%0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e62833 %T Association Between Risk Factors and Major Cancers: Explainable Machine Learning Approach %A Huang,Xiayuan %A Ren,Shushun %A Mao,Xinyue %A Chen,Sirui %A Chen,Elle %A He,Yuqi %A Jiang,Yun %K electronic health record %K EHR %K cancer risk modeling %K risk factor analysis %K explainable machine learning %K machine learning %K ML %K risk factor %K major cancers %K monitoring %K cancer risk %K breast cancer %K colorectal cancer %K lung cancer %K prostate cancer %K cancer patients %K clinical decision-making %D 2025 %7 2.5.2025 %9 %J JMIR Cancer %G English %X Background: Cancer is a life-threatening disease and a leading cause of death worldwide, with an estimated 611,000 deaths and over 2 million new cases in the United States in 2024. The rising incidence of major cancers, including among younger individuals, highlights the need for early screening and monitoring of risk factors to manage and decrease cancer risk. Objective: This study aimed to leverage explainable machine learning models to identify and analyze the key risk factors associated with breast, colorectal, lung, and prostate cancers. By uncovering significant associations between risk factors and these major cancer types, we sought to enhance the understanding of cancer diagnosis risk profiles. Our goal was to facilitate more precise screening, early detection, and personalized prevention strategies, ultimately contributing to better patient outcomes and promoting health equity. Methods: Deidentified electronic health record data from Medical Information Mart for Intensive Care (MIMIC)–III was used to identify patients with 4 types of cancer who had longitudinal hospital visits prior to their diagnosis presence. Their records were matched and combined with those of patients without cancer diagnoses using propensity scores based on demographic factors. Three advanced models, penalized logistic regression, random forest, and multilayer perceptron (MLP), were conducted to identify the rank of risk factors for each cancer type, with feature importance analysis for random forest and MLP models. The rank biased overlap was adopted to compare the similarity of ranked risk factors across cancer types. Results: Our framework evaluated the prediction performance of explainable machine learning models, with the MLP model demonstrating the best performance. It achieved an area under the receiver operating characteristic curve of 0.78 for breast cancer (n=58), 0.76 for colorectal cancer (n=140), 0.84 for lung cancer (n=398), and 0.78 for prostate cancer (n=104), outperforming other baseline models (P<.001). In addition to demographic risk factors, the most prominent nontraditional risk factors overlapped across models and cancer types, including hyperlipidemia (odds ratio [OR] 1.14, 95% CI 1.11‐1.17; P<.01), diabetes (OR 1.34, 95% CI 1.29‐1.39; P<.01), depressive disorders (OR 1.11, 95% CI 1.06‐1.16; P<.01), heart diseases (OR 1.42, 95% CI 1.32‐1.52; P<.01), and anemia (OR 1.22, 95% CI 1.14‐1.30; P<.01). The similarity analysis indicated the unique risk factor pattern for lung cancer from other cancer types. Conclusions: The study’s findings demonstrated the effectiveness of explainable ML models in assessing nontraditional risk factors for major cancers and highlighted the importance of considering unique risk profiles for different cancer types. Moreover, this research served as a hypothesis-generating foundation, providing preliminary results for future investigation into cancer diagnosis risk analysis and management. Furthermore, expanding collaboration with clinical experts for external validation would be essential to refine model outputs, integrate findings into practice, and enhance their impact on patient care and cancer prevention efforts. %R 10.2196/62833 %U https://cancer.jmir.org/2025/1/e62833 %U https://doi.org/10.2196/62833 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e67902 %T Examining Demographic, Geographic, and Temporal Patterns of Melanoma Incidence in Texas From 2000 to 2018: Retrospective Study %A Zhang,Kehe %A Taylor,Madison M %A Hunyadi,Jocelyn %A Doan,Hung Q %A Adamson,Adewole S %A Miller,Paige %A Nelson,Kelly C %A Bauer,Cici %K melanoma incidence %K melanoma screening %K geographic disparity %K geospatial analysis %K joinpoint regression %K demographic variation %K temporal trend analysis %K stage at diagnosis %D 2025 %7 2.5.2025 %9 %J JMIR Cancer %G English %X Background: Melanoma currently ranks as the fifth leading cancer diagnosis and is projected to become the second most common cancer in the United States by 2040. Melanoma detected at earlier stages may be treated with less-risky and less-costly therapeutic options. Objective: This study aims to analyze temporal and spatial trends in melanoma incidence by stage at diagnosis (overall, early, and late) in Texas from 2000 to 2018, focusing on demographic and geographic variations to identify high-risk populations and regions for targeted prevention efforts. Methods: We used melanoma incidence data from all 254 Texas counties from the Texas Cancer Registry (TCR) from 2000 to 2018, aggregated by county and year. Among these, 250 counties reported melanoma cases during the period. Counties with no cases reported in a certain year were treated as having no cases. Melanoma cases were classified by SEER Summary Stage and stratified by the following four key covariates: age, sex, race and ethnicity, and stage at diagnosis. Incidence rates (IRs) were calculated per 100,000 population, and temporal trends were analyzed using joinpoint regression to determine average annual percentage changes (AAPCs) with 95% CIs for the whole time period (2000‐2018), the most recent 10-year period (2009‐2018), and the most recent 5-year period (2014‐2018). Heat map visualizations were developed to assess temporal trends by patient age, year of diagnosis, stage at diagnosis, sex, and race and ethnicity. Spatial cluster analysis was conducted using Getis-Ord Gi* statistics to identify county-level geographic clusters of high and low melanoma incidence by stage at diagnosis. Results: A total of 82,462 melanoma cases were recorded, of which 74.7% (n=61,588) were early stage, 11.3% (n=9,352) were late stage, and 14% (n=11,522) were of unknown stage. Most cases were identified as males and non-Hispanic White individuals. Melanoma IRs increased from 2000 to 2018, particularly among older adults (60+ years; AAPC range 1.20%-1.84%; all P values were <.001), males (AAPC 1.59%; P<.001), and non-Hispanic White individuals (AAPC of 3.24% for early stage and 2.38% for late stage; P<.001 for early stage and P = .03 for late state). Early-stage diagnoses increased while the rates of late-stage diagnoses remained stable for the overall population. The spatial analysis showed that urban areas had higher early-stage incidence rates (P=.06), whereas rural areas showed higher late-stage incidence rates (P=.05), indicating possible geographic-based differences in access to dermatologic care. Conclusions: Melanoma incidence in Texas increased over the study time period, with the most-at-risk populations being non-Hispanic White individuals, males, and individuals aged 50 years and older. The stable rates of late-stage melanoma among racial and ethnic minority populations and rural populations highlight potential differences in access to diagnostic care. Future prevention efforts may benefit from increasing access to dermatologic care in areas with higher rates of late-stage melanoma at diagnosis. %R 10.2196/67902 %U https://cancer.jmir.org/2025/1/e67902 %U https://doi.org/10.2196/67902 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66530 %T Diagnosis Test Accuracy of Artificial Intelligence for Endometrial Cancer: Systematic Review and Meta-Analysis %A Wang,Longyun %A Wang,Zeyu %A Zhao,Bowei %A Wang,Kai %A Zheng,Jingying %A Zhao,Lijing %+ Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, No.4026, Yatai Street, Changchun, 130000, China, 86 15704313636, zheng_jy@jlu.edu.cn %K artificial intelligence %K endometrial cancer %K diagnostic test accuracy %K systematic review %K meta-analysis %K machine learning %K deep learning %D 2025 %7 18.4.2025 %9 Review %J J Med Internet Res %G English %X Background: Endometrial cancer is one of the most common gynecological tumors, and early screening and diagnosis are crucial for its treatment. Research on the application of artificial intelligence (AI) in the diagnosis of endometrial cancer is increasing, but there is currently no comprehensive meta-analysis to evaluate the diagnostic accuracy of AI in screening for endometrial cancer. Objective: This paper presents a systematic review of AI-based endometrial cancer screening, which is needed to clarify its diagnostic accuracy and provide evidence for the application of AI technology in screening for endometrial cancer. Methods: A search was conducted across PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases to include studies published in English, which evaluated the performance of AI in endometrial cancer screening. A total of 2 independent reviewers screened the titles and abstracts, and the quality of the selected studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies—2 (QUADAS-2) tool. The certainty of the diagnostic test evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results: A total of 13 studies were included, and the hierarchical summary receiver operating characteristic model used for the meta-analysis showed that the overall sensitivity of AI-based endometrial cancer screening was 86% (95% CI 79%-90%) and specificity was 92% (95% CI 87%-95%). Subgroup analysis revealed similar results across AI type, study region, publication year, and study type, but the overall quality of evidence was low. Conclusions: AI-based endometrial cancer screening can effectively detect patients with endometrial cancer, but large-scale population studies are needed in the future to further clarify the diagnostic accuracy of AI in screening for endometrial cancer. Trial Registration: PROSPERO CRD42024519835; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024519835 %M 40249940 %R 10.2196/66530 %U https://www.jmir.org/2025/1/e66530 %U https://doi.org/10.2196/66530 %U http://www.ncbi.nlm.nih.gov/pubmed/40249940 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 9 %N %P e71865 %T A Culturally Tailored Artificial Intelligence Chatbot (K-Bot) to Promote Human Papillomavirus Vaccination Among Korean Americans: Development and Usability Study %A Kim,Minjin %A Kim,Ellie %A Lee,Hyeongsuk %A Piao,Meihua %A Rosen,Brittany %A Allison,Jeroan J %A Zai,Adrian H %A Nguyen,Hoa L %A Shin,Dong-Soo %A Kahn,Jessica A %+ College of Nursing, University of Cincinnati, 3110 Vine St, PO Box 210038, Cincinnati, OH, 45221-0038, United States, 1 7202095559, kim3m4@ucmail.uc.edu %K human papillomavirus %K HPV vaccination %K artificial intelligence %K AI %K chatbot intervention %K Korean Americans %K usability testing %K culturally tailored intervention %D 2025 %7 7.4.2025 %9 Original Paper %J Asian Pac Isl Nurs J %G English %X Background: Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) worldwide and is associated with various cancers, including cervical and oropharyngeal cancers. Despite the availability of effective vaccines, significant disparities in HPV vaccination rates persist, particularly among racial and ethnic minorities, such as Korean Americans. Cultural stigma, language barriers, and limited access to tailored health information contribute to these disparities. Objective: This study aimed to develop and evaluate the usability of K-Bot, an artificial intelligence (AI)–powered, culturally tailored, bilingual (Korean and English) chatbot designed to provide culturally sensitive health information about HPV vaccination to Korean immigrants and Korean Americans. Methods: K-Bot was developed using CloudTuring and Google Dialogflow. Its dialogues were created using Centers for Disease Control and Prevention (CDC) evidence-based HPV information and tailored to the Korean American population based on findings from previous studies. The evaluation and refinement process for K-Bot was organized into 3 phases: (1) expert evaluation by a multidisciplinary panel, (2) usability testing, and (3) iterative refinement based on feedback. An online survey collected demographics, HPV awareness, and vaccination status before 6 focus groups (N=21) sessions using semistructured questions guided by Peter Morville’s usability framework. Quantitative data were analyzed descriptively, and thematic analysis assessed usability, cultural relevance, and content clarity across 6 dimensions: desirability, accessibility, findability, credibility, usability, and usefulness. Results: Participants had a mean age of 23.7 (SD 4.7) years, with most being female (n=12, 57.1%), second-generation individuals (n=13, 61.9%), and single (n=20, 95.2%). HPV awareness was high (n=19, 90.5%), vaccine knowledge was also high (n=18, 81.8%), but only 11 (52.4%) participants were vaccinated. Feedback-driven refinements addressed usability challenges, including simplifying navigation and adding visual elements. Participants described K-Bot as a promising tool for promoting HPV vaccination among Korean and Korean American users, citing its bilingual functionality and culturally tailored content as key strengths. Evidence-based information was valued, but participants recommended visuals to improve engagement and reduce cognitive load. Accessibility concerns included broken links, and participants proposed enhancements, such as animations, demographic-specific resources, and interactive features, to improve usability and engagement further. Conclusions: Usability testing of K-Bot revealed its potential as a culturally tailored, bilingual tool for promoting HPV vaccination among Korean immigrants and Korean Americans. Participants valued its evidence-based information, cultural relevance, and bilingual functionality but recommended improvements, such as enhanced navigation, visual elements, and interactive features, to boost engagement and usability. These findings support the potential of AI-driven tools to improve health care access by addressing key barriers to care. Further research is needed to evaluate their broader impact and optimize their design and implementation for individuals with diverse health care needs. %M 40194281 %R 10.2196/71865 %U https://apinj.jmir.org/2025/1/e71865 %U https://doi.org/10.2196/71865 %U http://www.ncbi.nlm.nih.gov/pubmed/40194281 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e69672 %T AI-Based Identification Method for Cervical Transformation Zone Within Digital Colposcopy: Development and Multicenter Validation Study %A Wu,Tong %A Wang,Yuting %A Cui,Xiaoli %A Xue,Peng %A Qiao,Youlin %+ School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, 31 Yard, Beijige Santiao, Beijing, 100730, China, 86 10 8778 8489, qiaoy@cicams.ac.cn %K artificial intelligence %K AI %K cervical cancer screening %K transformation zone %K diagnosis and early treatment %K lightweight neural network %D 2025 %7 31.3.2025 %9 Original Paper %J JMIR Cancer %G English %X Background: In low- and middle-income countries, cervical cancer remains a leading cause of death and morbidity for women. Early detection and treatment of precancerous lesions are critical in cervical cancer prevention, and colposcopy is a primary diagnostic tool for identifying cervical lesions and guiding biopsies. The transformation zone (TZ) is where a stratified squamous epithelium develops from the metaplasia of simple columnar epithelium and is the most common site of precancerous lesions. However, inexperienced colposcopists may find it challenging to accurately identify the type and location of the TZ during a colposcopy examination. Objective: This study aims to present an artificial intelligence (AI) method for identifying the TZ to enhance colposcopy examination and evaluate its potential clinical application. Methods: The study retrospectively collected data from 3616 women who underwent colposcopy at 6 tertiary hospitals in China between 2019 and 2021. A dataset from 4 hospitals was collected for model conduction. An independent dataset was collected from the other 2 geographic hospitals to validate model performance. There is no overlap between the training and validation datasets. Anonymized digital records, including each colposcopy image, baseline clinical characteristics, colposcopic findings, and pathological outcomes, were collected. The classification model was proposed as a lightweight neural network with multiscale feature enhancement capabilities and designed to classify the 3 types of TZ. The pretrained FastSAM model was first implemented to identify the location of the new squamocolumnar junction for segmenting the TZ. Overall accuracy, average precision, and recall were evaluated for the classification and segmentation models. The classification performance on the external validation was assessed by sensitivity and specificity. Results: The optimal TZ classification model performed with 83.97% classification accuracy on the test set, which achieved average precision of 91.84%, 89.06%, and 95.62% for types 1, 2, and 3, respectively. The recall and mean average precision of the TZ segmentation model were 0.78 and 0.75, respectively. The proposed model demonstrated outstanding performance in predicting 3 types of the TZ, achieving the sensitivity with 95% CIs for TZ1, TZ2, and TZ3 of 0.78 (0.74-0.81), 0.81 (0.78-0.82), and 0.8 (0.74-0.87), respectively, with specificity with 95% CIs of 0.94 (0.92-0.96), 0.83 (0.81-0.86), and 0.91 (0.89-0.92), based on a comprehensive external dataset of 1335 cases from 2 of the 6 hospitals. Conclusions: Our proposed AI-based identification system classified the type of cervical TZs and delineated their location on multicenter, colposcopic, high-resolution images. The findings of this study have shown its potential to predict TZ types and specific regions accurately. It was developed as a valuable assistant to encourage precise colposcopic examination in clinical practice. %M 40163848 %R 10.2196/69672 %U https://cancer.jmir.org/2025/1/e69672 %U https://doi.org/10.2196/69672 %U http://www.ncbi.nlm.nih.gov/pubmed/40163848 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e58529 %T Lung Cancer Screening in Family Members and Peers of Patients With Lung Cancer: Protocol for a Prospective Cohort Study %A Pitrou,Isabelle %A Petrangelo,Adriano %A Besson,Charlotte %A Pepe,Carmela %A Waschke,Annika Helen %A Agulnik,Jason %A Gonzalez,Anne V %A Ezer,Nicole %+ Centre for Outcomes Research and Evaluation (CORE), Research Institute McGill University Health Centre, 5252 De Maisonneuve, Montréal, QC, H4A 3S9, Canada, 1 5149341934 ext 76192, nicole.ezer@mcgill.ca %K lung cancer %K low-dose CT %K chest tomography %K lung cancer screening %K patient advocacy %K early detection of cancer %K referral and consultation %K cohort study %K patient empowerment %K patient experience %D 2025 %7 28.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Low-dose computed tomography (LDCT) screening is promising for the early detection of lung cancer (LC) and the reduction of LC-related mortality. Despite the implementation of LC screening programs worldwide, recruitment is challenging. While recruitment for LC screening is based on physician referrals and mass advertising, novel recruitment strategies are needed to improve the enrollment of high-risk individuals into LC screening. Objective: We aim to identify whether patients with LC can act as advocates to enroll their family members and close contacts into LC screening and whether this strategy increases screening uptake at the population level. Methods: We designed a prospective cohort study comprising 2 cohorts constituted between June 2023 and January 2024 with a prospective follow-up of 18 months. Patients with LC (cohort 1) are approached at clinics of the McGill University Health Centre, educated on tools for communicating with family members and close contacts about the benefits of LC screening, and invited to refer their close ones. Referred individuals (cohort 2) are directed to this study’s web-based questionnaire to assess their LC risk score with the PLCOm2012 (Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial) prediction model. Individuals meeting the eligibility criteria for LC screening (PLCOm2012 score ≥2% and aged 55-74 years) are directed toward the Quebec LC screening program. Data collected include sociodemographic characteristics, health literacy and smoking status (all participants), patient activation (cohort 1), perceived risk of LC, and generalized anxiety at baseline and at 28 days (cohort 2). LDCT completion within 18 months from referral is assessed from health records. Focus groups will identify the barriers and facilitators in the uptake of LC screening and preventative behaviors based on perceived genetic and clinical LC risks. The primary outcomes are the number of referred participants per survivor of LC and the mean risk of LC of the referred population based on PLCOm2012 scores. The secondary outcomes are the proportion of (1) participants eligible for LC screening; (2) participants eligible for screening who complete LDCT screening within 18 months of referral from a survivor of LC; (3) participants showing interest in genetic testing to inform LC risk; and (4) participants showing interest in a smoking cessation program. Multivariable logistic regression will identify the predictive factors of being referred for LC screening. PLCOm2012 scores will be compared for referred participants and controls from the provincial LC screening program. Results: Overall, 25 survivors of LC and 84 close contacts were enrolled from June 2023 to January 2024, with followed up through July 2025. The results are expected by the end of 2025. Conclusions: We describe an approach to LC screening referral, leveraging patients with LC as advocates to increase screening awareness and uptake among their family and peers. Trial Registration: ClinicalTrials.gov NCT05645731; https://clinicaltrials.gov/ct2/show/NCT05645731 International Registered Report Identifier (IRRID): DERR1-10.2196/58529 %R 10.2196/58529 %U https://www.researchprotocols.org/2025/1/e58529 %U https://doi.org/10.2196/58529 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e64809 %T Monthly Variations in Colorectal Cancer Screening Tests Among Federally Qualified Health Center Patients in Missouri: Quality Improvement Project %A McElroy,Jane A %A Smith,Jamie B %A Everett,Kevin D %K colorectal cancer screening %K federally qualified health center %K FQHC %K fecal immunochemical test %K FIT %K FIT-DNA %K colorectal cancer %K CRC %K cancer %K cancer screening %K colonoscopy %K United States %K health center %K quality improvement %D 2025 %7 19.3.2025 %9 %J JMIR Cancer %G English %X Background: Cancer is the second leading cause of death in the United States. Compelling evidence shows screening detects colorectal cancer (CRC) at earlier stages and prevents the development of CRC through the removal of precancerous polyps. The Healthy People 2030 goal for CRC screening is 68.3%, but only 36.5% of Missouri federally qualified health center patients aged 50‐75 years are up-to-date on CRC screening. For average risk patients, there are three commonly used screening tests in the United States—two types of stool tests collected at home (fecal immunochemical test [FIT]–immunochemical fecal occult blood test [FOBT] and FIT-DNA, such as Cologuard) and colonoscopies completed at procedural centers. Objective: This study aims to examine variation by month for the three types of CRC testing to evaluate consistent patient care by clinical staff. Methods: Data from 31 federally qualified health center clinics in Missouri from 2011 to 2023 were analyzed. A sample of 34,124 unique eligible “average risk” patients defined as persons not having a personal history of CRC or certain types of polyps, family history of CRC, personal history of inflammatory bowel disease, and personal history of receiving radiation to the abdomen or pelvic to treat a previous cancer or confirmed or suspected hereditary CRC syndrome. Another eligibility criterion is that patients need to be seen at least once at the clinic to be included in the denominator for the screening rate calculation. Descriptive statistics characterize the sample, while bivariate analyses assess differences in screening types by month. Results: Completion of CRC screening yielded statistically significant differences for patients completing the different types of CRC screening by month. October-January had the highest proportions of patients (644-680 per month, 8.5%‐10.2%) receiving a colonoscopy, while February-April had the lowest (509-578 per month, 6.9%‐7.8%), with 614 being the average monthly number of colonoscopies. For FIT-FOBT, June-August had the higher proportions of patients receiving this test (563-613 per month, 8.9%‐9.6%), whereas December-February had the lowest (453-495 per month, 7.1%‐8%), with 541 being the average monthly number of FIT-FOBT kits used. For FIT-DNA, March was the most popular month with 11.3% (n=261 per month) of patients using the Cologuard test, followed by April, May, and November (207-220 per month, 8.7%‐9.4%), and January and June (168-171 per month, 7.2%-7.3%) had the lowest proportion of patients using Cologuard, with 193 being the average monthly number of FIT-DNA kits used. Combining all tests, February had the fewest CRC tests completed (1153/16,173, 7.1%). Conclusions: Home-based tests are becoming popular, replacing the gold standard colonoscopy, but need to be repeated more frequently. Monthly variation of screening over the course of a year suggests that CRC screening efforts and patient care may be less than ideal. Months with lower rates of screening for each type of CRC test represent opportunities for improving CRC screening. %R 10.2196/64809 %U https://cancer.jmir.org/2025/1/e64809 %U https://doi.org/10.2196/64809 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e67840 %T Identifying Data-Driven Clinical Subgroups for Cervical Cancer Prevention With Machine Learning: Population-Based, External, and Diagnostic Validation Study %A Lu,Zhen %A Dong,Binhua %A Cai,Hongning %A Tian,Tian %A Wang,Junfeng %A Fu,Leiwen %A Wang,Bingyi %A Zhang,Weijie %A Lin,Shaomei %A Tuo,Xunyuan %A Wang,Juntao %A Yang,Tianjie %A Huang,Xinxin %A Zheng,Zheng %A Xue,Huifeng %A Xu,Shuxia %A Liu,Siyang %A Sun,Pengming %A Zou,Huachun %K cervical cancer %K human papillomavirus %K screening %K machine learning %K cervical tumor %K cancer %K carcinoma %K tumor %K malignant %K ML %K phenomapping strategy %K logistic regression %K regression %K population-based %K validation study %K cancer prevention %K validity %K usability %K algorithm %K surveillance %K electronic health record %K EHR %D 2025 %7 19.3.