received a mammogram in the past 12 months; (2) women (aged 21-65 years) received a Pap test in the past 12 months; and (3) individuals (aged ≥50 years) received a colon cancer screening in the past 12 months. Bivariate and multivariable logistic regression analyses were conducted. Results: Adults who reported receiving all three cancer screenings in the past 12 months were more likely to be non-Hispanic White; be married or living with a partner; have a bachelor’s degree or higher education level; have health insurance coverage; and perceive their health as excellent, very good, or good (all P<.001). Men were more likely to receive colon cancer screenings than women (P<.001). Multivariable logistic regression models showed women who used email to communicate with their health care providers had greater odds of receiving breast (odds ratio [OR] 1.32, 95% CI 1.20-1.44) and cervical (OR 1.11, 95% CI 1.02-1.20) cancer screenings than women who did not use email PPC. Adults who used email to communicate with their health care providers had 1.55 times greater odds (95% CI 1.42-1.69) of receiving a colon cancer screening than those who did not use email PPC. Conclusions: Our results demonstrate that email PPC is a marker of increased likelihood of adults completing age-appropriate cancer screenings, particularly breast, cervical, and colon cancer screenings. More research is needed to examine other factors related to the reasons for and quality of email PPC between patients and health care providers and determine avenues for health education and intervention to further explore this association. %M 34328421 %R 10.2196/23790 %U https://cancer.jmir.org/2021/3/e23790 %U https://doi.org/10.2196/23790 %U http://www.ncbi.nlm.nih.gov/pubmed/34328421 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e27168 %T Web-Based Multifaceted Approach for Community-Based HIV Self-Testing Among Female Sex Workers in Indonesia: Protocol for a Randomized Community Trial %A Yunus,Jessie Olivia %A Sawitri,Anak Agung Sagung %A Wirawan,Dewa Nyoman %A Mahendra,I Gusti Agung Agus %A Susanti,Dewi %A Utami Ds,Ni Kadek Ayu Dwi %A Asanab,Dedison %A Narayani,Ida Ayu %A Mukuan,Oldri Sherli %A Widihastuti,Asti %A Magnani,Robert %A Januraga,Pande Putu %+ Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Jalan PB Sudirman, Denpasar Bali, 80232, Indonesia, 62 361222510, sagung_sawitri@unud.ac.id %K HIV %K self-testing %K oral fluid test %K community-based screening %K female sex worker %K Indonesia %D 2021 %7 21.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: New HIV infections in Indonesia continue to be concentrated among key populations, including female sex workers (FSWs). However, increasing HIV testing among this subpopulation remains a challenge, necessitating exploration into alternative testing modalities. Objective: This study aims to assess whether the addition of an oral fluid testing option in community settings would increase the rate of HIV case identification among FSWs. Because the study was implemented early in the outbreak of COVID-19 in Indonesia, a secondary objective is to assess approaches and tools for implementing both community outreach and community HIV screening for FSWs during pandemic conditions. Methods: We undertook a community-based randomized trial in 23 national priority districts in which community outreach services were being provided. Community-based screening using an oral fluid-based rapid test was added to the community outreach standard of care in intervention districts with clients having the option of performing the test themselves or being assisted by outreach workers. A web-based system was created to screen for eligibility and collect participant data and test results, facilitating the process for both unassisted and assisted participants. Participants with reactive screening results were encouraged to undergo HIV testing at a health facility to confirm their diagnosis and initiate antiretroviral treatment as needed. Multiple means of recruitment were deployed including through outreach workers and social media campaigns. Results: Of the 1907 FSWs who registered, met the eligibility criteria, and gave consent to participate, 1545 undertook community oral fluid test (OFT) screening. Most (1516/1545, 98.1%) opted for assisted screening. Recruitment via social media fell far short of expectations as many who registered independently for the OFT because of the social media campaign did not identify as FSWs. They were eventually not eligible to participate, but their interest points to the possibility of implementing HIV self-testing in the general population. The successful recruitment through outreach workers, facilitated by social media, indicates that their roles remain crucial in accessing FSW networks and improving HIV testing uptake. Conclusions: The addition of HIV self-testing to the standard of care supported by a web-based data collection system was able to increase HIV case identification among FSWs in intervention districts. The high satisfaction of OFT users and the interest of the general population toward this alternative testing modality are promising for scaling up community HIV screening nationally. Trial Registration: ClinicalTrials.gov NCT04578145; https://clinicaltrials.gov/ct2/show/NCT04578145 International Registered Report Identifier (IRRID): RR1-10.2196/27168 %M 34287217 %R 10.2196/27168 %U https://www.researchprotocols.org/2021/7/e27168 %U https://doi.org/10.2196/27168 %U http://www.ncbi.nlm.nih.gov/pubmed/34287217 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e25310 %T Development of an Android-Based Self-Report Assessment for Elderly Driving Risk (SAFE-DR) App: Mixed Methods Study %A Hwang,Ho Sung %A Choi,Seong-Youl %+ Department of Occupational Therapy, Gwangju Women’s University, 201, Yeodae-gil, Gwangsan-gu, Gwangju, , Republic of Korea, 82 10 3209 ext 9146, ckshrj6@hanmail.net %K Android driving app %K driving safety %K reliability %K self-assessment %K validity %K mHealth %K driving %D 2021 %7 17.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Self-report assessments for elderly drivers are used in various countries for accessible, widespread self-monitoring of driving ability in the elderly population. Likewise, in South Korea, a paper-based Self-Report Assessment for Elderly Driving Risk (SAFE-DR) has been developed. Here, we implemented the SAFE-DR through an Android app, which provides the advantages of accessibility, convenience, and provision of diverse information, and verified its reliability and validity. Objective: This study tested the validity and reliability of a mobile app-based version of a self-report assessment for elderly persons contextualized to the South Korean culture and compared it with a paper-based test. Methods: In this mixed methods study, we recruited and interviewed 567 elderly drivers (aged 65 years and older) between August 2018 and May 2019. For participants who provided consent, the app-based test was repeated after 2 weeks and an additional paper-based test (Driver 65 Plus test) was administered. Using the collected data, we analyzed the reliability and validity of the app-based SAFE-DR. The internal consistency of provisional items in each subdomain of the SAFE-DR and the test-retest stability were analyzed to examine reliability. Exploratory factor analysis was performed to examine the validity of the subdomain configuration. To verify the appropriateness of using an app-based test for older drivers possibly unfamiliar with mobile technology, the correlation between the results of the SAFE-DR app and the paper-based offline test was also analyzed. Results: In the reliability analysis, Cronbach α for all items was 0.975 and the correlation of each item with the overall score ranged from r=0.520 to r=0.823; 4 items with low correlations were removed from each of the subdomains. In the retest after 2 weeks, the mean correlation coefficient across all items was r=0.951, showing very high reliability. Exploratory factor analysis on 40 of the 44 items established 5 subdomains: on-road (8 items), coping (16 items), cognitive functions (5 items), general conditions (8 items), and medical health (3 items). A very strong negative correlation of –0.864 was observed between the total score for the app-based SAFE-DR and the paper-based Driver 65 Plus with decorrelation scales. The app-based test was found to be reliable. Conclusions: In this study, we developed an app-based self-report assessment tool for elderly drivers and tested its reliability and validity. This app can help elderly individuals easily assess their own driving skills. Therefore, this assessment can be used to educate drivers and for preventive screening for elderly drivers who want to renew their driver’s licenses in South Korea. In addition, the app can contribute to safe driving among elderly drivers. %M 33934068 %R 10.2196/25310 %U https://mhealth.jmir.org/2021/6/e25310 %U https://doi.org/10.2196/25310 %U http://www.ncbi.nlm.nih.gov/pubmed/33934068 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e25021 %T Digital Solutions to Alleviate the Burden on Health Systems During a Public Health Care Crisis: COVID-19 as an Opportunity %A Willems,Sofie H %A Rao,Jyotsna %A Bhambere,Sailee %A Patel,Dipu %A Biggins,Yvonne %A Guite,Jessica W %+ Center for Advancement in Managing Pain, School of Nursing, The University of Connecticut, 231 Glenbrook Road, Storrs, CT, 06269-4026, United States, 1 215 964 5582, jessica.guite@uconn.com %K coronavirus %K digital health %K multiplatform %K chat %K symptom tracking %K well-being %K COVID-19 %K online platform %K symptom %K monitoring %K follow-up %D 2021 %7 11.6.2021 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X The COVID-19 pandemic has generated unprecedented and sustained health management challenges worldwide. Health care systems continue to struggle to support the needs of the majority of infected individuals that are either asymptomatic or have mild symptoms. In addition, long-term effects in the form of long-lasting COVID-19 symptoms or widespread mental health issues aggravated by the pandemic pose a burden on health care systems worldwide. This viewpoint article considers aspects of digital health care solutions and how they can play an ongoing role in safely addressing gaps in the health care support available from initially and repeatedly overwhelmed providers and systems. Digital solutions can be readily designed to address this need and can be flexible enough to adapt to the evolving management requirements of various stakeholders to reduce COVID-19 infection rates, acute hospitalizations, and mortality. Multiplatform solutions provide a hybrid model of care, which can include mobile and online platforms accompanied by direct clinician input and feedback. Desirable components to be included are discussed, including symptom tracking, patient education, well-being support, and bidirectional communication between patients and clinicians. Customizable and scalable digital health platforms not only can be readily adapted to further meet the needs of employers and public health stakeholders during the ongoing pandemic, but also hold relevance for flexibly meeting broader care management needs into the future. %M 34033575 %R 10.2196/25021 %U https://mhealth.jmir.org/2021/6/e25021 %U https://doi.org/10.2196/25021 %U http://www.ncbi.nlm.nih.gov/pubmed/34033575 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e24666 %T Contactless Sleep Monitoring for Early Detection of Health Deteriorations in Community-Dwelling Older Adults: Exploratory Study %A Schütz,Narayan %A Saner,Hugo %A Botros,Angela %A Pais,Bruno %A Santschi,Valérie %A Buluschek,Philipp %A Gatica-Perez,Daniel %A Urwyler,Prabitha %A Müri,René M %A Nef,Tobias %+ Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, Bern, Switzerland, 41 31 632 75 79, tobias.nef@artorg.unibe.ch %K sleep restlessness %K telemonitoring %K digital biomarkers %K contactless sensing %K pervasive computing %K home-monitoring %K older adults %K toss and turns %K sleep monitoring %K body movements in bed %D 2021 %7 11.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Population aging is posing multiple social and economic challenges to society. One such challenge is the social and economic burden related to increased health care expenditure caused by early institutionalizations. The use of modern pervasive computing technology makes it possible to continuously monitor the health status of community-dwelling older adults at home. Early detection of health issues through these technologies may allow for reduced treatment costs and initiation of targeted preventive measures leading to better health outcomes. Sleep is a key factor when it comes to overall health and many health issues manifest themselves with associated sleep deteriorations. Sleep quality and sleep disorders such as sleep apnea syndrome have been extensively studied using various wearable devices at home or in the setting of sleep laboratories. However, little research has been conducted evaluating the potential of contactless and continuous sleep monitoring in detecting early signs of health problems in community-dwelling older adults. Objective: In this work we aim to evaluate which contactlessly measurable sleep parameter is best suited to monitor perceived and actual health status changes in older adults. Methods: We analyzed real-world longitudinal (up to 1 year) data from 37 community-dwelling older adults including more than 6000 nights of measured sleep. Sleep parameters were recorded by a pressure sensor placed beneath the mattress, and corresponding health status information was acquired through weekly questionnaires and reports by health care personnel. A total of 20 sleep parameters were analyzed, including common sleep metrics such as sleep efficiency, sleep onset delay, and sleep stages but also vital signs in the form of heart and breathing rate as well as movements in bed. Association with self-reported health, evaluated by EuroQol visual analog scale (EQ-VAS) ratings, were quantitatively evaluated using individual linear mixed-effects models. Translation to objective, real-world health incidents was investigated through manual retrospective case-by-case analysis. Results: Using EQ-VAS rating based self-reported perceived health, we identified body movements in bed—measured by the number toss-and-turn events—as the most predictive sleep parameter (t score=–0.435, P value [adj]=<.001). Case-by-case analysis further substantiated this finding, showing that increases in number of body movements could often be explained by reported health incidents. Real world incidents included heart failure, hypertension, abdominal tumor, seasonal flu, gastrointestinal problems, and urinary tract infection. Conclusions: Our results suggest that nightly body movements in bed could potentially be a highly relevant as well as easy to interpret and derive digital biomarker to monitor a wide range of health deteriorations in older adults. As such, it could help in detecting health deteriorations early on and provide timelier, more personalized, and precise treatment options. %M 34114966 %R 10.2196/24666 %U https://mhealth.jmir.org/2021/6/e24666 %U https://doi.org/10.2196/24666 %U http://www.ncbi.nlm.nih.gov/pubmed/34114966 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e24766 %T Remote Rating of Atopic Dermatitis Severity Using Photo-Based Assessments: Proof-of-Concept and Reliability Evaluation %A Ali,Zarqa %A Joergensen,Kristina Melbardis %A Andersen,Anders Daniel %A Chiriac,Andrei %A Bjerre-Christensen,Theis %A Manole,Ionela %A Dutei,Ana-Maria %A Deaconescu,Irina %A Suru,Alina %A Serban,Adina %A Isberg,Ari Pall %A Dahiya,Priyanka %A Thomsen,Simon Francis %A Zibert,John Robert %+ Department of Dermato-Venereology and Wound Healing Centre, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen, 2400, Denmark, 45 60122596, zarqa_ali@hotmail.com %K atopic dermatitis %K eczema %K remote assessment %K photo %K photographs %K EASI %K SCORAD %K severity %K assessment %K agreement %D 2021 %7 25.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital imaging of dermatological patients is a novel approach to remote assessment and has recently become more relevant since telehealth and remote decentralized clinical trials are gaining ground. Objective: We aimed to investigate whether photographs taken by a smartphone are of adequate quality to allow severity assessments to be made and to explore the usefulness of an established atopic dermatitis severity assessment instrument on photograph evaluation. Methods: During scheduled visits in a previously published study, the investigating doctor evaluated the severity of atopic dermatitis using the Scoring AD (SCORAD) index and took photographs of the most representative lesions (target lesions) with both a smartphone and a digital single-lens reflex camera (DSLR). The photographs were then assessed by 5 dermatologists using the intensity items of the SCORAD (iSCORAD), which consists of erythema, oedema/papulation, excoriations, lichenification, oozing/crusts, and dryness (scale 0-3, maximum score 18). The mean iSCORAD of the photographs was calculated and compared with in-person assessments using Pearson correlation and Bland-Altman plots. Intraclass correlation coefficients were used for interrater reliability. Results: A total of 942 photographs from 95 patients were assessed. The iSCORAD based on smartphone photographs correlated strongly with the evaluations performed in person (iSCORAD: r=0.78, P<.001; objective SCORAD: r=0.81, P<.001; and total SCORAD: r=0.78, P<.001). For iSCORAD specifically, a Bland-Altman plot showed a difference in mean score of 1.31 for in-person and remote iSCORAD. In addition, the interrater agreement between the 5 rating dermatologists was 0.93 (95% CI 0.911-0.939). A total of 170 lesions were photographed, and the difference in mean scores was 1.32, 1.13, and 1.43 between in-person and remote evaluations based on photographs taken by a DSLR camera, a smartphone without flash, and a smartphone with flash, respectively. Conclusions: In terms of quality, remote atopic dermatitis severity assessments based on photographs are comparable to in-person assessments, and smartphone photos can be used to assess atopic dermatitis severity to a similar degree as photographs from a DSLR camera. Further, the variation in how the dermatologists in this study rated the iSCORAD based on the photographs was very low. %M 34032580 %R 10.2196/24766 %U https://formative.jmir.org/2021/5/e24766 %U https://doi.org/10.2196/24766 %U http://www.ncbi.nlm.nih.gov/pubmed/34032580 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e25520 %T Psychometric Evaluation and Workflow Integration Study of a Tablet-Based Tool to Detect Mild Cognitive Impairment in Older Adults: Protocol for a Mixed Methods Study %A McMurray,Josephine %A Levy,AnneMarie %A Holyoke,Paul %+ Wilfrid Laurier University, 73 George Street, Brantford, ON, N3T3Y3, Canada, 1 5192427477, jmcmurray@wlu.ca %K cognitive dysfunction %K dementia %K neuropsychological tests %K evaluation study %K technology %K aged %K primary health care %D 2021 %7 21.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: With the rapid aging of the global population, experts anticipate a surge in the prevalence of mild cognitive impairment (MCI) and dementia worldwide. It is argued that developing more sensitive, easy to administer, and valid MCI screening tools for use in primary care settings may initiate timely clinical and personal care planning and treatment, enabling early access to programs and services. Including functional competence measures in screening tests makes them more ecologically valid and may help to identify cognitive deficits at an earlier stage. Objective: We aim to conduct a preliminary evaluative study comparing the sensitivity, specificity, and reliability of the BrainFx Screen (referred to as SCREEN hereafter), a novel digital tool designed to assess functional competence and detect early signs of cognitive impairment, with the Quick Mild Cognitive Impairment, a validated and highly sensitive tool that detects MCI in the older adult population. We will also investigate the perceived usefulness and integration of the SCREEN into primary care practice to identify demonstrable impacts on clinical workflow and health care providers’ (HCP) perceptions of its success as a screening tool. Patients’ perceptions of completing the SCREEN and its impact on their quality of life will also be explored. Methods: This study has a concurrent, mixed methods, prospective, and quasi-experimental design. Participants will be recruited from 5 primary care family health teams (FHTs; defined by multidisciplinary practice and capitated funding) across southwestern Ontario, Canada. Participants will include HCPs, patients, care partners, and FHT administrative executives. Patients 55 years and older with no history of diagnoses for MCI, dementia, or Alzheimer disease rostered in one of the FHTs participating in the study will be eligible to participate. Their care partners will help triangulate the qualitative data collected from patients. Participating FHTs will identify an occupational therapist from their site to participate in the study; this HCP will both administer the research protocol and participate in semistructured in-depth interviews and questionnaires. Principal component analysis will be conducted on the SCREEN data to understand the test components better. Tests comparing sensitivity, specificity, and test-retest reliability will assess the validity of SCREEN as a screening tool for MCI. Results: This paper describes the study protocol and its activities to date. Data collection was halted early because of COVID-19 restrictions on research activity, and data analysis is currently in progress. Conclusions: At the end of the project, we anticipate having an initial comparative evaluation of the SCREEN as a tool for early detection of MCI in primary care older adult patient populations. Resource constraints on this research study limit our ability to conduct a randomized controlled trial; however, the results will assist developers of the SCREEN in determining whether rigorous controlled testing is warranted. International Registered Report Identifier (IRRID): DERR1-10.2196/25520 %M 34018966 %R 10.2196/25520 %U https://www.researchprotocols.org/2021/5/e25520 %U https://doi.org/10.2196/25520 %U http://www.ncbi.nlm.nih.gov/pubmed/34018966 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e24470 %T Performance of a Mobile Single-Lead Electrocardiogram Technology for Atrial Fibrillation Screening in a Semirural African Population: Insights From “The Heart of Ethiopia: Focus on Atrial Fibrillation” (TEFF-AF) Study %A Pitman,Bradley M %A Chew,Sok-Hui %A Wong,Christopher X %A Jaghoori,Amenah %A Iwai,Shinsuke %A Thomas,Gijo %A Chew,Andrew %A Sanders,Prashanthan %A Lau,Dennis H %+ Centre for Heart Rhythm Disorders, The University of Adelaide, 1 Port Rd, Adelaide, 5000, Australia, 61 8313 9000, dennis.h.lau@adelaide.edu.au %K atrial fibrillation %K screening %K sub-Saharan Africa %K single-lead ECG %D 2021 %7 19.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Atrial fibrillation (AF) screening using mobile single-lead electrocardiogram (ECG) devices has demonstrated variable sensitivity and specificity. However, limited data exists on the use of such devices in low-resource countries. Objective: The goal of the research was to evaluate the utility of the KardiaMobile device’s (AliveCor Inc) automated algorithm for AF screening in a semirural Ethiopian population. Methods: Analysis was performed on 30-second single-lead ECG tracings obtained using the KardiaMobile device from 1500 TEFF-AF (The Heart of Ethiopia: Focus on Atrial Fibrillation) study participants. We evaluated the performance of the KardiaMobile automated algorithm against cardiologists’ interpretations of 30-second single-lead ECG for AF screening. Results: A total of 1709 single-lead ECG tracings (including repeat tracing on 209 occasions) were analyzed from 1500 Ethiopians (63.53% [953/1500] male, mean age 35 [SD 13] years) who presented for AF screening. Initial successful rhythm decision (normal or possible AF) with one single-lead ECG tracing was lower with the KardiaMobile automated algorithm versus manual verification by cardiologists (1176/1500, 78.40%, vs 1455/1500, 97.00%; P<.001). Repeat single-lead ECG tracings in 209 individuals improved overall rhythm decision, but the KardiaMobile automated algorithm remained inferior (1301/1500, 86.73%, vs 1479/1500, 98.60%; P<.001). The key reasons underlying unsuccessful KardiaMobile automated rhythm determination include poor quality/noisy tracings (214/408, 52.45%), frequent ectopy (22/408, 5.39%), and tachycardia (>100 bpm; 167/408, 40.93%). The sensitivity and specificity of rhythm decision using KardiaMobile automated algorithm were 80.27% (1168/1455) and 82.22% (37/45), respectively. Conclusions: The performance of the KardiaMobile automated algorithm was suboptimal when used for AF screening. However, the KardiaMobile single-lead ECG device remains an excellent AF screening tool with appropriate clinician input and repeat tracing. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001107112; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378057&isReview=true %M 34009129 %R 10.2196/24470 %U https://mhealth.jmir.org/2021/5/e24470 %U https://doi.org/10.2196/24470 %U http://www.ncbi.nlm.nih.gov/pubmed/34009129 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e26289 %T Postmarketing Safety Monitoring After Influenza Vaccination Using a Mobile Health App: Prospective Longitudinal Feasibility Study %A Nguyen,Minh Tam H %A Krause,Gérard %A Keller-Stanislawski,Brigitte %A Glöckner,Stephan %A Mentzer,Dirk %A Ott,Jördis J %+ PhD Programme Epidemiology, Hannover Biomedical Research School, Hannover Medical School, Hannover, Germany, 49 531 6181 3115, joerdis.ott@helmholtz-hzi.de %K mHealth %K mobile health %K digital health %K adverse event %K adverse event following immunization %K active reporting %K pharmacovigilance %K therapeutic use %K adverse effect %D 2021 %7 7.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: For the safety monitoring of vaccinations postlicensure, reports of adverse events after immunization (AEFIs) are crucial. New technologies such as digital mobile apps can be used as an active approach to capture these events. We therefore conducted a feasibility study among recipients of the influenza vaccination using an app for assessment of the reporting of AEFIs. Objective: The goal of the research was to determine factors influencing adherence to and correct use of a newly developed app for individuals to report AEFI for 3 months using regular reminder functions, to identify determinants of AEFI occurrence and define reported AEFI types. Methods: We developed the app (SafeVac) and offered it to recipients of the influenza vaccination in 3 occupational settings in fall 2018. In this prospective longitudinal feasibility study, data on AEFIs were generated through SafeVac for 3 months. Using logistic and Cox regression, we assessed associations between app adherence, correct app entry, AEFIs, and sociodemographic parameters. Results: Of the individuals who logged into SafeVac, 61.4% (207/337) used the app throughout a 3-month period. App use adherence was negatively associated with female sex (odds ratio [OR] 0.47; CI 0.25-0.91) and correct app entry was negatively associated with older age (OR 0.96; CI 0.93-0.99) and lower education (OR 0.31; CI 0.13-0.76). AEFI occurrence was associated with female sex (hazard ratio 1.41; CI 1.01-1.96) and negatively with older age (hazard ratio 0.98; CI 0.97-0.99). The most common AEFIs reported were injection site pain (106/337), pain in extremity (103/337), and fatigue/asthenia (73/337). Conclusions: Digital AEFI reporting was feasible with SafeVac and generated plausible results for this observation period and setting. Studies directly comparing SafeVac with conventional passive reporting schemes could determine whether such digital approaches improve completeness, timeliness, and sensitivity of vaccine vigilance. Further studies should evaluate if these results are transferable to other vaccinations and populations and if introduction of such a tool has an influence on vaccination readiness and therefore vaccine safety. %M 33960950 %R 10.2196/26289 %U https://mhealth.jmir.org/2021/5/e26289 %U https://doi.org/10.2196/26289 %U http://www.ncbi.nlm.nih.gov/pubmed/33960950 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e22239 %T Promoting HIV, Hepatitis B Virus, and Hepatitis C Virus Screening Among Migrants With a Language Barrier: Protocol for the Development and Evaluation of an Electronic App (Apidé) %A Thonon,Frédérique %A Fahmi,Saleh %A Rousset-Torrente,Olivia %A Bessonneau,Pascal %A Griffith,James W %A Brown,Carter %A Chassany,Olivier %A Duracinsky,Martin %+ Patient-Reported Outcomes Unit (PROQOL), UMR 1123, Université de Paris, INSERM, F-75004, Hôpital Hôtel Dieu, 1 place du Parvis Notre Dame, Paris, 75004, France, 33 140275543, frederique.thonon@gmail.com %K HIV %K hepatitis B %K hepatitis C %K migrants %K screening %K language barrier %K eHealth %D 2021 %7 5.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Late diagnoses of HIV, hepatitis B, and hepatitis C are important public health problems that affect the population at large and migrants in particular. Missed opportunities of HIV and hepatitis screening are numerous, with language differences being a significant barrier to testing. Several studies have shown that migrants who do not speak the language of the health provider are less likely to get tested, due to health providers’ reluctance to offer a test and to migrants’ reluctance to accept testing. Objective: The aim of our study is to develop a multilingual electronic tool (app) that assists health providers in offering and explaining HIV and hepatitis screenings to migrants with a language barrier and to evaluate its acceptability and impact in terms of public health. Methods: The study will go through 3 stages: (1) concept development, (2) app development, and (3) app evaluation. A qualitative study has been undertaken to explore language barriers during health care encounters and their effect on communication, specifically when a screening test is offered. In parallel, a systematic review of the literature was conducted to have a comprehensive overlook of electronic tools designed to help health care providers communicate with migrants with a language barrier. To generate a list of items to be translated for inclusion in the app, we will conduct a focus group and Delphi survey. The development of the app will include translation and voice recording of items. The electronic development will also include 3 steps of user testing. The acceptability of the app will be evaluated using the System Usability Scale. Evaluation of the app’s efficacy will consist of a stepped wedge randomized controlled trial. The study will be carried out in 16 centers that treat migrants and offer them screening tests for infectious diseases. The primary outcome is the percentage of screening tests realized. The secondary outcomes are the rate of screening proposal by health professionals, acceptance rate by migrants, number of positive cases using this app, and frequency of use of the app. Results: The app evaluation study received a 3-year grant from the Agence Nationale de la Recherche contre le SIDA et les hépatites virales (ANRS) and from the Office Français de l’Immigration et Intégration (OFII). At the time of publication of this protocol, the initial qualitative study and systematic literature review were completed. Conclusions: This study will develop an app that assists health providers in offering and explaining HIV and hepatitis screenings to migrants with a language barrier and measure its acceptability and effectiveness in terms of public health. When completed, this app could be distributed to numerous professionals carrying out screening with migrant populations in various health care settings. International Registered Report Identifier (IRRID): PRR1-10.2196/22239 %M 33949963 %R 10.2196/22239 %U https://www.researchprotocols.org/2021/5/e22239 %U https://doi.org/10.2196/22239 %U http://www.ncbi.nlm.nih.gov/pubmed/33949963 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e23718 %T Leprosy Screening Based on Artificial Intelligence: Development of a Cross-Platform App %A De Souza,Márcio Luís Moreira %A Lopes,Gabriel Ayres %A Branco,Alexandre Castelo %A Fairley,Jessica K %A Fraga,Lucia Alves De Oliveira %+ Multicentre Biochemistry and Molecular Biology Program, Federal University of Juiz de Fora, R São Paulo 745 Centro, Governador Valadares-MG, Brazil, 55 33 33011000, artigoacm@gmail.com %K leprosy %K artificial intelligence %K random forest %K Python %K R %K apps %K mHealth %K shinyApp %D 2021 %7 7.