%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 %@ 2369-1999 %I JMIR Publications %V 4 %N 2 %P e10529 %T Association Between Adherence to Cancer Screening and Knowledge of Screening Guidelines: Feasibility Study Linking Self-Reported Survey Data With Medical Records %A Lofters,Aisha K %A Telner,Deanna %A Kalia,Sumeet %A Slater,Morgan %+ Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, ON,, Canada, 1 416 864 6060, aisha.lofters@utoronto.ca %K cancer screening %K electronic medical records %K electronic survey %K health literacy %K self-reported data %D 2018 %7 01.11.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: It is possible that patients who are more aware of cancer screening guidelines may be more likely to adhere to them. Objective: The aim of this study was to determine whether screening knowledge was associated with the documented screening participation. We also assessed the feasibility and acceptability of linking electronic survey data with clinical data in the primary care setting. Methods: We conducted an electronic survey at 2 sites in Toronto, Canada. At one site, eligible patients were approached in the waiting room to complete the survey; at the second site, eligible patients were sent an email inviting them to participate. All participants were asked to consent to the linkage of their survey results with their electronic medical record. Results: Overall, 1683 participants responded to the survey—247 responded in the waiting room (response rate, 247/366, 67.5%), whereas 1436 responded through email (response rate, 1436/5779, 24.8%). More than 80% (199/247 and 1245/1436) of participants consented to linking their survey data to their medical record. Knowledge of cancer screening guidelines was generally low. Although the majority of participants were able to identify the recommended tests for breast and cervical screening, very few participants correctly identified the recommended age and frequency of screening, with a maximum of 22% (21/95) of screen-eligible women correctly answering all 3 questions for breast cancer screening. However, this low level of knowledge among patients was not significantly associated with screening uptake, particularly after adjustment for sociodemographic characteristics. Conclusions: Although knowledge of screening guidelines was low among patients in our study, this was not associated with screening participation. Participants were willing to link self-reported data with their medical record data, which has substantial implications for future research. %M 30389655 %R 10.2196/10529 %U http://cancer.jmir.org/2018/2/e10529/ %U https://doi.org/10.2196/10529 %U http://www.ncbi.nlm.nih.gov/pubmed/30389655 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 3 %P e25 %T Designing Emails Aimed at Increasing Family Physicians’ Use of a Web-Based Audit and Feedback Tool to Improve Cancer Screening Rates: Cocreation Process %A Bravo,Caroline A %A Llovet,Diego %A Witteman,Holly O %A Desveaux,Laura %A Presseau,Justin %A Saragosa,Marianne %A Vaisson,Gratianne %A Umar,Shama %A Tinmouth,Jill %A Ivers,Noah M %+ Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada, 1 416 323 6060, noah.ivers@utoronto.ca %K audit and feedback %K clinical audit %K co-creation %K user design %K email %K behavior change %K physician engagement %D 2018 %7 04.09.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Providing clinical performance data to health professionals, a process known as audit and feedback, can play an important role in health system improvement. However, audit and feedback tools can only be effective if the targeted health professionals access and actively review their data. Email is used by Cancer Care Ontario, a provincial cancer agency, to promote access to a Web-based audit and feedback tool called the Screening Activity Report (SAR); however, current emails that lack behavior change content have been ineffective at encouraging log-in to the SAR. Objective: The objective of our study was to describe the process and experience of developing email content that incorporates user input and behavior change techniques (BCTs) to promote the use of the SAR among Ontario primary care providers. Methods: Our interdisciplinary research team first identified BCTs shown to be effective in other settings that could be adapted to promote use of the SAR. We then developed draft BCT-informed email content. Next, we conducted cocreation workshops with physicians who had logged in to the SAR more than once over the past year. Participants provided reactions to researcher-developed BCT-informed content and helped to develop an email that they believed would prompt their colleagues to use the SAR. Content from cocreation workshops was brought to focus groups with physicians who had not used the SAR in the past year. We analyzed notes from the cocreation workshops and focus groups to inform decisions about content. Finally, 8 emails were created to test BCT-informed content in a 2×2×2 factorial randomized experiment. Results: We identified 3 key tensions during the development of the email that required us to balance user input with scientific evidence, organizational policies, and our scientific objectives, which are as follows: conflict between user preference and scientific evidence, privacy constraints around personalizing unencrypted emails with performance data, and using cocreation methods in a study with the objective of developing an email that featured BCT-informed content. Conclusions: Teams tasked with developing content to promote health professional engagement with audit and feedback or other quality improvement tools might consider cocreation processes for developing communications that are informed by both users and BCTs. Teams should be cautious about making decisions solely based on user reactions because what users seem to prefer is not always the same as what works. Furthermore, implementing user recommendations may not always be feasible. Teams may face challenges when using cocreation methods to develop a product with the simultaneous goal of having clearly defined variables to test in later studies. The expected role of users, evidence, and the implementation context all warrant consideration to determine whether and how cocreation methods could help to achieve design and scientific objectives. %M 30181108 %R 10.2196/humanfactors.9875 %U http://humanfactors.jmir.org/2018/3/e25/ %U https://doi.org/10.2196/humanfactors.9875 %U http://www.ncbi.nlm.nih.gov/pubmed/30181108 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 2 %P e10073 %T Online Decision Support Tool for Personalized Cancer Symptom Checking in the Community (REACT): Acceptability, Feasibility, and Usability Study %A Nieroda,Marzena Ewa %A Lophatananon,Artitaya %A McMillan,Brian %A Chen,Li-Chia %A Hughes,John %A Daniels,Rona %A Clark,James %A Rogers,Simon %A Muir,Kenneth Ross %+ Division of Management Sciences and Marketing, Alliance Manchester Business School, The University of Manchester, Booth Street West, Manchester, M13 9PL, United Kingdom, 44 161 275 6739, marzena.nieroda@manchester.ac.uk %K early detection of cancer %K cancer education %K cancer symptoms %K cancer risk %K personalized risk %K website development %K REACT %D 2018 %7 04.07.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: Improving cancer survival in the UK, despite recent significant gains, remains a huge challenge. This can be attributed to, at least in part, patient and diagnostic delays, when patients are unaware they are suffering from a cancerous symptom and therefore do not visit a general practitioner promptly and/or when general practitioners fail to investigate the symptom or refer promptly. To raise awareness of symptoms that may potentially be indicative of underlying cancer among members of the public a symptom-based risk assessment model (developed for medical practitioner use and currently only used by some UK general practitioners) was utilized to develop a risk assessment tool to be offered to the public in community settings. Such a tool could help individuals recognize a symptom, which may potentially indicate cancer, faster and reduce the time taken to visit to their general practitioner. In this paper we report results about the design and development of the REACT (Risk Estimation for Additional Cancer Testing) website, a tool to be used in a community setting allowing users to complete an online questionnaire and obtain personalized cancer symptom-based risk estimation. Objective: The objectives of this study are to evaluate (1) the acceptability of REACT among the public and health care practitioners, (2) the usability of the REACT website, (3) the presentation of personalized cancer risk on the website, and (4) potential approaches to adopt REACT into community health care services in the UK. Methods: Our research consisted of multiple stages involving members of the public (n=39) and health care practitioners (n=20) in the UK. Data were collected between June 2017 and January 2018. User views were collected by (1) the “think-aloud” approach when participants using the website were asked to talk about their perceptions and feelings in relation to the website, and (2) self-reporting of website experiences through open-ended