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Cervical cancer remains a major global health issue. Personalized, data-driven cervical cancer prevention (CCP) strategies tailored to phenotypic profiles may improve prevention and reduce disease burden. Objective: This study aimed to identify subgroups with differential cervical precancer or cancer risks using machine learning, validate subgroup predictions across datasets, and propose a computational phenomapping strategy to enhance global CCP efforts. Methods: We explored the data-driven CCP subgroups by applying unsupervised machine learning to a deeply phenotyped, population-based discovery cohort. We extracted CCP-specific risks of cervical intraepithelial neoplasia (CIN) and cervical cancer through weighted logistic regression analyses providing odds ratio (OR) estimates and 95% CIs. We trained a supervised machine learning model and developed pathways to classify individuals before evaluating its diagnostic validity and usability on an external cohort. Results: This study included 551,934 women (median age, 49 years) in the discovery cohort and 47,130 women (median age, 37 years) in the external cohort. Phenotyping identified 5 CCP subgroups, with CCP4 showing the highest carcinoma prevalence. CCP2–4 had significantly higher risks of CIN2+ (CCP2: OR 2.07 [95% CI: 2.03‐2.12], CCP3: 3.88 [3.78‐3.97], and CCP4: 4.47 [4.33‐4.63]) and CIN3+ (CCP2: 2.10 [2.05‐2.14], CCP3: 3.92 [3.82‐4.02], and CCP4: 4.45 [4.31‐4.61]) compared to CCP1 (P<.001), consistent with the direction of results observed in the external cohort. The proposed triple strategy was validated as clinically relevant, prioritizing high-risk subgroups (CCP3-4) for colposcopies and scaling human papillomavirus screening for CCP1-2. Conclusions: This study underscores the potential of leveraging machine learning algorithms and large-scale routine electronic health records to enhance CCP strategies. By identifying key determinants of CIN2+/CIN3+ risk and classifying 5 distinct subgroups, our study provides a robust, data-driven foundation for the proposed triple strategy. This approach prioritizes tailored prevention efforts for subgroups with varying risks, offering a novel and scalable tool to complement existing cervical cancer screening guidelines. Future work should focus on independent external and prospective validation to maximize the global impact of this strategy. %R 10.2196/67840 %U https://publichealth.jmir.org/2025/1/e67840 %U https://doi.org/10.2196/67840 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e57414 %T Analyzing Online Search Trends for Kidney, Prostate, and Bladder Cancers in China: Infodemiology Study Using Baidu Search Data (2011-2023) %A Lin,Shuangquan %A Duan,Lingxing %A Xu,Xiangda %A Cao,Haichao %A Lu,Xiongbing %A Wen,Xi %A Wei,Shanzun %+ Urology Department, The Second Affiliated Hospital of Nanchang University, Nanchang University, 1st Mingde Rd Donghu, Nanchang, 330000, China, 1 458 800 6725, Zunny377@icloud.com %K bladder cancer %K kidney cancer %K prostate cancer %K Baidu Index %K infodemiology %K public interest %K patients’ concern %D 2025 %7 14.3.2025 %9 Original Paper %J JMIR Cancer %G English %X Background: Cancers of the bladder, kidney, and prostate are the 3 major genitourinary cancers that significantly contribute to the global burden of disease (GBD) and continue to show increasing rates of morbidity and mortality worldwide. In mainland China, understanding the cancer burden on patients and their families is crucial; however, public awareness and concerns about these cancers, particularly from the patient’s perspective, remain predominantly focused on financial costs. A more comprehensive exploration of their needs and concerns has yet to be fully addressed. Objective: This study aims to analyze trends in online searches and user information–seeking behaviors related to bladder, kidney, and prostate cancers—encompassing descriptive terms (eg, “bladder cancer,” “kidney cancer,” “prostate cancer”) as well as related synonyms and variations—on both national and regional scales. This study leverages data from mainland China’s leading search engine to explore the implications of these search patterns for addressing user needs and improving health management. Methods: The study analyzed Baidu Index search trends for bladder, kidney, and prostate cancers (from January 2011 to August 2023) at national and provincial levels. Search volume data were analyzed using the joinpoint regression model to calculate annual percentage changes (APCs) and average APCs (AAPCs), identifying shifts in public interest. User demand was assessed by categorizing the top 10 related terms weekly into 13 predefined topics, including diagnosis, treatment, and traditional Chinese medicine. Data visualization and statistical analyses were performed using Prism 9. Results revealed keyword trends, demographic distributions, and public information needs, offering insights into health communication and management strategies based on online information-seeking behavior. Results: Three cancer topics were analyzed using 39 search keywords, yielding a total Baidu Search Index (BSI) of 43,643,453. From 2011 to 2015, the overall APC was 15.2% (P<.05), followed by –2.8% from 2015 to 2021, and 8.9% from 2021 to 2023, with an AAPC of 4.9%. Bladder, kidney, and prostate cancers exhibited AAPCs of 2.8%, 3.9%, and 6.8%, respectively (P<.05). The age distribution of individuals searching for these cancer topics varied across the topics. Geographically, searches for cancer were predominantly conducted by people from East China, who accounted for approximately 30% of each cancer search query. Regarding user demand, the total BSI for relevant user demand terms from August 2022 to August 2023 was 676,526,998 out of 2,570,697,380 (15.74%), representing only a limited total cancer-related search volume. Conclusions: Online searches and inquiries related to genitourinary cancers are on the rise. The depth of users’ information demands appears to be influenced by regional economic levels. Cancer treatment decision-making may often involve a family-centered approach. Insights from internet search data can help medical professionals better understand public interests and concerns, enabling them to provide more targeted and reliable health care services. %M 40085845 %R 10.2196/57414 %U https://cancer.jmir.org/2025/1/e57414 %U https://doi.org/10.2196/57414 %U http://www.ncbi.nlm.nih.gov/pubmed/40085845 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e53328 %T Assessing Public Interest in Mammography, Computed Tomography Lung Cancer Screening, and Computed Tomography Colonography Screening Examinations Using Internet Search Data: Cross-Sectional Study %A Zippi,Zachary D %A Cortopassi,Isabel O %A Grage,Rolf A %A Johnson,Elizabeth M %A McCann,Matthew R %A Mergo,Patricia J %A Sonavane,Sushil K %A Stowell,Justin T %A Little,Brent P %K lung cancer %K lung cancer screening %K breast cancer %K mammography %K colon cancer %K CT colonography %K Google search %K internet %K Google Trends %K imaging-based %K cancer screening %K search data %K noninvasive %K cancer %K CT %K online %K public awareness %K big data %K analytics %K patient education %K screening uptake %D 2025 %7 11.3.2025 %9 %J JMIR Cancer %G English %X Background: The noninvasive imaging examinations of mammography (MG), low-dose computed tomography (CT) for lung cancer screening (LCS), and CT colonography (CTC) play important roles in screening for the most common cancer types. Internet search data can be used to gauge public interest in screening techniques, assess common screening-related questions and concerns, and formulate public awareness strategies. Objective: This study aims to compare historical Google search volumes for MG, LCS, and CTC and to determine the most common search topics. Methods: Google Trends data were used to quantify relative Google search frequencies for these imaging screening modalities over the last 2 decades. A commercial search engine tracking product (keywordtool.io) was used to assess the content of related Google queries over the year from May 1, 2022, to April 30, 2023, and 2 authors used an iterative process to agree upon a list of thematic categories for these queries. Queries with at least 10 monthly instances were independently assigned to the most appropriate category by the 2 authors, with disagreements resolved by consensus. Results: The mean 20-year relative search volume for MG was approximately 10-fold higher than for LCS and 25-fold higher than for CTC. Search volumes for LCS have trended upward since 2011. The most common topics of MG-related searches included nearby screening locations (60,850/253,810, 24%) and inquiries about procedural discomfort (28,970/253,810, 11%). Most common LCS-related searches included CT-specific inquiries (5380/11,150, 48%) or general inquiries (1790/11,150, 16%), use of artificial intelligence or deep learning (1210/11,150, 11%), and eligibility criteria (1020/11,150, 9%). For CTC, the most common searches were CT-specific inquiries (1800/5590, 32%) or procedural details (1380/5590, 25%). Conclusions: Over the past 2 decades, Google search volumes have been significantly higher for MG than for either LCS or CTC, although search volumes for LCS have trended upward since 2011. Knowledge of public interest and queries related to imaging-based screening techniques may help guide public awareness efforts. %R 10.2196/53328 %U https://cancer.jmir.org/2025/1/e53328 %U https://doi.org/10.2196/53328 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63626 %T Performance Evaluation of Large Language Models in Cervical Cancer Management Based on a Standardized Questionnaire: Comparative Study %A Kuerbanjiang,Warisijiang %A Peng,Shengzhe %A Jiamaliding,Yiershatijiang %A Yi,Yuexiong %+ , Department of Gynecology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei Province, 430071, China, 86 15671669885, yiyuexiong@163.com %K large language model %K cervical cancer %K screening %K artificial intelligence %K model interpretability %D 2025 %7 5.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Cervical cancer remains the fourth leading cause of death among women globally, with a particularly severe burden in low-resource settings. A comprehensive approach—from screening to diagnosis and treatment—is essential for effective prevention and management. Large language models (LLMs) have emerged as potential tools to support health care, though their specific role in cervical cancer management remains underexplored. Objective: This study aims to systematically evaluate the performance and interpretability of LLMs in cervical cancer management. Methods: Models were selected from the AlpacaEval leaderboard version 2.0 and based on the capabilities of our computer. The questions inputted into the models cover aspects of general knowledge, screening, diagnosis, and treatment, according to guidelines. The prompt was developed using the Context, Objective, Style, Tone, Audience, and Response (CO-STAR) framework. Responses were evaluated for accuracy, guideline compliance, clarity, and practicality, graded as A, B, C, and D with corresponding scores of 3, 2, 1, and 0. The effective rate was calculated as the ratio of A and B responses to the total number of designed questions. Local Interpretable Model-Agnostic Explanations (LIME) was used to explain and enhance physicians’ trust in model outputs within the medical context. Results: Nine models were included in this study, and a set of 100 standardized questions covering general information, screening, diagnosis, and treatment was designed based on international and national guidelines. Seven models (ChatGPT-4.0 Turbo, Claude 2, Gemini Pro, Mistral-7B-v0.2, Starling-LM-7B alpha, HuatuoGPT, and BioMedLM 2.7B) provided stable responses. Among all the models included, ChatGPT-4.0 Turbo ranked first with a mean score of 2.67 (95% CI 2.54-2.80; effective rate 94.00%) with a prompt and 2.52 (95% CI 2.37-2.67; effective rate 87.00%) without a prompt, outperforming the other 8 models (P<.001). Regardless of prompts, QiZhenGPT consistently ranked among the lowest-performing models, with P<.01 in comparisons against all models except BioMedLM. Interpretability analysis showed that prompts improved alignment with human annotations for proprietary models (median intersection over union 0.43), while medical-specialized models exhibited limited improvement. Conclusions: Proprietary LLMs, particularly ChatGPT-4.0 Turbo and Claude 2, show promise in clinical decision-making involving logical analysis. The use of prompts can enhance the accuracy of some models in cervical cancer management to varying degrees. Medical-specialized models, such as HuatuoGPT and BioMedLM, did not perform as well as expected in this study. By contrast, proprietary models, particularly those augmented with prompts, demonstrated notable accuracy and interpretability in medical tasks, such as cervical cancer management. However, this study underscores the need for further research to explore the practical application of LLMs in medical practice. %M 39908540 %R 10.2196/63626 %U https://www.jmir.org/2025/1/e63626 %U https://doi.org/10.2196/63626 %U http://www.ncbi.nlm.nih.gov/pubmed/39908540 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e56791 %T Effectiveness of Gastric Cancer Endoscopic Screening in Intermediate-Risk Countries: Protocol for a Systematic Review and Meta-Analysis %A Mourato,Maria Beatriz %A Pratas,Nuno %A Branco Pereira,Andreia %A Taré,Filipa %A Chança,Raphael %A Fronteira,Inês %A Dinis,Rui %A Areia,Miguel %+ NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, LA-REAL, CCAL, NOVA University Lisbon, Lisbon, Portugal, Rua do Instituto Bacteriológico, 5, Lisbon, 1150-082, Portugal, 351 351218803101, mbb.mourato@ensp.unl.pt %K gastric cancers %K endoscopic screening %K intermediate-risk countries %K neoplasia %K early detection %K diagnosis %K cancer screening %K survival %K meta-analysis %K gastrointestinal cancers %D 2025 %7 3.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Gastric cancer (GC) is the fifth most prevalent neoplasm worldwide and the fourth with the highest mortality, and its geographical distribution is not homogeneous with high-risk, intermediate-risk (IR), and low-risk areas. Advanced stages at diagnosis are related to high mortality, but early detection greatly increases the chances of survival. Upper endoscopy with biopsy is the gold standard for GC diagnosis. Several studies have investigated the relevance of endoscopic screening and how to implemente it in IR countries. However, most Western societies recommend screening only in selected populations with high-risk factors for GC. No systematic reviews on GC endoscopic screening in IR countries exist. Objective: We aimed to determine the effectiveness of endoscopic GC screening in IR countries. Methods: We will include randomized and nonrandomized controlled trials, cohort studies, case-control studies, cross-sectional studies, and economic studies focusing on endoscopic screening of GC in the asymptomatic population of IR countries. The search will be conducted in MEDLINE, SCOPUS, Embase, and Web of Science. Other gray literature sources will be additionally searched. Studies published in English, Portuguese, or Spanish until September 2024 will be included. Two independent reviewers will screen the titles and abstracts of all search results. The selected studies will then be fully analyzed, and the data will be collected and coded in a database. To minimize the risk of bias, the included studies will undergo a quality analysis according to Cochrane risk of bias tools, RoB 2 of randomized trials and ROBINS-I for nonrandomized trials; Newcastle-Ottawa Quality Assessment Scale for case-control and cohort studies; and National Heart, Lung and Blood Institute study quality assessment tools for cross-sectional studies. The data collected will be cataloged in 2 categories: efficacy or effectiveness data and economic data, and separate meta-analyses will be performed for each category if appropriate. Results: This study is expected to provide results on the efficacy, effectiveness, and cost-effectiveness of endoscopic screening in an IR population. To date, 969 studies were screened for title and abstract, 75 were selected for full-text screening, and 44 were retained for data analysis. Additionally, 2 studies were selected from our manual search. Currently, the study is in the early stages of data extraction and risk of bias assessment and is expected to be published in the first quarter of 2025. Conclusions: To our knowledge, this review will be the first to provide evidence on the effectiveness of endoscopic GC screening in IR countries. In doing so, we believe we will help guide future research, inform health care decisions and assist policy makers in this area, and support future decisions to implement GC screening programs in this type of population. Trial Registration: PROSPERO CRD42024502174; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=502174 International Registered Report Identifier (IRRID): DERR1-10.2196/56791 %M 39545590 %R 10.2196/56791 %U https://www.researchprotocols.org/2025/1/e56791 %U https://doi.org/10.2196/56791 %U http://www.ncbi.nlm.nih.gov/pubmed/39545590 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e60653 %T User and Developer Views on Using AI Technologies to Facilitate the Early Detection of Skin Cancers in Primary Care Settings: Qualitative Semistructured Interview Study %A Jones,Owain Tudor %A Calanzani,Natalia %A Scott,Suzanne E %A Matin,Rubeta N %A Emery,Jon %A Walter,Fiona M %+ Department of Public Health and Primary Care, University of Cambridge, East Forvie Building, Robinson Way, Cambridge, CB2 0SZ, United Kingdom, 44 7737204055, otj24@medschl.cam.ac.uk %K artificial intelligence %K AI %K machine learning %K ML %K primary care %K skin cancer %K melanoma %K qualitative research %K mobile phone %D 2025 %7 28.1.2025 %9 Original Paper %J JMIR Cancer %G English %X Background: Skin cancers, including melanoma and keratinocyte cancers, are among the most common cancers worldwide, and their incidence is rising in most populations. Earlier detection of skin cancer leads to better outcomes for patients. Artificial intelligence (AI) technologies have been applied to skin cancer diagnosis, but many technologies lack clinical evidence and/or the appropriate regulatory approvals. There are few qualitative studies examining the views of relevant stakeholders or evidence about the implementation and positioning of AI technologies in the skin cancer diagnostic pathway. Objective: This study aimed to understand the views of several stakeholder groups on the use of AI technologies to facilitate the early diagnosis of skin cancer, including patients, members of the public, general practitioners, primary care nurse practitioners, dermatologists, and AI researchers. Methods: This was a qualitative, semistructured interview study with 29 stakeholders. Participants were purposively sampled based on age, sex, and geographical location. We conducted the interviews via Zoom between September 2022 and May 2023. Transcribed recordings were analyzed using thematic framework analysis. The framework for the Nonadoption, Abandonment, and Challenges to Scale-Up, Spread, and Sustainability was used to guide the analysis to help understand the complexity of implementing diagnostic technologies in clinical settings. Results: Major themes were “the position of AI in the skin cancer diagnostic pathway” and “the aim of the AI technology”; cross-cutting themes included trust, usability and acceptability, generalizability, evaluation and regulation, implementation, and long-term use. There was no clear consensus on where AI should be placed along the skin cancer diagnostic pathway, but most participants saw the technology in the hands of either patients or primary care practitioners. Participants were concerned about the quality of the data used to develop and test AI technologies and the impact this could have on their accuracy in clinical use with patients from a range of demographics and the risk of missing skin cancers. Ease of use and not increasing the workload of already strained health care services were important considerations for participants. Health care professionals and AI researchers reported a lack of established methods of evaluating and regulating AI technologies. Conclusions: This study is one of the first to examine the views of a wide range of stakeholders on the use of AI technologies to facilitate early diagnosis of skin cancer. The optimal approach and position in the diagnostic pathway for these technologies have not yet been determined. AI technologies need to be developed and implemented carefully and thoughtfully, with attention paid to the quality and representativeness of the data used for development, to achieve their potential. %M 39874580 %R 10.2196/60653 %U https://cancer.jmir.org/2025/1/e60653 %U https://doi.org/10.2196/60653 %U http://www.ncbi.nlm.nih.gov/pubmed/39874580 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56946 %T Combining a Risk Factor Score Designed From Electronic Health Records With a Digital Cytology Image Scoring System to Improve Bladder Cancer Detection: Proof-of-Concept Study %A Cabon,Sandie %A Brihi,Sarra %A Fezzani,Riadh %A Pierre-Jean,Morgane %A Cuggia,Marc %A Bouzillé,Guillaume %+ Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Campus de Beaulieu, Bâtiment 22, 263 Avenue du General Leclerc, F-35000 Rennes, France, 33 2 23 23 62 20, sandie.cabon@univ-rennes.fr %K bladder cancer %K clinical data reuse %K multimodal data fusion %K clinical decision support %K machine learning %K risk factors %K electronic health records %K detection %K mortality %K therapeutic intervention %K diagnostic tools %K digital cytology %K image-based model %K clinical data %K algorithms %K patient %K biological information %D 2025 %7 22.