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: According to the World Health Organization, achieving targets for control of leprosy by 2030 will require disease elimination and interruption of transmission at the national or regional level. India and Brazil have reported the highest leprosy burden in the last few decades, revealing the need for strategies and tools to help health professionals correctly manage and control the disease. Objective: The main objective of this study was to develop a cross-platform app for leprosy screening based on artificial intelligence (AI) with the goal of increasing accessibility of an accurate method of classifying leprosy treatment for health professionals, especially for communities further away from major diagnostic centers. Toward this end, we analyzed the quality of leprosy data in Brazil on the National Notifiable Diseases Information System (SINAN). Methods: Leprosy data were extracted from the SINAN database, carefully cleaned, and used to build AI decision models based on the random forest algorithm to predict operational classification in paucibacillary or multibacillary leprosy. We used Python programming language to extract and clean the data, and R programming language to train and test the AI model via cross-validation. To allow broad access, we deployed the final random forest classification model in a web app via shinyApp using data available from the Brazilian Institute of Geography and Statistics and the Department of Informatics of the Unified Health System. Results: We mapped the dispersion of leprosy incidence in Brazil from 2014 to 2018, and found a particularly high number of cases in central Brazil in 2014 that further increased in 2018 in the state of Mato Grosso. For some municipalities, up to 80% of cases showed some data discrepancy. Of a total of 21,047 discrepancies detected, the most common was “operational classification does not match the clinical form.” After data processing, we identified a total of 77,628 cases with missing data. The sensitivity and specificity of the AI model applied for the operational classification of leprosy was 93.97% and 87.09%, respectively. Conclusions: The proposed app was able to recognize patterns in leprosy cases registered in the SINAN database and to classify new patients with paucibacillary or multibacillary leprosy, thereby reducing the probability of incorrect assignment by health centers. The collection and notification of data on leprosy in Brazil seem to lack specific validation to increase the quality of the data for implementations via AI. The AI models implemented in this work had satisfactory accuracy across Brazilian states and could be a complementary diagnosis tool, especially in remote areas with few specialist physicians. %M 33825685 %R 10.2196/23718 %U https://mhealth.jmir.org/2021/4/e23718 %U https://doi.org/10.2196/23718 %U http://www.ncbi.nlm.nih.gov/pubmed/33825685 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25031 %T Mobile HIV Testing Through Social Networking Platforms: Comparative Study %A Chiou,Piao-Yi %A Ko,Nai-Ying %A Chien,Chien-Yu %+ School of Nursing, College of Medicine, National Taiwan University, No 2-1, Xuzhou Road, Zhongzheng District, Taipei City, 100, Taiwan, 886 2 23123456 ext 88427, purechiou2@gmail.com %K HIV testing %K internet-based intervention %K men who have sex with men %K mobile apps %K mobile phone %K risk-taking %K social networking %K voluntary counseling and testing %D 2021 %7 26.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Improving HIV screening in key populations is a crucial strategy to achieve the goal of eliminating AIDS in 2030. Social networking platforms can be used to recruit high risk-taking men who have sex with men (MSM) to promote the delivery of voluntary counseling and testing (VCT) as mobile HIV testing. Therefore, client recruitment and availability of mobile HIV testing through social networking platforms requires further evaluation. Objective: The aim of this study is to compare the effects of targeting high risk-taking MSM and HIV case finding between two mobile HIV testing recruitment approaches: through the traditional website-based approach and through social networking platforms. Methods: A comparative study design and propensity score matching was applied. The traditional VCT model, that is, the control group, recruited MSM through a website, and a trained research assistant visited the walk-in testing station at a gay village on Friday and Saturday nights. The social networking VCT model, the experimental group, recruited MSM from social networking platforms by periodically reloading into and conducting web-based discussions on dating apps and Facebook. The participants then referred to others in their social networks via a popular messenger app in Taiwan. The test was conducted at a designated time and place during weekdays by a trained research assistant. Across both modes of contact, before the mobile HIV testing, participants needed to provide demographic characteristics and respond to a questionnaire about HIV risk-taking behaviors. Results: We recruited 831 MSM over 6 months, with a completion rate of 8.56% (616/7200) in the traditional VCT model and 20.71% (215/1038) in the social networking VCT model. After propensity score matching, there were 215 MSM in each group (mean age 29.97, SD 7.61 years). The social networking model was more likely to reach MSM with HIV risk-taking behaviors, that is, those seeking sexual activity through social media, having multiple sexual partners and unprotected anal intercourse, having experience of recreational drug use, and never having or not regularly having an HIV test, compared with the traditional model. HIV positive rates (incidence rate ratio 3.40, 95% CI 1.089-10.584; P=.03) and clinic referral rates (incidence rate ratio 0.03, 95% CI 0.001-0.585; P=.006) were significantly higher among those in the social networking VCT model than in the traditional VCT model. Conclusions: Through effective recruitment strategies on social networking platforms, the social networking VCT mode can be smoothly promoted, as compared with the traditional VCT model, to target high risk-taking MSM and increase testing outcomes. %M 33769298 %R 10.2196/25031 %U https://www.jmir.org/2021/3/e25031 %U https://doi.org/10.2196/25031 %U http://www.ncbi.nlm.nih.gov/pubmed/33769298 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e24275 %T Understanding On-Campus Interactions With a Semiautomated, Barcode-Based Platform to Augment COVID-19 Contact Tracing: App Development and Usage %A Scherr,Thomas Foster %A Hardcastle,Austin N %A Moore,Carson Paige %A DeSousa,Jenna Maria %A Wright,David Wilson %+ Department of Chemistry, Vanderbilt University, 7330 Stevenson Center, Station B 351822, Nashville, TN, 37235, United States, 1 6153222861, thomas.f.scherr@vanderbilt.edu %K contact tracing %K COVID-19 %K disease surveillance %K digital health %D 2021 %7 26.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic has forced drastic changes to daily life, from the implementation of stay-at-home orders to mandating facial coverings and limiting in-person gatherings. While the relaxation of these control measures has varied geographically, it is widely agreed that contact tracing efforts will play a major role in the successful reopening of businesses and schools. As the volume of positive cases has increased in the United States, it has become clear that there is room for digital health interventions to assist in contact tracing. Objective: The goal of this study was to evaluate the use of a mobile-friendly app designed to supplement manual COVID-19 contact tracing efforts on a university campus. Here, we present the results of a development and validation study centered around the use of the MyCOVIDKey app on the Vanderbilt University campus during the summer of 2020. Methods: We performed a 6-week pilot study in the Stevenson Center Science and Engineering Complex on Vanderbilt University’s campus in Nashville, TN. Graduate students, postdoctoral fellows, faculty, and staff >18 years who worked in Stevenson Center and had access to a mobile phone were eligible to register for a MyCOVIDKey account. All users were encouraged to complete regular self-assessments of COVID-19 risk and to key in to sites by scanning a location-specific barcode. Results: Between June 17, 2020, and July 29, 2020, 45 unique participants created MyCOVIDKey accounts. These users performed 227 self-assessments and 1410 key-ins. Self-assessments were performed by 89% (n=40) of users, 71% (n=32) of users keyed in, and 48 unique locations (of 71 possible locations) were visited. Overall, 89% (202/227) of assessments were determined to be low risk (ie, asymptomatic with no known exposures), and these assessments yielded a CLEAR status. The remaining self-assessments received a status of NOT CLEAR, indicating either risk of exposure or symptoms suggestive of COVID-19 (7.5% [n=17] and 3.5% [n=8] of self-assessments indicated moderate and high risk, respectively). These 25 instances came from 8 unique users, and in 19 of these instances, the at-risk user keyed in to a location on campus. Conclusions: Digital contact tracing tools may be useful in assisting organizations to identify persons at risk of COVID-19 through contact tracing, or in locating places that may need to be cleaned or disinfected after being visited by an index case. Incentives to continue the use of such tools can improve uptake, and their continued usage increases utility to both organizational and public health efforts. Parameters of digital tools, including MyCOVIDKey, should ideally be optimized to supplement existing contact tracing efforts. These tools represent a critical addition to manual contact tracing efforts during reopening and sustained regular activity. %M 33690142 %R 10.2196/24275 %U https://mhealth.jmir.org/2021/3/e24275 %U https://doi.org/10.2196/24275 %U http://www.ncbi.nlm.nih.gov/pubmed/33690142 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25107 %T Development and Evaluation of a Mobile App Designed to Increase HIV Testing and Pre-exposure Prophylaxis Use Among Young Men Who Have Sex With Men in the United States: Open Pilot Trial %A Biello,Katie B %A Hill-Rorie,Jonathan %A Valente,Pablo K %A Futterman,Donna %A Sullivan,Patrick S %A Hightow-Weidman,Lisa %A Muessig,Kathryn %A Dormitzer,Julian %A Mimiaga,Matthew J %A Mayer,Kenneth H %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main Street, 8th Floor, Providence, RI, 02912, United States, 1 (401)8633082, katie_biello@brown.edu %K HIV %K men who have sex with men %K pre-exposure prophylaxis %K pilot study %K mobile apps %K mobile phone %K mHealth %D 2021 %7 24.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: HIV disproportionately affects young men who have sex with men (YMSM) in the United States. Uptake of evidence-based prevention strategies, including routine HIV testing and use of pre-exposure prophylaxis (PrEP), is suboptimal in this population. Novel methods for reaching YMSM are required. Objective: The aim of this study is to describe the development and evaluate the feasibility and acceptability of the MyChoices app, a mobile app designed to increase HIV testing and PrEP use among YMSM in the United States. Methods: Informed by the social cognitive theory, the MyChoices app was developed using an iterative process to increase HIV testing and PrEP uptake among YMSM. In 2017, beta theater testing was conducted in two US cities to garner feedback (n=4 groups; n=28 YMSM). These findings were used to refine MyChoices, which was then tested for initial acceptability and usability in a technical pilot (N=11 YMSM). Baseline and 2-month postbaseline assessments and exit interviews were completed. Transcripts were coded using a deductive approach, and thematic analysis was used to synthesize data; app acceptability and use data were also reported. Results: The MyChoices app includes personalized recommendations for HIV testing frequency and PrEP use; information on types of HIV tests and PrEP; ability to search for nearby HIV testing and PrEP care sites; and ability to order free home HIV and sexually transmitted infection test kits, condoms, and lube. In theater testing, YMSM described that MyChoices appears useful and that they would recommend it to peers. Participants liked the look and feel of the app and believed that the ability to search for and be pinged when near an HIV testing site would be beneficial. Some suggested that portions of the app felt repetitive and preferred using casual language rather than formal or medicalized terms. Following theater testing, the MyChoices app was refined, and participants in the technical pilot used the app, on average, 8 (SD 5.0; range 2-18) times over 2 months, with an average duration of 28 (SD 38.9) minutes per session. At the 2-month follow-up, the mean System Usability Scale (0-100) score was 71 (ie, above average; SD 11.8). Over 80% (9/11) of the participants reported that MyChoices was useful and 91% (10/11) said that they would recommend it to a friend. In exit interviews, there was a high level of acceptability for the content, interface, and features. Conclusions: These data show the initial acceptability and user engagement of the MyChoices app. If future studies demonstrate efficacy in increasing HIV testing and PrEP uptake, the app is scalable to reach YMSM across the United States. Trial Registration: Clinicaltrials.gov NCT03179319; https://clinicaltrials.gov/ct2/show/NCT03179319 International Registered Report Identifier (IRRID): RR2-10.2196/10694 %M 33759792 %R 10.2196/25107 %U https://www.jmir.org/2021/3/e25107 %U https://doi.org/10.2196/25107 %U http://www.ncbi.nlm.nih.gov/pubmed/33759792 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e26320 %T A Screening Method Using Anomaly Detection on a Smartphone for Patients With Carpal Tunnel Syndrome: Diagnostic Case-Control Study %A Koyama,Takafumi %A Sato,Shusuke %A Toriumi,Madoka %A Watanabe,Takuro %A Nimura,Akimoto %A Okawa,Atsushi %A Sugiura,Yuta %A Fujita,Koji %+ Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 1138519, Japan, 81 3 5803 5279, fujiorth@tmd.ac.jp %K carpal tunnel syndrome %K anomaly detection %K machine learning %K smartphone %K screening %K thumb %K diagnostic %K data collection %K app %K algorithm %D 2021 %7 14.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Carpal tunnel syndrome (CTS) is a medical condition caused by compression of the median nerve in the carpal tunnel due to aging or overuse of the hand. The symptoms include numbness of the fingers and atrophy of the thenar muscle. Thenar atrophy recovers slowly postoperatively; therefore, early diagnosis and surgery are important. While physical examinations and nerve conduction studies are used to diagnose CTS, problems with the diagnostic ability and equipment, respectively, exist. Despite research on a CTS-screening app that uses a tablet and machine learning, problems with the usage rate of tablets and data collection for machine learning remain. Objective: To make data collection for machine learning easier and more available, we developed a screening app for CTS using a smartphone and an anomaly detection algorithm, aiming to examine our system as a useful screening tool for CTS. Methods: In total, 36 participants were recruited, comprising 36 hands with CTS and 27 hands without CTS. Participants controlled the character in our app using their thumbs. We recorded the position of the thumbs and time; generated screening models that classified CTS and non-CTS using anomaly detection and an autoencoder; and calculated the sensitivity, specificity, and area under the curve (AUC). Results: Participants with and without CTS were classified with 94% sensitivity, 67% specificity, and an AUC of 0.86. When dividing the data by direction, the model with data in the same direction as the thumb opposition had the highest AUC of 0.99, 92% sensitivity, and 100% specificity. Conclusions: Our app could reveal the difficulty of thumb opposition for patients with CTS and screen for CTS with high sensitivity and specificity. The app is highly accessible because of the use of smartphones and can be easily enhanced by anomaly detection. %M 33714936 %R 10.2196/26320 %U https://mhealth.jmir.org/2021/3/e26320 %U https://doi.org/10.2196/26320 %U http://www.ncbi.nlm.nih.gov/pubmed/33714936 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 6 %N 1 %P e23527 %T Point-of-Care Quantification of Serum Alpha-Fetoprotein for Screening Birth Defects in Resource-Limited Settings: Proof-of-Concept Study %A Srinivasan,Balaji %A Finkelstein,Julia L %A Erickson,David %A Mehta,Saurabh %+ Division of Nutritional Sciences, Cornell University, 314 Savage Hall, Ithaca, NY, 14850, United States, 1 607 255 2640, smehta@cornell.edu %K alpha-fetoprotein %K point-of-care testing %K screening %K neural tube defects %K mobile phone %D 2021 %7 3.3.2021 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Maternal serum alpha-fetoprotein (MSAFP) concentration typically increases during pregnancy and is routinely measured during the second trimester as a part of screening for fetal neural tube defects and Down syndrome. However, most pregnancy screening tests are not available in the settings they are needed the most. A mobile device–enabled technology based on MSAFP for screening birth defects could enable the rapid screening and triage of high-risk pregnancies, especially where maternal serum screening and fetal ultrasound scan facilities are not easily accessible. Shifting the approach from clinic- and laboratory-dependent care to a mobile platform based on our point-of-care approach will enable translation to resource-limited settings and the global health care market. Objective: The objective of this study is to develop and perform proof-of-concept testing of a lateral flow immunoassay on a mobile platform for rapid, point-of-care quantification of serum alpha-fetoprotein (AFP) levels, from a drop of human serum, within a few minutes. Methods: The development of the immunoassay involved the selection of commercially available antibodies and optimization of their concentrations by an iterative method to achieve the required detection limits. We compared the performance of our method with that of commercially obtained human serum samples, with known AFP concentrations quantified by the Abbott ARCHITECT chemiluminescent magnetic microparticle immunoassay (CMIA). Results: We tested commercially obtained serum samples (N=20) with concentrations ranging from 2.2 to 446 ng/mL to compare the results of our point-of-care assay with results from the Abbott ARCHITECT CMIA. A correlation of 0.98 (P<.001) was observed on preliminary testing and comparison with the CMIA. The detection range of our point-of-care assay covers the range of maternal serum AFP levels observed during pregnancy. Conclusions: The preliminary test results from the AFP test on the mobile platform performed in this study represent a proof of concept that will pave the way for our future work focused on developing a mobile device–enabled quad-screen point-of-care testing with the potential to enable the screening of high-risk pregnancies in various settings. The AFP test on the mobile platform can be applied to enable screening for high-risk pregnancies, within a few minutes, at the point of care even in remote areas where maternal serum tests and fetal ultrasound scans are not easily accessible; assessment of whether clinical follow-up and diagnostic testing may be needed after a positive initial screening evaluation; and development of surveillance tools for birth defects. %M 34746648 %R 10.2196/23527 %U https://biomedeng.jmir.org/2021/1/e23527 %U https://doi.org/10.2196/23527 %U http://www.ncbi.nlm.nih.gov/pubmed/34746648 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 1 %P e19859 %T Using Consumer-Grade Physical Activity Trackers to Measure Frailty Transitions in Older Critical Care Survivors: Exploratory Observational Study %A Kim,Ben %A Hunt,Miranda %A Muscedere,John %A Maslove,David M %A Lee,Joon %+ Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada, 1 403 220 2968, joonwu.lee@ucalgary.ca %K frailty %K frail elderly %K wearable electronic devices %K fitness trackers %K activity trackers %K heart rate %K sleep monitoring %K critical care outcomes %D 2021 %7 23.2.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Critical illness has been suggested as a sentinel event for frailty development in at-risk older adults. Frail critical illness survivors are affected by increased adverse health outcomes, but monitoring the recovery after intensive care unit (ICU) discharge is challenging. Clinicians and funders of health care systems envision an increased role of wearable devices in monitoring clinically relevant measures, as sensor technology is advancing rapidly. The use of wearable devices has also generated great interest among older patients, and they are the fastest growing group of consumer-grade wearable device users. Recent research studies indicate that consumer-grade wearable devices offer the possibility of measuring frailty. Objective: This study aims to examine the data collected from wearable devices for the progression of frailty among critical illness survivors. Methods: An observational study was conducted with 12 older survivors of critical illness from Kingston General Hospital in Canada. Frailty was measured using the Clinical Frailty Scale (CFS) at ICU admission, hospital discharge, and 4-week follow-up. A wearable device was worn between hospital discharge and 4-week follow-up. The wearable device collected data on step count, physical activity, sleep, and heart rate (HR). Patient assessments were reviewed, including the severity of illness, cognition level, delirium, activities of daily living, and comorbidity. Results: The CFS scores increased significantly following critical illness compared with the pre-ICU frailty level (P=.02; d=−0.53). Survivors who were frail over the 4-week follow-up period had significantly lower daily step counts than survivors who were not frail (P=.02; d=1.81). There was no difference in sleep and HR measures. Daily step count was strongly correlated with the CFS at 4-week follow-up (r=−0.72; P=.04). The average HR was strongly correlated with the CFS at hospital discharge (r=−0.72; P=.046). The HR SD was strongly correlated (r=0.78; P=.02) with the change in CFS from ICU admission to 4-week follow-up. No association was found between the CFS and sleep measures. The pattern of increasing step count over the 4-week follow-up period was correlated with worsening of frailty (r=.62; P=.03). Conclusions: This study demonstrated an association between frailty and data generated from a consumer-grade wearable device. Daily step count and HR showed a strong association with the frailty progression of the survivors of critical illness over time. Understanding this association could unlock a new avenue for clinicians to monitor and identify a vulnerable subset of the older adult population that might benefit from an early intervention. %M 33620323 %R 10.2196/19859 %U https://aging.jmir.org/2021/1/e19859 %U https://doi.org/10.2196/19859 %U http://www.ncbi.nlm.nih.gov/pubmed/33620323 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e23080 %T Effect of an mHealth Intervention on Hepatitis C Testing Uptake Among People With Opioid Use Disorder: Randomized Controlled Trial %A Hochstatter,Karli R %A Gustafson Sr,David H %A Landucci,Gina %A Pe-Romashko,Klaren %A Cody,Olivia %A Maus,Adam %A Shah,Dhavan V %A Westergaard,Ryan P %+ School of Social Work, Columbia University, 1255 Amsterdam Ave, New York, NY, 10027, United States, 1 9209600002, khochsta@medicine.wisc.edu %K intravenous injections %K mHealth %K hepatitis C virus %K opioid use disorder %K mobile phone %D 2021 %7 22.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The growing epidemic of opioid use disorder (OUD) and associated injection drug use has resulted in a surge of new hepatitis C virus (HCV) infections. Approximately half of the people with HCV infection are unaware of their HCV status. Improving HCV awareness and increasing screening among people with OUD are critical. Addiction-Comprehensive Health Enhancement Support System (A-CHESS) is an evidence-based, smartphone-delivered relapse prevention system that has been implemented among people with OUD who are receiving medications for addiction treatment (MAT) to improve long-term recovery. Objective: We incorporated HCV-related content and functionality into A-CHESS to characterize the HCV care continuum among people in early remission and receiving MAT for OUD and to determine whether incorporating such content and functionality into A-CHESS increases HCV testing. Methods: HCV intervention content, including dissemination of educational information, private messages tailored to individuals’ stage of HCV care, and a public discussion forum, was implemented into the A-CHESS platform. Between April 2016 and April 2020, 416 participants with OUD were enrolled in this study. Participants were randomly assigned to receive MAT alone (control arm) or MAT+A-CHESS (experimental arm). Quarterly telephone interviews were conducted from baseline to month 24 to assess risk behaviors and HCV testing history. Cox proportional hazards regression was used to assess whether participants who used A-CHESS were tested for HCV (either antibody [Ab] or RNA testing) at a higher rate than those in the control arm. To assess the effect of A-CHESS on subsets of participants at the highest risk for HCV, additional analyses were performed to examine the effect of the intervention among participants who injected drugs and shared injection equipment. Results: Overall, 44.2% (184/416) of the study participants were HCV Ab positive, 30.3% (126/416) were HCV Ab negative, and 25.5% (106/416) were considered untested at baseline. At month 24, there was no overall difference in HCV testing uptake between the intervention and control participants. However, among the subset of 109 participants who engaged in injection drug use, there was a slight trend toward increased HCV testing uptake among those who used A-CHESS (89% vs 85%; hazard ratio: 1.34; 95% CI 0.87-2.05; P=.18), and a stronger trend was observed when focusing on the subset of 32 participants who reported sharing injection equipment (87% vs 56%; hazard ratio: 2.92; 95% CI 0.959-8.86; P=.06). Conclusions: Incorporating HCV prevention and care information into A-CHESS may increase the uptake of HCV testing while preventing opioid relapse when implemented among populations who engage in high-risk behaviors such as sharing contaminated injection equipment. However, more studies that are powered to detect differences in HCV testing among high-risk groups are needed. Trial Registration: ClinicalTrials.gov NCT02712034; https://clinicaltrials.gov/ct2/show/NCT02712034 International Registered Report Identifier (IRRID): RR2-10.2196/12620 %M 33616545 %R 10.2196/23080 %U https://mhealth.jmir.org/2021/2/e23080 %U https://doi.org/10.2196/23080 %U http://www.ncbi.nlm.nih.gov/pubmed/33616545 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e22790 %T Mobile Remote Monitoring of Intimate Partner Violence Among Pregnant Patients During the COVID-19 Shelter-In-Place Order: Quality Improvement Pilot Study %A Krishnamurti,Tamar %A Davis,Alexander L %A Quinn,Beth %A Castillo,Anabel F %A Martin,Kelly L %A Simhan,Hyagriv N %+ Department of General Internal Medicine, University of Pittsburgh School of Medicine, 200 Meyran Avenue, Parkvale Building Suite 200, Pittsburgh, PA, 15213, United States, 1 4126924855, tamark@pitt.edu %K COVID-19 %K social isolation, sheltering-in-place %K intimate partner violence %K domestic violence %K pregnancy %K telemedicine %K telehealth %D 2021 %7 19.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Intimate partner violence (IPV) is one of the leading causes of pregnancy-related death. Prenatal health care providers can offer critical screening and support to pregnant people who experience IPV. During the COVID-19 shelter-in-place order, mobile apps may offer such people the opportunity to continue receiving screening and support services. Objective: We aimed to examine cases of IPV that were reported on a prenatal care app before and during the implementation of COVID-19 shelter-in-place mandates. Methods: The number of patients who underwent voluntary IPV screening and the incidence rate of IPV were determined by using a prenatal care app that was disseminated to patients from a single, large health care system. We compared the IPV screening frequencies and IPV incidence rates of patients who started using the app before the COVID-19 shelter-in-place order, to those of patients who started using the app during the shelter-in-place order. Results: We found 552 patients who started using the app within 60 days prior to the enforcement of the shelter-in-place order, and 407 patients who used the app at the start of shelter-in-place enforcement until the order was lifted. The incidence rates of voluntary IPV screening for new app users during the two time periods were similar (before sheltering in place: 252/552, 46%; during sheltering in place: 163/407, 40%). The overall use of the IPV screening tool increased during the shelter-in-place order. A slight, nonsignificant increase in the incidence of physical, sexual, and psychological violence during the shelter-in-place order was found across all app users (P=.56). Notably, none of the patients who screened positively for IPV had mentions of IPV in their medical charts. Conclusions: App-based screening for IPV is feasible during times when in-person access to health care providers is limited. Our results suggest that the incidence of IPV slightly increased during the shelter-in-place order. App-based screening may also address the needs of those who are unwilling or unable to share their IPV experiences with their health care provider. %M 33605898 %R 10.2196/22790 %U http://www.jmir.org/2021/2/e22790/ %U https://doi.org/10.2196/22790 %U http://www.ncbi.nlm.nih.gov/pubmed/33605898 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24268 %T Smartphone-Based Virtual Agents to Help Individuals With Sleep Concerns During COVID-19 Confinement: Feasibility Study %A Philip,Pierre %A Dupuy,Lucile %A Morin,Charles M %A de Sevin,Etienne %A Bioulac,Stéphanie %A Taillard,Jacques %A Serre,Fuschia %A Auriacombe,Marc %A Micoulaud-Franchi,Jean-Arthur %+ USR 3413 SANPSY, University of Bordeaux, Bordeaux, France, 33 557571100, lucile.dupuy@u-bordeaux.fr %K COVID-19 %K virtual agent %K sleep disorders %K technology acceptance %K agent %K sleep %K smartphone %K mobile phone %K eHealth %K feasibility %K stress %K app %K intervention %K behavior %D 2020 %7 18.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 crisis and consequent confinement restrictions have caused significant psychosocial stress and reports of sleep complaints, which require early management, have increased during recent months. To help individuals concerned about their sleep, we developed a smartphone-based app called KANOPEE that allows users to interact with a virtual agent dedicated to autonomous screening and delivering digital behavioral interventions. Objective: Our objective was to assess the feasibility of this app, in terms of inclusion rate, follow-up rate, perceived trust and acceptance of the virtual agent, and effects of the intervention program, in the context of COVID-19 confinement in France. Methods: The virtual agent is an artificial intelligence program using decision tree architecture and interacting through natural body motion and natural voice. A total of 2069 users aged 18 years and above downloaded the free app during the study period (April 22 to May 5, 2020). These users first completed a screening interview based on the Insomnia Severity Index (ISI) conducted by the virtual agent. If the users were positive for insomnia complaints (ISI score >14), they were eligible to join the 2-stage intervention program: (1) complete an electronic sleep diary for 1 week and (2) follow personalized sleep recommendations for 10 days. We collected and analyzed the following measures: sociodemographic information, ISI scores and sleep/wake schedules, and acceptance and trust of the agent. Results: Approximately 76% (1574/2069) of the app users completed the screening interview with the virtual agent. The virtual agent was well accepted by 27.4% (431/1574) of the users who answered the acceptance and trust questionnaires on its usability, satisfaction, benevolence, and credibility. Of the 773 screened users who reported sleep complaints (ISI score >14), 166 (21.5%) followed Step 1 of the intervention, and only 47 of those (28.3%) followed Step 2. Users who completed Step 1 found that their insomnia complaints (baseline mean ISI score 18.56, mean ISI score after Step 1 15.99; P<.001) and nocturnal sleep quality improved significantly after 1 week. Users who completed Step 2 also showed an improvement compared to the initial measures (baseline mean ISI score 18.87, mean ISI score after Step 2 14.68; P<.001). Users that were most severely affected (ISI score >21) did not respond to either intervention. Conclusions: These preliminary results suggest that the KANOPEE app is a promising solution to screen populations for sleep complaints and that it provides acceptable and practical behavioral advice for individuals reporting moderately severe insomnia. %M 33264099 %R 10.2196/24268 %U http://www.jmir.org/2020/12/e24268/ %U https://doi.org/10.2196/24268 %U http://www.ncbi.nlm.nih.gov/pubmed/33264099 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e22634 %T Screening for Depression in Daily Life: Development and External Validation of a Prediction Model Based on Actigraphy and Experience Sampling Method %A Minaeva,Olga %A Riese,Harriëtte %A Lamers,Femke %A Antypa,Niki %A Wichers,Marieke %A Booij,Sanne H %+ Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, 9713 GZ, Netherlands, 31 50 361 2065, o.minaeva@umcg.nl %K actigraphy %K activity tracker %K depression %K experience sampling method %K prediction model %K screening %D 2020 %7 1.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In many countries, depressed individuals often first visit primary care settings for consultation, but a considerable number of clinically depressed patients remain unidentified. Introducing additional screening tools may facilitate the diagnostic process. Objective: This study aimed to examine whether experience sampling method (ESM)-based measures of depressive affect and behaviors can discriminate depressed from nondepressed individuals. In addition, the added value of actigraphy-based measures was examined. Methods: We used data from 2 samples to develop and validate prediction models. The development data set included 14 days of ESM and continuous actigraphy of currently depressed (n=43) and nondepressed individuals (n=82). The validation data set included 30 days of ESM and continuous actigraphy of currently depressed (n=27) and nondepressed individuals (n=27). Backward stepwise logistic regression analysis was applied to build the prediction models. Performance of the models was assessed with goodness-of-fit indices, calibration curves, and discriminative ability (area under the receiver operating characteristic curve [AUC]). Results: In the development data set, the discriminative ability was good for the actigraphy model (AUC=0.790) and excellent for both the ESM (AUC=0.991) and the combined-domains model (AUC=0.993). In the validation data set, the discriminative ability was reasonable for the actigraphy model (AUC=0.648) and excellent for both the ESM (AUC=0.891) and the combined-domains model (AUC=0.892). Conclusions: ESM is a good diagnostic predictor and is easy to calculate, and it therefore holds promise for implementation in clinical practice. Actigraphy shows no added value to ESM as a diagnostic predictor but might still be useful when ESM use is restricted. %M 33258783 %R 10.2196/22634 %U https://www.jmir.org/2020/12/e22634 %U https://doi.org/10.2196/22634 %U http://www.ncbi.nlm.nih.gov/pubmed/33258783 %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 e23047 %T A Smartphone-Based Approach to Screening for Sudden Sensorineural Hearing Loss: Cross-Sectional Validity Study %A Lin,Heng-Yu Haley %A Chu,Yuan-Chia %A Lai,Ying-Hui %A Cheng,Hsiu-Lien %A Lai,Feipei %A Cheng,Yen-Fu %A Liao,Wen-Huei %+ Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, Taiwan, 886 2 2875 7808 ext 7264, whliaovictor@gmail.com %K sudden sensorineural hearing loss %K hearing test %K telemedicine %K mobile apps %K pure tone %K audiometry %D 2020 %7 11.