questionnaires. Data collection and data analysis continued simultaneously, allowing for website iterations between different points of data collection. Results: The results demonstrate the need for such a tool. Participants suggest the best way to offer REACT is through a guided approach, with a health care practitioner (eg, pharmacist or National Health Service Health Check nurse) present during the process of risk evaluation. User feedback, which was generally consistent across members of public and health care practitioners, has been used to inform the development of the website. The most important aspects were: simplicity, ability to evaluate multiple cancers, content emphasizing an inviting community “feel,” use (when possible) of layperson language in the symptom screening questionnaire, and a robust and positive approach to cancer communication relying on visual risk representation both with affected individuals and the entire population at risk. Conclusions: This study illustrates the benefits of involving public and stakeholders in developing and implementing a simple cancer symptom check tool within community. It also offers insights and design suggestions for user-friendly interfaces of similar health care Web-based services, especially those involving personalized risk estimation. %M 29973334 %R 10.2196/10073 %U http://cancer.jmir.org/2018/2/e10073/ %U https://doi.org/10.2196/10073 %U http://www.ncbi.nlm.nih.gov/pubmed/29973334 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e228 %T Web-Based Versus Usual Care and Other Formats of Decision Aids to Support Prostate Cancer Screening Decisions: Systematic Review and Meta-Analysis %A Baptista,Sofia %A Teles Sampaio,Elvira %A Heleno,Bruno %A Azevedo,Luís Filipe %A Martins,Carlos %+ Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, Porto, 4200 - 319, Portugal, 351 910357362, sofiatbaptista@gmail.com %K decision making %K decision aid %K internet %K patient participation %K prostate %K screening %D 2018 %7 26.06.2018 %9 Review %J J Med Internet Res %G English %X Background: Prostate cancer is a leading cause of cancer among men. Because screening for prostate cancer is a controversial issue, many experts in the field have defended the use of shared decision making using validated decision aids, which can be presented in different formats (eg, written, multimedia, Web). Recent studies have concluded that decision aids improve knowledge and reduce decisional conflict. Objective: This meta-analysis aimed to investigate the impact of using Web-based decision aids to support men’s prostate cancer screening decisions in comparison with usual care and other formats of decision aids. Methods: We searched PubMed, CINAHL, PsycINFO, and Cochrane CENTRAL databases up to November 2016. This search identified randomized controlled trials, which assessed Web-based decision aids for men making a prostate cancer screening decision and reported quality of decision-making outcomes. Two reviewers independently screened citations for inclusion criteria, extracted data, and assessed risk of bias. Using a random-effects model, meta-analyses were conducted pooling results using mean differences (MD), standardized mean differences (SMD), and relative risks (RR). Results: Of 2406 unique citations, 7 randomized controlled trials met the inclusion criteria. For risk of bias, selective outcome reporting and participant/personnel blinding were mostly rated as unclear due to inadequate reporting. Based on seven items, two studies had high risk of bias for one item. Compared to usual care, Web-based decision aids increased knowledge (SMD 0.46; 95% CI 0.18-0.75), reduced decisional conflict (MD –7.07%; 95% CI –9.44 to –4.71), and reduced the practitioner control role in the decision-making process (RR 0.50; 95% CI 0.31-0.81). Web-based decision aids compared to printed decision aids yielded no differences in knowledge, decisional conflict, and participation in decision or screening behaviors. Compared to video decision aids, Web-based decision aids showed lower average knowledge scores (SMD –0.50; 95% CI –0.88 to –0.12) and a slight decrease in prostate-specific antigen screening (RR 1.12; 95% CI 1.01-1.25). Conclusions: According to this analysis, Web-based decision aids performed similarly to alternative formats (ie, printed, video) for the assessed decision-quality outcomes. The low cost, readiness, availability, and anonymity of the Web can be an advantage for increasing access to decision aids that support prostate cancer screening decisions among men. %M 29945857 %R 10.2196/jmir.9070 %U http://www.jmir.org/2018/6/e228/ %U https://doi.org/10.2196/jmir.9070 %U http://www.ncbi.nlm.nih.gov/pubmed/29945857 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e203 %T Using Social Media to Target Cancer Prevention in Young Adults: Viewpoint %A Sarkar,Urmimala %A Le,Gem M %A Lyles,Courtney R %A Ramo,Danielle %A Linos,Eleni %A Bibbins-Domingo,Kirsten %+ Center for Vulnerable Populations, Division of General Internal Medicine, University of California, San Francisco, Building 10, 3rd Floor, 1001 Potrero Ave, San Francisco, CA, 94110, United States, 1 415 206 4273, urmimala.sarkar@ucsf.edu %K cancer %K prevention & control %K young adult %K behavior %K social media %D 2018 %7 05.06.2018 %9 Viewpoint %J J Med Internet Res %G English %X Focusing on primary cancer prevention can reduce its incidence. Changing health behaviors is critical to cancer prevention. Modifiable cancer risk factors include lifestyle behaviors related to vaccination, physical activity, weight control and maintenance, alcohol consumption, and tobacco use. These health habits are often formed in young adulthood, a life stage which currently intersects with the growing population of digital natives whose childhood occurred in the internet era. Social media is a critical communication medium to reach this population of digital natives. Using a life course perspective, the purpose of this viewpoint paper is to describe the current landscape of nascent research using social media to target cancer prevention efforts in young adults and propose future directions to strengthen the scientific knowledge supporting social media strategies to promote cancer prevention behaviors. Leveraging social media as a health promotion tool is a promising strategy to impact modifiable behavioral risk factors for cancer and warrants further research on developing effective communication strategies in young adults to prevent cancer in the future generations. %R 10.2196/jmir.8882 %U http://www.jmir.org/2018/6/e203/ %U https://doi.org/10.2196/jmir.8882 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e9 %T Developing a Self-Administered Decision Aid for Fecal Immunochemical Test–Based Colorectal Cancer Screening Tailored to Citizens With Lower Educational Attainment: Qualitative Study %A Gabel,Pernille %A Kirkegaard,Pia %A Larsen,Mette Bach %A Edwards,Adrian %A Andersen,Berit %+ Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Skovlyvej 15, Randers NØ, DK-8930, Denmark, 45 78420185, pergab@rm.dk %K colorectal neoplasms %K mass screening %K decision support techniques %K socioeconomic factors %K qualitative research %D 2018 %7 22.05.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Citizens with lower educational attainments (EA) take up colorectal cancer screening to a lesser degree, and more seldom read and understand conventional screening information than citizens with average EAs. The information needs of citizens with lower EA are diverse, however, with preferences ranging from wanting clear recommendations to seeking detailed information about screening. Decision aids have been developed to support citizens with lower EA in making informed decisions about colorectal cancer screening participation, but none embrace diverse information needs. Objective: The aim of this study was to develop a self-administered decision aid for participation in fecal immunochemical test–based colorectal cancer screening. The decision aid should be tailored to citizens with lower EA and should embrace diverse information needs. Methods: The Web-based decision aid was developed according to an international development framework, with specific steps for designing, alpha testing, peer reviewing, and beta testing the decision aid. In the design phase, a prototype of the decision aid was developed based on previous studies about the information needs of lower EA citizens and the International Patient Decision Aid Standards guidelines. Alpha testing was conducted using focus group interviews and email correspondence. Peer review was conducted using email correspondence. Both tests included both lower EA citizens and health care professionals. The beta testing was conducted using telephone interviews with citizens with lower EA. Data were analyzed using thematic analysis. Results: The developed decision aid presented information in steps, allowing citizens to read as much or as little as wanted. Values clarification questions were included after each section of information, and answers were summarized in a “choice-indicator” on the last page, guiding the citizens toward a decision about screening participation. Statistics were presented in both natural frequencies, absolute