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: To reduce the mortality related to bladder cancer, efforts need to be concentrated on early detection of the disease for more effective therapeutic intervention. Strong risk factors (eg, smoking status, age, professional exposure) have been identified, and some diagnostic tools (eg, by way of cystoscopy) have been proposed. However, to date, no fully satisfactory (noninvasive, inexpensive, high-performance) solution for widespread deployment has been proposed. Some new models based on cytology image classification were recently developed and bring good perspectives, but there are still avenues to explore to improve their performance. Objective: Our team aimed to evaluate the benefit of combining the reuse of massive clinical data to build a risk factor model and a digital cytology image–based model (VisioCyt) for bladder cancer detection. Methods: The first step relied on designing a predictive model based on clinical data (ie, risk factors identified in the literature) extracted from the clinical data warehouse of the Rennes Hospital and machine learning algorithms (logistic regression, random forest, and support vector machine). It provides a score corresponding to the risk of developing bladder cancer based on the patient’s clinical profile. Second, we investigated 3 strategies (logistic regression, decision tree, and a custom strategy based on score interpretation) to combine the model’s score with the score from an image-based model to produce a robust bladder cancer scoring system. Results: We collected 2 data sets. The first set, including clinical data for 5422 patients extracted from the clinical data warehouse, was used to design the risk factor–based model. The second set was used to measure the models’ performances and was composed of data for 620 patients from a clinical trial for which cytology images and clinicobiological features were collected. With this second data set, the combination of both models obtained areas under the curve of 0.82 on the training set and 0.83 on the test set, demonstrating the value of combining risk factor–based and image-based models. This combination offers a higher associated risk of cancer than VisioCyt alone for all classes, especially for low-grade bladder cancer. Conclusions: These results demonstrate the value of combining clinical and biological information, especially to improve detection of low-grade bladder cancer. Some improvements will need to be made to the automatic extraction of clinical features to make the risk factor–based model more robust. However, as of now, the results support the assumption that this type of approach will be of benefit to patients. %M 39841985 %R 10.2196/56946 %U https://www.jmir.org/2025/1/e56946 %U https://doi.org/10.2196/56946 %U http://www.ncbi.nlm.nih.gov/pubmed/39841985 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e59464 %T Developing and Assessing a Scalable Digital Health Tool for Pretest Genetic Education in Patients With Early-Onset Colorectal Cancer: Mixed Methods Design %A Rivera Rivera,Jessica N %A Snir,Moran %A Simmons,Emilie %A Schmidlen,Tara %A Sholeh,Misha %A Maconi,Melinda Leigh %A Geiss,Carley %A Fulton,Hayden %A Barton,Laura %A Gonzalez,Brian D %A Permuth,Jennifer %A Vadaparampil,Susan %+ Healthcare Delivery Research Network, MedStar Health Research Institute, 100 Irving Street NW, Washington, DC, 20010, United States, 1 443 692 1138, jessica.n.riverarivera@medstar.net %K genetic education %K genetic testing %K genetic counseling %K digital health %K early-onset colorectal cancer %D 2025 %7 17.1.2025 %9 Original Paper %J JMIR Cancer %G English %X Background: National guidelines recommend germline genetic testing (GT) for all patients with early-onset colorectal cancer. With recent advances in targeted therapies and GT, these guidelines are expected to expand to include broader groups of patients with colorectal cancer. However, there is a shortage of genetic professionals to provide the necessary education and support for informed consent. As such, there is a pressing need to identify alternative approaches to facilitate and expedite access to GT. Objective: This study describes the development of a pretest education intervention, Nest-CRC, to facilitate the uptake of germline GT among patients with early-onset colorectal cancer. Patients with early-onset colorectal cancer and health care providers reviewed Nest-CRC, and their reactions and recommendations were captured using a nested mixed methods approach. Methods: Using the learner verification approach, we conducted 2 sequential phases of surveys and interviews with English- and Spanish-speaking patients with early-onset colorectal cancer and health care providers. The surveys assessed participants’ experiences with genetic services and provided immediate feedback on the Nest-CRC genetic education modules. Semistructured interviews evaluated participants’ perceptions of self-efficacy, attraction, comprehension, cultural acceptability, and usability of Nest-CRC. Survey data were analyzed using descriptive statistics (mean, median, and proportions), while interview data were analyzed through line-by-line coding of the transcribed interviews. After each phase, Nest-CRC was refined based on participants’ recommendations. Results: A total of 52 participants, including 39 patients with early-onset colorectal cancer and 13 providers, participated in the study. Of these, 19 patients and 6 providers participated in phase 1 (N=25), and 20 patients and 7 providers participated in phase 2 (N=27). Most participants (phase 1: 23/25, 92%, to 25/25, 100%; phase 2: 24/27, 89%, to 27/27, 100%) agreed that each of the 5 education modules was easy to understand and helpful; 13 patients reported no history of GT, with 11 (85%) expressing interest in GT and 2 (15%) remaining unsure after completing Nest-CRC. Participants reported that Nest-CRC provided sufficient information to help them decide about GT. The tool was deemed acceptable by individuals from diverse backgrounds, and participants found it visually attractive, easy to comprehend, and user-friendly. Conclusions: The findings revealed that Nest-CRC is a promising strategy for facilitating pretest education and promoting GT. Nest-CRC has been refined based on participant recommendations and will be re-evaluated. %M 39819811 %R 10.2196/59464 %U https://cancer.jmir.org/2025/1/e59464 %U https://doi.org/10.2196/59464 %U http://www.ncbi.nlm.nih.gov/pubmed/39819811 %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 %@ 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 %@ 2369-2960 %I JMIR Publications %V 10 %N %P e65286 %T Development of a Prediction Model and Risk Score for Self-Assessment and High-Risk Population Identification in Liver Cancer Screening: Prospective Cohort Study %A Li,Xue %A Wang,Youqing %A Li,Huizhang %A Wang,Le %A Zhu,Juan %A Yang,Chen %A Du,Lingbin %K liver cancer %K cancer screening %K cancer surveillance %K prediction model %K early detection %K risk score %K self-assessment %D 2024 %7 30.12.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Liver cancer continues to pose a significant burden in China. To enhance the efficiency of screening, it is crucial to implement population stratification for liver cancer surveillance. Objective: This study aimed to develop a simple prediction model and risk score for liver cancer screening in the general population, with the goal of improving early detection and survival. Methods: This population-based cohort study focused on residents aged 40 to 74 years. Participants were enrolled between 2014 and 2019 and were prospectively followed until June 30, 2021. Data were collected through interviews at enrollment. A Cox proportional hazards regression was used to identify predictors and construct the prediction model. A risk score system was developed based on the weighted factors included in the prediction model. Results: A total of 153,082 study participants (67,586 males and 85,496 females) with a mean age of 55.86 years were included. During 781,125 person-years of follow-up (length of follow-up: median 6.07, IQR 3.07‐7.09 years), 290 individuals were diagnosed with liver cancer. Key factors identified for the prediction model and risk score system included age (hazard ratio [HR] 1.06, 95% CI 1.04‐1.08), sex (male: HR 3.41, 95% CI 2.44‐4.78), education level (medium: HR 0.84, 95% CI 0.61‐1.15; high: HR 0.37, 95% CI 0.17‐0.78), cirrhosis (HR 11.93, 95% CI 7.46‐19.09), diabetes (HR 1.59, 95% CI 1.08‐2.34), and hepatitis B surface antigen (HBsAg) status (positive: HR 3.84, 95% CI 2.38‐6.19; unknown: HR 1.04, 95% CI 0.73‐1.49). The model exhibited excellent discrimination in both the development and validation sets, with areas under the curve (AUC) of 0.802, 0.812, and 0.791 for predicting liver cancer at the 1-, 3-, and 5-year periods in the development set and 0.751, 0.763, and 0.712 in the validation set, respectively. Sensitivity analyses applied to the subgroups of participants without cirrhosis and with a negative or unknown HBsAg status yielded similar performances, with AUCs ranging from 0.707 to 0.831. Calibration plots indicated an excellent agreement between the observed and predicted probabilities of developing liver cancer over the 1-, 3-, and 5-year periods. Compared to the low-risk group, participants in the high-risk and moderate-risk groups had 11.88-fold (95% CI 8.67‐16.27) and 3.51-fold (95% CI 2.58‐4.76) higher risks of liver cancer, respectively. Decision curve analysis demonstrated that the risk score provided a higher net benefit compared to the current strategy. To aid in risk stratification for individual participants, a user-friendly web-based scoring system was developed. Conclusions: A straightforward liver cancer prediction model was created by incorporating easily accessible variables. This model enables the identification of asymptomatic individuals who should be prioritized for liver cancer screening. %R 10.2196/65286 %U https://publichealth.jmir.org/2024/1/e65286 %U https://doi.org/10.2196/65286 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e53229 %T Examining Racial Disparities in Colorectal Cancer Screening and the Role of Online Medical Record Use: Findings From a Cross-Sectional Study of a National Survey %A Ewing,Aldenise P %A Tounkara,Fode %A Marshall,Daniel %A Henry,Abhishek V %A Abdel-Rasoul,Mahmoud %A McElwain,Skylar %A Clark,Justice %A Hefner,Jennifer L %A Zaire,Portia J %A Nolan,Timiya S %A Tarver,Willi L %A Doubeni,Chyke A %K colorectal cancer %K cancer screening %K early detection %K Health Information National Trends Survey %K cancer disparities %K online medical records %K secondary data analysis %D 2024 %7 4.12.2024 %9 %J JMIR Cancer %G English %X Background: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Early detection via routine CRC screening can significantly lower risks for CRC-specific morbidity and mortality. Public health initiatives between 2000 and 2015 nearly doubled CRC screening rates for some US adults. However, screening rates remain lowest for adults aged 45‐49 years (20%), patients of safety net health care facilities (42%), adults without insurance (44%), and other subgroups compared with national averages (72%). Given the evolving landscape of digital health care and trends in web-based health information–seeking behaviors, leveraging online medical record (OMR) systems may be an underutilized resource to promote CRC screening utilization. Recognizing trends in OMR usage and patient demographics may enhance digital inclusion—a key social determinant of health—and support equitable web-based interventions aimed at boosting CRC screening across diverse populations. Objective: This study examined the association of accessing an OMR with CRC screening utilization and corresponding sociodemographic characteristics of US adults. Methods: In 2023, we conducted a secondary data analysis using a pooled, weighted sample from Health Information National Trends Survey (HINTS) 5 cycles, 2, 3, and 4 (2018‐2020), a nationally representative survey assessing how US adults access and use health-related information. We analyzed the association between sociodemographic characteristics, medical conditions, OMR access, and CRC screening behaviors via logistic regression. Results: The sample included adults aged 45‐75 years (N=5143). The mean age was 59 (SD 8) years for those who reported CRC screening and 52 (SD 6) years for those never screened. Nearly 70% (4029/5143) of participants reported CRC screening and 52% (2707/5143) reported OMR access in the past year. Adjusted odds of CRC screening were higher among non-Hispanic African American or Black adults than among non-Hispanic White adults (odds ratio [OR] 1.76, 95% CI 1.22‐2.53), adults who accessed an OMR (OR 1.89, 95% CI 1.45‐2.46), older individuals (OR 1.18, 95% CI 1.16‐1.21), the insured (OR 3.69, 95% CI 2.34‐5.82), and those with a professional or graduate degree versus those with a high school diploma or less (OR 2.65, 95% CI 1.28‐5.47). Individuals aged 65‐75 years were significantly more likely (P<.001) to be screened (1687/1831, 91%) than those aged 45‐49 years (190/610, 29%). Conclusions: Promoting OMR access, especially among the most disadvantaged Americans, may assist in reaching national screening goals. Emphasis should be placed on the mutability of OMR use compared with most other statistically significant associations with CRC screening behaviors. OMR access provides an intervenable means of promoting CRC education and screening, especially among those facing structural barriers to cancer diagnoses and care. Future research should focus on tailored and accessible interventions that expand OMR access, particularly for younger populations. %R 10.2196/53229 %U https://cancer.jmir.org/2024/1/e53229 %U https://doi.org/10.2196/53229 %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 %@ 2369-1999 %I JMIR Publications %V 10 %N %P e57964 %T Experiences of a Digital Behavior Change Intervention to Prevent Weight Gain and Promote Risk-Reducing Health Behaviors for Women Aged 18 to 35 Years at Increased Risk of Breast Cancer: Qualitative Interview Study %A Hawkes,Rhiannon E %A Pegington,Mary %A Davies,Alan %A Mueller,Julia %A Howell,Anthony %A Evans,D Gareth %A Howell,Sacha J %A French,David P %A Harvie,Michelle %+ Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Coupland 1 Building, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 0161 275 2584, rhiannon.hawkes@manchester.ac.uk %K breast cancer %K health behavior %K weight gain %K weight control %K BMI %K app %K acceptability %K feasibility %D 2024 %7 25.11.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Breast cancer is the most common form of cancer in women. Adult weight gain and modifiable health behaviors, including smoking, alcohol intake, and lack of physical activity, are well-known risk factors. Most weight gain in women occurs between the ages of 18 and 35 years. Digital interventions have the potential to address logistical challenges that arise in reaching women in this age range. We designed a digital intervention targeting weight gain prevention and other modifiable health behaviors for young women at increased risk of breast cancer. Women aged 18 to 35 years were recruited to this single-arm intervention study over 2 months to test the acceptability and usability of the intervention, which comprised a group welcome event held via videoconferencing, app, and private Facebook group. Objective: This nested qualitative substudy explored women’s views and experiences of being part of the digital health intervention to inform future intervention development for a feasibility study. Methods: A total of 20 women aged 23 to 35 years who were at increased risk of breast cancer were interviewed via telephone within 1 month after completing the intervention, between February 2023 and March 2023. The women were asked about their experiences of the digital intervention and the extent to which it may have influenced their health behaviors. Data were analyzed thematically and organized using the framework approach. Results: The interviews lasted for a median of 37 (IQR 30-46) minutes. Overall, the women perceived the digital health intervention comprising education, tracking, and support to be acceptable for weight gain prevention. In total, 4 themes were generated. A “missed opportunity” in breast cancer prevention services encompasses the lack of services that currently exist for young women at increased risk of breast cancer. The pros and cons of being part of a community encompasses the divergent views that the women had regarding engaging with other women at increased risk. The importance of an interactive app focuses on features that the women would want from the app to promote engagement with the intervention. The different wants and needs of different age groups highlights that an intervention such as this one would need to be customizable to suit the needs of women at different life stages. Conclusions: There is an unmet need in prevention services for young women aged 18 to 35 years at increased risk of breast cancer. The women perceived the app to be an acceptable intervention for weight gain prevention but emphasized that the intervention would need to be customizable to meet the needs of different age groups within the group of women aged 18 to 35 years. The digital intervention could be a scalable behavior change strategy for UK family history clinics. %M 39586077 %R 10.2196/57964 %U https://cancer.jmir.org/2024/1/e57964 %U https://doi.org/10.2196/57964 %U http://www.ncbi.nlm.nih.gov/pubmed/39586077 %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 e58066 %T Electronic Health Interventions and Cervical Cancer Screening: Systematic Review and Meta-Analysis %A Liu,Xiaoxia %A Ning,Lianzhen %A Fan,Wenqi %A Jia,Chanyi %A Ge,Lina %+ Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Nanhu Campus, No36 Sanhao Street, Heping District, Shenyang, 110004, China, 86 18940251669, geln@sj-hospital.org %K cervical cancer %K electronic health record %K cancer screening %K HPV %K women's health %K electronic health interventions %D 2024 %7 31.10.2024 %9 Review %J J Med Internet Res %G English %X Background: Cervical cancer is a significant cause of mortality in women. Although screening has reduced cervical cancer mortality, screening rates remain suboptimal. Electronic health interventions emerge as promising strategies to effectively tackle this issue. Objective: This systematic review and meta-analysis aimed to determine the effectiveness of electronic health interventions in cervical cancer screening. Methods: On December 29, 2023, we performed an extensive search for randomized controlled trials evaluating electronic health interventions to promote cervical cancer screening in adults. The search covered multiple databases, including MEDLINE, the Cochrane Central Registry of Controlled Trials, Embase, PsycINFO, PubMed, Scopus, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature. These studies examined the effectiveness of electronic health interventions on cervical cancer screening. Studies published between 2013 and 2022 were included. Two independent reviewers evaluated the titles, abstracts, and full-text publications, also assessing the risk of bias using the Cochrane Risk of Bias 2 tool. Subgroup analysis was conducted based on subjects, intervention type, and economic level. The Mantel-Haenszel method was used within a random-effects model to pool the relative risk of participation in cervical cancer screening. Results: A screening of 713 records identified 14 articles (15 studies) with 23,102 participants, which were included in the final analysis. The intervention strategies used in these studies included short messaging services (4/14), multimode interventions (4/14), phone calls (2/14), web videos (3/14), and internet-based booking (1/14). The results indicated that electronic health interventions were more effective than control interventions for improving cervical cancer screening rates (relative risk [RR] 1.464, 95% CI 1.285-1.667; P<.001; I2=84%), cervical cancer screening (intention-to-treat) (RR 1.382, 95% CI 1.214-1.574; P<.001; I2=82%), and cervical cancer screening (per-protocol; RR 1.565, 95% CI 1.381-1.772; P<.001; I2=74%). Subgroup analysis revealed that phone calls (RR 1.82, 95% CI 1.40-2.38), multimode (RR 1.62, 95% CI 1.26-2.08), SMS (RR 1.41, 95% CI 1.14-1.73), and video- and internet-based booking (RR 1.25, 95% CI 1.03-1.51) interventions were superior to usual care. In addition, electronic health interventions did not show a statistically significant improvement in cervical cancer screening rates among women with HPV (RR 1.17, 95% CI 0.95-1.45). Electronic health interventions had a greater impact on improving cervical cancer screening rates among women in low- and middle-income areas (RR 1.51, 95% CI 1.27-1.79). There were no indications of small study effects or publication bias. Conclusions: Electronic health interventions are recommended in cervical cancer screening programs due to their potential to increase participation rates. However, significant heterogeneity remained in this meta-analysis. Researchers should conduct large-scale studies focusing on the cost-effectiveness of these interventions. Trial Registration: CRD42024502884; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=502884 %M 39481096 %R 10.2196/58066 %U https://www.jmir.org/2024/1/e58066 %U https://doi.org/10.2196/58066 %U http://www.ncbi.nlm.nih.gov/pubmed/39481096 %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 %@ 2369-1999 %I JMIR Publications %V 10 %N %P e52639 %T Artificial Intelligence for Optimizing Cancer Imaging: User Experience Study %A Hesso,Iman %A Zacharias,Lithin %A Kayyali,Reem %A Charalambous,Andreas %A Lavdaniti,Maria %A Stalika,Evangelia %A Ajami,Tarek %A Acampa,Wanda %A Boban,Jasmina %A Nabhani-Gebara,Shereen %+ Pharmacy Department, Faculty of Health, Science, Social Care and Education, Kingston University London, Penrhyn Road, Kingston Upon Thames, KT1 2EE, United Kingdom, 44 2084177413, S.Nabhani@kingston.ac.uk %K artificial intelligence %K cancer %K cancer imaging %K UX design workshops %K Delphi method %K INCISIVE AI toolbox %K user experience %D 2024 %7 10.10.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: The need for increased clinical efficacy and efficiency has been the main force in developing artificial intelligence (AI) tools in medical imaging. The INCISIVE project is a European Union–funded initiative aiming to revolutionize cancer imaging methods using AI technology. It seeks to address limitations in imaging techniques by developing an AI-based toolbox that improves accuracy, specificity, sensitivity, interpretability, and cost-effectiveness. Objective: To ensure the successful implementation of the INCISIVE AI service, a study was conducted to understand the needs, challenges, and expectations of health care professionals (HCPs) regarding the proposed toolbox and any potential implementation barriers. Methods: A mixed methods study consisting of 2 phases was conducted. Phase 1 involved user experience (UX) design workshops with users of the INCISIVE AI toolbox. Phase 2 involved a Delphi study conducted through a series of sequential questionnaires. To recruit, a purposive sampling strategy based on the project’s consortium network was used. In total, 16 HCPs from Serbia, Italy, Greece, Cyprus, Spain, and the United Kingdom participated in the UX design workshops and 12 completed the Delphi study. Descriptive statistics were performed using SPSS (IBM Corp), enabling the calculation of mean rank scores of the Delphi study’s lists. The qualitative data collected via the UX design workshops was analyzed using NVivo (version 12; Lumivero) software. Results: The workshops facilitated brainstorming and identification of the INCISIVE AI toolbox’s desired features and implementation barriers. Subsequently, the Delphi study was instrumental in ranking these features, showing a strong consensus among HCPs (W=0.741, P<.001). Additionally, this study also identified implementation barriers, revealing a strong consensus among HCPs (W=0.705, P<.001). Key findings indicated that the INCISIVE AI toolbox could assist in areas such as misdiagnosis, overdiagnosis, delays in diagnosis, detection of minor lesions, decision-making in disagreement, treatment allocation, disease prognosis, prediction, treatment response prediction, and care integration throughout the patient journey. Limited resources, lack of organizational and managerial support, and data entry variability were some of the identified barriers. HCPs also had an explicit interest in AI explainability, desiring feature relevance explanations or a combination of feature relevance and visual explanations within the toolbox. Conclusions: The results provide a thorough examination of the INCISIVE AI toolbox’s design elements as required by the end users and potential barriers to its implementation, thus guiding the design and implementation of the INCISIVE technology. The outcome offers information about the degree of AI explainability required of the INCISIVE AI toolbox across the three services: (1) initial diagnosis; (2) disease staging, differentiation, and characterization; and (3) treatment and follow-up indicated for the toolbox. By considering the perspective of end users, INCISIVE aims to develop a solution that effectively meets their needs and drives adoption. %M 39388693 %R 10.2196/52639 %U https://cancer.jmir.org/2024/1/e52639 %U https://doi.org/10.2196/52639 %U http://www.ncbi.nlm.nih.gov/pubmed/39388693 %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 %@ 2561-326X %I JMIR Publications %V 8 %N %P e53224 %T The Development of a Digital Patient Navigation Tool to Increase Colorectal Cancer Screening Among Federally Qualified Health Center Patients: Acceptability and Usability Testing %A Savage,Leah C %A Soto-Cossio,Luz Estefhany %A Minardi,Francesca %A Beyrouty,Matthew %A Schoonover,Julie %A Musella,Jay %A Frazier,Michaela %A Villagra,Cristina N %A Sly,Jamilia R %A Erblich,Joel %A Itzkowitz,Steven H %A Jandorf,Lina H %A Calman,Neil S %A Atreja,Ashish %A Miller,Sarah J %+ Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Box 1077, 1 Gustave L Levy Place, New York, NY, 10029, United States, 1 2128247783, sarah.miller@mssm.edu %K digital navigation %K digital health %K Federally Qualified Health Center %K colorectal cancer %K cancer screening %K mobile phone %D 2024 %7 25.