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Sudden sensorineural hearing loss (SSNHL) is an otologic emergency that warrants urgent management. Pure-tone audiometry remains the gold standard for definitively diagnosing SSNHL. However, in clinical settings such as primary care practices and urgent care facilities, conventional pure-tone audiometry is often unavailable. Objective: This study aimed to determine the correlation between hearing outcomes measured by conventional pure-tone audiometry and those measured by the proposed smartphone-based Ear Scale app and determine the diagnostic validity of the hearing scale differences between the two ears as obtained by the Ear Scale app for SSNHL. Methods: This cross-sectional study included a cohort of 88 participants with possible SSNHL who were referred to an otolaryngology clinic or emergency department at a tertiary medical center in Taipei, Taiwan, between January 2018 and June 2019. All participants underwent hearing assessments with conventional pure-tone audiometry and the proposed smartphone-based Ear Scale app consecutively. The gold standard for diagnosing SSNHL was defined as the pure-tone average (PTA) difference between the two ears being ≥30 dB HL. The hearing results measured by the Ear Scale app were presented as 20 stratified hearing scales. The hearing scale difference between the two ears was estimated to detect SSNHL. Results: The study sample comprised 88 adults with a mean age of 46 years, and 50% (44/88) were females. PTA measured by conventional pure-tone audiometry was strongly correlated with the hearing scale assessed by the Ear Scale app, with a Pearson correlation coefficient of .88 (95% CI .82-.92). The sensitivity of the 5–hearing scale difference (25 dB HL difference) between the impaired ear and the contralateral ear in diagnosing SSNHL was 95.5% (95% CI 87.5%-99.1%), with a specificity of 66.7% (95% CI 43.0%-85.4%). Conclusions: Our findings suggest that the proposed smartphone-based Ear Scale app can be useful in the evaluation of SSNHL in clinical settings where conventional pure-tone audiometry is not available. %M 33174845 %R 10.2196/23047 %U http://mhealth.jmir.org/2020/11/e23047/ %U https://doi.org/10.2196/23047 %U http://www.ncbi.nlm.nih.gov/pubmed/33174845 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e21369 %T Influenza Screening via Deep Learning Using a Combination of Epidemiological and Patient-Generated Health Data: Development and Validation Study %A Choo,Hyunwoo %A Kim,Myeongchan %A Choi,Jiyun %A Shin,Jaewon %A Shin,Soo-Yong %+ Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, 115, Irwon-ro, Gangnam-gu, Seoul , Republic of Korea, 82 2 3410 1449, sy.shin@skku.edu %K influenza %K screening tool %K patient-generated health data %K mobile health %K mHealth %K deep learning %D 2020 %7 29.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Screening for influenza in primary care is challenging due to the low sensitivity of rapid antigen tests and the lack of proper screening tests. Objective: The aim of this study was to develop a machine learning–based screening tool using patient-generated health data (PGHD) obtained from a mobile health (mHealth) app. Methods: We trained a deep learning model based on a gated recurrent unit to screen influenza using PGHD, including each patient’s fever pattern and drug administration records. We used meteorological data and app-based surveillance of the weekly number of patients with influenza. We defined a single episode as the set of consecutive days, including the day the user was diagnosed with influenza or another disease. Any record a user entered 24 hours after his or her last record was considered to be the start of a new episode. Each episode contained data on the user’s age, gender, weight, and at least one body temperature record. The total number of episodes was 6657. Of these, there were 3326 episodes within which influenza was diagnosed. We divided these episodes into 80% training sets (2664/3330) and 20% test sets (666/3330). A 5-fold cross-validation was used on the training set. Results: We achieved reliable performance with an accuracy of 82%, a sensitivity of 84%, and a specificity of 80% in the test set. After the effect of each input variable was evaluated, app-based surveillance was observed to be the most influential variable. The correlation between the duration of input data and performance was not statistically significant (P=.09). Conclusions: These findings suggest that PGHD from an mHealth app could be a complementary tool for influenza screening. In addition, PGHD, along with traditional clinical data, could be used to improve health conditions. %M 33118941 %R 10.2196/21369 %U http://www.jmir.org/2020/10/e21369/ %U https://doi.org/10.2196/21369 %U http://www.ncbi.nlm.nih.gov/pubmed/33118941 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e17213 %T Screening for Hearing Impairment in Older Adults by Smartphone-Based Audiometry, Self-Perception, HHIE Screening Questionnaire, and Free-Field Voice Test: Comparative Evaluation of the Screening Accuracy With Standard Pure-Tone Audiometry %A Li,Lok Yee Joyce %A Wang,Shin-Yi %A Wu,Cheng-Jung %A Tsai,Cheng-Yu %A Wu,Te-Fang %A Lin,Yaoh-Shiang %+ Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd, Zhonghe District, New Taipei City, 23561, Taiwan, 886 22490088, b101090126@tmu.edu.tw %K hearing impairment %K self-perception %K HHIE-S questionnaire %K free-field voice test %K mobile phone %K audiometry %K mobile health %D 2020 %7 27.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hearing impairment is the most frequent sensory deficit in humans, affecting more than 360 million people worldwide. In fact, hearing impairment is not merely a health problem, but it also has a great impact on the educational performance, economic income, and quality of life. Hearing impairment is therefore an important social concern. Objective: We aimed to evaluate and compare the accuracy of self-perception, Hearing Handicap Inventory for the Elderly-Screening (HHIE-S) questionnaire, free-field voice test, and smartphone-based audiometry as tests for screening moderate hearing impairment in older adults in China. Methods: In this study, 41 patients were recruited through a single otology practice. All patients were older than 65 years. Patients with otorrhea and cognitive impairment were excluded. Moderate hearing impairment was defined as mean hearing thresholds at 500, 1000, 2000, and 4000 Hz >40 dB hearing loss (pure-tone average > 40 dB hearing loss). All patients completed 5 hearing tests, namely, the self-perception test, HHIE-S questionnaire test, free-field voice test, smartphone-based audiometry test, and standard pure-tone audiometry by the same audiologist. We compared the results of these tests to the standard audiogram in the better-hearing ear. Results: The sensitivity and the specificity of the self-perception test were 0.58 (95% CI 0.29-0.84) and 0.34 (95% CI 0.19-0.54), respectively. The sensitivity and the specificity of the HHIE-S questionnaire test were 0.67 (95% CI 0.35-0.89) and 0.31 (95% CI 0.316-0.51), respectively. The sensitivity and the specificity of the free-field voice test were 0.83 (95% CI 0.51-0.97) and 0.41 (95% CI 0.24-0.61), respectively. The sensitivity and the specificity of the smartphone-based audiometry test were 0.92 (95% CI 0.60-0.99) and 0.76 (95% CI 0.56-0.89), respectively. Smartphone-based audiometry correctly diagnosed the presence of hearing loss with high sensitivity and high specificity. Conclusions: Smartphone-based audiometry may be a dependable screening test to rule out moderate hearing impairment in the older population. %M 33107828 %R 10.2196/17213 %U http://mhealth.jmir.org/2020/10/e17213/ %U https://doi.org/10.2196/17213 %U http://www.ncbi.nlm.nih.gov/pubmed/33107828 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e20496 %T Use of mHealth Devices to Screen for Atrial Fibrillation: Cost-Effectiveness Analysis %A Giebel,Godwin D %+ E-Government/E-Health, Department of Business Information Systems, Baden-Wuerttemberg Cooperative State University Mannheim, Coblitzallee 1-9, Mannheim, 68163, Germany, 49 157 57953048, godwin.giebel@dhbw-mannheim.de %K mHealth %K atrial fibrillation %K screening devices %K strokes %K cost-effectiveness %K photoplethysmography %D 2020 %7 6.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With an estimated prevalence of around 3% and an about 2.5-fold increased risk of stroke, atrial fibrillation (AF) is a serious threat for patients and a high economic burden for health care systems all over the world. Patients with AF could benefit from screening through mobile health (mHealth) devices. Thus, an early diagnosis is possible with mHealth devices, and the risk for stroke can be markedly reduced by using anticoagulation therapy. Objective: The aim of this work was to assess the cost-effectiveness of algorithm-based screening for AF with the aid of photoplethysmography wrist-worn mHealth devices. Even if prevented strokes and prevented deaths from stroke are the most relevant patient outcomes, direct costs were defined as the primary outcome. Methods: A Monte Carlo simulation was conducted based on a developed state-transition model; 30,000 patients for each CHA2DS2-VASc (Congestive heart failure, Hypertension, Age≥75 years, Diabetes mellitus, Stroke, Vascular disease, Age 65-74 years, Sex category [female]) score from 1 to 9 were simulated. The first simulation served to estimate the economic burden of AF without the use of mHealth devices. The second simulation served to simulate the economic burden of AF with the use of mHealth devices. Afterwards, the groups were compared in terms of costs, prevented strokes, and deaths from strokes. Results: The CHA2DS2-VASc score as well as the electrocardiography (ECG) confirmation rate had the biggest impact on costs as well as number of strokes. The higher the risk score, the lower were the costs per prevented stroke. Higher ECG confirmation rates intensified this effect. The effect was not seen in groups with lower risk scores. Over 10 years, the use of mHealth (assuming a 75% ECG confirmation rate) resulted in additional costs (€1=US $1.12) of €441, €567, €536, €520, €606, €625, €623, €692, and €847 per patient for a CHA2DS2-VASc score of 1 to 9, respectively. The number of prevented strokes tended to be higher in groups with high risk for stroke. Higher ECG confirmation rates led to higher numbers of prevented strokes. The use of mHealth (assuming a 75% ECG confirmation rate) resulted in 25 (7), –68 (–54), 98 (–5), 266 (182), 346 (271), 642 (440), 722 (599), 1111 (815), and 1116 (928) prevented strokes (fatal) for CHA2DS2-VASc score of 1 to 9, respectively. Higher device accuracy in terms of sensitivity led to even more prevented fatal strokes. Conclusions: The use of mHealth devices to screen for AF leads to increased costs but also a reduction in the incidence of stroke. In particular, in patients with high CHA2DS2-VASc scores, the risk for stroke and death from stroke can be markedly reduced. %M 33021489 %R 10.2196/20496 %U http://mhealth.jmir.org/2020/10/e20496/ %U https://doi.org/10.2196/20496 %U http://www.ncbi.nlm.nih.gov/pubmed/33021489 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e17963 %T Supervised Digital Neuropsychological Tests for Cognitive Decline in Older Adults: Usability and Clinical Validity Study %A Lunardini,Francesca %A Luperto,Matteo %A Romeo,Marta %A Basilico,Nicola %A Daniele,Katia %A Azzolino,Domenico %A Damanti,Sarah %A Abbate,Carlo %A Mari,Daniela %A Cesari,Matteo %A Borghese,Nunzio Alberto %A Ferrante,Simona %+ Nearlab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Giuseppe Colombo 40, Milano, 20133, Italy, 39 3334335004, francesca.lunardini@polimi.it %K aging %K Bells Test %K computerized testing %K dementia %K early diagnosis %K eHealth %K mild cognitive impairment %K neuropsychological assessment %K Trail Making Test %D 2020 %7 21.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dementia is a major and growing health problem, and early diagnosis is key to its management. Objective: With the ultimate goal of providing a monitoring tool that could be used to support the screening for cognitive decline, this study aims to develop a supervised, digitized version of 2 neuropsychological tests: Trail Making Test and Bells Test. The system consists of a web app that implements a tablet-based version of the tests and consists of an innovative vocal assistant that acts as the virtual supervisor for the execution of the test. A replay functionality is added to allow inspection of the user’s performance after test completion. Methods: To deploy the system in a nonsupervised environment, extensive functional testing of the platform was conducted, together with a validation of the tablet-based tests. Such validation had the two-fold aim of evaluating system usability and acceptance and investigating the concurrent validity of computerized assessment compared with the corresponding paper-and-pencil counterparts. Results: The results obtained from 83 older adults showed high system acceptance, despite the patients’ low familiarity with technology. The system software was successfully validated. A concurrent validation of the system reported good ability of the digitized tests to retain the same predictive power of the corresponding paper-based tests. Conclusions: Altogether, the positive results pave the way for the deployment of the system to a nonsupervised environment, thus representing a potential efficacious and ecological solution to support clinicians in the identification of early signs of cognitive decline. %M 32955442 %R 10.2196/17963 %U http://mhealth.jmir.org/2020/9/e17963/ %U https://doi.org/10.2196/17963 %U http://www.ncbi.nlm.nih.gov/pubmed/32955442 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20261 %T Novel Toilet Paper–Based Point-Of-Care Test for the Rapid Detection of Fecal Occult Blood: Instrument Validation Study %A Wang,Hsin-Yao %A Lin,Ting-Wei %A Chiu,Sherry Yueh-Hsia %A Lin,Wan-Ying %A Huang,Song-Bin %A Hsieh,Jason Chia-Hsun %A Chen,Hsieh Cheng %A Lu,Jang-Jih %A Wu,Min-Hsien %+ PhD Program in Biomedical Engineering, Chang Gung University, No. 259, Wenhua 1st Rd, Guishan Dist, Taoyuan City, Taiwan, 886 32118800, mhwu@mail.cgu.edu.tw %K fecal occult blood test %K point-of-care diagnostics %K paper-based analytical devices %K diagnostic %K testing %K detection %K validation %K cancer %K public health %D 2020 %7 7.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Colorectal cancer screening by fecal occult blood testing has been an important public health test and shown to reduce colorectal cancer–related mortality. However, the low participation rate in colorectal cancer screening by the general public remains a problematic public health issue. This fact could be attributed to the complex and unpleasant operation of the screening tool. Objective: This study aimed to validate a novel toilet paper–based point-of-care test (ie, JustWipe) as a public health instrument to detect fecal occult blood and provide detailed results from the evaluation of the analytic characteristics in the clinical validation. Methods: The mechanism of fecal specimen collection by the toilet-paper device was verified with repeatability and reproducibility tests. We also evaluated the analytical characteristics of the test reagents. For clinical validation, we conducted comparisons between JustWipe and other fecal occult blood tests. The first comparison was between JustWipe and typical fecal occult blood testing in a central laboratory setting with 70 fecal specimens from the hospital. For the second comparison, a total of 58 volunteers were recruited, and JustWipe was compared with the commercially available Hemoccult SENSA in a point-of-care setting. Results: Adequate amounts of fecal specimens were collected using the toilet-paper device with small day-to-day and person-to-person variations. The limit of detection of the test reagent was evaluated to be 3.75 µg of hemoglobin per milliliter of reagent. Moreover, the test reagent also showed high repeatability (100%) on different days and high reproducibility (>96%) among different users. The overall agreement between JustWipe and a typical fecal occult blood test in a central laboratory setting was 82.9%. In the setting of point-of-care tests, the overall agreement between JustWipe and Hemoccult SENSA was 89.7%. Moreover, the usability questionnaire showed that the novel test tool had high scores in operation friendliness (87.3/100), ease of reading results (97.4/100), and information usefulness (96.1/100). Conclusions: We developed and validated a toilet paper–based fecal occult blood test for use as a point-of-care test for the rapid (in 60 seconds) and easy testing of fecal occult blood. These favorable characteristics render it a promising tool for colorectal cancer screening as a public health instrument. %M 32763879 %R 10.2196/20261 %U https://www.jmir.org/2020/8/e20261 %U https://doi.org/10.2196/20261 %U http://www.ncbi.nlm.nih.gov/pubmed/32763879 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e18392 %T The Association Between App-Administered Depression Assessments and Suicidal Ideation in User Comments: Retrospective Observational Study %A DeForte,Shelly %A Huang,Yungui %A Bourgeois,Tran %A Hussain,Syed-Amad %A Lin,Simon %+ Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43215, United States, 1 202 318 1627, simon.lin@nationwidechildrens.org %K mobile health %K mHealth %K depression %K qualitative research %K mental health %D 2020 %7 4.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many people use apps to help understand and manage their depression symptoms. App-administered questionnaires for the symptoms of depression, such as the Patient Health Questionnaire-9, are easy to score and implement in an app, but may not be accompanied by essential resources and access needed to provide proper support and avoid potential harm. Objective: Our primary goal was to evaluate the differences in risks and helpfulness associated with using an app to self-diagnose depression, comparing assessment-only apps with multifeatured apps. We also investigated whether, what, and how additional app features may mitigate potential risks. Methods: In this retrospective observational study, we identified apps in the Google Play store that provided a depression assessment as a feature and had at least five user comments. We separated apps into two categories based on those having only a depression assessment versus those that offered additional supportive features. We conducted theoretical thematic analyses over the user reviews, with thematic coding indicating the helpfulness of the app, the presence of suicidal ideation, and how and why the apps were used. We compared the results across the two categories of apps and analyzed the differences using chi-square statistical tests. Results: We evaluated 6 apps; 3 provided only a depression assessment (assessment only), and 3 provided features in addition to self-assessment (multifeatured). User comments for assessment-only apps indicated significantly more suicidal ideation or self-harm (n=31, 9.4%) compared to comments for multifeatured apps (n=48, 2.3%; X21=43.88, P<.001). Users of multifeatured apps were over three times more likely than assessment-only app users to comment in favor of the app’s helpfulness, likely due to features like mood tracking, journaling, and informational resources (n=56, 17% vs n=1223, 59% respectively; X21=200.36, P<.001). The number of users under the age of 18 years was significantly higher among assessment-only app users (n=40, 12%) than multifeatured app users (n=9, 0.04%; X21=189.09, P<.001). Conclusions: Apps that diagnose depression by self-assessment without context or other supportive features are more likely to be used by those under 18 years of age and more likely to be associated with increased user distress and potential harm. Depression self-assessments in apps should be implemented with caution and accompanied by evidence-based capabilities that establish proper context, increase self-empowerment, and encourage users to seek clinical diagnostics and outside help. %M 32663158 %R 10.2196/18392 %U https://mhealth.jmir.org/2020/8/e18392 %U https://doi.org/10.2196/18392 %U http://www.ncbi.nlm.nih.gov/pubmed/32663158 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17857 %T An App for Classifying Personal Mental Illness at Workplace Using Fit Statistics and Convolutional Neural Networks: Survey-Based Quantitative Study %A Yan,Yu-Hua %A Chien,Tsair-Wei %A Yeh,Yu-Tsen %A Chou,Willy %A Hsing,Shu-Chen %+ Respiratory Therapy Unit, Chi Mei Medical Center, No 901, Chung Hwa Road, Yung Kung Dist, Tainan, 710, Taiwan, 886 +886937399106, rtlisa1965@gmail.com %K respiratory therapist %K ELMI app %K Rasch analysis %K convolutional neural network %K mental health %K mobile phone %D 2020 %7 31.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mental illness (MI) is common among those who work in health care settings. Whether MI is related to employees’ mental status at work is yet to be determined. An MI app is developed and proposed to help employees assess their mental status in the hope of detecting MI at an earlier stage. Objective: This study aims to build a model using convolutional neural networks (CNNs) and fit statistics based on 2 aspects of measures and outfit mean square errors for the automatic detection and classification of personal MI at the workplace using the emotional labor and mental health (ELMH) questionnaire, so as to equip the staff in assessing and understanding their own mental status with an app on their mobile device. Methods: We recruited 352 respiratory therapists (RTs) working in Taiwan medical centers and regional hospitals to fill out the 44-item ELMH questionnaire in March 2019. The exploratory factor analysis (EFA), Rasch analysis, and CNN were used as unsupervised and supervised learnings for (1) dividing RTs into 4 classes (ie, MI, false MI, health, and false health) and (2) building an ELMH predictive model to estimate 108 parameters of the CNN model. We calculated the prediction accuracy rate and created an app for classifying MI for RTs at the workplace as a web-based assessment. Results: We observed that (1) 8 domains in ELMH were retained by EFA, (2) 4 types of mental health (n=6, 63, 265, and 18 located in 4 quadrants) were classified using the Rasch analysis, (3) the 44-item model yields a higher accuracy rate (0.92), and (4) an MI app available for RTs predicting MI was successfully developed and demonstrated in this study. Conclusions: The 44-item model with 108 parameters was estimated by using CNN to improve the accuracy of mental health for RTs. An MI app developed to help RTs self-detect work-related MI at an early stage should be made more available and viable in the future. %M 32735232 %R 10.2196/17857 %U https://mhealth.jmir.org/2020/7/e17857 %U https://doi.org/10.2196/17857 %U http://www.ncbi.nlm.nih.gov/pubmed/32735232 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e15591 %T Implementation Strategies for Web-Based Apps for Screening: Scoping Review %A Ooi,Chor Yau %A Ng,Chirk Jenn %A Sales,Anne E %A Lim,Hooi Min %+ University of Malaya eHealth Initiative, Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, , Kuala Lumpur, , Malaysia, 60 79492306, ngcj@um.edu.my %K internet %K mHealth %K eHealth %K mass screening %K implementation strategies %D 2020 %7 20.7.2020 %9 Review %J J Med Internet Res %G English %X Background: Screening is an effective primary prevention strategy in health care, as it enables the early detection of diseases. However, the uptake of such screening remains low. Different delivery methods for screening have been developed and found to be effective in increasing the uptake of screening, including the use of web-based apps. Studies have shown that web-based apps for screening are effective in increasing the uptake of health screening among the general population. However, not much is known about the effective implementation of such web-based apps in the real-world setting. Implementation strategies are theory-based methods or techniques used to enhance the adoption, implementation, and sustainability of evidence-based interventions. Implementation strategies are important, as they allow us to understand how to implement an evidence-based intervention. Therefore, a scoping review to identify the various implementation strategies for web-based apps for screening is warranted. Objective: This scoping review aims to identify (1) strategies used to implement web-based apps for health screening, (2) frameworks used for implementing web-based apps for health screening, (3) outcome measures of implementation strategies, and (4) effective implementation strategies. Methods: This scoping review was conducted based on Arksey and O’Malley’s framework. After identifying the review question, two researchers independently screened and selected relevant literature from PubMed, Embase, Cochrane, Cumulative Index of Nursing and Allied Health Literature, PsycINFO, International Standard Randomised Controlled Trial Number Registry, OpenGrey, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform, and Web of Science. This was followed by charting the data using a standardized form. Finally, we collated, summarized, and reported the results quantitatively and qualitatively based on the review objectives. Results: A total of 16,476 studies were retrieved, of which 5669 were duplicates. From a total of 10,807 studies, 10,784 studies were excluded based on their titles and abstracts. There were 23 full-text articles reviewed, and 4 articles were included in the final analysis. Many studies were excluded because they focused on the effectiveness and not on the implementation of web-based apps. Facilitation was the most cited implementation strategy used, followed by reminders, clinical champions, and educational meetings and materials. Only 2 studies used implementation frameworks to guide the evaluation of their studies. Common outcome measures for implementation strategies were feasibility, fidelity, and penetration. Implementation strategies reported to be effective were quality improvement meetings, facilitation, educational meetings, and clinical champions. Conclusions: There is a dearth of literature on the implementation of web-based apps for health screening. Implementation strategies were developed without any reported use of implementation theories or frameworks in most studies. More research on the development and evaluation of web-based screening app implementations is needed. %M 32706655 %R 10.2196/15591 %U http://www.jmir.org/2020/7/e15591/ %U https://doi.org/10.2196/15591 %U http://www.ncbi.nlm.nih.gov/pubmed/32706655 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e16455 %T Effectiveness of a Voice-Based Mental Health Evaluation System for Mobile Devices: Prospective Study %A Higuchi,Masakazu %A Nakamura,Mitsuteru %A Shinohara,Shuji %A Omiya,Yasuhiro %A Takano,Takeshi %A Mitsuyoshi,Shunji %A Tokuno,Shinichi %+ Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, , Japan, 81 3 5841 3432, higuchi@bioeng.t.u-tokyo.ac.jp %K mental health %K monitoring system %K stress evaluation %K voice analysis %D 2020 %7 20.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: We developed a system for monitoring mental health using voice data from daily phone calls, termed Mind Monitoring System (MIMOSYS), by implementing a method for estimating mental health status from voice data. Objective: The objective of this study was to evaluate the potential of this system for detecting depressive states and monitoring stress-induced mental changes. Methods: We opened our system to the public in the form of a prospective study in which data were collected over 2 years from a large, unspecified sample of users. We used these data to analyze the relationships between the rate of continued use, the men-to-women ratio, and existing psychological tests for this system over the study duration. Moreover, we analyzed changes in mental data over time under stress from particular life events. Results: The system had a high rate of continued use. Voice indicators showed that women have more depressive tendencies than men, matching the rate of depression in Japan. The system’s voice indicators and the scores on classical psychological tests were correlated. We confirmed deteriorating mental health for users in areas affected by major earthquakes in Japan around the time of the earthquakes. Conclusions: The results suggest that although this system is insufficient for detecting depression, it may be effective for monitoring changes in mental health due to stress. The greatest feature of our system is mental health monitoring, which is most effectively accomplished by performing long-term time-series analysis of the acquired data considering the user’s life events. Such a system can improve the implementation of patient interventions by evaluating objective data along with life events. %M 32554367 %R 10.2196/16455 %U http://formative.jmir.org/2020/7/e16455/ %U https://doi.org/10.2196/16455 %U http://www.ncbi.nlm.nih.gov/pubmed/32554367 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e18226 %T A One-Step, Streamlined Children’s Vision Screening Solution Based on Smartphone Imaging for Resource-Limited Areas: Design and Preliminary Field Evaluation %A Ma,Shuoxin %A Guan,Yongqing %A Yuan,Yazhen %A Tai,Yuan %A Wang,Tan %+ TerryDr Infomation Technology, Room A3-701, #180 RuanJianDaDao, YuHuaTai District, Nanjing, 210000, China, 86 13813998278, shuoxinma@163.com %K vision screening %K resource-limited application %K photorefraction %K strabismus %K myopia %K anisometropia %K mHealth %K screening %D 2020 %7 13.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Young children’s vision screening, as part of a preventative health care service, produces great value for developing regions. Besides yielding a high return on investment from forestalling surgeries using a low-cost intervention at a young age, it improves school performance and thus boosts future labor force quality. Leveraging low-skilled health care workers with smartphones and automated diagnosis to offer such programs can be a scalable model in resource-limited areas. Objective: This study aimed to develop and evaluate an effective, efficient, and comprehensive vision screening solution for school children in resource-limited areas. First, such an exam would need to cover the major risk factors of amblyopia and myopia, 2 major sources of vision impairment effectively preventable at a young age. Second, the solution must be integrated with digital patient record-keeping for long-term monitoring and popular statistical analysis. Last, it should utilize low-skilled technicians and only low-cost tools that are available in a typical school in developing regions, without compromising quality or efficiency. Methods: A workflow for the screening program was designed and a smartphone app was developed to implement it. In the standardized screening procedure, a young child went through the smartphone-based photoscreening in a dark room. The child held a smartphone in front of their forehead, displaying pre-entered personal information as a quick response code that duplexed as a reference of scale. In one 10-second procedure, the child’s personal information and interpupillary distance, relative visual axis alignment, and refractive error ranges were measured and analyzed automatically using image processing and artificial intelligence algorithms. The child’s risk for strabismus, myopia, and anisometropia was then derived and consultation given. Results: A preliminary evaluation of the solution was conducted alongside yearly physical exams in Luoyang, Henan, People’s Republic of China. It covered 20 students with suspected strabismus and 80 randomly selected students, aged evenly between 8 and 10. Each examinee took about 1 minute, and a streamlined workflow allowed 3 exams to run in parallel. The 1-shot and 2-shot measurement success rates were 87% and 100%, respectively. The sensitivity and specificity of strabismus detection were 0.80 and 0.98, respectively. The sensitivity and specificity of myopia detection were 0.83 and 1.00, respectively. The sensitivity and specificity of anisometropia detection were 0.80 and 1.00, respectively. Conclusions: The proposed vision screening program is effective, efficient, and scalable. Compared with previously published studies on utilizing a smartphone for an automated Hirschberg test and photorefraction screening, this comprehensive solution is optimized for practicality and robustness, and is thus better ready-to-deploy. Our evaluation validated the achievement of the program’s design specifications. %M 32673243 %R 10.2196/18226 %U http://mhealth.jmir.org/2020/7/e18226/ %U https://doi.org/10.2196/18226 %U http://www.ncbi.nlm.nih.gov/pubmed/32673243 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 3 %P e19713 %T Patients’ Utilization and Perception of an Artificial Intelligence–Based Symptom Assessment and Advice Technology in a British Primary Care Waiting Room: Exploratory Pilot Study %A Miller,Stephen %A Gilbert,Stephen %A Virani,Vishaal %A Wicks,Paul %+ Ada Health GmbH, Adalbertstraße 20, Berlin, , Germany, 49 3060031987, science@ada.com %K human-centered design %K innovative %K health care apps %K eHealth %K symptom checker %K primary care %K general practice %K app %K usability %K acceptability %K utility %D 2020 %7 10.7.