risk formats and graphically. The citizens easily and intuitively navigated around the final version of the decision aid and stated that they felt encouraged to think about the benefits and harms of colorectal cancer screening without being overloaded with information. They found the decision aid easy to understand and the text of suitable length. The health care professionals agreed with the citizens on most parts; however, concerns were raised about the length and readability of the text. Conclusions: We have developed a self-administered decision aid presenting information in steps. We involved both citizens and health care professionals to target the decision aid for citizens with lower EA. This decision aid represents a new way of communicating detailed information and may be able to enhance informed choices about colorectal cancer screening participation among citizens with lower EA. %M 30684402 %R 10.2196/formative.9696 %U http://formative.jmir.org/2018/1/e9/ %U https://doi.org/10.2196/formative.9696 %U http://www.ncbi.nlm.nih.gov/pubmed/30684402 %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 2 %P e52 %T Implementation of Digital Awareness Strategies to Engage Patients and Providers in a Lung Cancer Screening Program: Retrospective Study %A Jessup,Dana L %A Glover IV,McKinley %A Daye,Dania %A Banzi,Lynda %A Jones,Philip %A Choy,Garry %A Shepard,Jo-Anne O %A Flores,Efrén J %+ Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, United States, 1 617 724 5246, ejflores@mgh.harvard.edu %K lung neoplasms %K diagnostic imaging %K social media %K patient participation %K search engine %D 2018 %7 15.02.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Lung cancer is the leading cause of cancer-related deaths in the United States. Despite mandated insurance coverage for eligible patients, lung cancer screening rates remain low. Digital platforms, including social media, provide a potentially valuable tool to enhance health promotion and patient engagement related to lung cancer screening (LCS). Objective: The aim was to assess the effectiveness of LCS digital awareness campaigns on utilization of low-dose computed tomography (LDCT) and visits to institutional online educational content. Methods: A pay-per-click campaign utilizing Google and Facebook targeted adults aged 55 years and older and caregivers aged 18 years and older (eg, spouses, adult children) with LCS content during a 20-week intervention period from May to September 2016. A concurrent pay-per-click campaign using LinkedIn and Twitter targeted health care providers with LCS content. Geographic target radius was within 60 miles of an academic medical center. Social media data included aggregate demographics and click-through rates (CTRs). Primary outcome measures were visits to institutional Web pages and scheduled LDCT exams. Study period was 20 weeks before, during, and after the digital awareness campaigns. Results: Weekly visits to the institutional LCS Web pages were significantly higher during the digital awareness campaigns compared to the 20-week period prior to implementation (mean 823.9, SD 905.8 vs mean 51, SD 22.3, P=.001). The patient digital awareness campaign surpassed industry standard CTRs on Google (5.85%, 1108/18,955 vs 1.8%) and Facebook (2.59%, 47,750/1,846,070 vs 0.8%). The provider digital awareness campaign surpassed industry standard CTR on LinkedIn (1.1%, 630/57,079 vs 0.3%) but not Twitter (0.19%, 1139/587,133 vs 0.25%). Mean scheduled LDCT exam volumes per week before, during, and after the digital awareness campaigns were 17.4 (SD 7.5), 20.4 (SD 5.4), and 26.2 (SD 6.4), respectively, with the difference between the mean number of scheduled exams after the digital awareness campaigns and the number of exams scheduled before and after the digital awareness campaigns being statistically significant (P<.001). Conclusions: Implementation of the LCS digital awareness campaigns was associated with increased visits to institutional educational Web pages and scheduled LDCT exams. Digital platforms are an important tool to enhance health promotion activities and engagement with patients and providers. %M 29449199 %R 10.2196/jmir.8932 %U http://www.jmir.org/2018/2/e52/ %U https://doi.org/10.2196/jmir.8932 %U http://www.ncbi.nlm.nih.gov/pubmed/29449199 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 1 %P e2 %T Web-Based Communication Strategies Designed to Improve Intention to Minimize Risk for Colorectal Cancer: Randomized Controlled Trial %A Wilson,Carlene %A Flight,Ingrid %A Zajac,Ian T %A Turnbull,Deborah %A Young,Graeme P %A Olver,Ian %+ Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, SA, 5042, Australia, 61 3 9496 9967, carlene.wilson@flinders.edu.au %K internet %K randomized controlled trial %K information seeking behavior %K consumer health information %K health communication %D 2018 %7 12.02.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: People seek information on the Web for managing their colorectal cancer (CRC) risk but retrieve much personally irrelevant material. Targeting information pertinent to this cohort via a frequently asked question (FAQ) format could improve outcomes. Objective: We identified and prioritized colorectal cancer information for men and women aged 35 to 74 years (study 1) and built a website containing FAQs ordered by age and gender. In study 2, we conducted a randomized controlled trial (RCT) to test whether targeted FAQs were more influential on intention to act on CRC risk than the same information accessed via a generic topic list. Secondary analyses compared preference for information delivery, usability, relevance, and likelihood of recommendation of FAQ and LIST websites. Methods: Study 1 determined the colorectal cancer information needs of Australians (N=600) by sex and age group (35-49, 50-59, 60-74) through a Web-based survey. Free-text responses were categorized as FAQs: the top 5 issues within each of the 6 cohorts were identified. Study 2 (N=240) compared the impact of presentation as targeted FAQ links to information with links presented as a generic list (LIST) and a CONTROL (no information) condition. We also tested preference for presentation of access to information as FAQ or LIST by adding a CHOICE condition (a self-selected choice of FAQs or a list of information topics). Results: Study 1 showed considerable consistency in information priorities among all 6 cohorts with 2 main concerns: treatment of CRC and risk factors. Some differences included a focus on general risk factors, excluding diet and lifestyle, in the younger cohort, and on the existence of a test for CRC in the older cohorts. Study 2 demonstrated that, although respondents preferred information access ordered by FAQs over a list, presentation in this format had limited impact on readiness to act on colorectal cancer risk compared with the list or a no-information control (P=.06). Both FAQ and LIST were evaluated as equally usable. Those aged 35 to 49 years rated the information less relevant to them and others in their age group, and information ordered by FAQs was rated, across all age groups and both sexes, as less relevant to people outside the age group targeted within the FAQs. Conclusions: FAQs are preferred over a list as a strategy for presenting access to information about CRC. They may improve intention to act on risk, although further research is required. Future research should aim to identify better the characteristics of information content and presentation that optimize perceived relevance and fully engage the target audience. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12618000137291; https://www.anzctr.org. au/Trial/Registration/TrialReview.aspx?id=374129 (Archived by WebCite at http://www.webcitation.org/6x2Mr6rPC) %M 29434013 %R 10.2196/cancer.8250 %U http://cancer.jmir.org/2018/1/e2/ %U https://doi.org/10.2196/cancer.8250 %U http://www.ncbi.nlm.nih.gov/pubmed/29434013 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e46 %T Perceived Threat and Internet Use Predict Intentions to Get Bowel Cancer Screening (Colonoscopy): Longitudinal Questionnaire Study %A Becker,Daniela %A Grapendorf,Johannes %A Greving,Hannah %A Sassenberg,Kai %+ Social Processes Lab, Leibniz-Institut für Wissensmedien, Schleichstraße 6, Tübingen, 72076, Germany, 49 7071979231, d.becker@iwm-tuebingen.de %K emotion %K Internet %K colonoscopy %K cancer screening %D 2018 %7 07.02.