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Federally Qualified Health Centers (FQHCs) are an essential place for historically underserved patients to access health care, including screening for colorectal cancer (CRC), one of the leading causes of cancer death in the United States. Novel interventions aimed at increasing CRC screening completion rates at FQHCs are crucial. Objective: This study conducts user testing of a digital patient navigation tool, called eNav, designed to support FQHC patients in preparing for, requesting, and completing CRC screening tests. Methods: We recruited English- and Spanish-speaking patients (N=20) at an FQHC in New York City to user-test the eNav website (2 user tests; n=10 participants per user test). In each user test, participants engaged in a “think aloud” exercise and a qualitative interview to summarize and review their feedback. They also completed a baseline questionnaire gathering data about demographics, technology and internet use, medical history, and health literacy, and completed surveys to assess the website’s acceptability and usability. Based on participant feedback from the first user test, we modified the eNav website for a second round of testing. Then, feedback from the second user test was used to modify and finalize the eNav website. Results: Survey results supported the overall usability and acceptability of the website. The average System Usability Scale score for our first user test was 75.25; for the second, it was 75.28. The average Acceptability E-scale score for our first user test was 28.3; for the second, it was 29.2. These scores meet suggested benchmarks for usability and acceptability. During qualitative think-aloud exercises, in both user tests, many participants favorably perceived the website as motivating, interesting, informative, and user-friendly. Respondents also gave suggestions on how to improve the website’s content, usability, accessibility, and appeal. We found that some participants did not have the digital devices or internet access needed to interact with the eNav website at home. Conclusions: Based on participant feedback on the eNav website and reported limitations to digital access across both user tests, we made modifications to the content and design of the website. We also designed alternative methods of engagement with eNav to increase the tool’s usability, accessibility, and impact for patients with diverse needs, including those with limited access to devices or the internet at home. Next, we will test the eNav intervention in a randomized controlled trial to evaluate the efficacy of the eNav website for improving CRC screening uptake among patients treated at FQHCs. %M 39321451 %R 10.2196/53224 %U https://formative.jmir.org/2024/1/e53224 %U https://doi.org/10.2196/53224 %U http://www.ncbi.nlm.nih.gov/pubmed/39321451 %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 %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53200 %T Advancing Colorectal Cancer Detection With Blood-Based Tests: Qualitative Study and Discrete Choice Experiment to Elicit Population Preferences %A Ong,Clarence %A Cook,Alex R %A Tan,Ker-Kan %A Wang,Yi %+ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore, 117549, Singapore, 65 65164988, ephwyi@nus.edu.sg %K blood-based test %K colorectal cancer screening %K mixed methods research %K discrete choice experiment %D 2024 %7 17.7.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Colorectal cancer (CRC) is the second most deadly form of cancer, inducing an estimated 1.9 million incidence cases and 0.9 million deaths worldwide in 2020. Despite the availability of screening tests, their uptake remains suboptimal. However, blood-based tests that look for signs of cancer-specific markers in the body are increasingly available as an alternative for more invasive tests for cancer. Compared with existing tests, the benefits of blood-based tests for CRC include not needing pretest preparation, stool handling, and dietary or medication restrictions. Objective: This study aims to explore the population’s preferences for CRC screening tests, with a focus on blood-based tests, and investigate the factors influencing test uptake. Methods: We used a mixed methods approach, combining semistructured interviews and a discrete choice experiment (DCE) survey. Interviews were analyzed using thematic analysis to identify salient attributes for CRC screening tests. These attributes informed the design of the DCE survey. The DCE data were analyzed using mixed logit and mixed-mixed multinomial logit models. Results: Qualitative findings from 30 participants revealed that participants preferred blood-based tests due to their perceived low risk, minimal pain, and ease of sample collection. However, concerns about the test’s lower accuracy were also expressed. The DCE survey was completed by 1189 participants. In the mixed logit model, participants demonstrated a stronger preference for blood-based tests over a 2-day stool-based test. The mixed-mixed multinomial logit model identified 2 classes, strong supporters and weak supporters, for CRC screening. Weak supporters, but not strong supporters, had a higher preference for blood-based tests. Women, ethnic Chinese, and people aged 40 to 60 years were more likely to be weak supporters. Both models highlighted the high influence of cost and test sensitivity on participants’ preferences. Transitioning from a 2-day stool-based test to a blood-based test, assuming a national screening program at a base price of Singapore $5 (US $3.75), was estimated to have the potential to increase the relative uptake by 5.9% (95% CI 3.6%-8.2%). Conclusions: These findings contribute to our understanding of CRC screening preferences and provide insights into the factors driving test uptake. This study highlights the perceived advantages of blood-based tests and identifies areas of concern regarding their accuracy. Further research is needed to determine the actual increase in uptake rate when blood-based tests are made available. %M 39018093 %R 10.2196/53200 %U https://publichealth.jmir.org/2024/1/e53200 %U https://doi.org/10.2196/53200 %U http://www.ncbi.nlm.nih.gov/pubmed/39018093 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e58724 %T Investigating the Use of Serious Games for Cancer Control Among Children and Adolescents: Scoping Review %A Kim,Sunghak %A Wilson,Paije %A Abraham,Olufunmilola %+ Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Room 2515 Rennebohm Hall, 777 Highland Avenue, Madison, WI, 53705, United States, 1 6082634498, olufunmilola.abraham@wisc.edu %K serious games %K cancer control %K children %K adolescents %K scoping review %K game %K games %K gaming %K cancer %K oncology %K pediatric %K pediatrics %K paediatric %K paediatrics %K child %K children %K youth %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %K synthesis %K review methods %K review methodology %K search %K searches %K searching %K scoping %D 2024 %7 10.7.2024 %9 Review %J JMIR Serious Games %G English %X Background: Effective health care services that meet the diverse needs of children and adolescents with cancer are required to alleviate their physical, psychological, and social challenges and improve their quality of life. Previous studies showed that serious games help promote people’s health. However, the potential for serious games to be used for successful cancer control for children and adolescents has received less attention. Objective: This scoping review aimed to map the use of serious games in cancer prevention and cancer care for children and adolescents, and provide future directions for serious games’ development and implementation within the context of cancer control for children and adolescents. Methods: This study followed a combination of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and the JBI (Joanna Briggs Institute) framework for the conduct of scoping reviews. PubMed, CINAHL Plus Full Text, Scopus, Web of Science Core Collection, and American Psychological Association (APA) PsycINFO databases were used for the search. Results: From the initial 2750 search results, 63 papers were included in the review, with 28 quantitative, 14 qualitative, and 21 mixed method studies. Most of the studies were cancer care serious game papers (55/63, 87%) and a small number of studies were cancer prevention serious game papers (8/63, 13%). The majority of the included studies were published between 2019 and 2023 (cancer prevention: 5/8, 63%; cancer care: 35/55, 64%). The majority of the studies were conducted in Europe (cancer prevention: 3/8, 38%; cancer care: 24/55, 44%) and North America (cancer prevention: 4/8, 50%; cancer care: 17/55, 31%). Adolescents were the most represented age group in the studies’ participants (cancer prevention: 8/8, 100%; cancer care: 46/55, 84%). All (8/8, 100%) cancer prevention serious game papers included healthy people as participants, and 45 out of 55 (82%) cancer care serious game papers included patients with cancer. The majority of cancer prevention serious game papers addressed game preference as a target outcome (4/8, 50%). The majority of cancer care serious game papers addressed symptom management as a target outcome (28/55, 51%). Of the cancer care studies examining serious games for symptom management, the majority of the studies were conducted to treat psychological (13/55, 24%) and physical symptoms (10/55, 18%). Conclusions: This review shows both the growth of interest in the use of serious games for cancer control among children and adolescents and the potential for bias in the relevant literature. The diverse characteristics of the included papers suggest that serious games can be used in various ways for cancer control among children and adolescents while highlighting the need to develop and implement serious games in underrepresented areas. %M 38985502 %R 10.2196/58724 %U https://games.jmir.org/2024/1/e58724 %U https://doi.org/10.2196/58724 %U http://www.ncbi.nlm.nih.gov/pubmed/38985502 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55831 %T Digital Interventions to Modify Skin Cancer Risk Behaviors in a National Sample of Young Adults: Randomized Controlled Trial %A Heckman,Carolyn J %A Mitarotondo,Anna %A Lin,Yong %A Khavjou,Olga %A Riley,Mary %A Manne,Sharon L %A Yaroch,Amy L %A Niu,Zhaomeng %A Glanz,Karen %+ Rutgers Cancer Institute, 120 Albany St, New Brunswick, NJ, 08901, United States, 1 732 235 8830, ch842@rutgers.edu %K skin cancer prevention %K sun protection %K sun exposure %K digital intervention %K social media %K young adults %K sun %K skin cancer %K prevention %K cancer %K randomized controlled trial %K Facebook %K Instagram %K engagement %K behavior %K protection %K skin %K sunscreen %D 2024 %7 2.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Young adults engage in behaviors that place them at risk for skin cancer. Dissemination of digital health promotion interventions via social media is a potentially promising strategy to modify skin cancer risk behaviors by increasing UV radiation (UVR) protection and skin cancer examinations. Objective: This study aimed to compare 3 digital interventions designed to modify UVR exposure, sun protection, and skin cancer detection behaviors among young adults at moderate to high risk of skin cancer. Methods: This study was a hybrid type II effectiveness-implementation randomized controlled trial of 2 active interventions, a digital skin cancer risk reduction intervention (UV4.me [basic]) compared with an enhanced version (UV4.me2 [enhanced]), and an electronic pamphlet (e-pamphlet). Intervention effects were assessed over the course of a year among 1369 US young adults recruited primarily via Facebook and Instagram. Enhancements to encourage intervention engagement and behavior change included more comprehensive goal-setting activities, ongoing proactive messaging related to previously established mediators (eg, self-efficacy) of UVR exposure and protection, embedded incentives for module completion, and ongoing news and video updates. Primary outcome effects assessed via linear regression were UVR exposure and sun protection and protection habits. Secondary outcome effects assessed via logistic regression were skin self-exams, physician skin exams, sunscreen use, indoor tanning, and sunburn. Results: The active interventions increased sun protection (basic: P=.02; enhanced: P<.001) and habitual sun protection (basic: P=.04; enhanced P=.01) compared with the e-pamphlet. The enhanced intervention increased sun protection more than the basic one. Each active intervention increased sunscreen use at the 3-month follow-up (basic: P=.03; enhanced: P=.01) and skin self-exam at 1 year (basic: P=.04; enhanced: P=.004), compared with the e-pamphlet. Other intervention effects and differences between the Basic and Enhanced Intervention effects were nonsignificant. Conclusions: The active interventions were effective in improving several skin cancer risk and skin cancer prevention behaviors. Compared with the basic intervention, the enhanced intervention added to the improvement in sun protection but not other behaviors. Future analyses will explore intervention engagement (eg, proportion of content reviewed). Trial Registration: ClinicalTrials.gov NCT03313492; http://clinicaltrials.gov/ct2/show/NCT03313492 %M 38954433 %R 10.2196/55831 %U https://www.jmir.org/2024/1/e55831 %U https://doi.org/10.2196/55831 %U http://www.ncbi.nlm.nih.gov/pubmed/38954433 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52361 %T Quality of Life in Patients and Their Spouses and Cohabitating Partners in the Year Following a Cancer Biopsy (the Couples Cope Study): Protocol for a Prospective Observational Study %A Moreno,Patricia I %A Worch,Sarah M %A Thomas,Jessica L %A Nguyen,Rebecca L %A Medina,Heidy N %A Penedo,Frank J %A Moskowitz,Judith T %A Yanez,Betina %A Kircher,Sheetal M %A Kundu,Shilajit D %A Flury,Sarah C %A Cheung,Elaine O %+ Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, United States, 1 3052439844, patricia.moreno@miami.edu %K quality of life %K cancer %K biopsy %K couples %K dyads %K caregiver %K patients %K patient %K cancer biopsy %K spouse %K spouses %K partner %K partners %K diagnostic %K diagnostic procedure %K feasibility of recruitment %K recruitment %K prostate biopsy %K breast biopsy %K screening %K electronic health record %K survey %K surveys %D 2024 %7 18.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Receiving a diagnosis of cancer is a profound and often very stressful experience. Few studies have prospectively recruited patients prior to receiving a new diagnosis of cancer and included spouses or partners. Objective: The aim of the Couples Cope Study is to understand the impact of undergoing a diagnostic biopsy and receiving a new cancer diagnosis on quality of life (QoL) in both patients and their spouses or partners, as well as on the quality of their relationship. This protocol paper describes the study design and assesses the feasibility of recruitment and retention. Methods: Study staff reviewed the schedules of collaborating physicians using specific encounter codes to identify patients scheduled for breast or prostate biopsies. Potential participants were prescreened via the electronic health record and sent a recruitment letter at least 2 to 3 weeks prior to their biopsy procedure. Patients subsequently underwent a phone screening to determine eligibility. Patients who enrolled provided study staff with contact information for their spouses or partners. All consent forms were completed online. Surveys were completed online prior to receiving the biopsy results (baseline), and at 1, 3, 6, and 9 months after the biopsy. Study staff engaged in ongoing, personalized contact with participants and sent assessment completion reminders via phone and email. Results: A total of 2294 patients undergoing a breast or prostate biopsy were identified and 69% (n=1582) were eligible for phone screening following electronic health record prescreening. Of the 431 patients who underwent phone screening, 75% (n=321) were eligible to participate. Of the eligible patients, 72% (n=231) enrolled and 82% (n=190) of enrolled patients had an accompanying partner or spouse who also enrolled. A total of 77% (34/44) of patients who received a cancer diagnosis and 72% (26/36) of their spouses or partners were retained through 9 months, while 80% (53/66) of patients who received a benign diagnosis and 68% (42/62) of their partners were retained. Conclusions: Prospective recruitment of patients undergoing diagnostic biopsy and their partners is feasible and requires both strategic collaboration with providers and concerted prescreening and recruitment efforts by study staff. Importantly, this study was able to conduct all study activities online without disrupting clinical workflow and without requiring patients and their spouses or partners to come into the laboratory. Consideration should be given to the ratio of biopsies to cancer diagnoses, which can vary significantly by cancer type. Prospective studies are needed and can inform our ability to provide effective support earlier to couples facing a possible cancer diagnosis. Future studies should examine other tumor types that have received less attention in QoL studies, include behavioral and neurobiological assessments beyond self-report measures, and follow couples beyond 9 months in order to examine long-term effects on QoL. International Registered Report Identifier (IRRID): DERR1-10.2196/52361 %M 38889402 %R 10.2196/52361 %U https://www.researchprotocols.org/2024/1/e52361 %U https://doi.org/10.2196/52361 %U http://www.ncbi.nlm.nih.gov/pubmed/38889402 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53159 %T Development of an Electronic Health Record Self-Referral Tool for Lung Cancer Screening: One-Group Posttest Study %A Stang,Garrett S %A Tanner,Nichole T %A Hatch,Ashley %A Godbolt,Jakarri %A Toll,Benjamin A %A Rojewski,Alana M %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main St, Box G-S121-3, Providence, RI, 02912, United States, 1 4018633375, garrett_stang@brown.edu %K lung cancer screening %K LCS %K electronic health records %K EHR %K Health Belief Model %K HBM %K self-refer %K tobacco treatment %K cancer screening %K development %K self-referral tool %K electronic health record %K decision-making %D 2024 %7 12.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 14 million individuals in the United States are eligible for lung cancer screening (LCS), but only 5.8% completed screening in 2021. Given the low uptake despite the potential great health benefit of LCS, interventions aimed at increasing uptake are warranted. The use of a patient-facing electronic health record (EHR) patient portal direct messaging tool offers a new opportunity to both engage eligible patients in preventative screening and provide a unique referral pathway for tobacco treatment. Objective: This study sought to develop and pilot an EHR patient-facing self-referral tool for an established LCS program in an academic medical center. Methods: Guided by constructs of the Health Belief Model associated with LCS uptake (eg, knowledge and self-efficacy), formative development of an EHR-delivered engagement message, infographic, and self-referring survey was conducted. The survey submits eligible self-reported patient information to a scheduler for the LCS program. The materials were pretested using an interviewer-administered mixed methods survey captured through venue-day-time sampling in 5 network-affiliated pulmonology clinics. Materials were then integrated into the secure patient messaging feature in the EHR system. Next, a one-group posttest quality improvement pilot test was conducted. Results: A total of 17 individuals presenting for lung screening shared-decision visits completed the pretest survey. More than half were newly referred for LCS (n=10, 60%), and the remaining were returning patients. When asked if they would use a self-referring tool through their EHR messaging portal, 94% (n=16) reported yes. In it, 15 participants provided oral feedback that led to refinement in the tool and infographic prior to pilot-testing. When the initial application of the tool was sent to a convenience sample of 150 random patients, 13% (n=20) opened the self-referring survey. Of the 20 who completed the pilot survey, 45% (n=9) were eligible for LCS based on self-reported smoking data. A total of 3 self-referring individuals scheduled an LCS. Conclusions: Pretest and initial application data suggest this tool is a positive stimulus to trigger the decision-making process to engage in a self-referral process to LCS among eligible patients. This self-referral tool may increase the number of patients engaging in LCS and could also be used to aid in self-referral to other preventative health screenings. This tool has implications for clinical practice. Tobacco treatment clinical services or health care systems should consider using EHR messaging for LCS self-referral. This approach may be cost-effective to improve LCS engagement and uptake. Additional referral pathways could be built into this EHR tool to not only refer patients who currently smoke to LCS but also simultaneously trigger a referral to clinical tobacco treatment. %M 38865702 %R 10.2196/53159 %U https://formative.jmir.org/2024/1/e53159 %U https://doi.org/10.2196/53159 %U http://www.ncbi.nlm.nih.gov/pubmed/38865702 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e46737 %T Predicting Lung Cancer Survival to the Future: Population-Based Cancer Survival Modeling Study %A Meng,Fan-Tsui %A Jhuang,Jing-Rong %A Peng,Yan-Teng %A Chiang,Chun-Ju %A Yang,Ya-Wen %A Huang,Chi-Yen %A Huang,Kuo-Ping %A Lee,Wen-Chung %+ Institute of Health Data Analytics and Statistics, College of Public Health, National Taiwan University, Room 536, No 17, Xuzhou Road, Taipei, 100, Taiwan, 886 233668036, wenchung@ntu.edu.tw %K lung cancer %K survival %K survivorship-period-cohort model %K prediction %K prognosis %K early diagnosis %K lung cancer screening %K survival trend %K population-based %K population health %K public health %K surveillance %K low-dose computed tomography %D 2024 %7 31.