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: When someone needs to know whether and when to seek medical attention, there are a range of options to consider. Each will have consequences for the individual (primarily considering trust, convenience, usefulness, and opportunity costs) and for the wider health system (affecting clinical throughput, cost, and system efficiency). Digital symptom assessment technologies that leverage artificial intelligence may help patients navigate to the right type of care with the correct degree of urgency. However, a recent review highlighted a gap in the literature on the real-world usability of these technologies. Objective: We sought to explore the usability, acceptability, and utility of one such symptom assessment technology, Ada, in a primary care setting. Methods: Patients with a new complaint attending a primary care clinic in South London were invited to use a custom version of the Ada symptom assessment mobile app. This exploratory pilot study was conducted between November 2017 and January 2018 in a practice with 20,000 registered patients. Participants were asked to complete an Ada self-assessment about their presenting complaint on a study smartphone, with assistance provided if required. Perceptions on the app and its utility were collected through a self-completed study questionnaire following completion of the Ada self-assessment. Results: Over a 3-month period, 523 patients participated. Most were female (n=325, 62.1%), mean age 39.79 years (SD 17.7 years), with a larger proportion (413/506, 81.6%) of working-age individuals (aged 15-64) than the general population (66.0%). Participants rated Ada’s ease of use highly, with most (511/522, 97.8%) reporting it was very or quite easy. Most would use Ada again (443/503, 88.1%) and agreed they would recommend it to a friend or relative (444/520, 85.3%). We identified a number of age-related trends among respondents, with a directional trend for more young respondents to report Ada had provided helpful advice (50/54, 93%, 18-24-year olds reported helpful) than older respondents (19/32, 59%, adults aged 70+ reported helpful). We found no sex differences on any of the usability questions fielded. While most respondents reported that using the symptom checker would not have made a difference in their care-seeking behavior (425/494, 86.0%), a sizable minority (63/494, 12.8%) reported they would have used lower-intensity care such as self-care, pharmacy, or delaying their appointment. The proportion was higher for patients aged 18-24 (11/50, 22%) than aged 70+ (0/28, 0%). Conclusions: In this exploratory pilot study, the digital symptom checker was rated as highly usable and acceptable by patients in a primary care setting. Further research is needed to confirm whether the app might appropriately direct patients to timely care, and understand how this might save resources for the health system. More work is also needed to ensure the benefits accrue equally to older age groups. %M 32540836 %R 10.2196/19713 %U https://humanfactors.jmir.org/2020/3/e19713 %U https://doi.org/10.2196/19713 %U http://www.ncbi.nlm.nih.gov/pubmed/32540836 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e16345 %T Smartphone-Guided Algorithms for Use by Community Volunteers to Screen and Refer People With Eye Problems in Trans Nzoia County, Kenya: Development and Validation Study %A Rono,Hillary %A Bastawrous,Andrew %A Macleod,David %A Bunywera,Cosmas %A Mamboleo,Ronald %A Wanjala,Emmanuel %A Burton,Matthew %+ Clinical Research Department, International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom, 254 722627207, hillary.rono@lshtm.ac.uk %K visual impairment %K algorithms %K mobile phone %K screening %K mHealth %K sensitivity %K specificity %D 2020 %7 19.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The provision of eye care services is currently insufficient to meet the requirements of eye care. Many people remain unnecessarily visually impaired or at risk of becoming so because of treatable or preventable eye conditions. A lack of access and awareness of services is, in large part, a key barrier to handle this unmet need. Objective: This study aimed to assess whether utilizing novel smartphone-based clinical algorithms can task-shift eye screening to community volunteers (CVs) to accurately identify and refer patients to primary eye care services. In particular, we developed the Peek Community Screening app and assessed its validity in making referral decisions for patients with eye problems. Methods: We developed a smartphone-based clinical algorithm (the Peek Community Screening app) using age, distance vision, near vision, and pain as referral criteria. We then compared CVs’ referral decisions using this app with those made by an experienced ophthalmic clinical officer (OCO), which was the reference standard. The same participants were assessed by a trained CV using the app and by an OCO using standard outreach equipment. The outcome was the proportion of all decisions that were correct when compared with that of the OCO. Results: The required sensitivity and specificity for the Peek Community Screening app were achieved after seven iterations. In the seventh iteration, the OCO identified referable eye problems in 65.9% (378/574) of the participants. CVs correctly identified 344 of 378 (sensitivity 91.0%; 95% CI 87.7%-93.7%) of the cases and correctly identified 153 of 196 (specificity 78.1%; 95% CI 71.6%-83.6%) cases as not having a referable eye problem. The positive predictive value was 88.9% (95% CI 85.3%-91.8%), and the negative predictive value was 81.8% (95% CI 75.5%-87.1%). Conclusions: Development of such an algorithm is feasible; however, it requires considerable effort and resources. CVs can accurately use the Peek Community Screening app to identify and refer people with eye problems. An iterative design process is necessary to ensure validity in the local context. %M 32558656 %R 10.2196/16345 %U https://mhealth.jmir.org/2020/6/e16345 %U https://doi.org/10.2196/16345 %U http://www.ncbi.nlm.nih.gov/pubmed/32558656 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e17557 %T Feasibility and Acceptability of a Text Message–Based Intervention to Reduce Overuse of Alcohol in Emergency Department Patients: Controlled Proof-of-Concept Trial %A Burner,Elizabeth %A Zhang,Mark %A Terp,Sophie %A Ford Bench,Kelsey %A Lee,Joshua %A Lam,Chun Nok %A Torres,Jesus R %A Menchine,Michael %A Arora,Sanjay %+ Department of Emergency Medicine, Keck School of Medicine, University of Southern California, 1200 N State Street, Los Angeles, CA, 90033, United States, 1 323 409 6638, eburner@usc.edu %K mhealth %K alcohol misuse %K emergency department %K alcohol intervention %D 2020 %7 4.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Emergency department (ED) patients have high rates of risky alcohol use, and an ED visit offers an opportunity to intervene. ED-based screening, brief intervention, and referral to treatment (SBIRT) reduces alcohol use and health care costs. Mobile health (mHealth) interventions may expand the impact of SBIRTs but are understudied in low-resource ED populations. Objective: The objective of this study was to assess the feasibility of and patient satisfaction with a text-based mHealth extension of an ED screening program to reduce risky alcohol use in low-income, urban patients. Methods: Research assistants screened a convenience sample of ED patients in person for risky alcohol use via the Alcohol Use Disorders Identification Test (AUDIT). Patients who reported AUDIT scores ≥8 and <20 were informed of their AUDIT score and risk. RAs invited patients with SMS text message–capable phones to receive mROAD (mobilizing to Reduce Overuse of Alcohol in the ED), an SMS text message–based extension of the ED screening program. mROAD is a 7-day program of twice-daily SMS text messages based on the National Institutes of Health’s Rethinking Drinking campaign. Participants were allocated to a control group (daily sham text messages without specific guidance on behaviors, such as “Thanks for taking part!”) or to the mROAD intervention group. Patients were interviewed at 30 days to assess acceptability, satisfaction, and changes in drinking behavior. Satisfaction was examined descriptively. Pre and post measurements of drinking behaviors and motivation were compared, as were differences in change scores between the intervention arms. Results: Of 1028 patients screened, 95 (9.2%) exhibited risky alcohol use based on AUDIT, and 23/95 (24%) of those patients did not own an SMS text messaging–capable phone; this left 72/95 (76%) eligible patients. Among eligible participants, 48/72 (67%) agreed to enroll; 31/48 (65%) achieved follow-up (18/24 (75%) in the intervention group and 13/24 (55%) in the control group). Participants who completed follow-up reported high satisfaction. Changes in behavior were similar between the arms. Overall, the number of drinking days reported in the prior 30 days decreased by 5.0 (95% CI 1.7-8.3; P=.004), and the number of heavy drinking days decreased by 4.1 (95% CI 1.0 to 7.15, P=.01). Patients reported an 11-point increase (95% CI 2.6-20, P=.01, 10% overall increase) in motivation to change alcohol use via the Change Questionnaire. The were no statistical differences in drinking days, heavy drinking days, or motivation to change between the arms. Conclusions: The mROAD trial was feasible. Over three-quarters of ED patients with risky alcohol use owned a text message–capable phone, and two-thirds of these patients were willing to participate; only 1 patient opted out of the intervention. Although 35% of patients were lost to follow-up at 30 days, those patients who did follow up had favorable impressions of the program; more than 90% reported that SMS text messages were a “good way to teach,” and 89% of intervention arm participants enjoyed the program and found that the messages were motivating. Both the mROAD and sham message groups showed promising changes in alcohol use and motivation to change. mROAD is a feasible intervention that may reduce rates of risky alcohol use in ED patients. Trial Registration: ClinicalTrials.gov NCT02158949; https://clinicaltrials.gov/ct2/show/NCT02158949 %M 32496203 %R 10.2196/17557 %U http://mhealth.jmir.org/2020/6/e17557/ %U https://doi.org/10.2196/17557 %U http://www.ncbi.nlm.nih.gov/pubmed/32496203 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16658 %T Use of Smartphones to Detect Diabetic Retinopathy: Scoping Review and Meta-Analysis of Diagnostic Test Accuracy Studies %A Tan,Choon Han %A Kyaw,Bhone Myint %A Smith,Helen %A Tan,Colin S %A Tudor Car,Lorainne %+ Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, Singapore, 65 6904 1258, lorainne.tudor.car@ntu.edu.sg %K diabetic retinopathy %K smartphone %K mobile phone %K ophthalmoscopy %K artificial intelligence %K telemedicine %D 2020 %7 15.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Diabetic retinopathy (DR), a common complication of diabetes mellitus, is the leading cause of impaired vision in adults worldwide. Smartphone ophthalmoscopy involves using a smartphone camera for digital retinal imaging. Utilizing smartphones to detect DR is potentially more affordable, accessible, and easier to use than conventional methods. Objective: This study aimed to determine the diagnostic accuracy of various smartphone ophthalmoscopy approaches for detecting DR in diabetic patients. Methods: We performed an electronic search on the Medical Literature Analysis and Retrieval System Online (MEDLINE), EMBASE, and Cochrane Library for literature published from January 2000 to November 2018. We included studies involving diabetic patients, which compared the diagnostic accuracy of smartphone ophthalmoscopy for detecting DR to an accurate or commonly employed reference standard, such as indirect ophthalmoscopy, slit-lamp biomicroscopy, and tabletop fundus photography. Two reviewers independently screened studies against the inclusion criteria, extracted data, and assessed the quality of included studies using the Quality Assessment of Diagnostic Accuracy Studies–2 tool, with disagreements resolved via consensus. Sensitivity and specificity were pooled using the random effects model. A summary receiver operating characteristic (SROC) curve was constructed. This review is reported in line with the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies guidelines. Results: In all, nine studies involving 1430 participants were included. Most studies were of high quality, except one study with limited applicability because of its reference standard. The pooled sensitivity and specificity for detecting any DR was 87% (95% CI 74%-94%) and 94% (95% CI 81%-98%); mild nonproliferative DR (NPDR) was 39% (95% CI 10%-79%) and 95% (95% CI 91%-98%); moderate NPDR was 71% (95% CI 57%-81%) and 95% (95% CI 88%-98%); severe NPDR was 80% (95% CI 49%-94%) and 97% (95% CI 88%-99%); proliferative DR (PDR) was 92% (95% CI 79%-97%) and 99% (95% CI 96%-99%); diabetic macular edema was 79% (95% CI 63%-89%) and 93% (95% CI 82%-97%); and referral-warranted DR was 91% (95% CI 86%-94%) and 89% (95% CI 56%-98%). The area under SROC curve ranged from 0.879 to 0.979. The diagnostic odds ratio ranged from 11.3 to 1225. Conclusions: We found heterogeneous evidence showing that smartphone ophthalmoscopy performs well in detecting DR. The diagnostic accuracy for PDR was highest. Future studies should standardize reference criteria and classification criteria and evaluate other available forms of smartphone ophthalmoscopy in primary care settings. %M 32347810 %R 10.2196/16658 %U http://www.jmir.org/2020/5/e16658/ %U https://doi.org/10.2196/16658 %U http://www.ncbi.nlm.nih.gov/pubmed/32347810 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15502 %T Preparing African American Men to Make Informed Prostate Cancer Screening Decisions: Development and Pilot Testing of an Interactive Online Decision Aid %A Allen,Jennifer Dacey %A Reich,Amanda %A Cuevas,Adolfo G %A Ladin,Keren %+ Department of Community Health, Tufts University, 574 Boston Ave, Suite 208, Medford, MA, 02421, United States, 1 617 627 3233, jennifer.allen@tufts.edu %K decision support techniques %K prostate neoplasms %K early detection of cancer %K decision making (shared) %K men’s health %K minority health %D 2020 %7 5.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: African American men are at a higher risk of developing and dying from prostate cancer compared to white men. The serum prostate-specific antigen (PSA) screening test has a high risk of false-positive results and overdiagnosis; therefore, it is not routinely recommended. Rather, men are encouraged to make individualized decisions with their medical providers, after being fully informed about its potential benefits, limitations, and risks. Objective: This study aimed to describe the development and pilot testing of an interactive Web-based decision aid (DA; Prostate Cancer Screening Preparation [PCSPrep]) for African American men, designed to promote informed decision making for prostate cancer screening. Methods: Four focus groups (n=33) were conducted to assess men’s reactions to DAs developed in prior studies and gather information to modify the content and format. The pilot test employed a pre-posttest evaluation design. A convenience sample of 41 men aged 45-70 years with no history of prostate cancer was recruited from community settings. Participants completed online surveys before and after using PCSPrep that assessed prostate cancer screening knowledge, decision self-efficacy, decisional conflict, and preparation for decision making. Results: Use of PCSPrep was associated with a significant increase in prostate cancer knowledge (49% vs 62% correct responses; P<.001), and men also experienced less decisional conflict (24 vs 15 on a scale of 0-100; P=.008). No changes in self-efficacy about decision making or screening preferences were observed. Most men (81%) reported that using PCSPrep prepared them to make informed decisions in partnership with their provider. Conclusions: PCSPrep was an acceptable DA that improved men’s knowledge, reduced decisional conflict, and promoted the perception of being prepared for shared decision making. Further research is needed to test the DA in a larger randomized trial. %M 32369032 %R 10.2196/15502 %U https://mhealth.jmir.org/2020/5/e15502 %U https://doi.org/10.2196/15502 %U http://www.ncbi.nlm.nih.gov/pubmed/32369032 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e16085 %T The Acceptability and Effectiveness of Web-Based Developmental Surveillance Programs: Rapid Review %A Baker,Jess %A Kohlhoff,Jane %A Onobrakpor,Se-Inyenede %A Woolfenden,Sue %A Smith,Rebecca %A Knebel,Constanze %A Eapen,Valsamma %+ The University of New South Wales, L1 Mental Health Centre, Liverpool Hospital, Liverpool, NSW, 2170, Australia, 61 2 9616 4205, jessica.baker@unsw.edu.au %K public health surveillance %K mass screening %K developmental disabilities %K neurodevelopmental disorders %K review literature as topic %K health care disparities %D 2020 %7 23.4.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Web-based developmental surveillance programs may be an innovative solution to improving the early detection of childhood developmental difficulties, especially within disadvantaged populations. Objective: This review aimed to identify the acceptability and effectiveness of web-based developmental surveillance programs for children aged 0 to 6 years. Methods: A total of 6 databases and gray literature were searched using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses–informed protocol. Data extraction included variables related to health equity. Results: In total, 20 studies were identified. Most papers implemented web-based versions of the Modified Checklist for Autism in Toddlers, Revised with Follow-Up screener for autism spectrum disorder or Parent Evaluation of Developmental Status screeners for broad developmental delay. Caregivers and practitioners indicated a preference for web-based screeners, primarily for user-friendliness, improved follow-up accuracy, time, and training efficiencies. Conclusions: Although evidence is limited as to the necessity of web- versus face-to-face–based developmental screening, there are clear efficiencies in its use. Trial Registration: PROSPERO CRD42019127894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=127894 %M 32324149 %R 10.2196/16085 %U http://mhealth.jmir.org/2020/4/e16085/ %U https://doi.org/10.2196/16085 %U http://www.ncbi.nlm.nih.gov/pubmed/32324149 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 1 %P e14632 %T An App for Identifying Children at Risk for Developmental Problems Using Multidimensional Computerized Adaptive Testing: Development and Usability Study %A Hsu,Chen-Fang %A Chien,Tsair-Wei %A Chow,Julie Chi %A Yeh,Yu-Tsen %A Chou,Willy %+ Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Chi Mei Medical Groups, No. 901, Chung Hwa Road, Yung Kung District, Tainan, 710, Taiwan, 886 62812811, ufan0101@ms22.hinet.net %K computer adaptive testing %K developmental delay %K multidimensional %K mobile phone %K screening %D 2020 %7 16.4.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The use of multidomain developmental screening tools is a viable strategy for pediatric professionals to identify children at risk for developmental problems. However, a specialized multidimensional computer adaptive testing (MCAT) tool has not been developed to date. Objective: We developed an app using MCAT, combined with Multidimensional Screening in Child Development (MuSiC) for toddlers, to help patients and their family members or clinicians identify developmental problems at an earlier stage. Methods: We retrieved 75 item parameters from the MuSiC literature item bank for 1- to 3-year-old children, and simulated 1000 person measures from a normal standard distribution to compare the efficiency and precision of MCAT and nonadaptive testing (NAT) in five domains (ie, cognitive skills, language skills, gross motor skills, fine motor skills, and socioadaptive skills). The number of items saved and the cutoff points for the tool were determined and compared. We then developed an app for a Web-based assessment. Results: MCAT yielded significantly more precise measurements and was significantly more efficient than NAT, with 46.67% (=(75-40)/75) saving in item length when measurement differences less than 5% were allowed. Person-measure correlation coefficients were highly consistent among the five domains. Significantly fewer items were answered on MCAT than on NAT without compromising the precision of MCAT. Conclusions: Developing an app as a tool for parents that can be implemented with their own computers, tablets, or mobile phones for the online screening and prediction of developmental delays in toddlers is useful and not difficult. %M 32297867 %R 10.2196/14632 %U http://pediatrics.jmir.org/2020/1/e14632/ %U https://doi.org/10.2196/14632 %U http://www.ncbi.nlm.nih.gov/pubmed/32297867 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 4 %P e13657 %T Software for the Diagnosis of Sarcopenia in Community-Dwelling Older Adults: Design and Validation Study %A Lera,Lydia %A Angel,Bárbara %A Márquez,Carlos %A Saguez,Rodrigo %A Albala,Cecilia %+ Public Health Nutrition Unit, Institute of Nutrition and Food Technology, University of Chile, El Libano 5524, comuna Macul, Santiago de Chile, 7810000, Chile, 56 229781537, llera@inta.uchile.cl %K sarcopenia %K software %K elderly %K muscle %K mHealth %D 2020 %7 13.4.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: The usual diagnosis of sarcopenia requires a dual-energy x-ray absorptiometry (DXA) exam, which has low accessibility in primary care for Latin American countries. Objective: The aim of this study is to design and validate software for mobile devices (Android, IOS) and computers, based on an adapted version of the diagnostic algorithm of sarcopenia proposed by the European Working Group on Sarcopenia in Older People (EWGSOP). Methods: Follow-up exams were conducted on 430 community-dwelling Chileans 60 years and older (mean 68.2 years, SD 4.9) participating in the IsaMayor and Alexandros cohorts designed to study sarcopenia and disability associated with obesity, respectively. All the participants from the cohorts were randomly selected from the registries of primary health care centers and, for this study, must have a DXA scan at baseline. The software (HTSMayor) was designed according to an adapted version of the algorithm proposed by the EWGSOP and was divided into four phases: longitudinal validation of diagnostic algorithm of sarcopenia, alpha version, beta version, and release version. The software estimates appendicular skeletal muscle mass (ASM) using an anthropometric equation or DXA measurements with Chilean cut-off points. The predictive validation of the algorithm was estimated, comparing functional limitations (at least one activity of daily living, two instrumental activities of daily living, or three mobility limitations), falls, and osteoporosis at follow-ups in patients with and without sarcopenia at baseline, using adjusted logistic models. Results: After a median follow-up of 4.8 years (2078.4 person-years), 37 (9.9%) new cases of sarcopenia, out of the 374 patients without sarcopenia at baseline, were identified (incidence density rate=1.78 per 100 person-years). ASM estimated with the anthropometric equation showed both a high sensitivity and specificity as compared with those estimated by DXA measurements, yielding a concordance of 0.96. The diagnostic algorithm of sarcopenia considered in the software with the equation showed both a high sensitivity (82.1%) and specificity (94.9%) when compared with DXA (reference standard). Adults without sarcopenia (at baseline) showed better physical performance (after approximately 5 years) than adults with sarcopenia. Loss of functionality was greater in adults with sarcopenia (OR 5.0, 95% CI 2.2-11.4) than in adults without sarcopenia. In addition, the risks of falls (OR 2.2, 95% CI 1.1-4.3) and osteoporosis (OR 2.8, 95% CI 1.2-6.6) were higher in older persons with sarcopenia than those without sarcopenia. The measurements and results were completed for the beta and release tests with a mean time of 10 minutes and 11 minutes, respectively. Conclusions: We developed and validated a software for the diagnosis of sarcopenia in older Chilean adults that can be used on a mobile device or a computer with good sensitivity and specificity, thus allowing for the development of programs for the prevention, delay, or reversal of this disease. To our knowledge, HTSMayor is the first software to diagnose sarcopenia. International Registered Report Identifier (IRRID): RR2-10.2196/13657 %M 32281942 %R 10.2196/13657 %U https://medinform.jmir.org/2020/4/e13657 %U https://doi.org/10.2196/13657 %U http://www.ncbi.nlm.nih.gov/pubmed/32281942 %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 %@ 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 %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e16683 %T Using Mobile Health Tools to Engage Rural Underserved Individuals in a Diabetes Education Program in South Texas: Feasibility Study %A Yin,Zenong %A Lesser,Janna %A Paiva,Kristi A %A Zapata Jr,Jose %A Moreno-Vasquez,Andrea %A Grigsby,Timothy J %A Ryan-Pettes,Stacy R %A Parra-Medina,Deborah %A Estrada,Vanessa %A Li,Shiyu %A Wang,Jing %+ School of Nursing, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, United States, 1 210 450 8561, wangj1@uthscsa.edu %K Screening, Brief Intervention, and Referral to Treatment (SBIRT) %K Hispanic Americans %K behavioral economics %K rural population %K diabetes %K screening %D 2020 %7 24.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Access to diabetes education and resources for diabetes self-management is limited in rural communities, despite higher rates of diabetes in rural populations compared with urban populations. Technology and mobile health (mHealth) interventions can reduce barriers and improve access to diabetes education in rural communities. Screening, Brief Intervention, and Referral to Treatment (SBIRT) and financial incentives can be used with mHealth interventions to increase the uptake of diabetes education; however, studies have not examined their combined use for diabetes self-management in rural settings. Objective: This two-phase Stage 1 feasibility study aimed to use a mixed methods design to examine the feasibility and acceptability of an mHealth diabetes education program combining SBIRT and financial incentives to engage rural individuals. Methods: In Phase 1, we aimed to develop, adapt, and refine the intervention protocol. In Phase 2, a 3-month quasi-experimental study was conducted with individuals from 2 rural communities in South Texas. Study participants were individuals who attended free diabetes screening events in their community. Those with low or medium risk received health education material, whereas those with high risk or those with a previous diagnosis of diabetes participated in motivational interviewing and enrolled in the 6-week mHealth Diabetes Self-Management Education Program under either an unconditional or aversion incentive contract. The participants returned for a 3-month follow-up. Feasibility and acceptability of the intervention were determined by the rate of participant recruitment and retention, the fidelity of program delivery and compliance, and the participant’s satisfaction with the intervention program. Results: Of the 98 screened rural community members in South Texas, 72 individuals met the study eligibility and 62 individuals agreed to enroll in the study. The sample was predominately female and Hispanic, with an average age of 52.6 years. The feedback from study participants indicated high levels of satisfaction with the mHealth diabetes education program. In the poststudy survey, the participants reported high levels of confidence to continue lifestyle modifications, that is, weight loss, physical activity, and diet. The retention rate was 50% at the 3-month follow-up. Participation in the intervention was high at the beginning and dissipated in the later weeks regardless of the incentive contract type. Positive changes were observed in weight (mean -2.64, SD 6.01; P<.05) and glycemic control index (-.30; P<.05) in all participants from baseline to follow-up. Conclusions: The finding showed strong feasibility and acceptability of study recruitment and enrollment. The participants’ participation and retention were reasonable given the unforeseen events that impacted the study communities during the study period. Combining mHealth with SBIRT has the potential to reach individuals with need to participate in diabetes education in rural communities. %M 32207694 %R 10.2196/16683 %U http://mhealth.jmir.org/2020/3/e16683/ %U https://doi.org/10.2196/16683 %U http://www.ncbi.nlm.nih.gov/pubmed/32207694 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e15419 %T Evaluating the Feasibility and Acceptability of a Mobile Health–Based Female Community Health Volunteer Program for Hypertension Control in Rural Nepal: Cross-Sectional Study %A Ni,Zhao %A Atluri,Namratha %A Shaw,Ryan J %A Tan,Jingru %A Khan,Kinza %A Merk,Helena %A Ge,Yunfan %A Shrestha,Shrinkhala %A Shrestha,Abha %A Vasudevan,Lavanya %A Karmacharya,Biraj %A Yan,Lijing L %+ Kathmandu University, BP Highway, Panauti 45209, Kathmandu, Nepal, 977 11 490497, birajmk@gmail.com %K hypertension %K female community health volunteers %K mHealth %D 2020 %7 9.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hypertension is a major modifiable risk factor for cardiovascular disease, the world’s leading cause of death. The prevalence of hypertension is disproportionately higher in South Asian countries than in other regions of the world. Screening for hypertension in primary care settings remains a challenge in many South Asian countries, including Nepal. Nepal is located in the Himalayan Mountains region, posing significant geographical challenges for its rural citizens to access primary health care and service delivery. This barrier increases the costs and inconvenience for rural Nepalis to access hypertension screening and treatment. As a result, the prevalence of hypertension in Nepal tripled in the last 25 years to 22.4%-38.6%. Nepal’s Ministry of Health and Population relies on female community health volunteers to link health centers and communities to provide basic health services. Over 50,000 of these volunteers in Nepal have received basic health care training and are assigned to take care of maternal and child health. Due to limited health care resources, adopting new methods to control hypertension is an urgent need in Nepal. Several recent studies in Nepal have recommended extending the role of female community health volunteers to include hypertension management through blood pressure monitoring and home-based education. Objective: The goal of this study was to assess if a mobile health–based female community health volunteer approach of combining the traditional community health volunteer program with digital technologies would be feasible and acceptable in rural Nepal. Methods: In this study, we recruited 17 female community health volunteers and extended their role from maternal and child health to hypertension management through screening blood pressures. Results: All 17 female community health volunteers successfully measured 1113 rural Nepalis’ blood pressures, identified 169 hypertensive patients, and collected health behaviors data of the 169 hypertensive patients. Among the 169 patients, 70% of them had a mobile phone, and 92% were interested in receiving health-related information via a mobile phone. Among those who were interested in receiving information via a mobile phone, 84% preferred voice calls, and 7% and 1% preferred texting and apps, respectively. Conclusions: Results from this study indicate that a digital health intervention that leverages feature-phones combined with female community health volunteers may be an acceptable and pragmatic way to implement an evidence-based program to reduce hypertension in rural Nepal. %M 32149712 %R 10.2196/15419 %U http://mhealth.jmir.org/2020/3/e15419/ %U https://doi.org/10.2196/15419 %U http://www.ncbi.nlm.nih.gov/pubmed/32149712 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e15553 %T The Systematic Medical Appraisal Referral and Treatment Mental Health Project: Quasi-Experimental Study to Evaluate a Technology-Enabled Mental Health Services Delivery Model Implemented in Rural India %A Maulik,Pallab K %A Devarapalli,Siddhardha %A Kallakuri,Sudha %A Bhattacharya,Amritendu %A Peiris,David %A Patel,Anushka %+ George Insitute for Global Health, 311-312 Elegance Tower, New Delhi, 110025, India, 91 8800493204, pmaulik@georgeinstitute.org.in %K mental health services %K mHealth %K rural %K India %K mental disorders %K primary health care %D 2020 %7 27.2.