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Many people use the Internet for health-related information search, which is known to help regulate their emotional state. However, not much is known yet about how Web-based information search together with negative emotional states (ie, threat of cancer diagnosis) relate to preventive medical treatment decisions (ie, colonoscopy intentions). Objective: The aim of this study was to investigate how frequency of health-related Internet use together with perceived threat of a possible (bowel) cancer diagnosis influences intentions to get a colonoscopy. Previous research has shown that people who experience threat preferentially process positive information in an attempt to downregulate the aversive emotional state. The Internet can facilitate this regulatory strategy through allowing self-directed, unrestricted, and thus biased information search. In the context of threat regarding a possible bowel cancer diagnosis, feelings of threat can still be effectively reduced through cancer screening (ie, colonoscopy). We, therefore, predict that in that particular context, feelings of threat should be related to stronger colonoscopy intentions, and that this relationship should be enhanced for people who use the Internet often. Methods: A longitudinal questionnaire study was conducted among healthy participants who were approaching or just entering the bowel cancer risk group (aged 45-55 years). Perceived threat of a possible (bowel) cancer diagnosis, frequency of health-related Internet use, and intentions to have a colonoscopy were assessed at 2 time points (6-month time lag between the 2 measurement points T1 and T2). Multiple regression analyses were conducted to test whether threat and Internet use at T1 together predicted colonoscopy intentions at T2. Results: In line with our predictions, we found that the threat of a possible (bowel) cancer diagnosis interacted with the frequency of Internet use (both T1) to predict colonoscopy intentions (T2; B=.23, standard error [SE]=0.09, P=.01). For people who used the Internet relatively often (+1 SD), the positive relationship between threat and colonoscopy intentions was significantly stronger (B=.56, SE=0.15, P<.001) compared with participants who used the Internet less often (−1 SD; B=.17, SE=0.09, P=.07). This relationship was unique to Web-based (vs other types of) information search and independent of risk factors (eg, body mass index [BMI] and smoking). Conclusions: The results of this study suggest that health-related Internet use can facilitate emotion-regulatory processes. People who feel threatened by a possible (bowel) cancer diagnosis reported stronger colonoscopy intentions, especially when they used the Internet often. We propose that this is because people who experience threat are more likely to search for and process information that allows them to downregulate their aversive emotional state. In the present case of (bowel) cancer prevention, the most effective way to reduce threat is to get screened. %M 29415872 %R 10.2196/jmir.9144 %U http://www.jmir.org/2018/2/e46/ %U https://doi.org/10.2196/jmir.9144 %U http://www.ncbi.nlm.nih.gov/pubmed/29415872 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 3 %N 2 %P e24 %T An E-Learning Module to Improve Nongenetic Health Professionals’ Assessment of Colorectal Cancer Genetic Risk: Feasibility Study %A Douma,Kirsten Freya Lea %A Aalfs,Cora M %A Dekker,Evelien %A Tanis,Pieter J %A Smets,Ellen M %+ Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 205668735, k.f.douma@amc.uva.nl %K colorectal neoplasms %K colorectal, neoplasms, hereditary nonpolyposis %K adenomatous polyposis coli %K genetic testing %K gastroenterology %K health communication %K feasibility studies %K education %K professional %D 2017 %7 18.12.2017 %9 Original Paper %J JMIR Med Educ %G English %X Background: Nongenetic health providers may lack the relevant knowledge, experience, and communication skills to adequately detect familial colorectal cancer (CRC), despite a positive attitude toward the assessment of history of cancer in a family. Specific training may enable them to more optimally refer patients to genetic counseling. Objective: The aim of this study was to develop an e-learning module for gastroenterologists and surgeons (in training) aimed at improving attitudes, knowledge, and comprehension of communication skills, and to assess the feasibility of the e-learning module for continued medical education of these specialists. Methods: A focus group helped to inform the development of a training framework. The e-learning module was then developed, followed by a feasibility test among a group of surgeons-in-training (3rd- and 4th-year residents) and then among gastroenterologists, using pre- and posttest questionnaires. Results: A total of 124 surgeons-in-training and 14 gastroenterologists participated. The e-learning was positively received (7.5 on a scale of 1 to 10). Between pre- and posttest, attitude increased significantly on 6 out of the 10 items. Mean test score showed that knowledge and comprehension of communication skills improved significantly from 49% to 72% correct at pretest to 67% to 87% correct at posttest. Conclusions: This study shows the feasibility of a problem-based e-learning module to help surgeons-in-training and gastroenterologists in recognizing a hereditary predisposition in patients with CRC. The e-learning led to improvements in attitude toward the assessment of cancer family history, knowledge on criteria for referral to genetic counseling for CRC, and comprehension of communication skills. %M 29254907 %R 10.2196/mededu.7173 %U http://mededu.jmir.org/2017/2/e24/ %U https://doi.org/10.2196/mededu.7173 %U http://www.ncbi.nlm.nih.gov/pubmed/29254907 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 9 %P e319 %T Photoaging Mobile Apps in School-Based Melanoma Prevention: Pilot Study %A Brinker,Titus Josef %A Brieske,Christian Martin %A Schaefer,Christoph Matthias %A Buslaff,Fabian %A Gatzka,Martina %A Petri,Maximilian Philip %A Sondermann,Wiebke %A Schadendorf,Dirk %A Stoffels,Ingo %A Klode,Joachim %+ Department of Dermatology, Venereology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, Essen, 45147, Germany, 49 +4915175984347, titus.brinker@gmail.com %K melanoma %K skin cancer %K prevention %K mobile apps %K smartphones %K photoaging %K schools %K secondary schools %K adolescents %D 2017 %7 08.09.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Around 90% of melanomas are caused by exposure to ultraviolet (UV) radiation and are therefore eminently preventable. Tanning behavior is mostly initiated in early adolescence, often with the belief that it increases attractiveness; the problems related to malignant melanoma and other skin cancers are too far in the future to fathom. Given the substantial amount of time children and adolescents spend in schools, as well as with their mobile phones, addressing melanoma prevention via both of these ways is crucial. However, no school-based intervention using mobile apps has been evaluated to date. We recently released a photoaging mobile app, in which a selfie is altered to predict future appearance dependent on UV protection behavior and skin type. Objective: In this pilot study, we aimed to use mobile phone technology to improve school-based melanoma prevention and measure its preliminary success in different subgroups of students with regard to their UV protection behavior, Fitzpatrick skin type and age. Methods: We implemented a free photoaging mobile phone app (Sunface) in 2 German secondary schools via a method called mirroring. We “mirrored” the students’ altered 3-dimensional (3D) selfies reacting to touch on mobile phones or tablets via a projector in front of their whole grade. Using an anonymous questionnaire capturing sociodemographic data as well as risk factors for melanoma we then measured their perceptions of the intervention on a 5-point Likert scale among 205 students of both sexes aged 13-19 years (median 15 years). Results: We measured more than 60% agreement in both items that measured motivation to reduce UV exposure and only 12.5% disagreement: 126 (63.0%) agreed or strongly agreed that their 3D selfie motivated them to avoid using a tanning bed, and 124 (61.7%) to increase use of sun protection. However, only 25 (12.5%) disagreed with both items. The perceived effect on motivation was increased in participants with Fitzpatrick skin types 1-2 in both tanning bed avoidance (n=74, 71.8% agreement in skin types 1-2 vs n=50, 53.8% agreement in skin types 3-6) and increased use of sun protection (n=70, 68.0% agreement in skin types 1-2 vs n=52, 55.3% agreement in skin types 3-6), and also positively correlated with higher age. Conclusions: We present a novel way of integrating photoaging in school-based melanoma prevention that affects the students’ peer group, considers the predictors of UV exposure in accordance with the theory of planned behavior, and is particularly effective in changing behavioral predictors in fair-skinned adolescents (Fitzpatrick skin types 1-2). Further research is required to evaluate the intervention’s prospective effects on adolescents of various cultural backgrounds. %M 28887295 %R 10.2196/jmir.8661 %U http://www.jmir.org/2017/9/e319/ %U https://doi.org/10.2196/jmir.8661 %U http://www.ncbi.nlm.nih.gov/pubmed/28887295 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 9 %P e312 %T Effectiveness of a Web-Based Tailored Intervention With Virtual Assistants Promoting the Acceptability of HPV Vaccination Among Mothers of Invited Girls: Randomized Controlled Trial %A Pot,Mirjam %A Paulussen,Theo GWM %A Ruiter,Robert AC %A Eekhout,Iris %A de Melker,Hester E %A Spoelstra,Maxine EA %A van Keulen,Hilde M %+ Netherlands Organization for Applied Scientific Research (TNO), Child Health, Schipholweg 77, Leiden, 2316 ZL, Netherlands, 31 888662213, mirjam.pot@tno.nl %K vaccination %K health promotion %K web-based intervention computer-tailoring %K randomized controlled trial %D 2017 %7 06.09.