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Lung cancer remains the leading cause of cancer-related mortality globally, with late diagnoses often resulting in poor prognosis. In response, the Lung Ambition Alliance aims to double the 5-year survival rate by 2025. Objective: Using the Taiwan Cancer Registry, this study uses the survivorship-period-cohort model to assess the feasibility of achieving this goal by predicting future survival rates of patients with lung cancer in Taiwan. Methods: This retrospective study analyzed data from 205,104 patients with lung cancer registered between 1997 and 2018. Survival rates were calculated using the survivorship-period-cohort model, focusing on 1-year interval survival rates and extrapolating to predict 5-year outcomes for diagnoses up to 2020, as viewed from 2025. Model validation involved comparing predicted rates with actual data using symmetric mean absolute percentage error. Results: The study identified notable improvements in survival rates beginning in 2004, with the predicted 5-year survival rate for 2020 reaching 38.7%, marking a considerable increase from the most recent available data of 23.8% for patients diagnosed in 2013. Subgroup analysis revealed varied survival improvements across different demographics and histological types. Predictions based on current trends indicate that achieving the Lung Ambition Alliance’s goal could be within reach. Conclusions: The analysis demonstrates notable improvements in lung cancer survival rates in Taiwan, driven by the adoption of low-dose computed tomography screening, alongside advances in diagnostic technologies and treatment strategies. While the ambitious target set by the Lung Ambition Alliance appears achievable, ongoing advancements in medical technology and health policies will be crucial. The study underscores the potential impact of continued enhancements in lung cancer management and the importance of strategic health interventions to further improve survival outcomes. %M 38819904 %R 10.2196/46737 %U https://publichealth.jmir.org/2024/1/e46737 %U https://doi.org/10.2196/46737 %U http://www.ncbi.nlm.nih.gov/pubmed/38819904 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e56168 %T An Introduction to the OutSMART Cancer Serious Game: Current and Future Directions %A Abraham,Olufunmilola %A McCarthy,Tyler J %+ Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Rm 2515 Rennebohm Hall, 777 Highland Ave, Madison, WI, 53705, United States, 1 6082634498, olufunmilola.abraham@wisc.edu %K serious game %K cancer %K health education %K adolescents %K health behavior %K United States %K young people %K adolescent %K teenager %K teenagers %K cancer prevention %K education %K cancer risk %K tool %K OutSMART Cancer %K innovative %K game development %K cancer awareness %K prevention %K wellness %D 2024 %7 29.5.2024 %9 Viewpoint %J JMIR Cancer %G English %X Given that cancer is a challenging disease that plagues millions of individuals of all age groups and socioeconomic statuses globally, developmentally appropriate education is often lacking for young people, particularly adolescents. Increasing cancer awareness and prevention education among adolescents using innovative strategies, such as game-based learning, is critical in reducing the burden of this disease. Adolescents are understudied in the field of cancer prevention and control, yet vulnerable as they tackle creating life-long health behavior patterns. Targeting cancer prevention education for adolescents has the potential to support long-term healthy behavior and reduce their risk of cancer. This paper provides an overview of the Collaborative Research on MEdication use and family health (CRoME) Lab’s novel game-based cancer prevention education tool. OutSMART Cancer is an innovative, novel educational intervention in the form of a serious game. Serious games are educational tools that seek to impart knowledge and improve behaviors in their players. This game covers information related to breast cancer, colon cancer, and lung cancer. This viewpoint is a summary of the developmental process for the OutSMART Cancer game. We describe in detail the work preceding initial game development, the current version of the game, future directions for the game, and its educational potential. The long-term goal of OutSMART Cancer is to improve cancer awareness and knowledge regarding prevention behaviors in adolescents and support a lifetime of health and wellness. %M 38809587 %R 10.2196/56168 %U https://cancer.jmir.org/2024/1/e56168 %U https://doi.org/10.2196/56168 %U http://www.ncbi.nlm.nih.gov/pubmed/38809587 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e52577 %T “Notification! You May Have Cancer.” Could Smartphones and Wearables Help Detect Cancer Early? %A Scott,Suzanne E %A Thompson,Matthew J %+ Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, United Kingdom, 44 2078823550, suzanne.scott@qmul.ac.uk %K wearables %K early diagnosis %K cancer %K challenges %K diagnosis %K wearable %K detect %K detection %K smartphone %K cancer diagnosis %K symptoms %K monitoring %K monitor %K implementation %K anxiety %K health care service %K mobile phone %D 2024 %7 20.5.2024 %9 Viewpoint %J JMIR Cancer %G English %X This viewpoint paper considers the authors’ perspectives on the potential role of smartphones, wearables, and other technologies in the diagnosis of cancer. We believe that these technologies could be valuable additions in the pursuit of early cancer diagnosis, as they offer solutions to the timely detection of signals or symptoms and monitoring of subtle changes in behavior that may otherwise be missed. In addition to signal detection, technologies could assist symptom interpretation and guide and facilitate access to health care. This paper aims to provide an overview of the scientific rationale as to why these technologies could be valuable for early cancer detection, as well as outline the next steps for research and development to drive investigation into the potential for smartphones and wearables in this context and optimize implementation. We draw attention to potential barriers to successful implementation, including the difficulty of the development of signals and sensors with sufficient utility and accuracy through robust research with the target group. There are regulatory challenges; the potential for innovations to exacerbate inequalities; and questions surrounding acceptability, uptake, and correct use by the intended target group and health care practitioners. Finally, there is potential for unintended consequences on individuals and health care services including unnecessary anxiety, increased symptom burden, overinvestigation, and inappropriate use of health care resources. %M 38767941 %R 10.2196/52577 %U https://cancer.jmir.org/2024/1/e52577 %U https://doi.org/10.2196/52577 %U http://www.ncbi.nlm.nih.gov/pubmed/38767941 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54042 %T A Predictive Noninvasive Single-Nucleotide Variation–Based Biomarker Signature for Resectable Pancreatic Cancer: Protocol for a Prospective Validation Study %A Seeger,Nico %A Gutknecht,Stefan %A Zschokke,Irin %A Fleischmann,Isabella %A Roth,Nadja %A Metzger,Jürg %A Weber,Markus %A Breitenstein,Stefan %A Grochola,Lukasz Filip %+ Department of Visceral and Thoracic Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, Winterthur, 8401, Switzerland, 41 52 266 41 62, lukaszfilip.grochola@ksw.ch %K single-nucleotide polymorphism %K SNP %K single-nucleotide variation %K SNV %K pancreatic ductal adenocarcinoma %K PDAC %K noninvasive biomarker %K survival %K resection %K prospective validation %D 2024 %7 13.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Single-nucleotide variations (SNVs; formerly SNPs) are inherited genetic variants that can be easily determined in routine clinical practice using a simple blood or saliva test. SNVs have potential to serve as noninvasive biomarkers for predicting cancer-specific patient outcomes after resection of pancreatic ductal adenocarcinoma (PDAC). Two recent analyses led to the identification and validation of three SNVs in the CD44 and CHI3L2 genes (rs187115, rs353630, and rs684559), which can be used as predictive biomarkers to help select patients most likely to benefit from pancreatic resection. These variants were associated with an over 2-fold increased risk for tumor-related death in three independent PDAC study cohorts from Europe and the United States, including The Cancer Genome Atlas cohorts (reaching a P value of 1×10–8). However, these analyses were limited by the inherent biases of a retrospective study design, such as selection and publication biases, thereby limiting the clinical use of these promising biomarkers in guiding PDAC therapy. Objective: To overcome the limitations of previous retrospectively designed studies and translate the findings into clinical practice, we aim to validate the association of the identified SNVs with survival in a controlled setting using a prospective cohort of patients with PDAC following pancreatic resection. Methods: All patients with PDAC who will undergo pancreatic resection at three participating hospitals in Switzerland and fulfill the inclusion criteria will be included in the study consecutively. The SNV genotypes will be determined using standard genotyping techniques from patient blood samples. For each genotyped locus, log-rank and Cox multivariate regression tests will be performed, accounting for the relevant covariates American Joint Committee on Cancer stage and resection status. Clinical follow-up data will be collected for at least 3 years. Sample size calculation resulted in a required sample of 150 patients to sufficiently power the analysis. Results: The follow-up data collection started in August 2019 and the estimated end of data collection will be in May 2027. The study is still recruiting participants and 142 patients have been recruited as of November 2023. The DNA extraction and genotyping of the SNVs will be performed after inclusion of the last patient. Since no SNV genotypes have been determined, no data analysis has been performed to date. The results are expected to be published in 2027. Conclusions: This is the first prospective study of the CD44 and CHI3L2 SNV–based biomarker signature in PDAC. A prospective validation of this signature would enable its clinical use as a noninvasive predictive biomarker of survival after pancreatic resection that is readily available at the time of diagnosis and can assist in guiding PDAC therapy. The results of this study may help to individualize treatment decisions and potentially improve patient outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/54042 %M 38635586 %R 10.2196/54042 %U https://www.researchprotocols.org/2024/1/e54042 %U https://doi.org/10.2196/54042 %U http://www.ncbi.nlm.nih.gov/pubmed/38635586 %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 %@ 2561-326X %I JMIR Publications %V 8 %N %P e55202 %T A Health Information Technology Protocol to Enhance Colorectal Cancer Screening %A Baus,Adam %A Boatman,Dannell D %A Calkins,Andrea %A Pollard,Cecil %A Conn,Mary Ellen %A Subramanian,Sujha %A Kennedy-Rea,Stephenie %+ Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, 64 Medical Center Drive, PO Box 9190, Morgantown, WV, 26506, United States, 1 304 293 1083, abaus@hsc.wvu.edu %K electronic health record %K EHR %K colorectal cancer screening %K health information technology %K cancer %K colorectal cancer %D 2024 %7 19.4.2024 %9 Research Letter %J JMIR Form Res %G English %X This study addresses barriers to electronic health records–based colorectal cancer screening and follow-up in primary care through the development and implementation of a health information technology protocol. %M 38640474 %R 10.2196/55202 %U https://formative.jmir.org/2024/1/e55202 %U https://doi.org/10.2196/55202 %U http://www.ncbi.nlm.nih.gov/pubmed/38640474 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50000 %T Improvement of Cancer Prevention and Control: Reflection on the Role of Emerging Information Technologies %A Dong,Pei %A Mao,Ayan %A Qiu,Wuqi %A Li,Guanglin %+ Department of Public Health Strategy Research, Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Number 3 YaBao Road, Chaoyang District, Beijing, 100020, China, 86 01052328731, mao.ayan@imicams.ac.cn %K emerging information technologies %K cancer %K prevention and control %D 2024 %7 27.2.2024 %9 Viewpoint %J J Med Internet Res %G English %X Cancer has become an important public health problem affecting the health of Chinese residents, as well as residents all over the world. With the improvement of cancer prevention and treatment, the growth of the mortality rate of cancers has slowed down gradually, but the incidence rate is still increasing rapidly, and cancers still impose heavy disease and economic burdens. Cancer screening and early cancer diagnosis and treatment are important ways to reduce the burden of cancer-related diseases. At present, various projects for early cancer diagnosis and treatment have been implemented in China. With the expansion of the coverage of these projects, the problems related to project implementation, operation, and management have emerged gradually. In recent years, emerging information technologies have been applied in the field of health and have facilitated health management and clinical decision-making. Meanwhile, China announced multiple policies to encourage and promote the application of information technologies in the field of health. Therefore, combined with the analysis of major problems in cancer prevention and control projects, this paper probes into how to apply information technologies such as biological information mining, artificial intelligence, and electronic information collection technology to various stages of cancer prevention and control. Information technologies realize the integrated management of prevention and control processes, for example, mobilization and preliminary identification, high-risk assessment, clinical screening, clinical diagnosis and treatment, tracking and follow-up, and biological sample management of high-risk groups, and promote the efficient implementation of cancer prevention and control projects in China. %M 38412009 %R 10.2196/50000 %U https://www.jmir.org/2024/1/e50000 %U https://doi.org/10.2196/50000 %U http://www.ncbi.nlm.nih.gov/pubmed/38412009 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e46625 %T Improving Concordance Between Clinicians With Australian Guidelines for Bowel Cancer Prevention Using a Digital Application: Randomized Controlled Crossover Study %A Ow,Tsai-Wing %A Sukocheva,Olga %A Bampton,Peter %A Iyngkaran,Guruparan %A Rayner,Christopher K %A Tse,Edmund %+ Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia, 61 70740000, tsai-wing.ow@sa.gov.au %+ Faculty of Health and Medical Sciences, University of Adelaide, North Terrace, Adelaide, 5005, Australia, 61 83135208, tsai-wing.ow@sa.gov.au %K colorectal cancer %K guidelines %K colorectal cancer screening %K digital application %K questionnaire %K application %K cancer prevention %K prevention %K cancer %K bowel cancer %K surveillance %K clinical vignette quiz %K usability %K Australia %D 2024 %7 22.2.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Australia’s bowel cancer prevention guidelines, following a recent revision, are among the most complex in the world. Detailed decision tables outline screening or surveillance recommendations for 230 case scenarios alongside cessation recommendations for older patients. While these guidelines can help better allocate limited colonoscopy resources, their increasing complexity may limit their adoption and potential benefits. Therefore, tools to support clinicians in navigating these guidelines could be essential for national bowel cancer prevention efforts. Digital applications (DAs) represent a potentially inexpensive and scalable solution but are yet to be tested for this purpose. Objective: This study aims to assess whether a DA could increase clinician adherence to Australia’s new colorectal cancer screening and surveillance guidelines and determine whether improved usability correlates with greater conformance to guidelines. Methods: As part of a randomized controlled crossover study, we created a clinical vignette quiz to evaluate the efficacy of a DA in comparison with the standard resource (SR) for making screening and surveillance decisions. Briefings were provided to study participants, which were tailored to their level of familiarity with the guidelines. We measured the adherence of clinicians according to their number of guideline-concordant responses to the scenarios in the quiz using either the DA or the SR. The maximum score was 18, with higher scores indicating improved adherence. We also tested the DA’s usability using the System Usability Scale. Results: Of 117 participants, 80 were included in the final analysis. Using the SR, the adherence of participants was rated a median (IQR) score of 10 (7.75-13) out of 18. The participants’ adherence improved by 40% (relative risk 1.4, P<.001) when using the DA, reaching a median (IQR) score of 14 (12-17) out of 18. The DA was rated highly for usability with a median (IQR) score of 90 (72.5-95) and ranked in the 96th percentile of systems. There was a moderate correlation between the usability of the DA and better adherence (rs=0.4; P<.001). No differences between the adherence of specialists and nonspecialists were found, either with the SR (10 vs 9; P=.47) or with the DA (13 vs 15; P=.24). There was no significant association between participants who were less adherent with the DA (n=17) and their age (P=.06), experience with decision support tools (P=.51), or academic involvement with a university (P=.39). Conclusions: DAs can significantly improve the adoption of complex Australian bowel cancer prevention guidelines. As screening and surveillance guidelines become increasingly complex and personalized, these tools will be crucial to help clinicians accurately determine the most appropriate recommendations for their patients. Additional research to understand why some practitioners perform worse with DAs is required. Further improvements in application usability may optimize guideline concordance further. %M 38238256 %R 10.2196/46625 %U https://cancer.jmir.org/2024/1/e46625 %U https://doi.org/10.2196/46625 %U http://www.ncbi.nlm.nih.gov/pubmed/38238256 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47161 %T The Impact of Prostate-Specific Antigen Screening on Prostate Cancer Incidence and Mortality in China: 13-Year Prospective Population-Based Cohort Study %A Ruan,Xiaohao %A Zhang,Ning %A Wang,Dawei %A Huang,Jingyi %A Huang,Jinlun %A Huang,Da %A Chun,Tsun Tsun Stacia %A Ho,Brian Sze Ho %A Ng,Ada Tsui-Lin %A Tsu,James Hok-Leung %A Zhan,Yongle %A Na,Rong %+ Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China (Hong Kong), 852 22554852, ylzhan@connect.hku.hk %K prostate-specific antigen %K PSA %K prostate cancer %K prostate screening %K screening interval %K incidence %K mortality %K cohort study %K electronic health record %K China %D 2024 %7 18.1.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The status of prostate-specific antigen (PSA) screening is unclear in China. Evidence regarding the optimal frequency and interval of serial screening for prostate cancer (PCa) is disputable. Objective: This study aimed to depict the status of PSA screening and to explore the optimal screening frequency for PCa in China. Methods: A 13-year prospective cohort study was conducted using the Chinese Electronic Health Records Research in Yinzhou study’s data set. A total of 420,941 male participants aged ≥45 years were included between January 2009 and June 2022. Diagnosis of PCa, cancer-specific death, and all-cause death were obtained from the electronic health records and vital statistic system. Hazard ratios (HRs) with 95% CIs were estimated using Cox regression analysis. Results: The cumulative rate of ever PSA testing was 17.9% with an average annual percent change (AAPC) of 8.7% (95% CI 3.6%-14.0%) in the past decade in China. People with an older age, a higher BMI, higher waist circumference, tobacco smoking and alcohol drinking behaviors, higher level of physical activity, medication use, and comorbidities were more likely to receive PSA screening, whereas those with a lower education level and a widowed status were less likely to receive the test. People receiving serial screening ≥3 times were at a 67% higher risk of PCa detection (HR 1.67; 95% CI 1.48-1.88) but a 64% lower risk of PCa-specific mortality (HR 0.36; 95% CI 0.18-0.70) and a 28% lower risk of overall mortality (HR 0.72; 95% CI 0.67-0.77). People following a serial screening strategy at least once every 4 years were at a 25% higher risk of PCa detection (HR 1.25; 95% CI 1.13-1.36) but 70% (HR 0.30; 95% CI 0.16-0.57) and 23% (HR 0.77; 95% CI 0.73-0.82) lower risks of PCa-specific and all-cause mortality, respectively. Conclusions: This study reveals a low coverage of PSA screening in China and provides the first evidence of its benefits in the general Chinese population. The findings of this study indicate that receiving serial screening at least once every 4 years is beneficial for overall and PCa-specific survival. Further studies based on a nationwide population and with long-term follow-up are warranted to identify the optimal screening interval in China. %M 38236627 %R 10.2196/47161 %U https://publichealth.jmir.org/2024/1/e47161 %U https://doi.org/10.2196/47161 %U http://www.ncbi.nlm.nih.gov/pubmed/38236627 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e46474 %T Noninvasive Staging of Lymph Node Status in Breast Cancer Using Machine Learning: External Validation and Further Model Development %A Hjärtström,Malin %A Dihge,Looket %A Bendahl,Pär-Ola %A Skarping,Ida %A Ellbrant,Julia %A Ohlsson,Mattias %A Rydén,Lisa %+ Division of Oncology, Department of Clinical Sciences, Lund University, Scheeletorget 1, Lund, SE-223 81, Sweden, 46 737070404, malin.hjartstrom@med.lu.se %K breast neoplasm %K sentinel lymph node biopsy %K SLNB %K noninvasive lymph node staging %K NILS %K prediction model %K multilayer perceptron %K MLP %K register data %K breast cancer %K cancer %K validation study %K machine learning %K model development %K therapeutic %K feasibility %K diagnostic %K lymph node %K mammography images %D 2023 %7 20.11.