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Although around 10% of Indians experience depression, anxiety, or alcohol use disorders, very few receive adequate mental health care, especially in rural communities. Stigma and limited availability of mental health services contribute to this treatment gap. The Systematic Medical Appraisal Referral and Treatment Mental Health project aimed to address this gap. Objective: This study aimed to evaluate the effectiveness of an intervention in increasing the use of mental health services and reducing depression and anxiety scores among individuals at high risk of common mental disorders. Methods: A before-after study was conducted from 2014 to 2019 in 12 villages in Andhra Pradesh, India. The intervention comprised a community antistigma campaign, with the training of lay village health workers and primary care doctors to identify and manage individuals with stress, depression, and suicide risk using an electronic clinical decision support system. Results: In total, 900 of 22,046 (4.08%) adults screened by health workers had increased stress, depression, or suicide risk and were referred to a primary care doctor. At follow-up, 731 out of 900 (81.2%) reported visiting the doctor for their mental health symptoms, compared with 3.3% (30/900) at baseline (odds ratio 133.3, 95% CI 89.0 to 199.7; P<.001). Mean depression and anxiety scores were significantly lower postintervention compared with baseline from 13.4 to 3.1 (P<.001) and from 12.9 to 1.9 (P<.001), respectively. Conclusions: The intervention was associated with a marked increase in service uptake and clinically important reductions in depression and anxiety symptom scores. This will be further evaluated in a large-scale cluster randomized controlled trial. %M 32130125 %R 10.2196/15553 %U http://www.jmir.org/2020/2/e15553/ %U https://doi.org/10.2196/15553 %U http://www.ncbi.nlm.nih.gov/pubmed/32130125 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e14551 %T Tools for App- and Web-Based Self-Testing of Cognitive Impairment: Systematic Search and Evaluation %A Charalambous,Anna Pavlina %A Pye,Annie %A Yeung,Wai Kent %A Leroi,Iracema %A Neil,Malcolm %A Thodi,Chryssoula %A Dawes,Piers %+ Manchester Centre for Audiology and Deafness, University of Manchester and the Manchester Academic Health Sciences Centre, A3.09 Ellen Wilkinson Building, Manchester, M13 9PL, United Kingdom, 44 1613061758, piers.dawes@manchester.ac.uk %K telemedicine %K eHealth %K mHealth %K dementia %K mild cognitive impairment %K self-assessment %D 2020 %7 17.1.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Tools for app- and Web-based self-testing for identification of cognitive impairment are widely available but are of uncertain quality. Objective: The objective of this study was to undertake a scoping review of app- and Web-based self-tests for cognitive impairment and determine the validity of these tests. Methods: We conducted systematic searches in electronic databases, including Google search, Google Play Store, and iPhone Operating System App Store, using the search terms “Online OR Internet-based AND Memory OR Brain OR Dementia OR mild cognitive impairment OR MCI AND Test OR Screen OR Check.” Results: We identified 3057 tools, of which 25 were included in the review. Most tools meeting the inclusion criteria assessed multiple cognitive domains. The most frequently assessed domains were memory, attention, and executive function. We then conducted an electronic survey with the developers of the tools to identify data relating to development and validation of each tool. If no response to the survey was received, Google (to identify gray literature), Google Scholar, and Medical Literature Analysis and Retrieval System Online were searched using key terms “(name of developer, if available)” AND “(the name of the tool)” to identify any additional data. Only 7 tools had any information concerning psychometric quality, and only 1 tool reported data on performance norms, reliability, validity, sensitivity, and specificity for the detection of cognitive impairment. Conclusions: The number of cognitive self-assessment electronic health tools for cognitive impairment is increasing, but most are of uncertain quality. There is a need for well-validated tools and guidance for users concerning which tools provide reliable information about possible cognitive impairment that could warrant further investigation. %M 31951218 %R 10.2196/14551 %U https://www.jmir.org/2020/1/e14551 %U https://doi.org/10.2196/14551 %U http://www.ncbi.nlm.nih.gov/pubmed/31951218 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 12 %P e11643 %T How New Technologies Can Improve Prediction, Assessment, and Intervention in Obsessive-Compulsive Disorder (e-OCD): Review %A Ferreri,Florian %A Bourla,Alexis %A Peretti,Charles-Siegfried %A Segawa,Tomoyuki %A Jaafari,Nemat %A Mouchabac,Stéphane %+ Sorbonne Université, Department of Adult Psychiatry and Medical Psychology, APHP, Saint-Antoine Hospital, 184 rue du Faubourg Saint-Antoine, Paris, 75012, France, 33 149282635, alexis.bourla@aphp.fr %K obsessive-compulsive disorder %K ecological momentary assessment %K biofeedback %K digital biomarkers %K digital phenotyping %K mobile health %K virtual reality %K machine learning %D 2019 %7 10.12.2019 %9 Review %J JMIR Ment Health %G English %X Background: New technologies are set to profoundly change the way we understand and manage psychiatric disorders, including obsessive-compulsive disorder (OCD). Developments in imaging and biomarkers, along with medical informatics, may well allow for better assessments and interventions in the future. Recent advances in the concept of digital phenotype, which involves using computerized measurement tools to capture the characteristics of a given psychiatric disorder, is one paradigmatic example. Objective: The impact of new technologies on health professionals’ practice in OCD care remains to be determined. Recent developments could disrupt not just their clinical practices, but also their beliefs, ethics, and representations, even going so far as to question their professional culture. This study aimed to conduct an extensive review of new technologies in OCD. Methods: We conducted the review by looking for titles in the PubMed database up to December 2017 that contained the following terms: [Obsessive] AND [Smartphone] OR [phone] OR [Internet] OR [Device] OR [Wearable] OR [Mobile] OR [Machine learning] OR [Artificial] OR [Biofeedback] OR [Neurofeedback] OR [Momentary] OR [Computerized] OR [Heart rate variability] OR [actigraphy] OR [actimetry] OR [digital] OR [virtual reality] OR [Tele] OR [video]. Results: We analyzed 364 articles, of which 62 were included. Our review was divided into 3 parts: prediction, assessment (including diagnosis, screening, and monitoring), and intervention. Conclusions: The review showed that the place of connected objects, machine learning, and remote monitoring has yet to be defined in OCD. Smartphone assessment apps and the Web Screening Questionnaire demonstrated good sensitivity and adequate specificity for detecting OCD symptoms when compared with a full-length structured clinical interview. The ecological momentary assessment procedure may also represent a worthy addition to the current suite of assessment tools. In the field of intervention, CBT supported by smartphone, internet, or computer may not be more effective than that delivered by a qualified practitioner, but it is easy to use, well accepted by patients, reproducible, and cost-effective. Finally, new technologies are enabling the development of new therapies, including biofeedback and virtual reality, which focus on the learning of coping skills. For them to be used, these tools must be properly explained and tailored to individual physician and patient profiles. %M 31821153 %R 10.2196/11643 %U https://mental.jmir.org/2019/12/e11643 %U https://doi.org/10.2196/11643 %U http://www.ncbi.nlm.nih.gov/pubmed/31821153 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e13863 %T Accuracy of a Chatbot (Ada) in the Diagnosis of Mental Disorders: Comparative Case Study With Lay and Expert Users %A Jungmann,Stefanie Maria %A Klan,Timo %A Kuhn,Sebastian %A Jungmann,Florian %+ Department of Psychology, Johannes Gutenberg-University Mainz, Wallstraße 3, Mainz, 55122, Germany, 49 61313939201, jungmann@uni-mainz.de %K artificial intelligence %K eHealth %K mental disorders %K mHealth %K screening %K (mobile) app %K diagnostic %D 2019 %7 29.10.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Health apps for the screening and diagnosis of mental disorders have emerged in recent years on various levels (eg, patients, practitioners, and public health system). However, the diagnostic quality of these apps has not been (sufficiently) tested so far. Objective: The objective of this pilot study was to investigate the diagnostic quality of a health app for a broad spectrum of mental disorders and its dependency on expert knowledge. Methods: Two psychotherapists, two psychology students, and two laypersons each read 20 case vignettes with a broad spectrum of mental disorders. They used a health app (Ada—Your Health Guide) to get a diagnosis by entering the symptoms. Interrater reliabilities were computed between the diagnoses of the case vignettes and the results of the app for each user group. Results: Overall, there was a moderate diagnostic agreement (kappa=0.64) between the results of the app and the case vignettes for mental disorders in adulthood and a low diagnostic agreement (kappa=0.40) for mental disorders in childhood and adolescence. When psychotherapists applied the app, there was a good diagnostic agreement (kappa=0.78) regarding mental disorders in adulthood. The diagnostic agreement was moderate (kappa=0.55/0.60) for students and laypersons. For mental disorders in childhood and adolescence, a moderate diagnostic quality was found when psychotherapists (kappa=0.53) and students (kappa=0.41) used the app, whereas the quality was low for laypersons (kappa=0.29). On average, the app required 34 questions to be answered and 7 min to complete. Conclusions: The health app investigated here can represent an efficient diagnostic screening or help function for mental disorders in adulthood and has the potential to support especially diagnosticians in their work in various ways. The results of this pilot study provide a first indication that the diagnostic accuracy is user dependent and improvements in the app are needed especially for mental disorders in childhood and adolescence. %M 31663858 %R 10.2196/13863 %U http://formative.jmir.org/2019/4/e13863/ %U https://doi.org/10.2196/13863 %U http://www.ncbi.nlm.nih.gov/pubmed/31663858 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e12051 %T Validation of an mHealth App for Depression Screening and Monitoring (Psychologist in a Pocket): Correlational Study and Concurrence Analysis %A Ramos,Roann Munoz %A Cheng,Paula Glenda Ferrer %A Jonas,Stephan Michael %+ Department of Medical Informatics, RWTH Aachen University Hospital, Pauwelstrasse 30, Aachen, 52074, Germany, 49 2418080352, rramos@mi.rwth-aachen.de %K mobile health %K depression %K validation %K Psychologist in a Pocket %K PiaP %D 2019 %7 16.09.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) is a fast-growing professional sector. As of 2016, there were more than 259,000 mHealth apps available internationally. Although mHealth apps are growing in acceptance, relatively little attention and limited efforts have been invested to establish their scientific integrity through statistical validation. This paper presents the external validation of Psychologist in a Pocket (PiaP), an Android-based mental mHealth app which supports traditional approaches in depression screening and monitoring through the analysis of electronic text inputs in communication apps. Objective: The main objectives of the study were (1) to externally validate the construct of the depression lexicon of PiaP with standardized psychological paper-and-pencil tools and (2) to determine the comparability of PiaP, a new depression measure, with a psychological gold standard in identifying depression. Methods: College participants downloaded PiaP for a 2-week administration. Afterward, they were asked to complete 4 psychological depression instruments. Furthermore, 1-week and 2-week PiaP total scores (PTS) were correlated with (1) Beck Depression Index (BDI)-II and Center for Epidemiological Studies–Depression (CES-D) Scale for congruent construct validation, (2) Affect Balance Scale (ABS)–Negative Affect for convergent construct validation, and (3) Satisfaction With Life Scale (SWLS) and ABS–Positive Affect for divergent construct validation. In addition, concordance analysis between PiaP and BDI-II was performed. Results: On the basis of the Pearson product-moment correlation, significant positive correlations exist between (1) 1-week PTS and CES-D Scale, (2) 2-week PTS and BDI-II, and (3) PiaP 2-week PTS and SWLS. Concordance analysis (Bland-Altman plot and analysis) suggested that PiaP’s approach to depression screening is comparable with the gold standard (BDI-II). Conclusions: The evaluation of mental health has historically relied on subjective measurements. With the integration of novel approaches using mobile technology (and, by extension, mHealth apps) in mental health care, the validation process becomes more compelling to ensure their accuracy and credibility. This study suggests that PiaP’s approach to depression screening by analyzing electronic data is comparable with traditional and well-established depression instruments and can be used to augment the process of measuring depression symptoms. %M 31538946 %R 10.2196/12051 %U https://mhealth.jmir.org/2019/9/e12051/ %U https://doi.org/10.2196/12051 %U http://www.ncbi.nlm.nih.gov/pubmed/31538946 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e14172 %T A Tablet-Based App for Carpal Tunnel Syndrome Screening: Diagnostic Case-Control Study %A Fujita,Koji %A Watanabe,Takuro %A Kuroiwa,Tomoyuki %A Sasaki,Toru %A Nimura,Akimoto %A Sugiura,Yuta %+ Department of Orthopedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-ku, Tokyo, 1138519, Japan, 81 358035279, fujiorth@tmd.ac.jp %K carpal tunnel syndrome %K screening test %K movement %K thumb %D 2019 %7 13.09.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Carpal tunnel syndrome (CTS), the most common neuropathy, is caused by a compression of the median nerve in the carpal tunnel and is related to aging. The initial symptom is numbness and pain of the median nerve distributed in the hand area, while thenar muscle atrophy occurs in advanced stages. This atrophy causes failure of thumb motion and results in clumsiness; even after surgery, thenar atrophy does not recover for an extended period. Medical examination and electrophysiological testing are useful to diagnose CTS; however, visits to the doctor tend to be delayed because patients neglect the symptom of numbness in the hand. To avoid thenar atrophy-related clumsiness, early detection of CTS is important. Objective: To establish a CTS screening system without medical examination, we have developed a tablet-based CTS detection system, focusing on movement of the thumb in CTS patients; we examined the accuracy of this screening system. Methods: A total of 22 female CTS patients, involving 29 hands, and 11 female non-CTS participants were recruited. The diagnosis of CTS was made by hand surgeons based on electrophysiological testing. We developed an iPad-based app that recorded the speed and timing of thumb movements while playing a short game. A support vector machine (SVM) learning algorithm was then used by comparing the thumb movements in each direction among CTS and non-CTS groups with leave-one-out cross-validation; with this, we conducted screening for CTS in real time. Results: The maximum speed of thumb movements between CTS and non-CTS groups in each direction did not show any statistically significant difference. The CTS group showed significantly slower average thumb movement speed in the 3 and 6 o’clock directions (P=.03 and P=.005, respectively). The CTS group also took a significantly longer time to reach the points in the 2, 3, 4, 5, 6, 8, 9, and 11 o’clock directions (P<.05). Cross-validation revealed that 27 of 29 CTS hands (93%) were classified as having CTS, while 2 of 29 CTS hands (7%) did not have CTS. CTS and non-CTS were classified with 93% sensitivity and 73% specificity. Conclusions: Our newly developed app could classify disturbance of thumb opposition movement and could be useful as a screening test for CTS patients. Outside of the clinic, this app might be able to detect middle-to-severe-stage CTS and prompt these patients to visit a hand surgery specialist; this may also lead to medical cost-savings. %M 31586365 %R 10.2196/14172 %U http://mhealth.jmir.org/2019/9/e14172/ %U https://doi.org/10.2196/14172 %U http://www.ncbi.nlm.nih.gov/pubmed/31586365 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e14657 %T Response Time as an Implicit Self-Schema Indicator for Depression Among Undergraduate Students: Preliminary Findings From a Mobile App–Based Depression Assessment %A Chung,Kyungmi %A Park,Jin Young %A Joung,DaYoung %A Jhung,Kyungun %+ Department of Psychiatry, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Simgokro 100gil 25 Seo-gu, Incheon, 22711, Republic of Korea, 82 32 290 3878, kyungun12@gmail.com %K depressive symptoms %K response time %K self-concept %K mobile phone %K mobile apps %K diagnostic screening programs %K self-assessment %K treatment adherence %K compliance %D 2019 %7 13.09.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Response times to depressive symptom items in a mobile-based depression screening instrument has potential as an implicit self-schema indicator for depression but has yet to be determined; the instrument was designed to readily record depressive symptoms experienced on a daily basis. In this study, the well-validated Korean version of the Center for Epidemiologic Studies Depression Scale-Revised (K-CESD-R) was adopted. Objective: The purpose of this study was to investigate the relationship between depression severity (ie, explicit measure: total K-CESD-R Mobile scores) and the latent trait of interest in schematic self-referent processing of depressive symptom items (ie, implicit measure: response times to items in the K-CESD-R Mobile scale). The purpose was to investigate this relationship among undergraduate students who had never been diagnosed with, but were at risk for, major depressive disorder (MDD) or comorbid MDD with other neurological or psychiatric disorders. Methods: A total of 70 participants—36 males (51%) and 34 females (49%)—aged 19-29 years (mean 22.66, SD 2.11), were asked to complete both mobile and standard K-CESD-R assessments via their own mobile phones. The mobile K-CESD-R sessions (binary scale: yes or no) were administered on a daily basis for 2 weeks. The standard K-CESD-R assessment (5-point scale) was administered on the final day of the 2-week study period; the assessment was delivered via text message, including a link to the survey, directly to participants’ mobile phones. Results: A total of 5 participants were excluded from data analysis. The result of polynomial regression analysis showed that the relationship between total K-CESD-R Mobile scores and the reaction times to the depressive symptom items was better explained by a quadratic trend—F (2, 62)=21.16, P<.001, R2=.41—than by a linear trend—F (1, 63)=25.43, P<.001, R2=.29. It was further revealed that the K-CESD-R Mobile app had excellent internal consistency (Cronbach alpha=.94); at least moderate concurrent validity with other depression scales, such as the Korean version of the Quick Inventory for Depressive Symptomatology-Self Report (ρ=.38, P=.002) and the Patient Health Questionnaire-9 (ρ=.48, P<.001); a high adherence rate for all participants (65/70, 93%); and a high follow-up rate for 10 participants whose mobile or standard K-CESD-R score was 13 or greater (8/10, 80%). Conclusions: As hypothesized, based on a self-schema model for depression that represented both item and person characteristics, the inverted U-shaped relationship between the explicit and implicit self-schema measures for depression showed the potential of an organizational breakdown; this also showed the potential for a subsequent return to efficient processing of schema-consistent information along a continuum, ranging from nondepression through mild depression to severe depression. Further, it is expected that the updated K-CESD-R Mobile app can play an important role in encouraging people at risk for depression to seek professional follow-up for mental health care. %M 31586362 %R 10.2196/14657 %U https://mhealth.jmir.org/2019/9/e14657/ %U https://doi.org/10.2196/14657 %U http://www.ncbi.nlm.nih.gov/pubmed/31586362 %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 6 %P e13641 %T Accuracy of mHealth Devices for Atrial Fibrillation Screening: Systematic Review %A Giebel,Godwin Denk %A Gissel,Christian %+ Health Economics, Department of Economics and Business, Justus Liebig University, Licher Strasse 62, Giessen, 35394, Germany, 49 641 99 22070, christian.gissel@wirtschaft.uni-giessen.de %K mHealth %K atrial fibrillation %K wearable %K app %D 2019 %7 16.6.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) devices can be used for the diagnosis of atrial fibrillation. Early diagnosis allows better treatment and prevention of secondary diseases like stroke. Although there are many different mHealth devices to screen for atrial fibrillation, their accuracy varies due to different technological approaches. Objective: We aimed to systematically review available studies that assessed the accuracy of mHealth devices in screening for atrial fibrillation. The goal of this review was to provide a comprehensive overview of available technologies, specific characteristics, and accuracy of all relevant studies. Methods: PubMed and Web of Science databases were searched from January 2014 until January 2019. Our systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses. We restricted the search by year of publication, language, noninvasive methods, and focus on diagnosis of atrial fibrillation. Articles not including information about the accuracy of devices were excluded. Results: We found 467 relevant studies. After removing duplicates and excluding ineligible records, 22 studies were included. The accuracy of mHealth devices varied among different technologies, their application settings, and study populations. We described and summarized the eligible studies. Conclusions: Our systematic review identifies different technologies for screening for atrial fibrillation with mHealth devices. A specific technology’s suitability depends on the underlying form of atrial fibrillation to be diagnosed. With the suitable use of mHealth, early diagnosis and treatment of atrial fibrillation are possible. Successful application of mHealth technologies could contribute to significantly reducing the cost of illness of atrial fibrillation. %M 31199337 %R 10.2196/13641 %U http://mhealth.jmir.org/2019/6/e13641/ %U https://doi.org/10.2196/13641 %U http://www.ncbi.nlm.nih.gov/pubmed/31199337 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 2 %P e12700 %T Creating an mHealth App for Colorectal Cancer Screening: User-Centered Design Approach %A Griffin,Lauren %A Lee,Donghee %A Jaisle,Alyssa %A Carek,Peter %A George,Thomas %A Laber,Eric %A Lok,Benjamin %A Modave,François %A Paskett,Electra %A Krieger,Janice %+ STEM Translational Communication Center, University of Florida, Weimer Hall, University of Florida, Gainesville, FL, 32611, United States, 1 2198053886, lngriffin@ufl.edu %K communication %K cell phone %K mobile phone %K culturally appropriate technology %K interdisciplinary research %K colon cancer %K cancer screening %D 2019 %7 08.05.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Patients are increasingly using mobile health (mHealth) apps to monitor their health and educate themselves about medical issues. Despite the increasing popularity of such apps, poor design and usability often lead to suboptimal continued use of these apps and subsequently to poor adherence to the behavior changes at which they are aimed. One solution to these design problems is for app developers to use user-centered design (UCD) principles to consider the context and needs of users during the development process. Objective: This study aimed to present a case study on the design and development process for an mHealth app that uses virtual human technology (VHT) to encourage colorectal cancer (CRC) screening among patients aged 50 years and above. Methods: We have first provided an overview of the project and discussed its utilization of VHT. We have then reviewed UCD principles and how they can be incorporated into the development of health apps. We have described how we used UCD processes during the app’s development. We have then discussed the unique roles played by communication researchers, computer scientists, clinicians, and community participants in creating an mHealth app that is credible, usable, effective, and accessible to its target audience. Results: The principles of UCD were woven throughout the project development, with researchers collecting feedback from patients and providers at all stages and using that feedback to improve the credibility, usability, effectiveness, and accessibility of the mHealth app. The app was designed in an iterative process, which encouraged feedback and improvement of the app and allowed teams from different fields to revisit topics and troubleshoot problems. Conclusions: Implementing a UCD process contributed to the development of an app, which not only reflected cross-disciplinary expertise but also the needs, wants, and concerns of patients. %M 31066688 %R 10.2196/12700 %U http://humanfactors.jmir.org/2019/2/e12700/ %U https://doi.org/10.2196/12700 %U http://www.ncbi.nlm.nih.gov/pubmed/31066688 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e13822 %T Detecting Developmental Delay and Autism Through Machine Learning Models Using Home Videos of Bangladeshi Children: Development and Validation Study %A Tariq,Qandeel %A Fleming,Scott Lanyon %A Schwartz,Jessey Nicole %A Dunlap,Kaitlyn %A Corbin,Conor %A Washington,Peter %A Kalantarian,Haik %A Khan,Naila Z %A Darmstadt,Gary L %A Wall,Dennis Paul %+ Division of Systems Medicine, Department of Pediatrics, Stanford University, 1265 Welch Road, Palo Alto, CA, 94305, United States, 1 6173946031, dpwall@stanford.edu %K autism %K autism spectrum disorder %K machine learning %K developmental delays %K clinical resources %K Bangladesh %K Biomedical Data Science %D 2019 %7 24.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Autism spectrum disorder (ASD) is currently diagnosed using qualitative methods that measure between 20-100 behaviors, can span multiple appointments with trained clinicians, and take several hours to complete. In our previous work, we demonstrated the efficacy of machine learning classifiers to accelerate the process by collecting home videos of US-based children, identifying a reduced subset of behavioral features that are scored by untrained raters using a machine learning classifier to determine children’s “risk scores” for autism. We achieved an accuracy of 92% (95% CI 88%-97%) on US videos using a classifier built on five features. Objective: Using videos of Bangladeshi children collected from Dhaka Shishu Children’s Hospital, we aim to scale our pipeline to another culture and other developmental delays, including speech and language conditions. Methods: Although our previously published and validated pipeline and set of classifiers perform reasonably well on Bangladeshi videos (75% accuracy, 95% CI 71%-78%), this work improves on that accuracy through the development and application of a powerful new technique for adaptive aggregation of crowdsourced labels. We enhance both the utility and performance of our model by building two classification layers: The first layer distinguishes between typical and atypical behavior, and the second layer distinguishes between ASD and non-ASD. In each of the layers, we use a unique rater weighting scheme to aggregate classification scores from different raters based on their expertise. We also determine Shapley values for the most important features in the classifier to understand how the classifiers’ process aligns with clinical intuition. Results: Using these techniques, we achieved an accuracy (area under the curve [AUC]) of 76% (SD 3%) and sensitivity of 76% (SD 4%) for identifying atypical children from among developmentally delayed children, and an accuracy (AUC) of 85% (SD 5%) and sensitivity of 76% (SD 6%) for identifying children with ASD from those predicted to have other developmental delays. Conclusions: These results show promise for using a mobile video-based and machine learning–directed approach for early and remote detection of autism in Bangladeshi children. This strategy could provide important resources for developmental health in developing countries with few clinical resources for diagnosis, helping children get access to care at an early age. Future research aimed at extending the application of this approach to identify a range of other conditions and determine the population-level burden of developmental disabilities and impairments will be of high value. %M 31017583 %R 10.2196/13822 %U http://www.jmir.org/2019/4/e13822/ %U https://doi.org/10.2196/13822 %U http://www.ncbi.nlm.nih.gov/pubmed/31017583 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e11959 %T A Noninvasive, Economical, and Instant-Result Method to Diagnose and Monitor Type 2 Diabetes Using Pulse Wave: Case-Control Study %A Hao,Yiming %A Cheng,Feng %A Pham,Minh %A Rein,Hayley %A Patel,Devashru %A Fang,Yuchen %A Feng,Yiyi %A Yan,Jin %A Song,Xueyang %A Yan,Haixia %A Wang,Yiqin %+ Shanghai Key Laboratory of Health Identification and Assessment/Laboratory of Traditional Chinese Medicine Four Diagnostic Information, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai,, China, 86 21 51322447, wangyiqin2380@sina.com %K type 2 diabetes %K hypertension %K hyperlipidemia %K pulse wave analysis %K diagnosis %D 2019 %7 23.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: We should pay more attention to the long-term monitoring and early warning of type 2 diabetes and its complications. The traditional blood glucose tests are traumatic and cannot effectively monitor the development of diabetic complications. The development of mobile health is changing rapidly. Therefore, we are interested in developing a new noninvasive, economical, and instant-result method to accurately diagnose and monitor type 2 diabetes and its complications. Objective: We aimed to determine whether type 2 diabetes and its complications, including hypertension and hyperlipidemia, could be diagnosed and monitored by using pulse wave. Methods: We collected the pulse wave parameters from 50 healthy people, 139 diabetic patients without hypertension and hyperlipidemia, 133 diabetic patients with hypertension, 70 diabetic patients with hyperlipidemia, and 75 diabetic patients with hypertension and hyperlipidemia. The pulse wave parameters showing significant differences among these groups were identified. Various machine learning models such as linear discriminant analysis, support vector machines (SVMs), and random forests were applied to classify the control group, diabetic patients, and diabetic patients with complications. Results: There were significant differences in several pulse wave parameters among the 5 groups. The parameters height of tidal wave (h3), time distance between the start point of pulse wave and dominant wave (t1), and width of percussion wave in its one-third height position (W) increase and the height of dicrotic wave (h5) decreases when people develop diabetes. The parameters height of dominant wave (h1), h3, and height of dicrotic notch (h4) are found to be higher in diabetic patients with hypertension, whereas h5 is lower in diabetic patients with hyperlipidemia. For detecting diabetes, the method with the highest out-of-sample prediction accuracy is SVM with polynomial kernel. The algorithm can detect diabetes with 96.35% accuracy. However, all the algorithms have a low accuracy when predicting diabetic patients with hypertension and hyperlipidemia (below 70%). Conclusions: The results demonstrated that the noninvasive and convenient pulse-taking diagnosis described in this paper has the potential to become a low-cost and accurate method to monitor the development of diabetes. We are collecting more data to improve the accuracy for detecting hypertension and hyperlipidemia among diabetic patients. Mobile devices such as sport bands, smart watches, and other diagnostic tools are being developed based on the pulse wave method to improve the diagnosis and monitoring of diabetes, hypertension, and hyperlipidemia. %M 31012863 %R 10.2196/11959 %U http://mhealth.jmir.org/2019/4/e11959/ %U https://doi.org/10.2196/11959 %U http://www.ncbi.nlm.nih.gov/pubmed/31012863 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e10216 %T A Mobile Web App to Improve Health Screening Uptake in Men (ScreenMen): Utility and Usability Evaluation Study %A Teo,Chin Hai %A Ng,Chirk Jenn %A Lo,Sin Kuang %A Lim,Chip Dong %A White,Alan %+ Department of Primary Care Medicine, University of Malaya eHealth Initiative, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia, 60 37949 ext 2306, ngcj@um.edu.my %K internet %K mHealth %K eHealth %K mass screening %K health behavior %K men’s health %D 2019 %7 15.