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: In 2010, the human papillomavirus (HPV) vaccination was introduced in the Dutch National Immunization Program for 12-year-old girls, aiming to reduce the incidence of cervical cancer in women. HPV vaccination uptake turned out to be lower than expected: 61% versus 70%, respectively. Mothers were shown to play the most important role in the immunization decision about this vaccination. They had also expressed their need for interactive personal information about the HPV vaccination over and above the existing universal general information. To improve the effectiveness of the existing education about the HPV vaccination, we systematically developed a Web-based tailored intervention with virtual assistants providing mothers of girls to be invited with tailored feedback on their decision making about the HPV vaccination. Objective: The aim of this study was to evaluate the effectiveness of the Web-based tailored intervention for promoting HPV vaccination acceptance by means of a randomized controlled trial (RCT). Methods: Mothers were recruited via the Dutch vaccination register (Praeventis) (n=36,000) and three Web-based panels (n=2483). Those who gave informed consent (N=8062) were randomly assigned to the control (n=4067) or intervention condition (n=3995). HPV vaccination uptake, as registered by Praeventis once the HPV vaccination round was completed, was used as the primary outcome. Secondary outcomes were differential scores across conditions between baseline (before the provided access to the new tailored intervention) and follow-up (just before the first vaccination) regarding the mothers’ degree of informed decision making (IDM), decisional conflict, and critical determinants of HPV vaccination uptake among which are intention, attitude, risk perception, and outcome beliefs. Results: Intention-to-treat analysis (N=8062) showed a significant positive effect of the intervention on IDM, decisional conflict, and nearly all determinants of HPV vaccination uptake (P<.001). No effect was found on uptake (P=.60). This may be attributed to the overall high uptake rates in both conditions. Mothers evaluated the intervention as highly positive, including the website as well as the virtual assistants that were used to deliver the tailored feedback. Conclusions: This computer-tailored intervention has the potential to improve HPV vaccination acceptability and IDM and to decrease decisional conflict among mothers of invited girls. Implications for future research are discussed. Trial Registration: Trialregister.nl NTR4935; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4935 (Archived by WebCite at http://www.webcitation.org/6srT7l9EM) %M 28877862 %R 10.2196/jmir.7449 %U http://www.jmir.org/2017/9/e312/ %U https://doi.org/10.2196/jmir.7449 %U http://www.ncbi.nlm.nih.gov/pubmed/28877862 %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 %@ 2369-2960 %I JMIR Publications %V 3 %N 2 %P e33 %T Recruiting Young Gay and Bisexual Men for a Human Papillomavirus Vaccination Intervention Through Social Media: The Effects of Advertisement Content %A Reiter,Paul L %A Katz,Mira L %A Bauermeister,Jose A %A Shoben,Abigail B %A Paskett,Electra D %A McRee,Annie-Laurie %+ College of Medicine, Ohio State University, 1590 North High Street, Suite 525, Columbus, OH, 43201, United States, 1 614 366 4265, paul.reiter@osumc.edu %K HPV %K HPV vaccine %K gay and bisexual men %K social media %D 2017 %7 02.06.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Web-based approaches, specifically social media sites, represent a promising approach for recruiting young gay and bisexual men for research studies. Little is known, however, about how the performance of social media advertisements (ads) used to recruit this population is affected by ad content (ie, image and text). Objective: The aim of this study was to evaluate the effects of different images and text included in social media ads used to recruit young gay and bisexual men for the pilot test of a Web-based human papillomavirus (HPV) vaccination intervention. Methods: In July and September 2016, we used paid Facebook advertisements to recruit men who were aged 18-25 years, self-identified as gay or bisexual, US resident, and had not received HPV vaccine. A 4x2x2 factorial experiment varied ad image (a single young adult male, a young adult male couple, a group of young adult men, or a young adult male talking to a doctor), content focus (text mentioning HPV or HPV vaccine), and disease framing (text mentioning cancer or a sexually transmitted disease [STD]). Poisson regression determined whether these experimental factors affected ad performance. Results: The recruitment campaign reached a total of 35,646 users who viewed ads for 36,395 times. This resulted in an overall unique click-through rate of 2.01% (717/35,646) and an overall conversion rate of 0.66% (241/36,395). Reach was higher for ads that included an image of a couple (incidence rate ratio, IRR=4.91, 95% CI 2.68-8.97, P<.001) or a group (IRR=2.65, 95% CI 1.08-6.50, P=.03) compared with those that included an image of a single person. Ads that included an image of a couple also had a higher conversion rate (IRR=2.56, 95% CI 1.13-5.77, P=.02) than ads that included an image of a single person. Ads with text mentioning an STD had a higher unique click-through rate compared with ads with text mentioning cancer (IRR=1.34, 95% CI 1.06-1.69, P=.01). The campaign cost a total of US $413.72 and resulted in 150 eligible and enrolled individuals (US $2.76 per enrolled participant). Conclusions: Facebook ads are a convenient and cost-efficient strategy for reaching and recruiting young gay and bisexual men for a Web-based HPV vaccination intervention. To help optimize ad performance among this population, researchers should consider the importance of the text and image included in the social media recruitment ads. %M 28576758 %R 10.2196/publichealth.7545 %U http://publichealth.jmir.org/2017/2/e33/ %U https://doi.org/10.2196/publichealth.7545 %U http://www.ncbi.nlm.nih.gov/pubmed/28576758 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 2 %P e17 %T Using Google Trends Data to Study Public Interest in Breast Cancer Screening in Brazil: Why Not a Pink February? %A Vasconcellos-Silva,Paulo Roberto %A Carvalho,Dárlinton Barbosa Feres %A Trajano,Valéria %A de La Rocque,Lucia Rodriguez %A Sawada,Anunciata Cristina Marins Braz %A Juvanhol,Leidjaira Lopes %+ Laboratory of Innovation in Therapies, Teaching and Bioproducts /LITEB, Oswaldo Cruz Institute/IOC, Oswaldo Cruz Foundation, Manguinhos, Avenida Brasil 4365, Rio de Janeiro, CEP21040-360, Brazil, 55 21 25621477, bioeticaunirio@yahoo.com.br %K Internet %K cancer information seeking %K breast cancer %K mass screening %K health communication %K early detection of cancer %K infoveillance %K infodemiology %D 2017 %7 06.04.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: One of the major challenges of the Brazilian Ministry of Health is to foster interest in breast cancer screening (BCS), especially among women at high risk. Strategies have been developed to promote the early identification of breast cancer mainly by Pink October campaigns. The massive number of queries conducted through Google creates traffic data that can be analyzed to show unrevealed interest cycles and their seasonalities. Objectives: Using Google Trends, we studied cycles of public interest in queries toward mammography and breast cancer along the last 5 years. We hypothesize that these data may be correlated with collective interest cycles leveraged by national BCS campaigns such as Pink October. Methods: Google Trends was employed to normalize traffic data on a scale from 0 (<1% of the peak volume) to 100 (peak of traffic) presented as weekly relative search volume (RSV) concerning mammography and breast cancer as search terms. A time series covered the last 261 weeks (November 2011 to October 2016), and RSV of both terms were compared with their respective annual means. Polynomial trendlines (second order) were employed to estimate overall trends. Results: We found an upward trend for both terms over the 5 years, with almost parallel trendlines. Remarkable peaks were found along Pink October months— mammography and breast cancer searches were leveraged up reaching, respectively, 119.1% (2016) and 196.8% (2015) above annual means. Short downward RSVs along December-January months were also noteworthy along all the studied period. These trends traced an N-shaped pattern with higher peaks in Pink October months and sharp falls along subsequent December and January. Conclusions: Considering these findings, it would be reasonable to bring Pink October to the beginning of each year, thereby extending the beneficial effect of the campaigns. It would be more appropriate to start screening campaigns at the beginning of the year, when new resolutions are taken and new projects are added to everyday routines. Our work raises attention to the study of traffic data to encourage health campaign analysts to undertake better analysis based on marketing practices. %M 28385679 %R 10.2196/publichealth.7015 %U http://publichealth.jmir.org/2017/2/e17/ %U https://doi.org/10.2196/publichealth.7015 %U http://www.ncbi.nlm.nih.gov/pubmed/28385679 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 1 %P e14 %T Tweet for Behavior Change: Using Social Media for the Dissemination of Public Health Messages %A Gough,Aisling %A Hunter,Ruth F %A Ajao,Oluwaseun %A Jurek,Anna %A McKeown,Gary %A Hong,Jun %A Barrett,Eimear %A Ferguson,Marbeth %A McElwee,Gerry %A McCarthy,Miriam %A Kee,Frank %+ UKCRC Centre of Excellence in Public Health Northern Ireland, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Institute of Clinical Sciences, Block B, Belfast,, United Kingdom, 44 028 9097 8931, a.gough@qub.ac.uk %K social media %K Twitter %K awareness %K public heath %K skin cancer %K behavior change %K communication %D 2017 %7 23.03.