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Most patients diagnosed with breast cancer present with a node-negative disease. Sentinel lymph node biopsy (SLNB) is routinely used for axillary staging, leaving patients with healthy axillary lymph nodes without therapeutic effects but at risk of morbidities from the intervention. Numerous studies have developed nodal status prediction models for noninvasive axillary staging using postoperative data or imaging features that are not part of the diagnostic workup. Lymphovascular invasion (LVI) is a top-ranked predictor of nodal metastasis; however, its preoperative assessment is challenging. Objective: This paper aimed to externally validate a multilayer perceptron (MLP) model for noninvasive lymph node staging (NILS) in a large population-based cohort (n=18,633) and develop a new MLP in the same cohort. Data were extracted from the Swedish National Quality Register for Breast Cancer (NKBC, 2014-2017), comprising only routinely and preoperatively available documented clinicopathological variables. A secondary aim was to develop and validate an LVI MLP for imputation of missing LVI status to increase the preoperative feasibility of the original NILS model. Methods: Three nonoverlapping cohorts were used for model development and validation. A total of 4 MLPs for nodal status and 1 LVI MLP were developed using 11 to 12 routinely available predictors. Three nodal status models were used to account for the different availabilities of LVI status in the cohorts and external validation in NKBC. The fourth nodal status model was developed for 80% (14,906/18,663) of NKBC cases and validated in the remaining 20% (3727/18,663). Three alternatives for imputation of LVI status were compared. The discriminatory capacity was evaluated using the validation area under the receiver operating characteristics curve (AUC) in 3 of the nodal status models. The clinical feasibility of the models was evaluated using calibration and decision curve analyses. Results: External validation of the original NILS model was performed in NKBC (AUC 0.699, 95% CI 0.690-0.708) with good calibration and the potential of sparing 16% of patients with node-negative disease from SLNB. The LVI model was externally validated (AUC 0.747, 95% CI 0.694-0.799) with good calibration but did not improve the discriminatory performance of the nodal status models. A new nodal status model was developed in NKBC without information on LVI (AUC 0.709, 95% CI: 0.688-0.729), with excellent calibration in the holdout internal validation cohort, resulting in the potential omission of 24% of patients from unnecessary SLNBs. Conclusions: The NILS model was externally validated in NKBC, where the imputation of LVI status did not improve the model’s discriminatory performance. A new nodal status model demonstrated the feasibility of using register data comprising only the variables available in the preoperative setting for NILS using machine learning. Future steps include ongoing preoperative validation of the NILS model and extending the model with, for example, mammography images. %M 37983068 %R 10.2196/46474 %U https://cancer.jmir.org/2023/1/e46474 %U https://doi.org/10.2196/46474 %U http://www.ncbi.nlm.nih.gov/pubmed/37983068 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e48150 %T Association Between Socioeconomic Status and Adherence to Fecal Occult Blood Tests in Colorectal Cancer Screening Programs: Systematic Review and Meta-Analysis of Observational Studies %A Luo,Zilin %A Dong,Xuesi %A Wang,Chenran %A Cao,Wei %A Zheng,Yadi %A Wu,Zheng %A Xu,Yongjie %A Zhao,Liang %A Wang,Fei %A Li,Jibin %A Ren,Jiansong %A Shi,Jufang %A Chen,Wanqing %A Li,Ni %+ Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China, 86 18201116334, nli@cicams.ac.cn %K adherence %K colorectal cancer %K fecal occult blood test %K screening %K socioeconomic status %D 2023 %7 31.10.2023 %9 Review %J JMIR Public Health Surveill %G English %X Background: Screening adherence is important in reducing colorectal cancer (CRC) incidence and mortality. Disparity in CRC screening adherence was observed in populations of different socioeconomic status (SES), but the direction and strength of the association remained unclear. Objective: We aimed to systematically review all the observational studies that have analyzed the association between SES and adherence to organized CRC screening based on fecal occult blood tests. Methods: We systematically reviewed the studies in PubMed, Embase, and Web of Science and reference lists of relevant reviews from the inception of the database up until June 7, 2023. Individual SES, neighborhood SES, and small-area SES were included, while any SES aggregated by geographic areas larger than neighbors were excluded. Studies assessing SES with any index or score combining indicators of income, education, deprivation, poverty, occupation, employment, marital status, cohabitation, and others were included. A random effect model meta-analysis was carried out for pooled odds ratios (ORs) and relative risks for adherence related to SES. Results: Overall, 10 studies, with a total of 3,542,379 participants and an overall adherence rate of 64.9%, were included. Compared with low SES, high SES was associated with higher adherence (unadjusted OR 1.73, 95% CI 1.42-2.10; adjusted OR 1.53, 95% CI 1.28-1.82). In the subgroup of nonindividual-level SES, the adjusted association was significant (OR 1.57, 95% CI 1.26-1.95). However, the adjusted association was insignificant in the subgroup of individual-level SES (OR 1.46, 95% CI 0.98-2.17). As for subgroups of the year of print, not only was the unadjusted association significantly stronger in the subgroup of early studies (OR 1.97, 95% CI 1.59-2.44) than in the subgroup of late studies (OR 1.43, 95% CI 1.31-1.56), but also the adjusted one was significantly stronger in the early group (OR 1.86, 95% CI 1.43-2.42) than in the late group (OR 1.26, 95% CI 1.14-1.39), which was consistent and robust. Despite being statistically insignificant, the strength of the association seemed lower in studies that did not adjust for race and ethnicity (OR 1.31, 95% CI 1.21-1.43) than the overall estimate (OR 1.53, 95% CI 1.28-1.82). Conclusions: The higher-SES population had higher adherence to fecal occult blood test–based organized CRC screening. Neighborhood SES, or small-area SES, was more competent than individual SES to be used to assess the association between SES and adherence. The disparity in adherence between the high SES and the low SES narrowed along with the development of interventions and the improvement of organized programs. Race and ethnicity were probably important confounding factors for the association. %M 37906212 %R 10.2196/48150 %U https://publichealth.jmir.org/2023/1/e48150 %U https://doi.org/10.2196/48150 %U http://www.ncbi.nlm.nih.gov/pubmed/37906212 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45132 %T Implementing Smartphone-Based Telemedicine for Cervical Cancer Screening in Uganda: Qualitative Study of Stakeholders’ Perceptions %A Kabukye,Johnblack K %A Namugga,Jane %A Mpamani,Collins Jackson %A Katumba,Andrew %A Nakatumba-Nabende,Joyce %A Nabuuma,Hanifa %A Musoke,Stephen Senkomago %A Nankya,Esther %A Soomre,Edna %A Nakisige,Carolyn %A Orem,Jackson %+ SPIDER - The Swedish Program for ICT in Developing Regions, Department of Computer and Systems Sciences, Stockholm University, Borgarfjordsgatan 12 (NOD Building), Campus Kista, PO Box 7003 Kista, Stockholm, SE-164 07, Sweden, 46 8 16 20 00, kabukye@dsv.su.se %K telemedicine %K cervical cancer %K screening %K visual inspection with acetic acid %K cervicography %K Uganda %K digital health %D 2023 %7 2.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In Uganda, cervical cancer (CaCx) is the commonest cancer, accounting for 35.7% of all cancer cases in women. The rates of human papillomavirus vaccination and CaCx screening remain low. Digital health tools and interventions have the potential to improve different aspects of CaCx screening and control in Uganda. Objective: This study aimed to describe stakeholders’ perceptions of the telemedicine system we developed to improve CaCx screening in Uganda. Methods: We developed and implemented a smartphone-based telemedicine system for capturing and sharing cervical images and other clinical data, as well as an artificial intelligence model for automatic analysis of images. We conducted focus group discussions with health workers at the screening clinics (n=27) and women undergoing screening (n=15) to explore their perceptions of the system. The focus group discussions were supplemented with field observations and an evaluation survey of the health workers on system usability and the overall project. Results: In general, both patients and health workers had positive opinions about the system. Highlighted benefits included better cervical visualization, the ability to obtain a second opinion, improved communication between nurses and patients (to explain screening findings), improved clinical data management, performance monitoring and feedback, and modernization of screening service. However, there were also some negative perceptions. For example, some health workers felt the system is time-consuming, especially when it had just been introduced, while some patients were apprehensive about cervical image capture and sharing. Finally, commonplace challenges in digital health (eg, lack of interoperability and problems with sustainability) and challenges in cancer screening in general (eg, arduous referrals, inadequate monitoring and quality control) also resurfaced. Conclusions: This study demonstrates the feasibility and value of digital health tools in CaCx screening in Uganda, particularly with regard to improving patient experience and the quality of screening services. It also provides examples of potential limitations that must be addressed for successful implementation. %M 37782541 %R 10.2196/45132 %U https://www.jmir.org/2023/1/e45132 %U https://doi.org/10.2196/45132 %U http://www.ncbi.nlm.nih.gov/pubmed/37782541 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48737 %T Development and Testing of a Mobile App to Collect Social Determinants of Health Data in Cancer Settings: Interview Study %A Oyedele,Natasha K %A Lansey,Dina G %A Chiew,Calvin %A Chan,Cupid %A Quon,Harry %A Dean,Lorraine T %+ Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway St., Room 888, Baltimore, MD, 21205, United States, 1 617 840 0885, nsoodoo@gmail.com %K social determinants of health %K mobile apps %K medical oncology %K mobile phone %D 2023 %7 14.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Social determinants of health (SDOH) such as lack of basic resources, housing, transportation, and social isolation play an important role for patients on the cancer care continuum. Health systems’ current technological solutions for identifying and managing patients’ SDOH data largely focus on information recorded in the electronic health record by providers, which is often inaccessible to patients to contribute to or modify. Objective: We developed and tested a patient-centric SDOH screening tool designed for use on patients’ personal mobile phone that preserves patient privacy and confidentiality, collects information about the unmet social needs of patients with cancer, and communicates them to the provider. Methods: We interviewed 22 patients with cancer, oncologists, and social workers associated with a US-based comprehensive cancer center to better understand how patients’ SDOH information is collected and reported. After triangulating data obtained from thematic analysis of interviews, an environmental scan, and a literature search of validated tools to collect SDOH data, we developed an SDOH screening tool mobile app and conducted a pilot study of 16 dyadic pairs of patients and cancer care team members at the same cancer center. We collected patient SDOH data using 36 survey items covering 7 SDOH domains and used validated scales and follow-up interviews to assess the app’s usability and acceptability among patients and cancer care team members. Results: Formative interviews with patients and care team members revealed that transportation, financial challenges, food insecurity, and low health literacy were common SDOH challenges and that a mobile app that collected those data, shared those data with care team members, and offered supportive resources could be useful and valuable. In the pilot study, 25% (4/16) of app-using patients reported having at least one of the abovementioned social needs; the most common social need was social isolation (7/16, 44%). Patients rated the mobile app as easy to use, accurately capturing their SDOH, and preserving their privacy but suggested that the app could be more helpful by connecting patients to actual resources. Providers reported high acceptability and usability of the app. Conclusions: Use of a brief, patient-centric, mobile app–based SDOH screening tool can effectively capture SDOH of patients with cancer for care team members in a way that preserves patient privacy and that is acceptable and usable for patients and care team members. However, only collecting SDOH information is not sufficient; usefulness can be increased by connecting patients directly to resources to address their unmet social needs. %M 37707880 %R 10.2196/48737 %U https://formative.jmir.org/2023/1/e48737 %U https://doi.org/10.2196/48737 %U http://www.ncbi.nlm.nih.gov/pubmed/37707880 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43345 %T Using the Multidimensional Health Locus of Control Scale Form C to Investigate Health Beliefs About Bladder Cancer Prevention and Treatment Among Male Patients: Cross-Sectional Study %A Xing,Zhaoquan %A Ji,Meng %A Shan,Yi %A Dong,Zhaogang %A Xu,Xiaofei %+ The University of Sydney, A18 - Brennan MacCallum Building, 3 Parramatta Road, Camperdown, NSW, Sydney, 2050, Australia, 61 2 9351 4512, christine.ji@sydney.edu.au %K health beliefs %K Multidimensional Health Locus of Control %K Chinese translation %K bladder cancer prevention and treatment %K male patients %K latent class analysis %D 2023 %7 16.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Bladder cancer is a leading cause of death among Chinese male populations in recent years. The health locus of control construct can mediate health status and outcomes, and it has proven helpful in predicting and explaining specific health-related behaviors. However, it has never been used to investigate health beliefs about bladder cancer prevention and treatment. Objective: This study aimed to classify male patients into different latent groups according to their beliefs about bladder cancer prevention and treatment and to identify associated factors to provide implications for the delivery of tailored education and interventions and the administration of targeted prevention and treatment. Methods: First, we designed a four-section questionnaire to solicit data: section 1—age, gender, and education; section 2—the communicative subscale of the All Aspects of Health Literacy Scale; section 3—the eHealth Literacy Scale; and section 4—health beliefs about bladder cancer prevention and treatment measured by the Multidimensional Health Locus of Control Scale Form C. We hypothesized that the participants’ health beliefs about bladder cancer prevention and treatment measured in section 4 could be closely associated with information collected through sections 1 to 3. We recruited 718 Chinese male patients from Qilu Hospital of Shandong University, China, and invited them to participate in a web-based questionnaire survey. Finally, we used latent class analysis to identify subgroups of men based on their categorical responses to the items on the Multidimensional Health Locus of Control Scale Form C and ascertained factors contributing to the low self-efficacy group identified. Results: We identified 2 subgroups defined as low and moderate self-efficacy groups representing 75.8% (544/718) and 24.2% (174/718) of the total sample, respectively. Men in the low self-efficacy cluster (cluster 1: 544/718, 75.8%) were less likely to believe in their own capability or doctors’ advice to achieve optimal outcomes in bladder cancer prevention and treatment. Men in the moderate self-efficacy cluster (cluster 2: 174/718, 24.2%) had distinct psychological traits. They had stronger beliefs in their own capability to manage their health with regard to bladder cancer prevention and treatment and moderate to high levels of trust in health and medical professionals and their advice to achieve better prevention and treatment outcomes. Four factors contributing to low self-efficacy were identified, including limited education (Year 6 to Year 12), aged ≥44 years, limited communicative health literacy, and limited digital health literacy. Conclusions: This was the first study investigating beliefs about bladder cancer prevention and treatment among Chinese male patients. Given that bladder cancer represents a leading cause of death among Chinese male populations in recent years, the low self-efficacy cluster and associated contributing factors identified in this study can provide implications for clinical practice, health education, medical research, and health policy-making. %M 37585255 %R 10.2196/43345 %U https://formative.jmir.org/2023/1/e43345 %U https://doi.org/10.2196/43345 %U http://www.ncbi.nlm.nih.gov/pubmed/37585255 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e43024 %T Tailoring a Text Messaging and Fotonovela Program to Increase Patient Engagement in Colorectal Cancer Screening in a Large Urban Community Clinic Population: Quality Improvement Project %A Guo,Monica %A Brar Prayaga,Rena %A Levitz,Carly E %A Kuo,Elena S %A Ruiz,Esmeralda %A Torres-Ozadali,Evelyn %A Escaron,Anne %+ Institute for Health Equity, AltaMed, 2035 Camfield Ave, Los Angeles, CA, 90040, United States, 1 323 914 9765, monguo@altamed.org %K colorectal cancer screening %K texting program %K fotonovela %K fecal immunochemical test %K FIT %K FIT kit %K thematic analysis %K mobile phone %D 2023 %7 10.8.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Appropriate annual screenings for colorectal cancer (CRC) are an essential preventive measure for the second-leading cause of cancer-related death in the United States. Studies have shown that CRC screening rates are influenced by various social determinants of health (SDOH) factors, including race, ethnicity, and geography. According to 2018 national data, participation in screening is lowest among Hispanic or Latinx individuals (56.1%). At an urban Federally Qualified Health Center, a quality improvement project was conducted to evaluate a texting program with a motivational fotonovela—a short narrative comic. Fotonovelas have previously been used in programs to improve knowledge of cervical cancer and human papillomavirus, vaccinations, and treatments for depression. Objective: This study aimed to encourage compliance with fecal immunochemical test (FIT) screening. Patient engagement involved a texting program with fotonovelas informed by behavior change techniques. This study sought to understand the qualitative characteristics of patient motivation, intention, and barriers to completing their screening. Methods: A total of 5241 English-speaking or Spanish-speaking Federally Qualified Health Center patients aged 50 to 75 years were randomized to either intervention (a 4-week tailored 2-way texting program with a fotonovela comic) or usual care (an SMS text message reminder and patient navigator phone call). The texting vendor used a proprietary algorithm to categorize patients in the intervention group into SDOH bands based on their home addresses (high impact=high social needs and low impact=low social needs). Over 4 weeks, patients were texted questions about receiving and returning their FIT, what barriers they may be experiencing, and their thoughts about the fotonovela. Results: The SDOH index analysis showed that most of the patient population was in the SDOH band categories of high impact (555/2597, 21.37%) and very high impact (1416/2597, 54.52%). Patients sent 1969 total responses to the texting system. Thematic analysis identified 3 major themes in these responses: messages as a reminder, where patients reported that they were motivated to return the FIT and had already done so or would do so as soon as possible; increasing patients’ understanding of screening importance, where patients expressed an increased knowledge about the purpose and importance of the FIT; and expressing barriers, where patients shared reasons for not completing the FIT. Conclusions: The texting program and fotonovela engaged a subset of patients in each SDOH band, including the high and very high impact bands. Creating culturally tailored messages can encourage patient engagement for accepting the content of the messaging, confirming intentions to complete their FIT, and sharing insights about barriers to behavior change. To better support all patients across the continuum of care with CRC screening, it is important to continue to develop and assess strategies that engage patients who did not return their home-mailed FIT. %M 37561562 %R 10.2196/43024 %U https://cancer.jmir.org/2023/1/e43024 %U https://doi.org/10.2196/43024 %U http://www.ncbi.nlm.nih.gov/pubmed/37561562 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42898 %T Public Preference Heterogeneity and Predicted Uptake Rate of Upper Gastrointestinal Cancer Screening Programs in Rural China: Discrete Choice Experiments and Latent Class Analysis %A Liu,Ruyue %A Li,Qiuxia %A Li,Yifan %A Wei,Wenjian %A Ma,Siqi %A Wang,Jialin %A Zhang,Nan %+ Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Huaiyin District, Jinan, 250117, China, 86 15562637630, nanzhang@vip.126.com %K upper gastrointestinal cancer %K screening programs %K discrete choice experiment %K latent class logit model %K public preference heterogeneity %K uptake rate %D 2023 %7 10.7.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Rapid increases in the morbidity and mortality of patients with upper gastrointestinal cancer (UGC) in high-incidence countries in Asia have raised public health concerns. Screening can effectively reduce the incidence and mortality of patients with UGC, but the low population uptake rate seriously affects the screening effect. Objective: We aimed to determine the characteristics that influence residents’ preference heterogeneity for a UGC-screening program and the extent to which these characteristics predict residents’ uptake rates. Methods: A discrete choice experiment was conducted in 1000 residents aged 40-69 years who were randomly selected from 3 counties (Feicheng, Linqu, and Dongchangfu) in Shandong Province, China. Each respondent was repeatedly asked to choose from 9 discrete choice questions of 2 hypothetical screening programs comprising 5 attributes: screening interval, screening technique, regular follow-up for precancerous lesions, mortality reduction, and out-of-pocket costs. The latent class logit model was used to estimate residents’ preference heterogeneity for each attribute level, their willingness to pay, and the expected uptake rates. Results: Of the 1000 residents invited, 926 (92.6%) were included in the final analyses. The mean age was 57.32 (SD 7.22) years. The best model contained 4 classes of respondents (Akaike information criterion=7140.989, Bayesian information criterion=7485.373) defined by different preferences for the 5 attributes. In the 4-class model, out of 926 residents, 88 (9.5%) were assigned to class 1, named as the negative latent type; 216 (3.3%) were assigned to class 2, named as the positive integrated type; 434 (46.9%) were assigned to class 3, named as the positive comfortable type; and 188 (20.3%) were assigned to class 4, named as the neutral quality type. For these 4 latent classes, “out-of-pocket cost” is the most preferred attribute in negative latent type and positive integrated type residents (45.04% vs 66.04% importance weights), whereas “screening technique” is the most preferred factor in positive comfortable type residents (62.56% importance weight) and “screening interval” is the most valued attribute in neutral quality type residents (47.05% importance weight). Besides, residents in different classes had common preference for painless endoscopy, and their willingness to pay were CNY ¥385.369 (US $59.747), CNY ¥93.44 (US $14.486), CNY ¥1946.48 (US $301.810), and CNY ¥3566.60 (US $552.961), respectively. Residents’ participation rate could increase by more than 89% (except for the 60.98% in class 2) if the optimal UGC screening option with free, follow-up for precancerous lesions, 45% mortality reduction, screening every year, and painless endoscopy was implemented. Conclusions: Public preference heterogeneity for UGC screening does exist. Most residents have a positive attitude toward UGC screening, but their preferences vary in selected attributes and levels, except for painless endoscopy. Policy makers should consider these heterogeneities to formulate UGC-screening programs that incorporate the public’s needs and preferences to improve participation rates. %M 37428530 %R 10.2196/42898 %U https://publichealth.jmir.org/2023/1/e42898 %U https://doi.org/10.2196/42898 %U http://www.ncbi.nlm.nih.gov/pubmed/37428530 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38388 %T Evaluating Human Papillomavirus eHealth in Hmong Adolescents to Promote Vaccinations: Pilot Feasibility Study %A Lee,Hee Yun %A Xiong,Serena %A Sur,Aparajita %A Khang,Tounhia %A Vue,Bai %A Culhane-Pera,Kathleen A %A Pergament,Shannon %A Torres,M Beatriz %A Koopmeiners,Joseph S %A Desai,Jay %+ School of Social Work, The University of Alabama, 2024 Little Hall Box 870314, Tuscaloosa, AL, 35487, United States, 1 205 348 6553, hlee94@ua.edu %K human papillomavirus %K HPV %K HPV vaccine %K community-based participatory action research %K CBPAR %K eHealth %K website %K social cognitive theory %K Hmong %K mobile phone %D 2023 %7 20.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Human papillomavirus (HPV) is a common sexually transmitted infection, causing multiple cancers, including cervical, penile, and anal. Infection and subsequent health risks caused by HPV can be diminished by HPV vaccination. Unfortunately, vaccination rates among Hmong Americans are substantially lower than those among other racial and ethnic groups, despite having higher cervical cancer rates than non-Hispanic White women. Such disparities and sparse literature highlight the need for innovative and culturally appropriate educational interventions to improve HPV vaccine rates in Hmong Americans. Objective: We aimed to develop and evaluate the effectiveness and usability of an innovative web-based eHealth educational website, the Hmong Promoting Vaccines website (HmongHPV website), for Hmong-American parents and adolescents to improve their knowledge, self-efficacy, and decision-making capacities to obtain HPV vaccinations. Methods: Through social cognitive theory and community-based participatory action research process, we created a theory-driven and culturally and linguistically appropriate website for Hmong parents and adolescents. We conducted a pre-post intervention pilot study to assess the website’s effectiveness and usability. Overall, 30 Hmong-American parent and adolescent dyads responded to questions about HPV and HPV vaccine knowledge, self-efficacy, and decision-making at preintervention, 1 week after intervention, and at the 5-week follow-up. Participants responded to survey questions about website content and processes at 1 and 5 weeks, and a subset of 20 dyad participants participated in telephone interviews 6 weeks later. We used paired t tests (2-tailed) to measure the change in knowledge, self-efficacy, and decision-making processes, and used template analysis to identify a priori themes for website usability. Results: Participants’ HPV and HPV vaccine knowledge improved significantly from pre- to postintervention stage and follow-up. Knowledge scores increased from preintervention to 1 week after intervention for both parents (HPV knowledge, P=.01; vaccine knowledge, P=.01) and children (HPV knowledge, P=.01; vaccine knowledge, P<.001), which were sustained at the 5-week follow-up. Parents’ average self-efficacy score increased from 21.6 at baseline to 23.9 (P=.007) at post intervention and 23.5 (P=.054) at follow-up. Similar improvements were observed in the teenagers’ self-efficacy scores (from 30.3 at baseline to 35.6, P=.009, at post intervention and 35.9, P=.006, at follow-up). Collaborative decision-making between parents and adolescents improved immediately after using the website (P=.002) and at follow-up (P=.02). The interview data also revealed that the website’s content was informative and engaging; in particular, participants enjoyed the web-based quizzes and vaccine reminders. Conclusions: This theory-driven, community-based participatory action research–designed and culturally and linguistically appropriate educational website was well received. It improved Hmong parents’ and adolescents’ knowledge, self-efficacy, and decision-making processes regarding HPV vaccination. Future studies should examine the website’s impact on HPV vaccine uptake and its potential for broader use across various settings (eg, clinics and schools). %M 37338961 %R 10.2196/38388 %U https://formative.jmir.org/2023/1/e38388 %U https://doi.org/10.2196/38388 %U http://www.ncbi.nlm.nih.gov/pubmed/37338961 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37553 %T Gender Effects on the Impact of Colorectal Cancer Risk Calculators on Screening Intentions: Experimental Study %A Lee,Jungmin %A Keil,Mark %A Lee,Jong Seok %A Baird,Aaron %A Choi,Hyoung-Yong %+ J Mack Robinson College of Business, Georgia State University, 55 Park Place NE, suite 1704, Atlanta, GA, 30303, United States, 1 404 413 7360, jlee469@gsu.edu %K colorectal %K cancer %K oncology %K risk calculator %K risk %K perceived susceptibility %K susceptibility %K gender %K intention %K randomized %K randomization %K screening %K perception %K prevention %D 2023 %7 12.