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Globally, the uptake of health screening is suboptimal, especially in men and those of younger age. In view of the increasing internet access and mobile phone ownership, ScreenMen, a mobile Web app, was developed to improve health screening uptake in men. Objective: This study aimed to evaluate the utility and usability of ScreenMen. Methods: This study used both qualitative and quantitative methods. Healthy men working in a banking institution were recruited to participate in this study. They were purposively sampled according to job position, age, education level, and screening status. Men were asked to use ScreenMen independently while the screen activities were being recorded. Once completed, retrospective think aloud with playback was conducted with men to obtain their feedback. They were asked to answer the System Usability Scale (SUS). Intention to undergo screening pre- and postintervention was also measured. Qualitative data were analyzed using a framework approach followed by thematic analysis. For quantitative data, the mean SUS score was calculated and change in intention to screening was analyzed using McNemar test. Results: In total, 24 men participated in this study. On the basis of the qualitative data, men found ScreenMen useful as they could learn more about their health risks and screening. They found ScreenMen convenient to use, which might trigger men to undergo screening. In terms of usability, men thought that ScreenMen was user-friendly and easy to understand. The key revision done on utility was the addition of a reminder function, whereas for usability, the revisions done were in terms of attracting and gaining users’ trust, improving learnability, and making ScreenMen usable to all types of users. To attract men to use it, ScreenMen was introduced to users in terms of improving health instead of going for screening. Another important revision made was emphasizing the screening tests the users do not need, instead of just informing them about the screening tests they need. A Quick Assessment Mode was also added for users with limited attention span. The quantitative data showed that 8 out of 23 men (35%) planned to attend screening earlier than intended after using the ScreenMen. Furthermore, 4 out of 12 (33%) men who were in the precontemplation stage changed to either contemplation or preparation stage after using ScreenMen with P=.13. In terms of usability, the mean SUS score of 76.4 (SD 7.72) indicated that ScreenMen had good usability. Conclusions: This study showed that ScreenMen was acceptable to men in terms of its utility and usability. The preliminary data suggested that ScreenMen might increase men’s intention to undergo screening. This paper also presented key lessons learned from the beta testing, which is useful for public health experts and researchers when developing a user-centered mobile Web app. %M 30985280 %R 10.2196/10216 %U https://mhealth.jmir.org/2019/4/e10216/ %U https://doi.org/10.2196/10216 %U http://www.ncbi.nlm.nih.gov/pubmed/30985280 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e12033 %T A Mobile Phone–Based Approach for Hearing Screening of School-Age Children: Cross-Sectional Validation Study %A Chu,Yuan-Chia %A Cheng,Yen-Fu %A Lai,Ying-Hui %A Tsao,Yu %A Tu,Tzong-Yang %A Young,Shuenn Tsong %A Chen,Tzer-Shyong %A Chung,Yu-Fang %A Lai,Feipei %A Liao,Wen-Huei %+ Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, No 201, Sec 2, Shipai Rd, Beitou District, Taipei, 11217, Taiwan, 886 938102333, whliaovictor@gmail.com %K hearing tests %K telemedicine %K mobile apps %K audiometry, pure-tone %D 2019 %7 01.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pure-tone screening (PTS) is considered as the gold standard for hearing screening programs in school-age children. Mobile devices, such as mobile phones, have the potential for audiometric testing. Objective: This study aimed to demonstrate a new approach to rapidly screen hearing status and provide stratified test values, using a smartphone-based hearing screening app, for each screened ear of school-age children. Method: This was a prospective cohort study design. The proposed smartphone-based screening method and a standard sound-treated booth with PTS were used to assess 85 school-age children (170 ears). Sound-treated PTS involved applying 4 test tones to each tested ear: 500 Hz at 25 dB and 1000 Hz, 2000 Hz, and 4000 Hz at 20 dB. The results were classified as pass (normal hearing in the ear) or fail (possible hearing impairment). The proposed smartphone-based screening employs 20 stratified hearing scales. Thresholds were compared with those of pure-tone average (PTA). Results: A total of 85 subjects (170 ears), including 38 males and 47 females, aged between 11 and 12 years with a mean (SD) of 11 (0.5) years, participated in the trial. Both screening methods produced comparable pass and fail results (pass in 168 ears and fail in 2 ears). The smartphone-based screening detected moderate or worse hearing loss (average PTA>25 dB) accurately. Both the sensitivity and specificity of the smartphone-based screening method were calculated at 100%. Conclusions: The results of the proposed smartphone-based self-hearing test demonstrated high concordance with conventional PTS in a sound-treated booth. Our results suggested the potential use of the proposed smartphone-based hearing screening in a school-age population. %M 30932870 %R 10.2196/12033 %U https://mhealth.jmir.org/2019/4/e12033/ %U https://doi.org/10.2196/12033 %U http://www.ncbi.nlm.nih.gov/pubmed/30932870 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 3 %P e12392 %T Screening Depression and Related Conditions via Text Messaging Versus Interview Assessment: Protocol for a Randomized Study %A Jin,Haomiao %A Wu,Shinyi %+ Department of Adult Mental Health and Wellness, Suzanne Dworak-Peck School of Social Work, University of Southern California, 1149 South Hill Street, Suite 360, Los Angeles, CA, 90015, United States, 1 213 821 9361, haomiaoj@usc.edu %K depression %K diabetes %K comorbidity %K screening %K primary care %K health information technology %K information and communication technology %K text messaging %K patient-reported outcome measures %D 2019 %7 29.03.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Depression is an often underdiagnosed and, therefore, untreated comorbidity for low-income, racially or ethnically diverse patients with a chronic illness such as diabetes. Recent updates from the US Preventive Services Task Force guidelines in 2016 recommend depression screening for every adult but does not suggest the mode of assessment. Short message service (SMS) text messaging is an inexpensive, private, and scalable approach to provide depression screening and monitoring; it can also alleviate many barriers, such as transportation, childcare, and clinical visit time faced by the low-income population, in receiving a diagnosis of depression. Current evidence is inconsistent in comparing technology-mediated assessment versus interviewer (INTW) assessment in collecting sensitive health information, as some studies suggest that technology encourages self-disclosure while the other studies show the opposite effect. Objective: The proposed study will test the use of SMS text messaging to assess depression and its related conditions, including functional disability, pain, and anxiety, in low-income, culturally diverse, safety-net primary care populations with diabetes. The study will examine the concordance between SMS text message and interviewer assessments and evaluate test-retest reliability. Methods: The proposed study will adopt a randomized design with 200 patients assigned to four study groups: SMS/INTW, INTW/SMS, SMS/SMS, and INTW/INTW. The first two groups will be used to examine the concordance between SMS text message and interviewer assessments. The third and fourth groups will be used to evaluate test-retest reliability. Participants of the study will be recruited from the participants of the prior Diabetes-Depression Care-management Adoption Trial, a large comparative effectiveness research trial in collaboration with the Los Angeles County Department of Health Services. Test-retest reliability and concordance between SMS text message and interviewer assessments will be evaluated by the interclass correlation coefficient and the kappa statistic. Missing data patterns will be explored to understand whether participants are willing to self-disclose information related to depression in SMS text message assessments. Results: Recruitment of participants was conducted from June 2017 to November 2017. A total of 206 participants were enrolled: 52 (25.2%) in SMS/INTW, 53 (25.7%) in SMS/SMS, 49 (23.8%) in INTW/SMS, and 52 (25.2%) in INTW/INTW. The average age of the participants was 57.1 years (SD 9.2). A total of 57.8% (119/206) of participants were female, 93.2% (192/206) were Latino, and 77.7% (160/206) chose Spanish as their preferred language. Analysis of the SMS text message assessment shows the cost of distributing the 16 questions is about US $0.50 per person per assessment. Full results of the study will be reported elsewhere. Conclusions: This study is anticipated to establish the feasibility of using SMS text messaging to assess depression and its related conditions in low-income, culturally diverse, safety-net primary care populations with diabetes. We also expect to generate knowledge about whether patients in the targeted population are willing to reply and self-disclose sensitive information about depression and its related conditions through SMS text message assessments. International Registered Report Identifier (IRRID): DERR1-10.2196/12392 %M 30924787 %R 10.2196/12392 %U http://www.researchprotocols.org/2019/3/e12392/ %U https://doi.org/10.2196/12392 %U http://www.ncbi.nlm.nih.gov/pubmed/30924787 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e12284 %T Mobile Phone–Based Use of the Photoplethysmography Technique to Detect Atrial Fibrillation in Primary Care: Diagnostic Accuracy Study of the FibriCheck App %A Proesmans,Tine %A Mortelmans,Christophe %A Van Haelst,Ruth %A Verbrugge,Frederik %A Vandervoort,Pieter %A Vaes,Bert %+ Department of Public Health and Primary Care, University of Leuven, Blok J, Kapucijnenvoer 33, Leuven, 3000, Belgium, 32 16337468, bert.vaes@kuleuven.be %K atrial fibrillation %K electrocardiography %K photoplethysmography %K mobile phone %K algorithm %D 2019 %7 27.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone apps using photoplethysmography (PPG) technology through their built-in camera are becoming an attractive alternative for atrial fibrillation (AF) screening because of their low cost, convenience, and broad accessibility. However, some important questions concerning their diagnostic accuracy remain to be answered. Objective: This study tested the diagnostic accuracy of the FibriCheck AF algorithm for the detection of AF on the basis of mobile phone PPG and single-lead electrocardiography (ECG) signals. Methods: A convenience sample of patients aged 65 years and above, with or without a known history of AF, was recruited from 17 primary care facilities. Patients with an active pacemaker rhythm were excluded. A PPG signal was obtained with the rear camera of an iPhone 5S. Simultaneously, a single‑lead ECG was registered using a dermal patch with a wireless connection to the same mobile phone. PPG and single-lead ECG signals were analyzed using the FibriCheck AF algorithm. At the same time, a 12‑lead ECG was obtained and interpreted offline by independent cardiologists to determine the presence of AF. Results: A total of 45.7% (102/223) subjects were having AF. PPG signal quality was sufficient for analysis in 93% and single‑lead ECG quality was sufficient in 94% of the participants. After removing insufficient quality measurements, the sensitivity and specificity were 96% (95% CI 89%-99%) and 97% (95% CI 91%-99%) for the PPG signal versus 95% (95% CI 88%-98%) and 97% (95% CI 91%-99%) for the single‑lead ECG, respectively. False-positive results were mainly because of premature ectopic beats. PPG and single‑lead ECG techniques yielded adequate signal quality in 196 subjects and a similar diagnosis in 98.0% (192/196) subjects. Conclusions: The FibriCheck AF algorithm can accurately detect AF on the basis of mobile phone PPG and single-lead ECG signals in a primary care convenience sample. %M 30916656 %R 10.2196/12284 %U http://mhealth.jmir.org/2019/3/e12284/ %U https://doi.org/10.2196/12284 %U http://www.ncbi.nlm.nih.gov/pubmed/30916656 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12615 %T A Rapid, Mobile Neurocognitive Screening Test to Aid in Identifying Cognitive Impairment and Dementia (BrainCheck): Cohort Study %A Groppell,Samantha %A Soto-Ruiz,Karina M %A Flores,Benjamin %A Dawkins,William %A Smith,Isabella %A Eagleman,David M %A Katz,Yael %+ BrainCheck Inc, 2450 Holcombe Blvd Ste X+240, Houston, TX, 77021, United States, 1 8326816760, karina.soto.md@gmail.com %K dementia %K neurocognitive tests %K neurocognitive computerized assessment tools (NCAT) %K mild cognitive impairment (MCI) %K BrainCheck %K digital testing %K Alzheimer’s disease %K electronic neurocognitive tools %K computerized cognitive assessment %K digital cognitive assessment %D 2019 %7 21.03.2019 %9 Original Paper %J JMIR Aging %G English %X Background: The US population over the age of 65 is expected to double by the year 2050. Concordantly, the incidence of dementia is projected to increase. The subclinical stage of dementia begins years before signs and symptoms appear. Early detection of cognitive impairment and/or cognitive decline may allow for interventions to slow its progression. Furthermore, early detection may allow for implementation of care plans that may affect the quality of life of those affected and their caregivers. Objective: We sought to determine the accuracy and validity of BrainCheck Memory as a diagnostic aid for age-related cognitive impairment, as compared against physician diagnosis and other commonly used neurocognitive screening tests, including the Saint Louis University Mental Status (SLUMS) exam, the Mini-Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA). Methods: We tested 583 volunteers over the age of 49 from various community centers and living facilities in Houston, Texas. The volunteers were divided into five cohorts: a normative population and four comparison groups for the SLUMS exam, the MMSE, the MoCA, and physician diagnosis. Each comparison group completed their respective assessment and BrainCheck Memory. Results: A total of 398 subjects were included in the normative population. A total of 84 participants were in the SLUMS exam cohort, 51 in the MMSE cohort, 35 in the MoCA cohort, and 18 in the physician cohort. BrainCheck Memory assessments were significantly correlated to the SLUMS exam, with coefficients ranging from .5 to .7. Correlation coefficients for the MMSE and BrainCheck and the MoCA and BrainCheck were also significant. Of the 18 subjects evaluated by a physician, 9 (50%) were healthy, 6 (33%) were moderately impaired, and 3 (17%) were severely impaired. A significant difference was found between the severely and moderately impaired subjects and the healthy subjects (P=.02). We derived a BrainCheck Memory composite score that showed stronger correlations with the standard assessments as compared to the individual BrainCheck assessments. Receiver operating characteristic (ROC) curve analysis of this composite score found a sensitivity of 81% and a specificity of 94%. Conclusions: BrainCheck Memory provides a sensitive and specific metric for age-related cognitive impairment in older adults, with the advantages of a mobile, digital, and easy-to-use test. Trial Registration: ClinicalTrials.gov NCT03608722; https://clinicaltrials.gov/ct2/show/NCT03608722 (Archived by WebCite at http://www.webcitation.org/76JLoYUGf) %M 31518280 %R 10.2196/12615 %U http://aging.jmir.org/2019/1/e12615/ %U https://doi.org/10.2196/12615 %U http://www.ncbi.nlm.nih.gov/pubmed/31518280 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 3 %N 1 %P e9894 %T Mobile Health for Central Sleep Apnea Screening Among Patients With Stable Heart Failure: Single-Cohort, Open, Prospective Trial %A Treskes,Roderick Willem %A Maan,Arie C %A Verwey,Harriette Florence %A Schot,Robert %A Beeres,Saskia Lambertha Maria Anna %A Tops,Laurens F %A Van Der Velde,Enno Tjeerd %A Schalij,Martin Jan %A Slats,Annelies Margaretha %+ Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands, 31 0715262020, r.w.treskes@lumc.nl %K mobile health %K central sleep apnea %K heart failure %K prevention %K screening %K mobile phone %D 2019 %7 19.03.2019 %9 Original Paper %J JMIR Cardio %G English %X Background: Polysomnography is the gold standard for detection of central sleep apnea in patients with stable heart failure. However, this procedure is costly, time consuming, and a burden to the patient and therefore unsuitable as a screening method. An electronic health (eHealth) app to measure overnight oximetry may be an acceptable screening alternative, as it can be automatically analyzed and is less burdensome to patients. Objective: This study aimed to assess whether overnight pulse oximetry using a smartphone-compatible oximeter can be used to detect central sleep apnea in a population with stable heart failure. Methods: A total of 26 patients with stable heart failure underwent one night of both a polygraph examination and overnight saturation using a smartphone-compatible oximeter. The primary endpoint was agreement between the oxygen desaturation index (ODI) above or below 15 on the smartphone-compatible oximeter and the diagnosis of the polygraph. Results: The median age of patients was 66.4 (interquartile range, 62-71) years and 92% were men. The median body mass index was 27.1 (interquartile range, 24.4-30.8) kg/m2. Two patients were excluded due to incomplete data, and two other patients were excluded because they could not use a smartphone. Seven patients had central sleep apnea, and 6 patients had obstructive sleep apnea. Of the 7 (of 22, 32%) patients with central sleep apnea that were included in the analysis, 3 (13%) had an ODI≥15. Of all patients without central sleep apnea, 8 (36%) had an ODI<15. The McNemar test yielded a P value of .55. Conclusions: Oxygen desaturation measured by this smartphone-compatible oximeter is a weak predictor of central sleep apnea in patients with stable heart failure. %M 31758786 %R 10.2196/cardio.9894 %U http://cardio.jmir.org/2019/1/e9894/ %U https://doi.org/10.2196/cardio.9894 %U http://www.ncbi.nlm.nih.gov/pubmed/31758786 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e11437 %T Diagnostic Performance of a Smart Device With Photoplethysmography Technology for Atrial Fibrillation Detection: Pilot Study (Pre-mAFA II Registry) %A Fan,Yong-Yan %A Li,Yan-Guang %A Li,Jian %A Cheng,Wen-Kun %A Shan,Zhao-Liang %A Wang,Yu-Tang %A Guo,Yu-Tao %+ Department of Cardiology, Chinese People's Liberation Army General Hospital, 28 Fuxing Rd, Beijing, 100853, China, 86 13810021492, guoyutao2010@126.com %K atrial fibrillation %K photoplethysmography %K detection %K accuracy %K mobile phone %K smart band %K algorithm %D 2019 %7 05.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. The asymptomatic nature and paroxysmal frequency of AF lead to suboptimal early detection. A novel technology, photoplethysmography (PPG), has been developed for AF screening. However, there has been limited validation of mobile phone and smart band apps with PPG compared to 12-lead electrocardiograms (ECG). Objective: We investigated the feasibility and accuracy of a mobile phone and smart band for AF detection using pulse data measured by PPG. Methods: A total of 112 consecutive inpatients were recruited from the Chinese PLA General Hospital from March 15 to April 1, 2018. Participants were simultaneously tested with mobile phones (HUAWEI Mate 9, HUAWEI Honor 7X), smart bands (HUAWEI Band 2), and 12-lead ECG for 3 minutes. Results: In all, 108 patients (56 with normal sinus rhythm, 52 with persistent AF) were enrolled in the final analysis after excluding four patients with unclear cardiac rhythms. The corresponding sensitivity and specificity of the smart band PPG were 95.36% (95% CI 92.00%-97.40%) and 99.70% (95% CI 98.08%-99.98%), respectively. The positive predictive value of the smart band PPG was 99.63% (95% CI 97.61%-99.98%), the negative predictive value was 96.24% (95% CI 93.50%-97.90%), and the accuracy was 97.72% (95% CI 96.11%-98.70%). Moreover, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of mobile phones with PPG for AF detection were over 94%. There was no significant difference after further statistical analysis of the results from the different smart devices compared with the gold-standard ECG (P>.99). Conclusions: The algorithm based on mobile phones and smart bands with PPG demonstrated good performance in detecting AF and may represent a convenient tool for AF detection in at-risk individuals, allowing widespread screening of AF in the population. Trial Registration: Chinese Clinical Trial Registry ChiCTR-OOC-17014138; http://www.chictr.org.cn/showproj.aspx?proj=24191 (Archived by WebCite at http://www.webcitation/76WXknvE6) %M 30835243 %R 10.2196/11437 %U http://mhealth.jmir.org/2019/3/e11437/ %U https://doi.org/10.2196/11437 %U http://www.ncbi.nlm.nih.gov/pubmed/30835243 %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 %@ 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 %@ 1438-8871 %I JMIR Publications %V 20 %N 11 %P e10258 %T An Unsupervised Smart App–Optimized HIV Self-Testing Program in Montreal, Canada: Cross-Sectional Study %A Pant Pai,Nitika %A Smallwood,Megan %A Desjardins,Laurence %A Goyette,Alexandre %A Birkas,Krisztian G %A Vassal,Anne-Fanny %A Joseph,Lawrence %A Thomas,Réjean %+ Division of Clinical Epidemiology, Research Institute of McGill University Health Centre, 5252 Boul de Maisonneuve O, Montreal, QC, H4A 3S5, Canada, 1 5149341934 ext 44729, nitika.pai@mcgill.ca %K feasibility %K HIV %K impact %K mobile phone %K MSM %K self-testing %D 2018 %7 27.11.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Although HIV self-testing strategies have been recommended by the World Health Organization, HIV self-tests are not yet approved in Canada. Currently approved HIV self-tests offer toll-free lines that are insufficient for initiating expedited linkages to counseling and care, accurate interpretation, and support during HIV self-testing. We developed an innovative, multilingual software app called HIVSmart! to plug these gaps. Objective: This study aimed to test our app-optimized oral HIV self-testing strategy for feasibility in men who have sex with men (MSM) who presented to test at a large sexual health clinic (Clinique Médicale L’Actuel) in Montreal. Methods: Between July 2016 and February 2017, we offered a strategy consisting of the OraQuick In-Home HIV Test (an investigational device) and a tablet installed with the HIVSmart! app to study participants, who presented at a private office in the clinic, mimicking an unsupervised home environment. We evaluated the strategy for its feasibility, acceptability, and preference. Using the HIVSmart! app, participants were guided through the self-testing process. We determined feasibility with a metric defined as the completion rate, which consisted of the following 3 steps: (1) self-test conduct; (2) self-test interpretation; and (3) linkages to care. Participants independently performed, interpreted, recorded their self-test and result, engaged in pre- and posttest counseling, and sought linkages to care. Laboratory tests (p24, Western Blot, and RNA), as per country algorithms, were expedited, and linkages based on the rapid test status were arranged. Results: Mean age of the 451 participants enrolled was 34 (range, 18-73) years. Of all participants, 97.1% (438/451) completed and submitted the survey through the HIVSmart! app. In total, 84.7% (371/438) of the participants were well educated (beyond high school) and 52.5% (230/438) had been tested within the past 6 months. Of the 451, 11.5% (52/451) were on pre-exposure prophylaxis. Feasibility (completion rate), an average proportion of the 3 steps, was computed to be 96.6% (419/451). The acceptability of the strategy was high at 98.5% (451/458). A majority of the participants (448/451, 99.3%) were found to be self-tested and lab-confirmed negative and were counseled after self- and rapid tests. In total, 0.7% (3/451) of the participants who self-tested positive and were lab-confirmed positive were linked to a physician within the same day. Furthermore, 98.8% (417/422) of the participants found the app to be useful and 94.0% (424/451) were willing to recommend it to a friend or partner. Conclusions: The HIVSmart! app-optimized strategy was feasible, accepted, and preferred by an educated, urban MSM population of Montreal. With the app, participants were able to perform, interpret, store results, and get rapidly linked to care. The HIVSmart!-optimized, self-testing strategy could be adapted and contextualized to many at-risk populations within Canada and worldwide, thereby maximizing its public health impact. %M 30465709 %R 10.2196/10258 %U http://www.jmir.org/2018/11/e10258/ %U https://doi.org/10.2196/10258 %U http://www.ncbi.nlm.nih.gov/pubmed/30465709 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e196 %T Preferences of Underserved Chilean Women on a Mobile Technology Intervention for Cervical Cancer Screening: Qualitative Study %A Soto,Mauricio %A Martinez-Gutierrez,Javiera %A Momany,McKenzie %A Capurro,Daniel %A Ciampi Spode,Francis %A Cea,Emilia %A Mergudich,Tania %A Puschel,Klaus %+ Department of Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4686, Macul, Santiago,, Chile, 56 223548688, jmartigu@uc.cl %K mHealth %K cancer screening %K Latina women %D 2018 %7 20.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In Chile and Latin America, cervical cancer disproportionately affects women of low socioeconomic status. Mobile technology (mobile health, mHealth) may be able to address this disparity by targeting women in underserved populations. However, there is a lack of information regarding barriers to the implementation of mHealth interventions in underserved populations. Objective: The objective of this study was to investigate the use of cell phones and text messaging (short message service, SMS) in Latina women from disadvantaged communities to design an mHealth intervention for improving cervical cancer screening rates. Methods: We conducted 9 focus groups among women aged 25-64 years to better understand the implementation barriers and perceptions of a text message (SMS)–based intervention designed to improve cervical cancer screening rates. We used the PRECEDE-PROCEED model to categorize identified themes using template analysis. Results: Focus group results indicated that older women use mobile phones to receive calls from family and friends but seldom send text messages. Furthermore, they prefer personal contact with their health care providers regarding Papanicolaou (Pap) testing. Younger women, on the other hand, find text messaging easy to use and frequently send texts to family and friends. Importantly, women of all ages mentioned they would like to receive text messages about Pap tests. Factors that facilitate the uptake of the intervention include ease of access to Pap testing, inclusion of family members, and reminder messaging. Potential barriers include cost and the impersonal nature of messaging. Health team members support an mHealth intervention even though they acknowledge the potential barriers to this strategy. Overall, these results support the implementation of an mHealth intervention to increase cervical cancer screening rates. Conclusions: This study describes the opinions of women nonadherent to Pap testing on the potential use of mobile technologies for cervical cancer screening. Although the overall acceptance was positive, older women prefer personal contact and phone calls over text messaging. Information surrounding these preferences will aid in the implementation of effective strategies to improve cancer screening in underserved populations. %M 30459141 %R 10.2196/mhealth.9494 %U http://mhealth.jmir.org/2018/11/e196/ %U https://doi.org/10.2196/mhealth.9494 %U http://www.ncbi.nlm.nih.gov/pubmed/30459141 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e186 %T A Tablet-Based Mobile Hearing Screening System for Preschoolers: Design and Validation Study %A Yimtae,Kwanchanok %A Israsena,Pasin %A Thanawirattananit,Panida %A Seesutas,Sangvorn %A Saibua,Siwat %A Kasemsiri,Pornthep %A Noymai,Anukool %A Soonrach,Tharapong %+ National Electronics and Computer Technology Center, National Science and Technology Development Agency, 112 Thailand Science Park, Klong Luang, Pathumthani, Thailand, 66 5646900, pasin.israsena@nectec.or.th %K hearing screening %K mobile health %K speech audiometry %K hearing loss %D 2018 %7 23.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hearing ability is important for children to develop speech and language skills as they grow. After a mandatory newborn hearing screening, group or mass screening of children at later ages, such as at preschool age, is often practiced. For this practice to be effective and accessible in low-resource countries such as Thailand, innovative enabling tools that make use of pervasive mobile and smartphone technology should be considered. Objective: This study aims to develop a cost-effective, tablet-based hearing screening system that can perform a rapid minimal speech recognition level test. Methods: An Android-based screening app was developed. The screening protocol involved asking children to choose pictures corresponding to a set of predefined words heard at various sound levels offered in a specifically designed sequence. For the app, the set of words was validated, and their corresponding speech power levels were calibrated. We recruited 122 children, aged 4-5 years, during the development phase. Another 63 children of the same age were screened for their hearing abilities using the app in version 2. The results in terms of the sensitivity and specificity were compared with those measured using the conventional audiometric equipment. Results: For screening purposes, the sensitivity of the developed screening system version 2 was 76.67% (95% CI 59.07-88.21), and the specificity was 95.83% (95% CI 89.77-98.37) for screening children with mild hearing loss (pure-tone average threshold at 1, 2, and 4 kHz, >20 dB). The time taken for the screening of each child was 150.52 (SD 19.07) seconds (95% CI 145.71-155.32 seconds). The average time used for conventional play audiometry was 11.79 (SD 3.66) minutes (95% CI 10.85-12.71 minutes). Conclusions: This study shows the potential use of a tablet-based system for rapid and mobile hearing screening. The system was shown to have good overall sensitivity and specificity. Overall, the idea can be easily adopted for systems based on other languages. %M 30355558 %R 10.2196/mhealth.9560 %U http://mhealth.jmir.org/2018/10/e186/ %U https://doi.org/10.2196/mhealth.9560 %U http://www.ncbi.nlm.nih.gov/pubmed/30355558 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e142 %T Tobacco-Smoking, Alcohol-Drinking, and Betel-Quid-Chewing Behaviors: Development and Use of a Web-Based Survey System %A Hsu,Kuo-Yao %A Tsai,Yun-Fang %A Huang,Chu-Ching %A Yeh,Wen-Ling %A Chang,Kai-Ping %A Lin,Chen-Chun %A Chen,Ching-Yen %A Lee,Hsiu-Lan %+ School of Nursing, College of Medicine, Chang Gung University, 259, Wen-Hwa 1st Road, Tao-Yuan, 333, Taiwan, 886 32118800 ext 3204, yftsai@mail.cgu.edu.tw %K tobacco smoking %K alcohol drinking %K betel-quid chewing %K Web-based survey system %D 2018 %7 11.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smoking tobacco, drinking alcohol, and chewing betel quid are health-risk behaviors for several diseases, such as cancer, cardiovascular disease, and diabetes, with severe impacts on health. However, health care providers often have limited time to assess clients’ behaviors regarding smoking tobacco, drinking alcohol, and chewing betel quid and intervene, if needed. Objective: The objective of this study was to develop a Web-based survey system; determine the rates of tobacco-smoking, alcohol-drinking, and betel-quid-chewing behaviors; and estimate the efficiency of the system (time to complete the survey). Methods: Patients and their family members or friends were recruited from gastrointestinal medical–surgical, otolaryngology, orthopedics, and rehabilitation clinics or wards at a medical center in northern Taiwan. Data for this descriptive, cross-sectional study were extracted from a large series of research studies. A Web-based survey system was developed using a Linux, Apache, MySQL, PHP stack solution. The Web survey was set up to include four questionnaires: the Chinese-version Fagerstrom Tolerance Questionnaire, the Chinese-version Alcohol Use Disorders Identification Test, the Betel Nut Dependency Scale, and a sociodemographic form with several chronic diseases. After the participants completed the survey, the system automatically calculated their score, categorized their risk level for each behavior, and immediately presented and explained their results. The system also recorded the time each participant took to complete the survey. Results: Of 782 patient participants, 29.6% were addicted to nicotine, 13.3% were hazardous, harmful, or dependent alcohol drinkers, and 1.5% were dependent on chewing betel quid. Of 425 family or friend participants, 19.8% were addicted to nicotine, 5.6% were hazardous, harmful, or dependent alcohol drinkers, and 0.9% were dependent on chewing betel quid. Regarding the mean time to complete the survey, patients took 7.9 minutes (SD 3.0; range 3-20) and family members or friends took 7.7 minutes (SD 2.8; range 3-18). Most of the participants completed the survey within 5-10 minutes. Conclusions: The Web-based survey was easy to self-administer. Health care providers can use this Web-based survey system to save time in assessing these risk behaviors in clinical settings. All smokers had mild-to-severe nicotine addiction, and 5.6%-12.3% of patients and their family members or friends were at risk of alcohol dependence. Considering that these three behaviors, particularly in combination, dramatically increase the risk of esophageal cancer, appropriate and convenient interventions are necessary for preserving public health in Taiwan. %M 29891467 %R 10.2196/mhealth.9783 %U http://mhealth.jmir.org/2018/6/e142/ %U https://doi.org/10.2196/mhealth.9783 %U http://www.ncbi.nlm.nih.gov/pubmed/29891467 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e10662 %T A Mobile App for Identifying Individuals With Undiagnosed Diabetes and Prediabetes and for Promoting Behavior Change: 2-Year Prospective Study %A Leung,Angela YM %A Xu,Xin Yi %A Chau,Pui Hing %A Yu,Yee Tak Esther %A Cheung,Mike KT %A Wong,Carlos KH %A Fong,Daniel YT %A Wong,Janet YH %A Lam,Cindy LK %+ Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, GH528, 5th Floor, Core G, School of Nursing, Hung Hom, Kowloon, Hong Kong SAR,, China (Hong Kong), 852 27665587, angela.ym.leung@polyu.edu.hk %K diabetes mellitus %K prediabetes %K prediabetic state %K mobile apps %K lifestyle %D 2018 %7 24.