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media public health campaigns have the advantage of tailored messaging at low cost and large reach, but little is known about what would determine their feasibility as tools for inducing attitude and behavior change. Objective: The aim of this study was to test the feasibility of designing, implementing, and evaluating a social media–enabled intervention for skin cancer prevention. Methods: A quasi-experimental feasibility study used social media (Twitter) to disseminate different message “frames” related to care in the sun and cancer prevention. Phase 1 utilized the Northern Ireland cancer charity’s Twitter platform (May 1 to July 14, 2015). Following a 2-week “washout” period, Phase 2 commenced (August 1 to September 30, 2015) using a bespoke Twitter platform. Phase 2 also included a Thunderclap, whereby users allowed their social media accounts to automatically post a bespoke message on their behalf. Message frames were categorized into 5 broad categories: humor, shock or disgust, informative, personal stories, and opportunistic. Seed users with a notable following were contacted to be “influencers” in retweeting campaign content. A pre- and postintervention Web-based survey recorded skin cancer prevention knowledge and attitudes in Northern Ireland (population 1.8 million). Results: There were a total of 417,678 tweet impressions, 11,213 engagements, and 1211 retweets related to our campaign. Shocking messages generated the greatest impressions (shock, n=2369; informative, n=2258; humorous, n=1458; story, n=1680), whereas humorous messages generated greater engagement (humorous, n=148; shock, n=147; story, n=117; informative, n=100) and greater engagement rates compared with story tweets. Informative messages, resulted in the greatest number of shares (informative, n=17; humorous, n=10; shock, n=9; story, n=7). The study findings included improved knowledge of skin cancer severity in a pre- and postintervention Web-based survey, with greater awareness that skin cancer is the most common form of cancer (preintervention: 28.4% [95/335] vs postintervention: 39.3% [168/428] answered “True”) and that melanoma is most serious (49.1% [165/336] vs 55.5% [238/429]). The results also show improved attitudes toward ultraviolet (UV) exposure and skin cancer with a reduction in agreement that respondents “like to tan” (60.5% [202/334] vs 55.6% [238/428]). Conclusions: Social media–disseminated public health messages reached more than 23% of the Northern Ireland population. A Web-based survey suggested that the campaign might have contributed to improved knowledge and attitudes toward skin cancer among the target population. Findings suggested that shocking and humorous messages generated greatest impressions and engagement, but information-based messages were likely to be shared most. The extent of behavioral change as a result of the campaign remains to be explored, however, the change of attitudes and knowledge is promising. Social media is an inexpensive, effective method for delivering public health messages. However, existing and traditional process evaluation methods may not be suitable for social media. %M 28336503 %R 10.2196/publichealth.6313 %U http://publichealth.jmir.org/2017/1/e14/ %U https://doi.org/10.2196/publichealth.6313 %U http://www.ncbi.nlm.nih.gov/pubmed/28336503 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 4 %N 2 %P e13 %T A Video Game Promoting Cancer Risk Perception and Information Seeking Behavior Among Young-Adult College Students: A Randomized Controlled Trial %A Khalil,Georges Elias %A Beale,Ivan L %A Chen,Minxing %A Prokhorov,Alexander V %+ The M.D. Anderson Cancer Center, Department of Behavioral Science, University of Texas, 1155 Pressler St. Unit 1330, Houston, TX,, United States, 1 713 563 2605, gekhalil@mdanderson.org %K cancer %K risk %K information seeking %K perceived risk %K perceived susceptibility %K perceived severity %K cancer prevention %K games for health %K serious games %D 2016 %7 28.07.2016 %9 Original Paper %J JMIR Serious Games %G English %X Background: Risky behaviors tend to increase drastically during the transition into young adulthood. This increase may ultimately facilitate the initiation of carcinogenic processes at a young age, highlighting a serious public health problem. By promoting information seeking behavior (ISB), young adults may become aware of cancer risks and potentially take preventive measures. Objective: Based on the protection motivation theory, the current study seeks to evaluate the impact of challenge in a fully automated video game called Re-Mission on young adult college students' tendency to perceive the severity of cancer, feel susceptible to cancer, and engage in ISB. Methods: A total of 216 young adults were recruited from a university campus, consented, screened, and randomized in a single-blinded format to 1 of 3 conditions: an intervention group playing Re-Mission at high challenge (HC; n=85), an intervention group playing Re-Mission at low challenge (LC; n=81), and a control group with no challenge (NC; presented with illustrated pictures of Re-Mission; n=50). Measurement was conducted at baseline, immediate posttest, 10-day follow-up, and 20-day follow-up. Repeated-measures mixed-effect models were conducted for data analysis of the main outcomes. Results: A total of 101 young adults continued until 20-day follow-up. Mixed-effect models showed that participants in the HC and LC groups were more likely to increase in perceived susceptibility to cancer (P=.03), perceived severity of cancer (P=.02), and ISB (P=.01) than participants in the NC group. The LC group took until 10-day follow-up to show increase in perceived susceptibility (B=0.47, standard error (SE) 0.16, P=.005). The HC group showed an immediate increase in perceived susceptibility at posttest (B=0.43, SE 0.14, P=.002). The LC group exhibited no changes in perceived severity (B=0.40, SE 0.33, P=.24). On the other hand, the HC group showed a significant increase from baseline to posttest (B=0.39, SE 0.14, P=.005), maintaining this increase until 20-day follow-up (B=−0.007, SE 0.26, P=.98). Further analyses indicated that perceived threat from virtual cancer cells in the game is related to the increase in perceived severity (B=0.1, SE 0.03, P=.001), and perceived susceptibility is related to changes in ISB at 10-day follow-up (B=0.21, SE 0.08, P=.008). Conclusions: The feature of challenge with cancer cells in a virtual environment has the potential to increase cancer risk perception and ISB. The results are promising considering that the Re-Mission intervention was neither designed for cancer risk communication, nor applied among healthy individuals. Further research is needed to understand the theoretical framework underlying the effects of Re-Mission on ISB. The findings call for the development of a Web-based, game-based intervention for cancer risk communication and information seeking among young adults. ClinicalTrial: International Standard Randomized Controlled Trial Number (ISRCTN): 15789289; http://www.controlled-trials.com/ISRCTN15789289 (Archived by WebCite at http://www.webcitation.org/6jGYZC3lZ) %M 27470927 %R 10.2196/games.5793 %U http://games.jmir.org/2016/2/e13/ %U https://doi.org/10.2196/games.5793 %U http://www.ncbi.nlm.nih.gov/pubmed/27470927 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e69 %T Mobile Phone Apps for Preventing Cancer Through Educational and Behavioral Interventions: State of the Art and Remaining Challenges %A Coughlin,Steven %A Thind,Herpreet %A Liu,Benyuan %A Champagne,Nicole %A Jacobs,Molly %A Massey,Rachael I %+ University of Massachusetts Lowell, Department of Community Health and Sustainability, One University Avenue, Kitson Hall 313A, Lowell, MA, 01854, United States, 1 404 983 2524, stevecatlanta@aol.com %K mobile phone apps %K cancer %K early detection of cancer %K diet %K environmental carcinogens %K health literacy %K nutrition %K obesity %K prevention %K randomized controlled trials %K screening %K smoking %K sun safety %K weight loss %D 2016 %7 30.05.