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: According to a 2020 study by the American Cancer Society, colorectal cancer (CRC) represents the third leading cause of cancer both in incidence and death in the United States. Nonetheless, CRC screening remains lower than that for other high-risk cancers such as breast and cervical cancer. Risk calculators are increasingly being used to promote cancer awareness and improve compliance with CRC screening tests. However, research concerning the effects of CRC risk calculators on the intention to undergo CRC screening has been limited. Moreover, some studies have found the impacts of CRC risk calculators to be inconsistent, reporting that receiving personalized assessments from such calculators lowers people’s risk perception. Objective: The objective of this study is to examine the effect of using CRC risk calculators on individuals’ intentions to undergo CRC screening. In addition, this study aims to examine the mechanisms through which using CRC risk calculators might influence individuals’ intentions to undergo CRC screening. Specifically, this study focuses on the role of perceived susceptibility to CRC as a potential mechanism mediating the effect of using CRC risk calculators. Finally, this study examines how the effect of using CRC risk calculators on individuals’ intentions to undergo CRC screening may vary by gender. Methods: We recruited a total of 128 participants through Amazon Mechanical Turk who live in the United States, have health insurance, and are in the age group of 45 to 85 years. All participants answered questions needed as input for the CRC risk calculator but were randomly assigned to treatment (CRC risk calculator results immediately received) and control (CRC risk calculator results made available after the experiment ended) groups. The participants in both groups answered a series of questions regarding demographics, perceived susceptibility to CRC, and their intention to get screened. Results: We found that using CRC risk calculators (ie, answering questions needed as input and receiving calculator results) has a positive effect on intentions to undergo CRC screening, but only for men. For women, using CRC risk calculators has a negative effect on their perceived susceptibility to CRC, which in turn reduces the intention to sign up for CRC screening. Additional simple slope and subgroup analyses confirm that the effect of perceived susceptibility on CRC screening intention is moderated by gender. Conclusions: This study shows that using CRC risk calculators can increase individuals’ intentions to undergo CRC screening, but only for men. For women, using CRC risk calculators can reduce their intentions to undergo CRC screening, as it reduces their perceived susceptibility to CRC. Given these mixed results, although CRC risk calculators can be a useful source of information on one’s CRC risk, patients should be discouraged from relying solely on them to inform decisions regarding CRC screening. %M 37307035 %R 10.2196/37553 %U https://formative.jmir.org/2023/1/e37553 %U https://doi.org/10.2196/37553 %U http://www.ncbi.nlm.nih.gov/pubmed/37307035 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45360 %T Profiles and Findings of Population-Based Esophageal Cancer Screening With Endoscopy in China: Systematic Review and Meta-analysis %A Li,He %A Teng,Yi %A Yan,Xinxin %A Cao,Maomao %A Yang,Fan %A He,Siyi %A Zhang,Shaoli %A Li,Qianru %A Xia,Changfa %A Li,Kai %A Chen,Wanqing %+ Office of Cancer Screening, National Cancer Center of China/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 17 Panjia-yuan South Lane, Chaoyang District, Beijing, 100021, China, 86 13241914190, chenwq@cicams.ac.cn %K esophageal cancer %K screening %K high-risk individuals %K detection rates %K China %D 2023 %7 1.6.2023 %9 Review %J JMIR Public Health Surveill %G English %X Background: Population-based esophageal cancer (EC) screening trials and programs have been conducted in China for decades; however, screening strategies have been adopted in different regions and screening profiles are unclear. Objective: We performed a meta-analysis to profile EC screening in China by positivity rate, compliance rate, and endoscopy findings, aiming to provide explicit evidence and recommendations for EC screening programs. Methods: English (PubMed, Embase) and Chinese (China National Knowledge Infrastructure, Wanfang) language databases were systematically searched for population-based EC screening studies in the Chinese population until December 31, 2022. A meta-analysis was performed by standard methodology using a random-effects model. Pooled prevalence rates were calculated for three groups: high-risk areas with a universal endoscopy strategy, rural China with a risk-stratified endoscopic screening (RSES) strategy, and urban China with an RSES strategy. Positive cases included lesions of severe dysplasia, carcinoma in situ, intramucosal carcinoma, submucosal carcinoma, and invasive carcinoma. Results: The pooled positivity rate of the high-risk population was higher in rural China (44.12%) than in urban China (23.11%). The compliance rate of endoscopic examinations was the highest in rural China (52.40%), followed by high-risk areas (50.11%), and was the lowest in urban China (23.67%). The pooled detection rate of positive cases decreased from 1.03% (95% CI 0.82%-1.30%) in high-risk areas to 0.48% (95% CI 0.25%-0.93%) in rural China and 0.12% (95% CI 0.07%-0.21%) in urban China. The pooled detection rate of low-grade intraepithelial neoplasia (LGIN) was also in the same order, being the highest in high-risk areas (3.99%, 95% CI 2.78%-5.69%), followed by rural China (2.55%, 95% CI 1.03%-6.19%) and urban China (0.34%, 95% CI 0.14%-0.81%). Higher detection rates of positive cases and LGIN were observed among males than among females and at older ages. The pooled early detection rate was 81.90% (95% CI 75.58%-86.88%), which was similar to the rates in high-risk areas (82.09%), in rural China (80.76%), and in urban China (80.08%). Conclusions: Under the current screening framework, a higher screening benefit was observed in high-risk areas than in other regions. To promote EC screening and reduce the current inequality of screening in China, more focus should be given to optimizing strategies of high-risk individual assessment and surveillance management to improve compliance with endoscopic examination. Trial Registration: PROSPERO CRD42022375720; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=375720 %M 37261899 %R 10.2196/45360 %U https://publichealth.jmir.org/2023/1/e45360 %U https://doi.org/10.2196/45360 %U http://www.ncbi.nlm.nih.gov/pubmed/37261899 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44593 %T The Indigenous Australian Human Papillomavirus (HPV) Cohort Study 2, Continuation for 5 to 10 Years: Protocol for a Longitudinal Study %A Hedges,Joanne %A Sethi,Sneha %A Garvey,Gail %A Whop,Lisa J %A Canfell,Karen %A Dodd,Zell %A Larkins,Priscilla %A Antonsson,Annika %A Smith,Megan A %A Mittinty,Murthy %A Leane,Catherine %A Reid,Nicolas %A Ooi,Eng H %A Ju,Xiangqun %A Logan,Richard %A Jamieson,Lisa %+ Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Level 4, Rundle Mall Plaza, Adelaide, SA 5005, Australia, 61 8 8313 4611, lisa.jamieson@adelaide.edu.au %K Aboriginal South Australian %K human papillomavirus %K oral HPV infection %K oral pharyngeal squamous cell carcinoma %K OPSCC %D 2023 %7 17.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Human papillomavirus (HPV) infection, a common sexually transmitted disease, is associated with cancers of the cervix, vulva, vagina, penis, anus, and head and neck. Oropharyngeal squamous cell carcinoma (OPSCC; throat cancer) is a type of cancer involving the head and neck area that is rapidly increasing across the globe. There are higher rates of OPSCC among Indigenous populations relative to non–Indigenous Australian populations, although the HPV-attributable fraction remains unknown. For the first time at a global level, we plan to extend an Indigenous Australian adult cohort to monitor, screen, and ultimately prevent HPV-associated OPSCC and to undertake extensive cost-effectiveness modelling around HPV vaccination. Objective: This study aims to (1) extend follow-up to a minimum of 7 years post recruitment to describe the prevalence, incidence, clearance, and persistence of oral HPV infection; and (2) conduct clinical examinations of the head and neck, oral cavity, and oropharynx and collect saliva samples for early-stage OPSCC testing. Methods: We will continue to implement a longitudinal design for the next study phase, where we will ascertain the prevalence, incidence, clearance, and persistence of oral HPV infection at 48, 60, and 72 months; undertake clinical examinations/saliva assessments to detect early-stage OPSCC; and refer for treatment. The primary outcome measures are changes in oral HPV infection status, biomarker measures of early HPV-related cancer, and clinical evidence of early-stage OPSCC. Results: Participant 48-month follow-up will commence in January 2023. The first results are expected to be submitted for publication 1 year after 48-month follow-up begins. Conclusions: Our findings have potential to change the way in which OPSCC among Australian Indigenous adults is managed, with desired impacts including cost-savings on expensive cancer treatments; improved nutritional, social, and emotional outcomes; and improved quality of life for both Indigenous adults and the Indigenous community more broadly. Continuing a large, representative Indigenous adult cohort to track oral HPV infection and monitor early OPSCC is essential to yield critical information to include in the management armamentarium of health and well-being recommendations for Australia’s First Nations. International Registered Report Identifier (IRRID): PRR1-10.2196/44593 %M 37195752 %R 10.2196/44593 %U https://www.researchprotocols.org/2023/1/e44593 %U https://doi.org/10.2196/44593 %U http://www.ncbi.nlm.nih.gov/pubmed/37195752 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e40917 %T Exploring the Acceptability of Text Messages to Inform and Support Shared Decision-making for Colorectal Cancer Screening: Online Panel Survey %A Hwang,Soohyun %A Lazard,Allison J %A Reffner Collins,Meredith K %A Brenner,Alison T %A Heiling,Hillary M %A Deal,Allison M %A Crockett,Seth D %A Reuland,Daniel S %A Elston Lafata,Jennifer %+ Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, United States, 1 7347076635, soohwang@live.unc.edu %K text messages %K shared decision-making %K colorectal cancer %K cancer screening %K mHealth %K cancer %K health care %K marginalized groups %D 2023 %7 5.5.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: While online portals may be helpful to engage patients in shared decision-making at the time of cancer screening, because of known disparities in patient portal use, sole reliance on portals to support cancer screening decision-making could exacerbate well-known disparities in this health care area. Innovative approaches are needed to engage patients in health care decision-making and to support equitable shared decision-making. Objective: We assessed the acceptability of text messages to engage sociodemographically diverse individuals in colorectal cancer (CRC) screening decisions and support shared decision-making in practice. Methods: We developed a brief text message program offering educational information consisting of components of shared decision-making regarding CRC screening (eg, for whom screening is recommended, screening test options, and pros/cons of options). The program and postprogram survey were offered to members of an online panel. The outcome of interest was program acceptability measured by observed program engagement, participant-reported acceptability, and willingness to use similar programs (behavioral intent). We evaluated acceptability among historically marginalized categories of people defined by income, literacy, and race. Results: Of the 289 participants, 115 reported having a low income, 146 were Black/African American, and 102 had less than extreme confidence in their health literacy. With one exception, we found equal or greater acceptability, regardless of measure, within each of the marginalized categories of people compared to their counterparts. The exception was that participants reporting an income below US $50,000 were less likely to engage with sufficient content of the program to learn that there was a choice among different CRC screening tests (difference –10.4%, 95% CI –20.1 to –0.8). Of note, Black/African American participants reported being more likely to sign up to receive text messages from their doctor’s office compared to white participants (difference 18.7%, 95% CI 7.0-30.3). Conclusions: Study findings demonstrate general acceptance of text messages to inform and support CRC screening shared decision-making. %M 37145859 %R 10.2196/40917 %U https://cancer.jmir.org/2023/1/e40917 %U https://doi.org/10.2196/40917 %U http://www.ncbi.nlm.nih.gov/pubmed/37145859 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e44695 %T Exploring Cancer Incidence, Risk Factors, and Mortality in the Lleida Region: Interactive, Open-source R Shiny Application for Cancer Data Analysis %A Florensa,Didac %A Mateo-Fornes,Jordi %A Lopez Sorribes,Sergi %A Torres Tuca,Anna %A Solsona,Francesc %A Godoy,Pere %+ Department of Computer Engineering, University of Lleida, C/ Jaume II, 69, Lleida, 25002, Spain, 34 603534021, didac.florensa@gencat.cat %K R Shiny %K cloud computing %K microservices %K Docker %K decision support system %K cancer incidence %K cancer risk factors, cancer mortality %D 2023 %7 20.4.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: The cancer incidence rate is essential to public health surveillance. The analysis of this information allows authorities to know the cancer situation in their regions, especially to determine cancer patterns, monitor cancer trends, and help prioritize the allocation of health resource. Objective: This study aimed to present the design and implementation of an R Shiny application to assist cancer registries conduct rapid descriptive and predictive analytics in a user-friendly, intuitive, portable, and scalable way. Moreover, we wanted to describe the design and implementation road map to inspire other population registries to exploit their data sets and develop similar tools and models. Methods: The first step was to consolidate the data into the population registry cancer database. These data were cross validated by ASEDAT software, checked later, and reviewed by experts. Next, we developed an online tool to visualize the data and generate reports to assist decision-making under the R Shiny framework. Currently, the application can generate descriptive analytics using population variables, such as age, sex, and cancer type; cancer incidence in region-level geographical heat maps; line plots to visualize temporal trends; and typical risk factor plots. The application also showed descriptive plots about cancer mortality in the Lleida region. This web platform was built as a microservices cloud platform. The web back end consists of an application programming interface and a database, which NodeJS and MongoDB have implemented. All these parts were encapsulated and deployed by Docker and Docker Compose. Results: The results provide a successful case study in which the tool was applied to the cancer registry of the Lleida region. The study illustrates how researchers and cancer registries can use the application to analyze cancer databases. Furthermore, the results highlight the analytics related to risk factors, second tumors, and cancer mortality. The application shows the incidence and evolution of each cancer during a specific period for gender, age groups, and cancer location, among other functionalities. The risk factors view permitted us to detect that approximately 60% of cancer patients were diagnosed with excess weight at diagnosis. Regarding mortality, the application showed that lung cancer registered the highest number of deaths for both genders. Breast cancer was the lethal cancer in women. Finally, a customization guide was included as a result of this implementation to deploy the architecture presented. Conclusions: This paper aimed to document a successful methodology for exploiting the data in population cancer registries and propose guidelines for other similar records to develop similar tools. We intend to inspire other entities to build an application that can help decision-making and make data more accessible and transparent for the community of users. %M 37079353 %R 10.2196/44695 %U https://cancer.jmir.org/2023/1/e44695 %U https://doi.org/10.2196/44695 %U http://www.ncbi.nlm.nih.gov/pubmed/37079353 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46657 %T Using User-Centered Design to Facilitate Adherence to Annual Lung Cancer Screening: Protocol for a Mixed Methods Study for Intervention Development %A Hirsch,Erin A %A Studts,Jamie L %+ Division of Medical Oncology, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, 13001 E. 17th Place, Mail Stop B189, Aurora, CO, 80045, United States, 1 303 724 1658, Erin.Hirsch@cuanschutz.edu %K health information processing %K intervention design %K lung cancer %K lung cancer screening %K LCS %K mixed methods %K photovoice %K user-centered design %D 2023 %7 14.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Lung cancer is the leading cause of cancer-related death in the United States, with the majority of lung cancer occurrence diagnosed after the disease has already metastasized. Lung cancer screening (LCS) with low-dose computed tomography can diagnose early-stage disease, especially when eligible individuals participate in screening on a yearly basis. Unfortunately, annual adherence has emerged as a challenge for academic and community screening programs, endangering the individual and population health benefits of LCS. Reminder messages have effectively increased adherence rates in breast, colorectal, and cervical cancer screenings but have not been tested with LCS participants who experience unique barriers to screening associated with the stigma of smoking and social determinants of health. Objective: This research aims to use a theory-informed, multiphase, and mixed methods approach with LCS experts and participants to develop a set of clear and engaging reminder messages to support LCS annual adherence. Methods: In aim 1, survey data informed by the Cognitive-Social Health Information Processing model will be collected to assess how LCS participants process health information aimed at health protective behavior to develop content for reminder messages and pinpoint options for message targeting and tailoring. Aim 2 focuses on identifying themes for message imagery through a modified photovoice activity that asks participants to identify 3 images that represent LCS and then participate in an interview about the selection, likes, and dislikes of each photo. A pool of candidate messages for multiple delivery platforms will be developed in aim 3, using results from aim 1 for message content and aim 2 for imagery selection. The refinement of message content and imagery combinations will be completed through iterative feedback from LCS experts and participants. Results: Data collection began in July 2022 and will be completed by May 2023. The final reminder message candidates are expected to be completed by June 2023. Conclusions: This project proposes a novel approach to facilitate adherence to annual LCS through the development of reminder messages that embrace content and imagery representative of the target population directly in the design process. Developing effective strategies to increase LCS adherence is instrumental in achieving optimal LCS outcomes at individual and population health levels. International Registered Report Identifier (IRRID): DERR1-10.2196/46657 %M 37058339 %R 10.2196/46657 %U https://www.researchprotocols.org/2023/1/e46657 %U https://doi.org/10.2196/46657 %U http://www.ncbi.nlm.nih.gov/pubmed/37058339 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42782 %T Susceptibility to Breast Cancer Misinformation Among Chinese Patients: Cross-sectional Study %A Shan,Yi %A Ji,Meng %A Xing,Zhaoquan %A Dong,Zhaogang %A Xu,Xiaofei %+ School of Languages and Cultures, The University of Sydney, A18 - Brennan MacCallum Building, Camperdown, Sydney, NSW 2006, Australia, 61 2 9351 4512, christine.ji@sydney.edu.au %K susceptibility %K breast cancer misinformation %K Chinese patients %K logistic regression %K predicting factors %K cancer %K misinformation %K China %K breast cancer %K policy %K age %K gender %K education %K literacy %K clinical %D 2023 %7 5.