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To decrease the burden of diabetes in society, early screening of undiagnosed diabetes and prediabetes is needed. Integrating a diabetes risk score into a mobile app would provide a useful platform to enable people to self-assess their risk of diabetes with ease. Objective: The objectives of this study were to (1) assess the profile of Diabetes Risk Score mobile app users, (2) determine the optimal cutoff value of the Finnish Diabetes Risk Score to identify undiagnosed diabetes and prediabetes in the Chinese population, (3) estimate users’ chance of developing diabetes within 2 years of using the app, and (4) investigate high-risk app users’ lifestyle behavior changes after ascertaining their risk level from the app. Methods: We conducted this 2-phase study among adults via mobile app and online survey from August 2014 to December 2016. Phase 1 adopted a cross-sectional design, with a descriptive analysis of the app users’ profile. We used a Cohen kappa score to show the agreement between the risk level (as shown in the app) and glycated hemoglobin test results. We used sensitivity, specificity, and area under the curve to determine the optimal cutoff value of the diabetes risk score in this population. Phase 2 was a prospective cohort study. We used a logistic regression model to estimate the chance of developing diabetes after using the app. Paired t tests compared high-risk app users’ lifestyle changes. Results: A total of 13,289 people used the app in phase 1a. After data cleaning, we considered 4549 of these as valid data. Most users were male, and 1811 (39.81%) had tertiary education or above. Among them, 188 (10.4%) users agreed to attend the health assessment in phase 1b. We recommend the optimal value of the diabetes risk score for identifying persons with undiagnosed diabetes and prediabetes to be 9, with an area under the receiver operating characteristic curve of 0.67 (95% CI 0.60-0.74), sensitivity of 0.70 (95% CI 0.58-0.80), and specificity of 0.57 (95% CI 0.47-0.66). At the 2-year follow-up, people in the high-risk group had a higher chance of developing diabetes (odds ratio 4.59, P=.048) than the low-risk group. The high-risk app users improved their daily intake of vegetables (baseline: mean 0.76, SD 0.43; follow-up: mean 0.93, SD 0.26; t81=–3.77, P<.001) and daily exercise (baseline: mean 0.40, SD 0.49; follow-up: mean 0.54, SD 0.50; t81=–2.08, P=.04). Conclusions: The Diabetes Risk Score app has been shown to be a feasible and reliable tool to identify persons with undiagnosed diabetes and prediabetes and to predict diabetes incidence in 2 years. The app can also encourage high-risk people to modify dietary habits and reduce sedentary lifestyle. %M 29793901 %R 10.2196/10662 %U http://mhealth.jmir.org/2018/5/e10662/ %U https://doi.org/10.2196/10662 %U http://www.ncbi.nlm.nih.gov/pubmed/29793901 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 5 %P e135 %T A Digital App to Aid Detection, Monitoring, and Management of Dyslexia in Young Children (DIMMAND): Protocol for a Digital Health and Education Solution %A Sood,Mariam R %A Toornstra,Annet %A Sereno,Martin I %A Boland,Mark %A Filaretti,Daniele %A Sood,Anuj %+ Synergation Limited, 61 Hillside Road, Northwood, Middlesex, HA6 1PZ, United Kingdom, 44 7554401772, mariam_reeny@yahoo.com %K dyslexia %K digital health %K early education %K special education needs %K study skills %K EdTech %K serious games %D 2018 %7 17.05.2018 %9 Proposal %J JMIR Res Protoc %G English %X Background: Dyslexia, a specific learning difficulty and a disability as defined in the Equality Act 2010, is a lifelong condition that affects a child from the start of education. Dyslexia is characterized by difficulties in language processing (reading, spelling, and writing) which do not correspond with the child’s general intellectual abilities. Although dyslexia cannot be cured, there is a consensus that interventions are more effective and have greater impact the earlier they are administered. Effective interventions start with diagnosis. Currently, formal diagnosis requires an assessment by a dyslexia specialist or educational psychologist. These assessments are expensive and are not easy for a non-specialist teacher or parent to interpret. Consequently, formal assessments are normally performed at a much later age, when interventions are less likely to be effective. Combining the latest in scientific research, expertise of dyslexia practitioners and real-time interactivity facilitated by digital technologies, we aim to provide a cost-effective and convenient solution that focuses on early dyslexia detection and management. Objective: We discuss the rationale and protocol for the design and development of a digital health solution aimed at improving the early detection, monitoring and management of dyslexia (DIMMAND) in young children (4-8 years). The primary objective is to create a game-based digital solution aimed at children, parents, and teachers that firstly assesses, then monitors and manages progress in a convenient, cost-effective and private environment. Methods: The proposed solution will be designed and developed in phases. In the initial phase, the full functional specification of the games that constitute the app will be designed, together with the overall architecture of the solution. Prototype proof-of-concept implementation for few of these games, and commercialization strategies will also be developed. The follow-on phases will see the design implemented into a validated solution. Results: In the initial phase, we worked closely with dyslexia specialists, adult dyslexics, teachers of special-needs children, parents of dyslexic children, and senior dyslexia representatives for large organizations. These interactions provided insights into the range of language difficulties faced by dyslexics, which solutions are used by teachers and professionals, and an overall understanding of the market. We comprehensively defined the ethical, privacy, and data security issues. The detailed design spec of the games, the methodology to be followed to interpret the results, and flow diagrams illustrating how the game screens will be presented was completed. As proof of concept, a few reading, visual, and auditory games were developed and successfully tested by stakeholders on different digital devices. The stakeholders provided regular feedback and confirmed the viability of our game-based solution. Conclusions: DIMMAND has the potential to provide significant positive health care and economic impact. It is expected to reduce intervention costs, improve dyslexia detection at an early age and aid self-management. Registered Report Identifier: RR1-10.2196/9583 %M 29773528 %R 10.2196/resprot.9583 %U http://www.researchprotocols.org/2018/5/e135/ %U https://doi.org/10.2196/resprot.9583 %U http://www.ncbi.nlm.nih.gov/pubmed/29773528 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e105 %T Experiences of General Practitioners and Practice Support Staff Using a Health and Lifestyle Screening App in Primary Health Care: Implementation Case Study %A Webb,Marianne Julie %A Wadley,Greg %A Sanci,Lena Amanda %+ Department of General Practice, Melbourne Medical School, University of Melbourne, Ground Floor, 200 Berkeley Street, Parkville, 3053, Australia, 61 90355011, webbm@unimelb.edu.au %K adolescent %K primary health care %K primary prevention %K health behavior %K quality improvement %K telemedicine %D 2018 %7 24.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Technology-based screening of young people for mental health disorders and health compromising behaviors in general practice increases the disclosure of sensitive health issues and improves patient-centered care. However, few studies investigate how general practitioners (GPs) and practice support staff (receptionists and practice managers) integrate screening technology into their routine work, including the problems that arise and how the staff surmount them. Objective: The aim of this study was to investigate the implementation of a health and lifestyle screening app, Check Up GP, for young people aged 14 to 25 years attending an Australian general practice. Methods: We conducted an in-depth implementation case study of Check Up GP in one general practice clinic, with methodology informed by action research. Semistructured interviews and focus groups were conducted with GPs and support staff at the end of the implementation period. Data were thematically analyzed and mapped to normalization process theory constructs. We also analyzed the number of times we supported staff, the location where young people completed Check Up GP, and whether they felt they had sufficient privacy and received a text messaging (short message service, SMS) link at the time of taking their appointment. Results: A total of 4 GPs and 10 support staff at the clinic participated in the study, with all except 3 receptionists participating in the final interviews and focus groups. During the 2-month implementation period, the technology and administration of Check Up GP was iterated through 4 major quality improvement cycles in response to the needs of the staff. This resulted in a reduction in the average time taken to complete Check Up GP from 14 min to 10 min, improved SMS text messaging for young people, and a more consistent description of the app by receptionists to young people. In the first weeks of implementation, researchers needed to regularly support staff with the app’s administration; however, this support decreased over time, even as usage rose slightly. The majority of young people (73/87, 84%) completed Check Up GP in the waiting room, with less than half (35/80, 44%) having received an SMS from the clinic with a link to the tool. Participating staff valued Check Up GP, particularly its facilitation of youth-friendly practice. However, there was at first a lack of organizational systems and capacity to implement the app and also initially a reliance on researchers to facilitate the process. Conclusions: The implementation of a screening app in the dynamic and time-restricted general practice setting presents a range of technical and administrative challenges. Successful implementation of a screening app is possible but requires adequate time and intensive facilitation. More resources, external to staff, are needed to drive and support sustainable technology innovation and implementation in general practice settings. %M 29691209 %R 10.2196/mhealth.8778 %U http://mhealth.jmir.org/2018/4/e105/ %U https://doi.org/10.2196/mhealth.8778 %U http://www.ncbi.nlm.nih.gov/pubmed/29691209 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 2 %P e45 %T Developing Sustainable and Impactful Mobile Phone HIV Testing Interventions for Spanish-Speaking Men Who Have Sex With Men in the United States: Lessons Learned From Informative Interviews %A Mitchell,Jason %A Torres,Maria Beatriz %A Asmar,Lucy %A Danh,Thu %A Horvath,Keith J %+ Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Road, Biomed T110, Honolulu, HI, 96822, United States, 1 808 956 3342, jasonmit@hawaii.edu %K smartphone %K HIV testing %K HIV prevention %K men who have sex with men %K Spanish %D 2018 %7 24.04.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although many men who have sex with men (MSM) test for HIV at least once in their lifetime, opportunities to improve regular HIV testing, particularly among Hispanic or Latino MSM, is needed. Many mHealth interventions in development, including the ones on HIV testing, have primarily focused on English-speaking white, black, and MSM of other races. To date, no studies have assessed app use, attitudes, and motivations for downloading and sustaining use of mobile apps and preferences with respect to HIV prevention among Spanish-speaking, Hispanic MSM in the United States. Objective: The primary aims of this study were to determine what features and functions of smartphone apps do Hispanic, Spanish-speaking MSM believe are associated with downloading apps to their smartphones, (2) what features and functions of smartphone apps are most likely to influence men’s sustained use of apps over time, and (3) what features and functions do men prefer in a smartphone app aimed to promote regular testing for HIV. Methods: Interviews (N=15) were conducted with a racially diverse group of sexually active, HIV-negative, Spanish-speaking, Hispanic MSM in Miami, Florida. Interviews were digitally recorded, transcribed verbatim, translated back to English, and de-identified for analysis. A constant-comparison method (ie, grounded theory coding) was employed to examine themes that emerged from the interviews. Results: Personal interest was the primary reason associated with whether men downloaded an app. Keeping personal information secure, cost, influence by peers and posted reviews, ease of use, and functionality affected whether they downloaded and used the app over time. Men also reported that entertainment value and frequency of updates influenced whether they kept and continued to use an app over time. There were 4 reasons why participants chose to delete an app—dislike, lack of use, cost, and lack of memory or space. Participants also shared their preferences for an app to encourage regular HIV testing by providing feedback on test reminders, tailored testing interval recommendations, HIV test locator, and monitoring of personal sexual behaviors. Conclusions: The features and functions of mobile apps that Spanish-speaking MSM in this study believed were associated with downloading and/or sustained engagement of an app generally reflected the priorities mentioned in an earlier study with English-speaking MSM. Unlike the earlier study, Spanish-speaking MSM prioritized personal interest in a mobile app and de-emphasized the efficiency of an app to make their lives easier in their decision to download an app to their mobile device. Tailoring mobile apps to the language and needs of Spanish-speaking MSM is critical to help increase their willingness to download a mobile app. Despite the growing number of HIV-prevention apps in development, few are tailored to Spanish-speaking MSM, representing an important gap that should be addressed in future research. %M 29691205 %R 10.2196/publichealth.8992 %U http://publichealth.jmir.org/2018/2/e45/ %U https://doi.org/10.2196/publichealth.8992 %U http://www.ncbi.nlm.nih.gov/pubmed/29691205 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e90 %T The Interactive Child Distress Screener: Development and Preliminary Feasibility Testing %A March,Sonja %A Day,Jamin %A Zieschank,Kirsty %A Ireland,Michael %+ Institute for Resilient Regions, University of Southern Queensland, Sinnathamby Blvd, Springfield Central, 4300, Australia, 61 34704434, sonja.march@usq.edu.au %K child %K preschool %K mental health %K symptom assessment %K self-assessment (psychology) %D 2018 %7 19.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Early identification of child emotional and behavioral concerns is essential for the prevention of mental health problems; however, few suitable child-reported screening measures are available. Digital tools offer an exciting opportunity for obtaining clinical information from the child’s perspective. Objective: The aim of this study was to describe the initial development and pilot testing of the Interactive Child Distress Screener (ICDS). The ICDS is a Web-based screening instrument for the early identification of emotional and behavioral problems in children aged between 5 and 12 years. Methods: This paper utilized a mixed-methods approach to (1) develop and refine item content using an expert review process (study 1) and (2) develop and refine prototype animations and an app interface using codesign with child users (study 2). Study 1 involved an iterative process that comprised the following four steps: (1) the initial development of target constructs, (2) preliminary content validation (face validity, item importance, and suitability for animation) from an expert panel of researchers and psychologists (N=9), (3) item refinement, and (4) a follow-up validation with the same expert panel. Study 2 also comprised four steps, which are as follows: (1) the development of prototype animations, (2) the development of the app interface and a response format, (3) child interviews to determine feasibility and obtain feedback, and (4) refinement of animations and interface. Cognitive interviews were conducted with 18 children aged between 4 and 12 years who tested 3 prototype animated items. Children were asked to describe the target behavior, how well the animations captured the intended behavior, and provide suggestions for improvement. Their ability to understand the wording of instructions was also assessed, as well as the general acceptability of character and sound design. Results: In study 1, a revised list of 15 constructs was generated from the first and second round of expert feedback. These were rated highly in terms of importance (mean 6.32, SD 0.42) and perceived compatibility of items (mean 6.41, SD 0.45) on a 7-point scale. In study 2, overall feedback regarding the character design and sounds was positive. Children’s ability to understand intended behaviors varied according to target items, and feedback highlighted key objectives for improvements such as adding contextual cues or improving character detail. These design changes were incorporated through an iterative process, with examples presented. Conclusions: The ICDS has potential to obtain clinical information from the child’s perspective that may otherwise be overlooked. If effective, the ICDS will provide a quick, engaging, and easy-to-use screener that can be utilized in routine care settings. This project highlights the importance of involving an expert review and user codesign in the development of digital assessment tools for children. %M 29674310 %R 10.2196/mhealth.9456 %U http://mhealth.jmir.org/2018/4/e90/ %U https://doi.org/10.2196/mhealth.9456 %U http://www.ncbi.nlm.nih.gov/pubmed/29674310 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e26 %T Impact of Mental Health Screening on Promoting Immediate Online Help-Seeking: Randomized Trial Comparing Normative Versus Humor-Driven Feedback %A Choi,Isabella %A Milne,David N %A Deady,Mark %A Calvo,Rafael A %A Harvey,Samuel B %A Glozier,Nick %+ Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, 94 Mallett Street, Camperdown, Sydney, 2050, Australia, 61 029515 ext 1593, isabella.choi@sydney.edu.au %K online help-seeking %K screening %K feedback %K randomized trial %K mental health %K resilience %K depression %D 2018 %7 05.04.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Given the widespread availability of mental health screening apps, providing personalized feedback may encourage people at high risk to seek help to manage their symptoms. While apps typically provide personal score feedback only, feedback types that are user-friendly and increase personal relevance may encourage further help-seeking. Objective: The aim of this study was to compare the effects of providing normative and humor-driven feedback on immediate online help-seeking, defined as clicking on a link to an external resource, and to explore demographic predictors that encourage help-seeking. Methods: An online sample of 549 adults were recruited using social media advertisements. Participants downloaded a smartphone app known as “Mindgauge” which allowed them to screen their mental wellbeing by completing standardized measures on Symptoms (Kessler 6-item Scale), Wellbeing (World Health Organization [Five] Wellbeing Index), and Resilience (Brief Resilience Scale). Participants were randomized to receive normative feedback that compared their scores to a reference group or humor-driven feedback that presented their scores in a relaxed manner. Those who scored in the moderate or poor ranges in any measure were encouraged to seek help by clicking on a link to an external online resource. Results: A total of 318 participants scored poorly on one or more measures and were provided with an external link after being randomized to receive normative or humor-driven feedback. There was no significant difference of feedback type on clicking on the external link across all measures. A larger proportion of participants from the Wellbeing measure (170/274, 62.0%) clicked on the links than the Resilience (47/179, 26.3%) or Symptoms (26/75, 34.7%) measures (χ2=60.35, P<.001). There were no significant demographic factors associated with help-seeking for the Resilience or Wellbeing measures. Participants with a previous episode of poor mental health were less likely than those without such history to click on the external link in the Symptoms measure (P=.003, odds ratio [OR] 0.83, 95% CI 0.02-0.44), and younger adults were less likely to click on the link compared to older adults across all measures (P=.005, OR 0.44, 95% CI 0.25-0.78). Conclusions: This pilot study found that there was no difference between normative and humor-driven feedback on promoting immediate clicks to an external resource, suggesting no impact on online help-seeking. Limitations included: lack of personal score control group, limited measures of predictors and potential confounders, and the fact that other forms of professional help-seeking were not assessed. Further investigation into other predictors and factors that impact on help-seeking is needed. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000707460; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=370187 (Archived by WebCite at http://www.webcitation.org/6y8m8sVxr) %M 29622528 %R 10.2196/mental.9480 %U http://mental.jmir.org/2018/2/e26/ %U https://doi.org/10.2196/mental.9480 %U http://www.ncbi.nlm.nih.gov/pubmed/29622528 %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 %@ 2369-3762 %I JMIR Publications %V 4 %N 1 %P e10 %T Improving Internal Medicine Residents’ Colorectal Cancer Screening Knowledge Using a Smartphone App: Pilot Study %A Khan,Zubair %A Darr,Umar %A Khan,Muhammad Ali %A Nawras,Mohamad %A Khalil,Basmah %A Abdel-Aziz,Yousef %A Alastal,Yaseen %A Barnett,William %A Sodeman,Thomas %A Nawras,Ali %+ Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH, 43614, United States, 1 4193834000, zubair.khan@utoledo.edu %K colorectal cancer %K cancer screening %K early detection of cancer %K residents’ education %K smartphone %K mobile apps %D 2018 %7 13.03.2018 %9 Original Paper %J JMIR Med Educ %G English %X Background: Colorectal cancer (CRC) is the third most common type of cancer and the second leading cause of cancer death in the United States. About one in three adults in the United States is not getting the CRC screening as recommended. Internal medicine residents are deficient in CRC screening knowledge. Objective: The objective of our study was to assess the improvement in internal medicine residents’ CRC screening knowledge via a pilot approach using a smartphone app. Methods: We designed a questionnaire based on the CRC screening guidelines of the American Cancer Society, American College of Gastroenterology, and US Preventive Services Task Force. We emailed the questionnaire via a SurveyMonkey link to all the residents of an internal medicine department to assess their knowledge of CRC screening guidelines. Then we designed an educational intervention in the form of a smartphone app containing all the knowledge about the CRC screening guidelines. The residents were introduced to the app and asked to download it onto their smartphones. We repeated the survey to test for changes in the residents’ knowledge after publication of the smartphone app and compared the responses with the previous survey. We applied the Pearson chi-square test and the Fisher exact test to look for statistical significance. Results: A total of 50 residents completed the first survey and 41 completed the second survey after publication of the app. Areas of CRC screening that showed statistically significant improvement (P<.05) were age at which CRC screening was started in African Americans, preventive tests being ordered first, identification of CRC screening tests, identification of preventive and detection methods, following up positive tests with colonoscopy, follow-up after colonoscopy findings, and CRC surveillance in diseases. Conclusions: In this modern era of smartphones and gadgets, developing a smartphone-based app or educational tool is a novel idea and can help improve residents’ knowledge about CRC screening. %M 29535080 %R 10.2196/mededu.9635 %U http://mededu.jmir.org/2018/1/e10/ %U https://doi.org/10.2196/mededu.9635 %U http://www.ncbi.nlm.nih.gov/pubmed/29535080 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e5 %T A Mobile App to Screen for Neurocognitive Impairment: Preliminary Validation of NeuroScreen Among HIV-Infected South African Adults %A Robbins,Reuben N %A Gouse,Hetta %A Brown,Henry G %A Ehlers,Andries %A Scott,Travis M %A Leu,Cheng-Shiun %A Remien,Robert H %A Mellins,Claude A %A Joska,John A %+ HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, New York State Psychiatric Institute & Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, United States, 1 6467746968, rnr2110@cumc.columbia.edu %K HIV %K neurocognitive %K impairment %K lay health workers %K resource-limited settings %K South Africa %K tablet %K app %K neuropsychology %D 2018 %7 05.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Neurocognitive impairment (NCI) is one of the most common complications of HIV infection, and has serious medical and functional consequences. South Africa has 7 million people living with HIV (PLHIV) with up to three-quarters of antiretroviral therapy (ART)-naïve individuals having NCI. South Africa’s health system struggles to meet the care needs of its millions of PLHIV; screening for NCI is typically neglected due to limited clinical staff trained to administer, score, and interpret neuropsychological tests, as well as long test batteries and limited screening tools for South African populations. Without accurate, clinically useful, and relatively brief NCI screening tests that can be administered by all levels of clinical staff, critical opportunities to provide psychoeducation, behavioral planning, additional ART adherence support, and adjuvant therapies for NCI (when they become available) are missed. To address these challenges and gap in care, we developed an mHealth app screening tool, NeuroScreen, to detect NCI that can be administered by all levels of clinical staff, including lay health workers. Objective: The purpose of this study was to examine sensitivity and specificity of an adapted version of NeuroScreen to detect NCI (as determined by a gold standard neuropsychological test battery administered by a trained research psychometrist) among HIV-infected South Africans when administered by a lay health worker. Methods: A total of 102 HIV-infected black South African adults who had initiated ART at least 12 months prior were administered NeuroScreen and a gold standard neuropsychological test battery in the participants’ choice of language (ie, English or isiXhosa). Three composite z scores were calculated for NeuroScreen: (1) sum of all individual test scores, (2) sum of all individual test scores and error scores from four tests, and (3) sum of four tests (abbreviated version). Global deficit scores were calculated for the gold standard battery where a score of 0.5 or greater indicated the presence of NCI. Results: The mean age of participants was 33.31 (SD 7.46) years, most (59.8%, 61/102) had at least 12 years of education, and 81.4% (83/102) of the sample was female. Gold standard test battery results indicated that 26.5% (27/102) of the sample had NCI. Sensitivity and specificity of age-, education-, and sex-adjusted NeuroScreen scores were 81.48% and 74.67% for composite score 1, 81.48% and 81.33% for composite score 2, and 92.59% and 70.67% for composite score 3, respectively. Conclusions: NeuroScreen, a highly automated, easy-to-use, tablet-based screening test to detect NCI among English- and isiXhosa-speaking South African HIV patients demonstrated robust sensitivity and specificity to detect NCI when administered by lay health workers. NeuroScreen could help make screening for NCI more feasible. However, additional research is needed with larger samples and normative test performance data are needed. %M 29305338 %R 10.2196/mhealth.9148 %U http://mhealth.jmir.org/2018/1/e5/ %U https://doi.org/10.2196/mhealth.9148 %U http://www.ncbi.nlm.nih.gov/pubmed/29305338 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 12 %P e246 %T The Impact of mHealth Interventions on Breast Cancer Awareness and Screening: Systematic Review Protocol %A Tokosi,Temitope O %A Fortuin,Jill %A Douglas,Tania S %+ Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa, +27 21 4066571, jbfortuin@gmail.com %K mHealth %K breast cancer %K women %K awareness %K screening %D 2017 %7 21.12.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mobile health (mHealth) is the use of mobile communication technologies to promote health by supporting health care practices (eg, health data collection, delivery of health care information). mHealth technologies (such as mobile phones) can be used effectively by health care practitioners in the distribution of health information and have the potential to improve access to and quality of health care, as well as reduce the cost of health services. Current literature shows limited scientific evidence related to the benefits of mHealth interventions for breast cancer, which is the leading cause of cancer deaths in women worldwide and contributes a large proportion of all cancer deaths, especially in developing countries. Women, especially in low- and middle-income countries (LMICs), are faced with low odds of surviving breast cancer. This finding is likely due to multiple factors related to health systems: low priority of women’s health and cancer on national health agendas; lack of awareness that breast cancer can be effectively treated if detected early; and societal, cultural, and religious factors that are prevalent in LMICs. The proposed systematic review will examine the impact of mHealth interventions on breast cancer awareness and screening among women aged 18 years and older. Objective: The objectives of this study are to identify and describe the various mHealth intervention strategies that are used for breast cancer, and assess the impact of mHealth strategies on breast cancer awareness and screening. Methods: Literature from various databases such as MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane Central Register of Controlled Trials will be examined. Trial registers, reports, and unpublished theses will also be included. All mobile technologies such as cell phones, personal digital assistants, and tablets that have short message service, multimedia message service, video, and audio capabilities will be included. mHealth is the primary intervention. The search strategy will include keywords such as “mHealth,” “breast cancer,” “awareness,” and “screening,” among other medical subject heading terms. Articles published from January 1, 1964 to December 31, 2016 will be eligible for inclusion. Two authors will independently screen and select studies, extract data, and assess the risk of bias, with discrepancies resolved by dialogue involving a third author. We will assess statistical heterogeneity by examining the types of participants, interventions, study designs, and outcomes in each study, and pool studies judged to be statistically homogeneous. In the assessment of heterogeneity, a sensitivity analysis will be considered to explore statistical heterogeneity. Statistical heterogeneity will be investigated using the Chi-square test of homogeneity on Cochrane's Q statistic and quantified using the I-squared statistic. Results: The search strategy will be refined with the assistance of an information specialist from November 1, 2017 to January 31, 2018. Literature searches will take place from February 2018 to April 2018. Data extraction and capturing in Review Manager (RevMan, Version 5.3) will take place from May 1, 2018 to July 31, 2018. The final stages will include analyses and writing, which is anticipated occur between August 2018 and October 2018. Conclusions: The knowledge derived from this study will inform health care stakeholders, including researchers, policy makers, investors, health professionals, technologists, and engineers, on the impact of mHealth interventions on breast cancer screening and awareness. Trial Registration: Prospero registration number CRD42016050202 %M 29269341 %R 10.2196/resprot.8043 %U http://www.researchprotocols.org/2017/12/e246/ %U https://doi.org/10.2196/resprot.8043 %U http://www.ncbi.nlm.nih.gov/pubmed/29269341 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 9 %P e135 %T Atrial Fibrillation Screening in Nonmetropolitan Areas Using a Telehealth Surveillance System With an Embedded Cloud-Computing Algorithm: Prospective Pilot Study %A Chen,Ying-Hsien %A Hung,Chi-Sheng %A Huang,Ching-Chang %A Hung,Yu-Chien %A Hwang,Juey-Jen %A Ho,Yi-Lwun %+ Department of Internal Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Taipei, 10002, Taiwan, 886 2 2312 3456 ext 63651, ylho@ntu.edu.tw %K atrial fibrillation %K screen %K cloud-computing algorithm %K electrocardiography %D 2017 %7 26.09.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Atrial fibrillation (AF) is a common form of arrhythmia that is associated with increased risk of stroke and mortality. Detecting AF before the first complication occurs is a recognized priority. No previous studies have examined the feasibility of undertaking AF screening using a telehealth surveillance system with an embedded cloud-computing algorithm; we address this issue in this study. Objective: The objective of this study was to evaluate the feasibility of AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm. Methods: We conducted a prospective AF screening study in a nonmetropolitan area using a single-lead electrocardiogram (ECG) recorder. All ECG measurements were reviewed on the telehealth surveillance system and interpreted by the cloud-computing algorithm and a cardiologist. The process of AF screening was evaluated with a satisfaction questionnaire. Results: Between March 11, 2016 and August 31, 2016, 967 ECGs were recorded from 922 residents in nonmetropolitan areas. A total of 22 (2.4%, 22/922) residents with AF were identified by the physician’s ECG interpretation, and only 0.2% (2/967) of ECGs contained significant artifacts. The novel cloud-computing algorithm for AF detection had a sensitivity of 95.5% (95% CI 77.2%-99.9%) and specificity of 97.7% (95% CI 96.5%-98.5%). The overall satisfaction score for the process of AF screening was 92.1%. Conclusions: AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm is feasible. %M 28951384 %R 10.2196/mhealth.8290 %U https://mhealth.jmir.org/2017/9/e135/ %U https://doi.org/10.2196/mhealth.8290 %U http://www.ncbi.nlm.nih.gov/pubmed/28951384 %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 %@ 2291-5222 %I JMIR Publications %V 5 %N 8 %P e118 %T Improving Patient-Centered Care for Young People in General Practice With a Codesigned Screening App: Mixed Methods Study %A Webb,Marianne Julie %A Wadley,Greg %A Sanci,Lena Amanda %+ Department of General Practice, Melbourne Medical School, Faculty of Medicine, University of Melbourne, Ground Floor, 200 Berkeley Street, Parkville, 3010, Australia, 61 390355011, webbm@unimelb.edu.au %K adolescent %K needs assessment %K general practice %K primary prevention %K health behavior %K health information technology %K patient-centered care %D 2017 %7 11.08.