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Rapid developments in technology have encouraged the use of mobile phones in smoking cessation, promoting healthy diet, nutrition, and physical activity, sun safety, and cancer screening. Although many apps relating to the prevention of cancer and other chronic diseases are available from major mobile phone platforms, relatively few have been tested in research studies to determine their efficacy. Objective: In this paper, we discuss issues related to the development and testing of new apps for preventing cancer through smoking cessation, sun safety, and other healthy behaviors, including key methodologic issues and outstanding challenges. Methods: An exploratory literature review was conducted using bibliographic searches in PubMed and CINAHL with relevant search terms (eg, smartphones, smoking cessation, cancer prevention, cancer screening, and carcinogens) to identify papers published in English through October 2015. Results: Only 4 randomized controlled trials of the use of mobile phone apps for smoking cessation and 2 trials of apps for sun safety were identified, indicating that it is premature to conduct a systematic search and meta-analysis of the published literature on this topic. Conclusions: Future studies should utilize randomized controlled trial research designs, larger sample sizes, and longer study periods to better establish the cancer prevention and control capabilities of mobile phone apps. In developing new and refined apps for cancer prevention and control, both health literacy and eHealth literacy should be taken into account. There is a need for culturally appropriate, tailored health messages to increase knowledge and awareness of health behaviors such as smoking cessation, cancer screening, and sun safety. Mobile phone apps are likely to be a useful and low-cost intervention for preventing cancer through behavioral changes. %M 27242162 %R 10.2196/mhealth.5361 %U http://mhealth.jmir.org/2016/2/e69/ %U https://doi.org/10.2196/mhealth.5361 %U http://www.ncbi.nlm.nih.gov/pubmed/27242162 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e21 %T Benefits of E-Cigarettes Among Heavy Smokers Undergoing a Lung Cancer Screening Program: Randomized Controlled Trial Protocol %A Lucchiari,Claudio %A Masiero,Marianna %A Veronesi,Giulia %A Maisonneuve,Patrick %A Spina,Stefania %A Jemos,Costantino %A Omodeo Salè,Emanuela %A Pravettoni,Gabriella %+ Università Degli Studi di Milano, Department of Philosophy, Via Festa del Perdono 7, Milano, 20122, Italy, 39 0250312240, claudio.lucchiari@unimi.it %K tobacco cessation %K electronic cigarettes %K lung cancer screening %K smoking related diseases. %D 2016 %7 03.02.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smoking is a global public health problem. For this reason, experts have called smoking dependence a global epidemic. Over the past 5 years, sales of electronic cigarettes, or e-cigarettes, have been growing strongly in many countries. Yet there is only partial evidence that e-cigarettes are beneficial for smoking cessation. In particular, although it has been proven that nicotine replacement devices may help individuals stop smoking and tolerate withdrawal symptoms, e-cigarettes’ power to increase the quitting success rate is still limited, ranging from 5% to 20% dependent on smokers’ baseline conditions as shown by a recent Cochrane review. Consequently, it is urgent to know if e-cigarettes may have a higher success rate than other nicotine replacement methods and under what conditions. Furthermore, the effects of the therapeutic setting and the relationship between individual characteristics and the success rate have not been tested. This protocol is particularly innovative, because it aims to test the effectiveness of electronic devices in a screening program (the COSMOS II lung cancer prevention program at the European Institute of Oncology), where tobacco reduction is needed to lower individuals’ lung cancer risks. Objective: This protocol was designed with the primary aim of investigating the role of tobacco-free cigarettes in helping smokers improve lung health and either quit smoking or reduce their tobacco consumption. In particular, we aim to investigate the impact of a 3-month e-cigarettes program to reduce smoking-related respiratory symptoms (eg, dry cough, shortness of breath, mouth irritation, and phlegm) through reduced consumption of tobacco cigarettes. Furthermore, we evaluate the behavioral and psychological (eg, well-being, mood, and quality of life) effects of the treatment. Methods: This is a prospective, randomized, placebo-controlled, double-blind, three-parallel group study. The study is organized as a nested randomized controlled study with 3 branches: a nicotine e-cigarettes group, a nicotine-free e-cigarettes group, and a control group. The study is nested in a screening program for early lung cancer detection in heavy smokers. Results: The study is open and is still recruiting. Conclusions: Stopping or reducing tobacco consumption should be a main goal of any health organization. However, traditional antismoking programs are expensive and not always effective. Therefore, favoring a partial or complete shift to e-cigarettes in heavy smokers (eg, persons at high risk for a number of diseases) could be considered a moral imperative. However, before following this path, sound and reliable data on large samples and in a variety of contexts are required. Trial Registration: Clinicaltrials.gov NCT02422914; https://clinicaltrials.gov/ct2/show/NCT02422914 (Archived by WebCite at http://www.webcitation.org/6etwz1bPL) %M 26842790 %R 10.2196/resprot.4805 %U http://www.researchprotocols.org/2016/1/e21/ %U https://doi.org/10.2196/resprot.4805 %U http://www.ncbi.nlm.nih.gov/pubmed/26842790 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e19 %T Developing a Tablet-Based Self-Persuasion Intervention Promoting Adolescent HPV Vaccination: Protocol for a Three-Stage Mixed-Methods Study %A Tiro,Jasmin A %A Lee,Simon Craddock %A Marks,Emily G %A Persaud,Donna %A Skinner,Celette Sugg %A Street,Richard L %A Wiebe,Deborah J %A Farrell,David %A Bishop,Wendy Pechero %A Fuller,Sobha %A Baldwin,Austin S %+ Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, United States, 1 214 648 0263, jasmin.tiro@utsouthwestern.edu %K adolescents %K intervention development %K HPV vaccination %K self-persuasion %D 2016 %7 29.01.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Human papillomavirus (HPV)-related cancers are a significant burden on the US health care system that can be prevented through adolescent HPV vaccination. Despite guidelines recommending vaccination, coverage among US adolescents is suboptimal particularly among underserved patients (uninsured, low income, racial, and ethnic minorities) seen in safety-net health care settings. Many parents are ambivalent about the vaccine and delay making a decision or talking with a provider about it. Self-persuasion—generating one’s own arguments for a health behavior—may be particularly effective for parents who are undecided or not motivated to make a vaccine decision. Objective: Through a 3-stage mixed-methods protocol, we will identify an optimal and feasible self-persuasion intervention strategy to promote adolescent HPV vaccination in safety-net clinics. Methods: In Stage 1, we will define content for a tablet-based self-persuasion app by characterizing (1) parents’ self-generated arguments through cognitive interviews conducted with parents (n=50) of patients and (2) parent-provider HPV vaccine discussions through audio recordings of clinic visits (n=50). In Stage 2, we will compare the effects of the four self-persuasion intervention conditions that vary by cognitive processing level (parents verbalize vs listen to arguments) and choice of argument topics (parents choose vs are assigned topics) on parental vaccine intentions in a 2 × 2 factorial design randomized controlled trial (n=160). This proof-of-concept trial design will identify which intervention condition is optimal by quantitatively examining basic self-persuasion mechanisms (cognitive processing and choice) and qualitatively exploring parent experiences with intervention tasks. In Stage 3, we will conduct a pilot trial (n=90) in the safety-net clinics to assess feasibility of the optimal intervention condition identified in Stage 2. We will also assess its impact on parent-provider discussions. Results: This paper describes the study protocol and activities to date. Currently, we have developed the initial prototype of the tablet app for English- and Spanish-speaking populations, and completed Stage 1 data collection. Conclusions: Our systematic collaboration between basic and applied behavioral scientists accelerates translation of promising basic psychological research into innovative interventions suitable for underserved, safety-net populations. At project’s end, we plan to have a feasible and acceptable self-persuasion intervention that can affect key cancer disparities in the United States through prevention of HPV-related cancers. Trial Registration: ClinicalTrials.gov http://clinicaltrials.gov/ct2/show/NCT02537756 and http://clinicaltrials.gov/ct2/show/NCT02535845 (Archived by WebCite at http://www.webcitation.org/6e5XcOGXz and http://www.webcitation.org/6e5XfHoic, respectively). %M 26825137 %R 10.2196/resprot.5092 %U http://www.researchprotocols.org/2016/1/e19/ %U https://doi.org/10.2196/resprot.5092 %U http://www.ncbi.nlm.nih.gov/pubmed/26825137 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 1 %N 2 %P e8 %T Response Across the Health-Literacy Spectrum of Kidney Transplant Recipients to a Sun-Protection Education Program Delivered on Tablet Computers: Randomized Controlled Trial %A Robinson,June K %A Friedewald,John J %A Desai,Amishi %A Gordon,Elisa J %+ Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 1260, Chicago, IL, 60611, United States, 1 312 926 7449, june-robinson@northwestern.edu %K culturally sensitive %K electronic health intervention %K kidney transplant recipients %K post-transplant outcomes %K skin cancer %K squamous cell carcinoma %K sun protection %K tablet computer %K patient education %K mobile health %D 2015 %7 18.08.2015 %9 Original Paper %J JMIR Cancer %G English %X Background: Sun protection can reduce skin cancer development in kidney transplant recipients, who have a greater risk of developing squamous cell carcinoma than the general population. Objective: A culturally sensitive sun-protection program (SunProtect) was created in English and Spanish with the option of choosing audio narration provided by the tablet computer (Samsung Galaxy Tab 2 10.1). The intervention, which showed skin cancer on patients with various skin tones, explained the following scenarios: skin cancer risk, the ability of sun protection to reduce this risk, as well as offered sun-protection choices. The length of the intervention was limited to the time usually spent waiting during a visit to the nephrologist. Methods: The development of this culturally sensitive, electronic, interactive sun-protection educational program, SunProtect, was guided by the “transtheoretical model,” which focuses on decision making influenced by perceptions of personal risk or vulnerability to a health threat, importance (severity) of the disease, and benefit of sun-protection behavior. Transportation theory, which holds that narratives can have uniquely persuasive effects in overcoming preconceived beliefs and cognitive biases because people transported into a narrative world will alter their beliefs based on information, claims, or events depicted, guided the use of testimonials. Participant tablet use was self-directed. Self-reported responses to surveys were entered into the database through the tablet. Usability was tested through interviews. A randomized controlled pilot trial with 170 kidney transplant recipients was conducted, where the educational program (SunProtect) was delivered through a touch-screen tablet to 84 participants. Results: The study involved 62 non-Hispanic white, 60 non-Hispanic black, and 48 Hispanic/Latino kidney transplant recipients. The demographic survey data showed no significant mean differences between the intervention and control groups in age, sex, income, or time since transplantation. The mean duration of program use varied by the ethnic/racial group, with non-Hispanic whites having the shortest use (23 minutes) and Hispanic/Latinos having the longest use (42 minutes). Knowledge, awareness of skin cancer risk, willingness to change sun protection, and use of sun protection increased from baseline to 2 weeks after the program in participants from all ethnic/racial groups in comparison with controls (P<.05). Kidney transplant recipients with inadequate (47/170, 28%) and marginal functional health literacy (59/170, 35%) listened to either Spanish or English audio narration accompanying the text and graphics. After completion of the program, Hispanic/Latino patients with initially inadequate health literacy increased their knowledge more than non-Hispanic white and black patients with adequate health literacy (P<.05). Sun protection implemented 2 weeks after education varied by the ethnic/racial group. Outdoor activities were reduced by Hispanics/Latinos, non-Hispanic blacks sought shade, Hispanic/Latinos and non-Hispanic blacks wore clothing, and non-Hispanic whites wore sunscreen (P<.05). Conclusion: Educational program with a tablet computer during the kidney transplant recipients’ 6- or 12-month follow-up visits to the transplant nephrologist improved sun protection in all racial/ethnic groups. Tablets may be used to provide patient education and reduce the physician’s burden of educating and training patients. Trial Registration: ClinicalTrials.gov NCT01646099; https://clinicaltrials.gov/ct2/show/NCT01646099 %M 28410176 %R 10.2196/cancer.4787 %U http://cancer.jmir.org/2015/2/e8/ %U https://doi.org/10.2196/cancer.4787 %U http://www.ncbi.nlm.nih.gov/pubmed/28410176 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 2 %P e76 %T Using Ecological Momentary Assessment to Study Tobacco Behavior in Urban India: There’s an App for That %A Soong,Andrea %A Chen,Julia Cen %A Borzekowski,Dina LG %+ Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St, 4th Floor, Baltimore, MD, 21205, United States, 1 410 502 2482, asoong@jhu.edu %K ecological momentary assessment %K tobacco control %K cell phones %K mobile phones %K mHealth %K telemedicine %K smoking %D 2015 %7 24.06.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Ecological momentary assessment (EMA) uses real-time data collection to assess participants’ behaviors and environments. This paper explores the strengths and limitations of using EMA to examine social and environmental exposure to tobacco in urban India among older adolescents and adults. Objective: Objectives of this study were (1) to describe the methods used in an EMA study of tobacco use in urban India using a mobile phone app for data collection, (2) to determine the feasibility of using EMA in the chosen setting by drawing on participant completion and compliance rates with the study protocol, and (3) to provide recommendations on implementing mobile phone EMA research in India and other low- and middle-income countries. Methods: Via mobile phones and the Internet, this study used two EMA surveys: (1) a momentary survey, sent multiple times per day at random to participants, which asked about their real-time tobacco use (smoked and smokeless) and exposure to pro- and antitobacco messaging in their location, and 2) an end-of-day survey sent at the end of each study day. Trained participants, from Hyderabad and Kolkata, India, reported on their social and environmental exposure to tobacco over 10 consecutive days. This feasibility study examined participant compliance, exploring factors related to the successful completion of surveys and the validity of EMA data. Results: The sample included 205 participants, the majority of whom were male (135/205, 65.9%). Almost half smoked less than daily (56/205, 27.3%) or daily (43/205, 21.0%), and 4.4% (9/205) used smokeless tobacco products. Participants completed and returned 46.87% and 73.02% of momentary and end-of-day surveys, respectively. Significant predictors of momentary survey completion included employment and completion of end-of-day surveys. End-of-day survey completion was only significantly predicted by momentary survey completion. Conclusions: This first study of EMA in India offers promising results, although more research is needed on how to increase compliance. End-of-day survey completion, which has a lower research burden, may be the more appropriate approach to understanding behaviors such as tobacco use within vulnerable populations in challenging locations. Compliance may also be improved by increasing the number of study visits, compliance checks, or opportunities for retraining participants before and during data collection. %M 26109369 %R 10.2196/resprot.4408 %U http://www.researchprotocols.org/2015/2/e76/ %U https://doi.org/10.2196/resprot.4408 %U http://www.ncbi.nlm.nih.gov/pubmed/26109369 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 1 %N 1 %P e1 %T YouTube Videos Related to Skin Cancer: A Missed Opportunity for Cancer Prevention and Control %A Basch,Corey H %A Basch,Charles E %A Hillyer,Grace Clarke %A Reeves,Rachel %+ William Paterson University, 143 H Wing, Wayne, NJ, 07470, United States, 1 973 720 2603, baschc@wpunj.edu %K skin cancer %K social media %K YouTube %D 2015 %7 02.03.2015 %9 Short Paper %J JMIR Cancer %G English %X Background: Early detection and treatment influence the mortality risk of skin cancer. Objective: The objective of this study was to analyze the content of the most viewed professional and consumer videos uploaded to YouTube related to skin cancer. Methods: A total of 140 professional and consumer videos uploaded between 2007 and 2014 were identified and coded. Coding involved identifying and sorting followed by gathering descriptive information, including length of the video, number of views, and year uploaded. A dichotomous coding scheme (ie, yes or no) was used in coding specific aspects of video content, including provision of information, type of skin cancer, age group, family history, risk reduction, risk factors, fear, and home remedies for skin cancer treatment. Results: The majority of videos provided information related to screening. Many consumer videos conveyed information related to the use of a black salve as a home remedy for skin cancer, despite the fact that there is no evidence that it is an effective treatment. Conclusions: Research is needed to identify characteristics of videos that are most likely to be viewed to inform the development of credible communications. %M 28410167 %R 10.2196/cancer.4204 %U http://cancer.jmir.org/2015/1/e1/ %U https://doi.org/10.2196/cancer.4204 %U http://www.ncbi.nlm.nih.gov/pubmed/28410167