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite experiencing a high prevalence and co-occurrence of mental health disorders and health-compromising behaviors, young people tend not to seek professional help for these concerns. However, they do regularly attend primary care, making primary care providers ideally situated to identify and discuss mental health and lifestyle issues as part of young people’s routine health care. Objective: The aim was to investigate whether using a codesigned health and lifestyle-screening app, Check Up GP, in general practice influenced young people’s assessment of the quality of their care (measures of patient-centered care and youth friendliness), and their disclosure of sensitive issues. In addition, this study aimed to explore young people’s acceptance and experience of using a screening app during regular health care. Methods: This was a mixed methods implementation study of Check Up GP with young people aged 14 to 25 years attending a general practice clinic in urban Melbourne, Australia. A 1-month treatment-as-usual group was compared to a 2-month intervention group in which young people and their general practitioners (GPs) used Check Up GP. Young people in both groups completed an exit survey immediately after their consultation about disclosure, patient-centered and youth-friendly care, and judgment. In addition, participants in the intervention group were surveyed about app acceptability and usability and their willingness to use it again. Semistructured interviews with participants in the intervention group expanded on themes covered in the survey. Results: The exit survey was completed by 30 young people in the treatment-as-usual group and 85 young people in the intervention group. Young people using Check Up GP reported greater disclosure of health issues (P<.001), and rated their GP higher in patient-centered care: communication and partnership (P=.01), personal relationship (P=.01), health promotion (P=.03), and interest in effect on life (P<.001). No differences were found on core indicators of youth-friendly care: trust, level of comfort, expectations met, and time to ask questions. In all, 86% (73/85) of young people felt the app was a “good idea” and only 1% (1/85) thought it a “bad idea.” Thematic analysis of qualitative interviews with 14 participants found that Check Up GP created scope to address unmet health needs and increased sense of preparedness, with use moderated by honesty, motivation, app content and functionality, and app administration. Conclusions: Integrating a health and lifestyle-screening app into face-to-face care can enrich young people’s experience of seeing their GP, create scope to identify and address unmet health needs, and increase patient-centered care. Further research is needed to investigate the effect of using a health and lifestyle-screening app in a diverse range of clinic types and settings, and with a diverse range of GPs and youth. %M 28801302 %R 10.2196/mhealth.7816 %U http://mhealth.jmir.org/2017/8/e118/ %U https://doi.org/10.2196/mhealth.7816 %U http://www.ncbi.nlm.nih.gov/pubmed/28801302 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 7 %P e135 %T Randomized Trial Comparing the Electronic Composite Psychosocial Screener YouthCHAT With a Clinician-Interview Assessment for Young People: A Study Protocol %A Thabrew,Hiran %A Corter,Arden %A Goodyear-Smith,Felicity %A Goldfinch,Mary %+ University of Auckland, Department of Psychological Medicine, University of Auckland, Level 12, Support Block, Auckland Hospital, Park Road, Grafton, Auckland, 1142, New Zealand, 64 21402055, h.thabrew@auckland.ac.nz %K mass screening %K adolescents %K substance-related disorders %K depression %K anxiety %K primary health care %K school health %K services %K chronic disease %D 2017 %7 31.07.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Psychosocial problems such as depression, anxiety, and substance abuse are common and burdensome in young people, particularly those with long-term physical conditions such as asthma and diabetes. In New Zealand, “screening” for such problems is undertaken routinely only with Year 9 students in low-decile schools and opportunistically in pediatric settings using a nonvalidated and time-consuming clinician-administered Home, Education/employment, Eating, Activity, Drugs, Sexuality, Suicide/depression, Safety (HEEADSSS) interview. The Youth version, Case-finding and Help Assessment Tool (YouthCHAT) is a relatively new, locally developed, eTablet-based composite screener for identifying similar psychosocial issues to HEEADSSS. Based on individually validated screening instruments, it is self-administered within minutes. Preliminary testing has revealed its acceptability to young people, but further research is required to expand its modules to cover all HEEADSSS domains, to evaluate its acceptability for young people with and without long-term physical conditions, and to compare its effectiveness against HEEADSSS. Objective: Our aim is to (1) ascertain acceptability and utility of YouthCHAT for children with long-term physical illness and high school students, (2) validate three additional YouthCHAT domains against comparable HEEADSSS domains, and (3) compare the performance of YouthCHAT and HEEADSSS in the high school setting. Methods: During the first phase of the study, three additional YouthCHAT domains were codesigned with high school students. During the second phase of the study, the updated version of YouthCHAT will be administered to 30 young people with long-term physical conditions, and to 150 high school students either before or after HEEADSSS in the form of a randomized trial with counter-balanced design. Primary outcomes include comparability between HEEADSSS and YouthCHAT in detecting psychosocial issues, and time to administer; acceptability of YouthCHAT as an acceptable alternative or companion to HEEADSSS assessment; and the utility of YouthCHAT in helping streamline assessment processes. Results: Recruitment for the first phase of this project commenced in November 2016, and the phase will run from February to November 2017. Conclusions: If YouthCHAT is found to be acceptable to study participants and as effective as a HEEADSSS assessment, it could be an innovative and more efficient means of routine screening for common psychosocial health issues in young people with and without long-term physical conditions. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12616001243404p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371422 (Archived by WebCite at http://www.webcitation.org/ 6rmlEiM1L) %M 28760727 %R 10.2196/resprot.7995 %U http://www.researchprotocols.org/2017/7/e135/ %U https://doi.org/10.2196/resprot.7995 %U http://www.ncbi.nlm.nih.gov/pubmed/28760727 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 3 %P e45 %T Informing the Development of a Mobile Phone HIV Testing Intervention: Intentions to Use Specific HIV Testing Approaches Among Young Black Transgender Women and Men Who Have Sex With Men %A Koblin,Beryl A %A Nandi,Vijay %A Hirshfield,Sabina %A Chiasson,Mary Ann %A Hoover,Donald R %A Wilton,Leo %A Usher,DaShawn %A Frye,Victoria %+ Laboratory of Infectious Disease Prevention, New York Blood Center, 310 E.67th Street, New York, NY,, United States, 1 212 570 3105, bkoblin@nybc.org %K HIV infections %K African American %K homosexuality, male %K transgender persons %K cell phones %D 2017 %7 07.07.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Regular human immunodeficiency virus (HIV) testing of persons at risk is critical to HIV prevention. Infrequent HIV testing and late diagnosis of HIV infection have been observed among young black men who have sex with men (MSM) and transwomen (transgender women)—two groups overrepresented in the HIV epidemic. Objective: The objective of this study was to inform the development of a brief mobile phone intervention to increase HIV testing among young black MSM and transwomen by providing a tailored recommendation of an optimal HIV testing approach. We identified demographic, behavioral, psychosocial, and sociostructural factors associated with intentions to use three specific HIV testing approaches: self-testing, testing at a clinic or other provider, and couples HIV testing and counseling (CHTC). Methods: Individuals were eligible for a Web-based survey if they were male at birth; were between the ages of 16 and 29 years; self-identified as black, African American, Caribbean black, African black, or multiethnic black; were not known to be HIV-infected; and reported insertive or receptive anal intercourse with a man or transwoman in the last 12 months. Recruitment occurred via banner advertisements placed on a range of social and sexual networking websites and apps in New York City and nationally, and via events attended by young black MSM and transwomen in New York City. Intention to test by each testing method was analyzed using logistic regression with best subset models and stepwise variable selection. Results: Among 169 participants, intention to use a self-test was positively associated with comfort in testing by a friend or a partner at home (Adjusted odds ratio, AOR, 2.40; 95% CI 1.09-5.30), and stigma or fear as a reason not to test (AOR 8.61; 95% CI 2.50-29.68) and negatively associated with higher social support (AOR 0.48; 95% CI 0.33-0.72) and having health insurance (AOR 0.21; 95% CI 0.09-0.54). Intention to test at a clinic or other provider was positively associated with self-efficacy for HIV testing (AOR 2.87; 95% CI 1.48-5.59) and social support (AOR 1.98; 95% CI 1.34-2.92), and negatively associated with a lifetime history of incarceration (AOR 0.37; 95% CI 0.16-0.89). Intention to test by CHTC was negatively associated with higher educational level (Some college or Associate’s degree vs high school graduate or less [AOR 0.81; 95% CI 0.39-1.70]; Bachelor’s degree or more vs high school graduate or less [AOR 0.28; 95% CI 0.11-0.70]). Conclusions: Unique factors were associated with intention to test using specific testing approaches. These data will be critical for the development of a tailored intervention that shows promise to increase comfort and experiences with a variety of testing approaches among young black MSM and transwomen. %M 28687531 %R 10.2196/publichealth.7397 %U http://publichealth.jmir.org/2017/3/e45/ %U https://doi.org/10.2196/publichealth.7397 %U http://www.ncbi.nlm.nih.gov/pubmed/28687531 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e72 %T A Smartphone-Based Approach for Triage of Human Papillomavirus-Positive Sub-Saharan African Women: A Prospective Study %A Urner,Esther %A Delavy,Martine %A Catarino,Rosa %A Viviano,Manuela %A Meyer-Hamme,Ulrike %A Benski,Anne-Caroline %A Jinoro,Jeromine %A Heriniainasolo,Josea Lea %A Undurraga,Manuela %A De Vuyst,Hugo %A Combescure,Christophe %A Vassilakos,Pierre %A Petignat,Patrick %+ Gynecology Division, Department of Gynecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, Geneva, 1206, Switzerland, 41 22 372 68 16, martinegilliane@gmail.com %K cervical cancer %K squamous intraepithelial lesions of the cervix %K HPV %K acetic acid %K lugol’s iodine %K smartphone %K mobile phone %D 2017 %7 29.05.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Sub-Saharan African countries are marked by a high incidence of cervical cancer. Madagascar ranks 11th among the countries with the highest cervical cancer incidence worldwide. Objective: The aim of the study was to evaluate the performances of digital smartphone-based visual inspection with acetic acid (D-VIA) and Lugol’s iodine (D-VILI) for diagnosing cervical precancer and cancer. Methods: Human papillomavirus (HPV)-positive women recruited through a cervical screening campaign had D-VIA and D-VILI examinations with endocervical curettage (ECC) and cervical biopsy. Three images were captured for each woman (native, D-VIA, D-VILI) using a smartphone camera. The images were randomly coded and distributed on 2 online databases (Google Forms). The D-VIA form included native and D-VIA images, and the D-VILI form included native and D-VILI images. Pathological cases were defined as cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Physicians rated the images as non-pathological or pathological. Using the ECC and cervical biopsy results as references, the sensitivity and specificity of D-VIA and D-VILI examinations for each and all physicians were calculated. Results: Altogether, 15 clinicians assessed 240 images. Sensitivity was higher for the D-VIA interpretations (94.1%; 95% CI 81.6-98.3) than for the D-VILI interpretations (78.8%; 95% CI 54.1-92.1; P=.009). In contrast, the specificity was higher for the D-VILI interpretations (56.4%; 95% CI 38.3-72.9) than for the D-VIA interpretations (50.4%; 95% CI 35.9-64.8; P=.005). Conclusion: Smartphone-based image for triage of HPV-positive women is more accurate for detecting CIN2+ lesions with D-VIA than D-VILI, although with a small loss of specificity. %M 28554879 %R 10.2196/mhealth.6697 %U http://mhealth.jmir.org/2017/5/e72/ %U https://doi.org/10.2196/mhealth.6697 %U http://www.ncbi.nlm.nih.gov/pubmed/28554879 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e88 %T Pregnant Women’s Views on the Feasibility and Acceptability of Web-Based Mental Health E-Screening Versus Paper-Based Screening: A Randomized Controlled Trial %A Kingston,Dawn %A Austin,Marie-Paule %A Veldhuyzen van Zanten,Sander %A Harvalik,Paula %A Giallo,Rebecca %A McDonald,Sarah D %A MacQueen,Glenda %A Vermeyden,Lydia %A Lasiuk,Gerri %A Sword,Wendy %A Biringer,Anne %+ Faculty of Nursing, University of Calgary, 2500 University Ave NW, Calgary, AB, T2N 1N4, Canada, 1 4032202634, dawn.kingston@ucalgary.ca %K pregnancy %K mental health %K screening %K prenatal care %K computers %D 2017 %7 07.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Major international guidelines recommend mental health screening during the perinatal period. However, substantial barriers to screening have been reported by pregnant and postpartum women and perinatal care providers. E-screening offers benefits that may address implementation challenges. Objective: The primary objective of this randomized controlled trial was to evaluate the feasibility and acceptability of Web-based mental health e-screening compared with paper-based screening among pregnant women. A secondary objective was to identify factors associated with women’s preferences for e-screening and disclosure of mental health concerns. Methods: Pregnant women recruited from community and hospital-based antenatal clinics and hospital-based prenatal classes were computer-randomized to a fully automated Web-based e-screening intervention group or a paper-based control group. Women were eligible if they spoke or read English, were willing to be randomized to e-screening, and were willing to participate in a follow-up diagnostic interview. The intervention group completed the Antenatal Psychosocial Health Assessment and the Edinburgh Postnatal Depression Scale on a tablet computer, while controls completed them on paper. All women completed self-report baseline questions and were telephoned 1 week after randomization by a blinded research assistant for a MINI International Neuropsychiatric Interview. Renker and Tonkin’s tool of feasibility and acceptability of computerized screening was used to assess the feasibility and acceptability of e-screening compared with paper-based screening. Intention-to-treat analysis was used. To identify factors associated with preference for e-screening and disclosure, variables associated with each outcome at P<.20 were simultaneously entered into final multivariable models to estimate adjusted odds ratios (AORs) and 95% CIs. Results: Of the 675 eligible women approached, 636 agreed to participate (participation rate 94.2%) and were randomized to the intervention (n=305) or control (n=331) groups. There were no significant baseline differences between groups. More women in the e-screening group strongly or somewhat agreed that they would like to use a tablet for answering questions on emotional health (57.9%, 175/302 vs 37.2%, 121/325) and would prefer using a tablet to paper (46.0%, 139/302 vs 29.2%, 95/325), compared with women in the paper-based screening group. There were no differences between groups in women’s disclosure of emotional health concerns (94.1%, 284/302 vs 90.2%, 293/325). Women in the e-screening group consistently reported the features of e-screening more favorably than controls (more private or confidential, less impersonal, less time-consuming). In the multivariable models, being in the e-screening group was significantly associated with preferring e-screening (AOR 2.29, 95% CI 1.66-3.17), while no factors were significantly associated with disclosure. Conclusions: The findings suggest that mental health e-screening is feasible and acceptable to pregnant women. Trial Registration: Clinicaltrials.gov NCT01899534; https://clinicaltrials.gov/ct2/show/NCT01899534 (Archived by WebCite at http://www.webcitation.org/6ntWg1yWb) %M 28389421 %R 10.2196/jmir.6866 %U http://www.jmir.org/2017/4/e88/ %U https://doi.org/10.2196/jmir.6866 %U http://www.ncbi.nlm.nih.gov/pubmed/28389421 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 3 %N 1 %P e1 %T Rotterdam Prostate Cancer Risk Calculator: Development and Usability Testing of the Mobile Phone App %A Pereira-Azevedo,Nuno %A Osório,Luís %A Fraga,Avelino %A Roobol,Monique J %+ Department of Urology, Erasmus University Medical Center, Room NA-1706, PO Box 2040, Erasmus MC, University Medical Center Rotterdam, Rotterdam, 3000 CA Rotterdam, Netherlands, 31 107032240, nuno@pereira-azevedo.com %K mHealth %K prostate cancer %K nomogram %D 2017 %7 06.01.2017 %9 Original Paper %J JMIR Cancer %G English %X Background: The use of prostate cancer screening tools that take into account relevant prebiopsy information (ie, risk calculators) is recommended as a way of determining the risk of cancer and the subsequent need for a prostate biopsy. This has the potential to limit prostate cancer overdiagnosis and subsequent overtreatment. mHealth apps are gaining traction in urological practice and are used by both practitioners and patients for a variety of purposes. Objective: The impetus of the study was to design, develop, and assess a smartphone app for prostate cancer screening, based on the Rotterdam Prostate Cancer Risk Calculator (RPCRC). Methods: The results of the Rotterdam arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC) study were used to elaborate several algorithms that allowed the risk of prostate cancer to be estimated. A step-by-step workflow was established to ensure that depending on the available clinical information the most complete risk model of the RPCRC was used. The user interface was designed and then the app was developed as a native app for iOS. The usability of the app was assessed using the Post-Study System Usability Questionnaire (PSSUQ) developed by IBM, in a group of 92 participants comprising urologists, general practitioners, and medical students. Results: A total of 11 questions were built into the app, and, depending on the answers, one of the different algorithms of the RPCRC could be used to predict the risk of prostate cancer and of clinically significant prostate cancer (Gleason score ≥7 and clinical stage >T2b). The system usefulness, information quality, and interface quality scores were high—92% (27.7/30), 87% (26.2/30), and 89% (13.4/15), respectively. No usability problems were identified. Conclusions: The RPCRC app is helpful in predicting the risk of prostate cancer and, even more importantly, clinically significant prostate cancer. Its algorithms have been externally validated before and the usability score shows the app’s interface is well designed. Further usability testing is required in different populations to verify these results and ensure that it is easy to use, to warrant a broad appeal, and to provide better patient care. %M 28410180 %R 10.2196/cancer.6750 %U http://cancer.jmir.org/2017/1/e1/ %U https://doi.org/10.2196/cancer.6750 %U http://www.ncbi.nlm.nih.gov/pubmed/28410180 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 8 %P e216 %T Depression Screening Using Daily Mental-Health Ratings from a Smartphone Application for Breast Cancer Patients %A Kim,Junetae %A Lim,Sanghee %A Min,Yul Ha %A Shin,Yong-Wook %A Lee,Byungtae %A Sohn,Guiyun %A Jung,Kyung Hae %A Lee,Jae-Ho %A Son,Byung Ho %A Ahn,Sei Hyun %A Shin,Soo-Yong %A Lee,Jong Won %+ Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic Of Korea, 82 2 3010 5603, jongwonlee116@gmail.com %K depression %K smartphone applications %K mental health %K breast cancer (neoplasms) %D 2016 %7 04.08.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile mental-health trackers are mobile phone apps that gather self-reported mental-health ratings from users. They have received great attention from clinicians as tools to screen for depression in individual patients. While several apps that ask simple questions using face emoticons have been developed, there has been no study examining the validity of their screening performance. Objective: In this study, we (1) evaluate the potential of a mobile mental-health tracker that uses three daily mental-health ratings (sleep satisfaction, mood, and anxiety) as indicators for depression, (2) discuss three approaches to data processing (ratio, average, and frequency) for generating indicator variables, and (3) examine the impact of adherence on reporting using a mobile mental-health tracker and accuracy in depression screening. Methods: We analyzed 5792 sets of daily mental-health ratings collected from 78 breast cancer patients over a 48-week period. Using the Patient Health Questionnaire-9 (PHQ-9) as the measure of true depression status, we conducted a random-effect logistic panel regression and receiver operating characteristic (ROC) analysis to evaluate the screening performance of the mobile mental-health tracker. In addition, we classified patients into two subgroups based on their adherence level (higher adherence and lower adherence) using a k-means clustering algorithm and compared the screening accuracy between the two groups. Results: With the ratio approach, the area under the ROC curve (AUC) is 0.8012, indicating that the performance of depression screening using daily mental-health ratings gathered via mobile mental-health trackers is comparable to the results of PHQ-9 tests. Also, the AUC is significantly higher (P=.002) for the higher adherence group (AUC=0.8524) than for the lower adherence group (AUC=0.7234). This result shows that adherence to self-reporting is associated with a higher accuracy of depression screening. Conclusions: Our results support the potential of a mobile mental-health tracker as a tool for screening for depression in practice. Also, this study provides clinicians with a guideline for generating indicator variables from daily mental-health ratings. Furthermore, our results provide empirical evidence for the critical role of adherence to self-reporting, which represents crucial information for both doctors and patients. %M 27492880 %R 10.2196/jmir.5598 %U http://www.jmir.org/2016/8/e216/ %U https://doi.org/10.2196/jmir.5598 %U http://www.ncbi.nlm.nih.gov/pubmed/27492880 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e156 %T Does a Mobile Phone Depression-Screening App Motivate Mobile Phone Users With High Depressive Symptoms to Seek a Health Care Professional’s Help? %A BinDhim,Nasser F %A Alanazi,Eman M %A Aljadhey,Hisham %A Basyouni,Mada H %A Kowalski,Stefan R %A Pont,Lisa G %A Shaman,Ahmed M %A Trevena,Lyndal %A Alhawassi,Tariq M %+ College of Health Sciences, Health Informatics, Saudi Electronic University, Abu Baker St, Riyadh, 11673, Saudi Arabia, 966 112613500 ext 1065, nbin6641@uni.sydney.edu.au %K mental health %K depression %K mobile phone %K public health informatics %K patients’ screening %D 2016 %7 27.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The objective of disease screening is to encourage high-risk subjects to seek health care diagnosis and treatment. Mobile phone apps can effectively screen mental health conditions, including depression. However, it is not known how effective such screening methods are in motivating users to discuss the obtained results of such apps with health care professionals. Does a mobile phone depression-screening app motivate users with high depressive symptoms to seek health care professional advice? This study aimed to address this question. Method: This was a single-cohort, prospective, observational study of a free mobile phone depression app developed in English and released on Apple’s App Store. Apple App Store users (aged 18 or above) in 5 countries, that is, Australia, Canada, New Zealand (NZ), the United Kingdom (UK), and the United States (US), were recruited directly via the app’s download page. The participants then completed the Patient Health Questionnaire (PHQ-9), and their depression screening score was displayed to them. If their score was 11 or above and they had never been diagnosed with depression before, they were advised to take their results to their health care professional. They were to follow up after 1 month. Results: A group of 2538 participants from the 5 countries completed PHQ-9 depression screening with the app. Of them, 322 participants were found to have high depressive symptoms and had never been diagnosed with depression, and received advice to discuss their results with health care professionals. About 74% of those completed the follow-up; approximately 38% of these self-reported consulting their health care professionals about their depression score. Only positive attitude toward depression as a real disease was associated with increased follow-up response rate (odds ratio (OR) 3.2, CI 1.38-8.29). Conclusions: A mobile phone depression-screening app motivated some users to seek a depression diagnosis. However, further study should investigate how other app users use the screening results provided by such apps. %M 27349441 %R 10.2196/jmir.5726 %U http://www.jmir.org/2016/6/e156/ %U https://doi.org/10.2196/jmir.5726 %U http://www.ncbi.nlm.nih.gov/pubmed/27349441 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 5 %P e130 %T Hearing Tests on Mobile Devices: Evaluation of the Reference Sound Level by Means of Biological Calibration %A Masalski,Marcin %A Kipiński,Lech %A Grysiński,Tomasz %A Kręcicki,Tomasz %+ Department and Clinic of Otolaryngology, Head and Neck Surgery, Wroclaw Medical University, Borowska 213, Wrocław, 50-556, Poland, 48 515086252, marcin.masalski@pwr.edu.pl %K hearing test, mobile device, calibration %D 2016 %7 30.05.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Hearing tests carried out in home setting by means of mobile devices require previous calibration of the reference sound level. Mobile devices with bundled headphones create a possibility of applying the predefined level for a particular model as an alternative to calibrating each device separately. Objective: The objective of this study was to determine the reference sound level for sets composed of a mobile device and bundled headphones. Methods: Reference sound levels for Android-based mobile devices were determined using an open access mobile phone app by means of biological calibration, that is, in relation to the normal-hearing threshold. The examinations were conducted in 2 groups: an uncontrolled and a controlled one. In the uncontrolled group, the fully automated self-measurements were carried out in home conditions by 18- to 35-year-old subjects, without prior hearing problems, recruited online. Calibration was conducted as a preliminary step in preparation for further examination. In the controlled group, audiologist-assisted examinations were performed in a sound booth, on normal-hearing subjects verified through pure-tone audiometry, recruited offline from among the workers and patients of the clinic. In both the groups, the reference sound levels were determined on a subject’s mobile device using the Bekesy audiometry. The reference sound levels were compared between the groups. Intramodel and intermodel analyses were carried out as well. Results: In the uncontrolled group, 8988 calibrations were conducted on 8620 different devices representing 2040 models. In the controlled group, 158 calibrations (test and retest) were conducted on 79 devices representing 50 models. Result analysis was performed for 10 most frequently used models in both the groups. The difference in reference sound levels between uncontrolled and controlled groups was 1.50 dB (SD 4.42). The mean SD of the reference sound level determined for devices within the same model was 4.03 dB (95% CI 3.93-4.11). Statistically significant differences were found across models. Conclusions: Reference sound levels determined in the uncontrolled group are comparable to the values obtained in the controlled group. This validates the use of biological calibration in the uncontrolled group for determining the predefined reference sound level for new devices. Moreover, due to a relatively small deviation of the reference sound level for devices of the same model, it is feasible to conduct hearing screening on devices calibrated with the predefined reference sound level. %M 27241793 %R 10.2196/jmir.4987 %U http://www.jmir.org/2016/5/e130/ %U https://doi.org/10.2196/jmir.4987 %U http://www.ncbi.nlm.nih.gov/pubmed/27241793 %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 %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 3 %P e35 %T ClereMed: Lessons Learned From a Pilot Study of a Mobile Screening Tool to Identify and Support Adults Who Have Difficulty With Medication Labels %A Grindrod,Kelly Anne %A Gates,Allison %A Dolovich,Lisa %A Slavcev,Roderick %A Drimmie,Rob %A Aghaei,Behzad %A Poon,Calvin %A Khan,Shamrozé %A Leat,Susan J %+ School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L3G1, Canada, 1 519 888 4567 ext 21358, kgrindrod@uwaterloo.ca %K low vision %K legibility %K prescription labelling %K medication labels %K usability %K cognitive impairment %K visual impairment %D 2014 %7 15.08.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: In order to take medications safely and effectively, individuals need to be able to see, read, and understand the medication labels. However, one-half of medication labels are currently misunderstood, often because of low literacy, low vision, and cognitive impairment. We sought to design a mobile tool termed ClereMed that could rapidly screen for adults who have difficulty reading or understanding their medication labels. Objective: The aim of this study was to build the ClereMed prototype; to determine the usability of the prototype with adults 55 and over; to assess its accuracy for identifying adults with low-functional reading ability, poor ability on a real-life pill-sorting task, and low cognition; and to assess the acceptability of a touchscreen device with older adults with age-related changes to vision and cognition. Methods: This pilot study enrolled adults (≥55 years) who were recruited through pharmacies, retirement residences, and a low-vision optometry clinic. ClereMed is a hypertext markup language (HTML)-5 prototype app that simulates medication taking using an iPad, and also provides information on how to improve the accessibility of prescription labels. A paper-based questionnaire included questions on participant demographics, computer literacy, and the Systems Usability Scale (SUS). Cognition was assessed using the Montreal Cognitive Assessment tool, and functional reading ability was measured using the MNRead Acuity Chart. Simulation results were compared with a real-life, medication-taking exercise using prescription vials, tablets, and pillboxes. Results: The 47 participants had a mean age of 76 (SD 11) years and 60% (28/47) were female. Of the participants, 32% (15/47) did not own a computer or touchscreen device. The mean SUS score was 76/100. ClereMed correctly identified 72% (5/7) of participants with functional reading difficulty, and 63% (5/8) who failed a real-life pill-sorting task, but only 21% (6/28) of participants with cognitive impairment. Participants who owned a computer or touchscreen completed ClereMed in a mean time of 26 (SD 16) seconds, compared with 52 (SD 34) seconds for those who do not own a device (P<.001). Those who had difficulty, struggled with screen glare, button activation, and the “drag and drop” function. Conclusions: ClereMed was well accepted by older participants, but it was only moderately accurate for reading ability and not for mild cognitive impairment. Future versions may be most useful as part of a larger medication assessment or as a tool to help family members and caregivers identify individuals with impaired functional reading ability. Future research is needed to improve the sensitivity for measuring cognitive impairment and on the feasibility of implementing a mobile app into pharmacy workflow. %M 25131813 %R 10.2196/mhealth.3250 %U http://mhealth.jmir.org/2014/3/e35/ %U https://doi.org/10.2196/mhealth.3250 %U http://www.ncbi.nlm.nih.gov/pubmed/25131813