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Currently, breast cancer is the most commonly diagnosed cancer and the sixth-leading cause of cancer-related deaths among Chinese women. Worse still, misinformation contributes to the aggravation of the breast cancer burden in China. There is a pressing need to investigate the susceptibility to breast cancer misinformation among Chinese patients. However, no study has been performed in this respect. Objective: This study aims to ascertain whether some demographics (age, gender, and education), some health literacy skills, and the internal locus of control are significantly associated with the susceptibility to misinformation about all types of breast cancers among randomly sampled Chinese patients of both genders in order to provide insightful implications for clinical practice, health education, medical research, and health policy making. Methods: We first designed a questionnaire comprising 4 sections of information: age, gender, and education (section 1); self-assessed disease knowledge (section 2); the All Aspects of Health Literacy Scale (AAHLS), the eHealth Literacy Scale (eHEALS), the 6-item General Health Numeracy Test (GHNT-6), and the “Internal” subscale of the Multidimensional Health Locus of Control (MHLC) scales (section 3); and 10 breast cancer myths collected from some officially registered and authenticated websites (section 4). Subsequently, we recruited patients from Qilu Hospital of Shandong University, China, using randomized sampling. The questionnaire was administered via wenjuanxing, the most popular online survey platform in China. The collected data were manipulated in a Microsoft Excel file. We manually checked the validity of each questionnaire using the predefined validity criterion. After that, we coded all valid questionnaires according to the predefined coding scheme, based on Likert scales of different point (score) ranges for different sections of the questionnaire. In the subsequent step, we calculated the sums of the subsections of the AAHLS and the sums of the 2 health literacy scales (the eHEALS and GHNT-6) and the 10 breast cancer myths. Finally, we applied logistic regression modeling to relate the scores in section 4 to the scores in sections 1-3 of the questionnaire to identify what significantly contributes to the susceptibility to breast cancer misinformation among Chinese patients. Results: All 447 questionnaires collected were valid according to the validity criterion. The participants were aged 38.29 (SD 11.52) years on average. The mean score for their education was 3.68 (SD 1.46), implying that their average educational attainment was between year 12 and a diploma (junior college). Of the 447 participants, 348 (77.85%) were women. The mean score for their self-assessed disease knowledge was 2.50 (SD 0.92), indicating that their self-assessed disease knowledge status was between “knowing a lot” and “knowing some.” The mean scores of the subconstructs in the AAHLS were 6.22 (SD 1.34) for functional health literacy, 5.22 (SD 1.54) for communicative health literacy, and 11.19 (SD 1.99) for critical health literacy. The mean score for eHealth literacy was 24.21 (SD 5.49). The mean score for the 6 questions in the GHNT-6 was 1.57 (SD 0.49), 1.21 (SD 0.41), 1.24 (SD 0.43), 1.90 (SD 0.30), 1.82 (SD 0.39), and 1.73 (SD 0.44), respectively. The mean score for the patients’ health beliefs and self-confidence was 21.19 (SD 5.63). The mean score for their response to each myth ranged from 1.24 (SD 0.43) to 1.67 (SD 0.47), and the mean score for responses to the 10 myths was 14.03 (SD 1.78). Through interpreting these descriptive statistics, we found that Chinese female patients’ limited ability to rebut breast cancer misinformation is mainly attributed to 5 factors: (1) lower communicative health literacy, (2) certainty about self-assessed eHealth literacy skills, (3) lower general health numeracy, (4) positive self-assessment of general disease knowledge, and (5) more negative health beliefs and lower levels of self-confidence. Conclusions: Drawing on logistic regression modeling, we studied the susceptibility to breast cancer misinformation among Chinese patients. The predicting factors of the susceptibility to breast cancer misinformation identified in this study can provide insightful implications for clinical practice, health education, medical research, and health policy making. %M 37018020 %R 10.2196/42782 %U https://formative.jmir.org/2023/1/e42782 %U https://doi.org/10.2196/42782 %U http://www.ncbi.nlm.nih.gov/pubmed/37018020 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43041 %T Development of a Tailored Mobile Phone–Based Intervention to Facilitate Parent-Child Communication and Build Human Papillomavirus Vaccine Confidence: Formative Qualitative Study %A Cunningham-Erves,Jennifer %A Wilkins,Consuelo H %A Dempsey,Amanda F %A Jones,Jessica L %A Thompson,Chris %A Edwards,Kathryn %A Davis,Megan %A Mayberry,Lindsay S %A Landsittal,Douglas %A Hull,Pamela C %+ Department of Internal Medicine, Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN, 37208, United States, 1 6153275692, jerves@mmc.edu %K human papillomavirus %K HPV %K vaccine %K hesitancy %K parent-child communication %K theory %K mobile health %K mHealth %K adolescents %K patient education %D 2023 %7 4.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Human papillomavirus (HPV) vaccine hesitancy is on the rise, and provider communication is a first-line strategy to address parental concerns. The use of the presumptive approach and motivational interviewing by providers may not be enough to influence parental decision-making owing to the providers’ limited time, self-efficacy, and skills to implement these strategies. Interventions to enhance provider communication and build parental HPV vaccine confidence have been undertested. Delivering tailored patient education to parents via mobile phones before they visit the health care provider may address time constraints during clinic visits and positively affect vaccine uptake. Objective: This study aimed to describe the development and evaluate the acceptability of a mobile phone–based, family-focused intervention guided by theory to address concerns of HPV vaccine–hesitant parents before the clinic visit, as well as explore intervention use to facilitate parent-child communication. Methods: The health belief model and theory of reasoned action guided intervention content development. A multilevel stakeholder engagement process was used to iteratively develop the HPVVaxFacts intervention, including a community advisory board review, a review by an advisory panel comprising HPV vaccine–hesitant parents, a health communications expert review, semistructured qualitative interviews with HPV vaccine–hesitant parents (n=31) and providers (n=15), and a content expert review. Inductive thematic analysis was used to identify themes in the interview data. Results: The qualitative interviews yielded 4 themes: overall views toward mobile device use for health information, acceptability of HPVVaxFacts, facilitators of HPVVaxFacts use, and barriers to HPVVaxFacts use. In parent interviews after reviewing HPVVaxFacts prototypes, almost all parents (29/31, 94%) stated they intended to have their child vaccinated. Most of the parents stated that they liked the added adolescents’ corner to engage in optional parent-child communication (ie, choice to share and discuss information with their child; 27/31, 87%) and shared decision-making in some cases (8/31, 26%). After incorporating all input, the final intervention consisted of a 10-item survey to identify the top 3 concerns of parents, followed by tailored education that was mapped to each of the following concerns: evidential messages, images or graphics to enhance comprehension and address low literacy, links to credible websites, a provider video, suggested questions to ask their child’s physician, and an optional adolescents’ corner to educate the patient and support parent-child communication. Conclusions: The multilevel stakeholder-engaged process used to iteratively develop this novel intervention for HPV vaccine–hesitant families can be used as a model to develop future mobile health interventions. This intervention is currently being pilot-tested in preparation for a randomized controlled trial aiming to increase HPV vaccination among adolescent children of vaccine-hesitant parents in a clinic setting. Future research can adapt HPVVaxFacts for other vaccines and use in other settings (eg, health departments and pharmacies). %M 37014680 %R 10.2196/43041 %U https://formative.jmir.org/2023/1/e43041 %U https://doi.org/10.2196/43041 %U http://www.ncbi.nlm.nih.gov/pubmed/37014680 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 15 %N %P e42704 %T Acceptability of Automated Robotic Clinical Breast Examination: Survey Study %A Jenkinson,George P %A Houghton,Natasha %A van Zalk,Nejra %A Waller,Jo %A Bello,Fernando %A Tzemanaki,Antonia %+ Bristol Robotics Laboratory, Department of Mechanical Engineering, University of Bristol, T Block, UWE Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom, 44 0117 328 6913, george.jenkinson.2018@bristol.ac.uk %K breast cancer detection %K automated diagnosis %K breast examination %K health care robotics %K patient and public involvement %K participatory design %K user acceptability %K mammography %K breast cancer %D 2023 %7 3.4.2023 %9 Original Paper %J J Particip Med %G English %X Background: In the United Kingdom, women aged 50 to 70 years are invited to undergo mammography. However, 10% of invasive breast cancers occur in women aged ≤45 years, representing an unmet need for young women. Identifying a suitable screening modality for this population is challenging; mammography is insufficiently sensitive, whereas alternative diagnostic methods are invasive or costly. Robotic clinical breast examination (R-CBE)—using soft robotic technology and machine learning for fully automated clinical breast examination—is a theoretically promising screening modality with early prototypes under development. Understanding the perspectives of potential users and partnering with patients in the design process from the outset is essential for ensuring the patient-centered design and implementation of this technology. Objective: This study investigated the attitudes and perspectives of women regarding the use of soft robotics and intelligent systems in breast cancer screening. It aimed to determine whether such technology is theoretically acceptable to potential users and identify aspects of the technology and implementation system that are priorities for patients, allowing these to be integrated into technology design. Methods: This study used a mixed methods design. We conducted a 30-minute web-based survey with 155 women in the United Kingdom. The survey comprised an overview of the proposed concept followed by 5 open-ended questions and 17 closed questions. Respondents were recruited through a web-based survey linked to the Cancer Research United Kingdom patient involvement opportunities web page and distributed through research networks’ mailing lists. Qualitative data generated via the open-ended questions were analyzed using thematic analysis. Quantitative data were analyzed using 2-sample Kolmogorov-Smirnov tests, 1-tailed t tests, and Pearson coefficients. Results: Most respondents (143/155, 92.3%) indicated that they would definitely or probably use R-CBE, with 82.6% (128/155) willing to be examined for up to 15 minutes. The most popular location for R-CBE was at a primary care setting, whereas the most accepted method for receiving the results was an on-screen display (with an option to print information) immediately after the examination. Thematic analysis of free-text responses identified the following 7 themes: women perceive that R-CBE has the potential to address limitations in current screening services; R-CBE may facilitate increased user choice and autonomy; ethical motivations for supporting R-CBE development; accuracy (and users’ perceptions of accuracy) is essential; results management with clear communication is a priority for users; device usability is important; and integration with health services is key. Conclusions: There is a high potential for the acceptance of R-CBE in its target user group and a high concordance between user expectations and technological feasibility. Early patient participation in the design process allowed the authors to identify key development priorities for ensuring that this new technology meets the needs of users. Ongoing patient and public involvement at each development stage is essential. %M 37010907 %R 10.2196/42704 %U https://jopm.jmir.org/2023/1/e42704 %U https://doi.org/10.2196/42704 %U http://www.ncbi.nlm.nih.gov/pubmed/37010907 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e42890 %T The Effect of Clinical Decision Prompts in Improving Human Papillomavirus Vaccination Rates in a Multispecialty Practice in a Predominantly Hispanic Population: Quasi-Experimental Study %A Molokwu,Jennifer %A Mendez,Melissa %A Bracamontes,Christina %+ Department of Family And Community Medicine, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Drive, El Paso, TX, 79905, United States, 1 9152240472, jennifer.molokwu@ttuhsc.edu %K HPV %K HPV vaccination %K electronic clinical decision support %K EMR prompt %K clinical %K decision %K vaccine %K pediatrics %K age %K ethnicity %K race %K language %K immunization %D 2023 %7 15.3.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: The human papillomavirus (HPV) is implicated in the causal pathway of cancers of the vulva, vagina, penis, cervix, anus, and oropharyngeal region. It is the most common sexually transmitted infection in the United States. Despite the documented safety and effectiveness of the HPV vaccine, rates lag behind those of other vaccines given at the same age. Objective: Provider recommendation is identified as a robust predictor of HPV vaccine uptake, and physician-prompting is shown to increase the provision of preventive care services in general. Theoretically, providing reminders to providers should increase opportunities for providing HPV vaccine recommendations and therefore affect vaccination rates. The objective of our study was to assess the effectiveness of an electronic medical record (EMR) prompt in improving HPV vaccination rates in an academic clinic setting caring for a predominantly Hispanic border population. Methods: We used a quasi-experimental design with a retrospective chart audit to evaluate the effect of a clinical decision prompt (CDP) on improving HPV immunization rates in different specialty settings. We introduced an EMR prompt to remind providers to recommend the HPV vaccine when seeing appropriate patients in an obstetrics and gynecology (OBGYN), pediatrics (PD), and family medicine (FM) clinic in a large multispecialty academic group located along the Texas-Mexico border. We assessed HPV vaccination rates in all the departments involved before and after introducing the prompts. Participants included male and female patients between the ages of 9 and 26 years, presenting at the clinics between January 2014 and December 2015. Results: We reviewed over 2800 charts in all 3 clinics. After adjusting for age, ethnicity, race, type of insurance, preferred language, and clinic, the odds of immunization were 92% (P<.001) higher in patients after the prompt implementation of the EMR. In addition, there was an overall statistically significant increase in the overall HPV vaccination completion rates after implementing the CDP (31.96% vs 21.22%; P<.001). Again, OBGYN saw the most significant improvement in vaccination completion rates, with rates at follow-up 66.02% higher than baseline rates (P=.04). PD and FM had somewhat similar but no less impressive improvements (57.7% and 58.36%; P<.001). Conclusions: Implementing an EMR CDP improved our overall odds of HPV vaccination completion by 92%. We theorize that the decision prompts remind health care providers to discuss or recommend the HPV vaccination during clinical service delivery. CDPs in the EMR help increase HPV vaccination rates in multiple specialties and are a low-cost intervention for improving vaccination rates. %M 36920453 %R 10.2196/42890 %U https://cancer.jmir.org/2023/1/e42890 %U https://doi.org/10.2196/42890 %U http://www.ncbi.nlm.nih.gov/pubmed/36920453 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43586 %T Disparity in Lung Cancer Screening Among Smokers and Nonsmokers in China: Prospective Cohort Study %A Wang,Le %A Wang,Youqing %A Wang,Fei %A Gao,Yumeng %A Fang,Zhimei %A Gong,Weiwei %A Li,Huizhang %A Zhu,Chen %A Chen,Yaoyao %A Shi,Lei %A Du,Lingbin %A Li,Ni %+ Department of Cancer Prevention, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, No.1 East Banshan Road, Gongshu District, Hangzhou, 310022, China, 86 571 88122219, dulb@zjcc.org.cn %K lung cancer %K screening %K smoker %K nonsmoker %D 2023 %7 14.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Low-dose computed tomography (LDCT) screening is effective in reducing lung cancer mortality in smokers; however, the evidence in nonsmokers is scarce. Objective: This study aimed to evaluate the participant rate and effectiveness of one-off LDCT screening for lung cancer among smokers and nonsmokers. Methods: A population-based prospective cohort study was performed to enroll participants aged between 40 and 74 years from 2013 to 2019 from 4 cities in Zhejiang Province, China. Participants who were evaluated as having a high risk of lung cancer from an established risk score model were recommended to undergo LDCT screening. Follow-up outcomes were retrieved on June 30, 2020. The uptake rate of LDCT screening for evaluated high-risk participants and the detection rate of early-stage lung cancer (stage 0-I) were calculated. The lung cancer incidence, lung cancer mortality, and all-cause mortality were compared between the screened and nonscreened groups. Results: At baseline, 62.56% (18,818/30,079) of smokers and 6% (5483/91,455) of nonsmokers were identified as high risk (P<.001), of whom 41.9% (7885/18,818) and 66.31% (3636/5483) underwent LDCT screening (P<.001), respectively. After a median follow-up of 5.1 years, 1100 lung cancer cases and 456 all-cause death cases (116 lung cancer death cases) were traced. The proportion of early-stage lung cancer among smokers was 60.3% (173/287), which was lower than the proportion of 80.3% (476/593) among nonsmokers (P<.001). Among smokers, a higher proportion was found in the screened group (72/106, 67.9%) than the nonscreened group (56/114, 49.1%; P=.005), whereas no significance was found (42/44, 96% vs 10/12, 83%; P=.20) among nonsmokers. Compared with participants who were not screened, LDCT screening in smokers significantly increased lung cancer incidence (hazard ratio [HR] 1.39, 95% CI 1.09-1.76; P=.007) but reduced lung cancer mortality (HR 0.52, 95% CI 0.28-0.96; P=.04) and all-cause mortality (HR 0.47, 95% CI 0.32-0.69; P<.001). Among nonsmokers, no significant results were found for lung cancer incidence (P=.06), all-cause mortality (P=.89), and lung cancer mortality (P=.17). Conclusions: LDCT screening effectively reduces lung cancer and all-cause mortality among high-risk smokers. Further efforts to define high-risk populations and explore adequate lung cancer screening modalities for nonsmokers are needed. %M 36917151 %R 10.2196/43586 %U https://publichealth.jmir.org/2023/1/e43586 %U https://doi.org/10.2196/43586 %U http://www.ncbi.nlm.nih.gov/pubmed/36917151 %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 %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e40185 %T The Prognostic and Predictive Effects of Human Papillomavirus Status in Hypopharyngeal Carcinoma: Population-Based Study %A Yang,Shi-Ping %A Lin,Xiang-Ying %A Hu,Min %A Cai,Cheng-Fu %+ Department of Otorhinolaryngology Head and Neck Surgery, Zhongshan Hospital, School of Medicine, Xiamen University, 201-209, South Hubin Road, Xiamen, 361004, China, 86 5922292201, caichengfuxmu@126.com %K hypopharyngeal carcinoma %K human papillomavirus %K HPV %K chemotherapy %K radiotherapy %K prognosis %K cancer %K carcinoma %D 2022 %7 16.12.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The role of the Human Papillomavirus (HPV) status in patients with hypopharyngeal squamous cell carcinoma (HSCC) remains controversial. Objective: Our aim was to determine the prognostic and predictive effects of HPV status in patients with locally advanced HSCC (stage III-IVB) receiving primary radiotherapy. Methods: Patients diagnosed with stage III-IVB HSCC between 2010 and 2016 were identified. HPV status, demographics, clinicopathological characteristics, treatment, and survival data were captured. Kaplan-Meier analysis, multivariable Cox regression analysis, and propensity score matching analysis were performed. Results: We identified 531 patients in this study and 142 (26.7%) patients with HPV-positive diseases. No significant differences were observed between those with HPV-negative and HPV-positive diseases with regard to demographics, clinicopathological characteristics, and chemotherapy use. HPV-positive HSCC had better head and neck cancer-specific survival (HNCSS; P=.001) and overall survival (OS; P<.001) compared to those with HPV-negative tumors. Similar results were found using the multivariable Cox regression analysis. Sensitivity analyses showed that the receipt of chemotherapy was associated with significantly improving HNCSS (P<.001) and OS (P<.001) compared to not receiving chemotherapy in HPV-negative HSCC, whereas comparable HNCSS (P=.59) and OS (P=.12) were found between both treatment arms in HPV-positive HSCC. Similar results were found after propensity score matching. Conclusions: Approximately one-quarter of HSCC may be HPV-related, and HPV-positive HSCC is associated with improved survival outcomes. Furthermore, additional chemotherapy appears to be not related to a survival benefit in patients with HPV-positive tumors who received primary radiotherapy. %M 36525304 %R 10.2196/40185 %U https://publichealth.jmir.org/2022/12/e40185 %U https://doi.org/10.2196/40185 %U http://www.ncbi.nlm.nih.gov/pubmed/36525304 %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 %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e38628 %T The Risk Factors for Cervical Cytological Abnormalities Among Women Infected With Non-16/18 High-Risk Human Papillomavirus: Cross-sectional Study %A Xiao,Ting %A Ou,Chun-Quan %A Yang,Jun %A Wang,Chunhua %A Yang,Mei %A Yu,Tingyu %A Shen,Liang %A Xu,Xiaohan %A Xing,Hui %+ Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, No 136, Jingzhou Street, Xiangcheng District, Xiangyang, 441021, China, 86 13508668281, huixinghx123@163.com %K non-16/18 high-risk human papillomavirus %K cervical cytological abnormalities %K risk factors %K logistic regression %K cervical cancer %K screening %K rural %K pelvic examination %K education %K gravidity %D 2022 %7 8.12.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: High-risk human papillomavirus (hrHPV) infection is a necessary cause of almost all cervical cancers. Relative to hrHPV 16/18 infection, non-16/18 hrHPV infection is of less concern. However, the increasing prevalence of non-16/18 hrHPV infections has become an important public health issue. The early identification and treatment of cervical cytological abnormalities in women infected with non-16/18 hrHPV reduces the incidence of cervical cancer. To date, no study has examined the risk factors for cytological abnormalities in this high-risk population. Objective: This population-based, cross-sectional study aimed to identify the risk factors for cervical cytological abnormalities in women infected with non-16/18 hrHPV. Methods: A total of 314,587 women from the general population were recruited for cervical cancer screening at 136 primary care hospitals in Xiangyang, China. Of these, 311,604 women underwent HPV genotyping, and 17,523 non-16/18 hrHPV–positive women were referred for cytological screening according to the screening program. A logistic regression model was used to assess the risk factors for cytological abnormalities among these non-16/18 hrHPV–positive women. A separate analysis was performed to determine the factors influencing high-grade cytological abnormalities. Results: The non-16/18 hrHPV infection rate was 5.88% (18,323/311,604), which was 3-fold higher than that of hrHPV 16/18 (6068/311,604, 1.95%). Among the non-16/18 hrHPV–positive women who underwent ThinPrep cytologic test, the overall prevalence rates of cervical cytological abnormalities and high-grade cytological abnormalities were 13.46% (2359/17,523) and 1.18% (206/17,523), respectively. Multivariate logistic regression analysis revealed that women with middle or high school educational attainment were at a higher risk of having cytological abnormalities than those who received primary education (odds ratio [OR] 1.31, 95% CI 1.17-1.45; P<.001, and OR 1.32, 95% CI 1.14-1.53; P<.001, respectively). Living in rural areas (OR 2.58, 95% CI 2.29-2.90; P<.001), gravidity ≥3 (OR 2.77, 95% CI 1.19-6.45; P=.02), cervix abnormalities detected in pelvic examination (OR 1.22, 95% CI 1.11-1.34; P<.001), and having a cervical cancer screening 3 years ago (OR 0.79, 95% CI 0.62-1.00; P=.048) were associated with cytological abnormalities. The risk factors for high-grade cytological abnormalities included middle school education (OR 1.45, 95% CI 1.07-1.98; P=.02), living in rural regions (OR 1.52, 95% CI 1.10-2.10; P=.01), and cervix abnormality (OR 1.72, 95% CI 1.30-2.26; P<.001). Conclusions: The dominant epidemic of non-16/18 hrHPV infection is revealed in Chinese women. Multiple risk factors for cervical cytological abnormalities have been identified in women infected with non-16/18 hrHPV. These findings can provide important information for clinically actionable decisions for the screening, early diagnosis, intervention, and prevention of cervical cancer in non-16/18 hrHPV–positive women. %M 36480259 %R 10.2196/38628 %U https://publichealth.jmir.org/2022/12/e38628 %U https://doi.org/10.2196/38628 %U http://www.ncbi.nlm.nih.gov/pubmed/36480259 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e42343 %T Feasibility of a Reinforcement Learning–Enabled Digital Health Intervention to Promote Mammograms: Retrospective, Single-Arm, Observational Study %A Bucher,Amy %A Blazek,E Susanne %A West,Ashley B %+ Lirio, 320 Corporate Drive, NW, Knoxville, TN, 37923, United States, 1 865 839 6158, abucher@lirio.com %K artificial intelligence %K reinforcement learning %K feasibility studies %K mammograms %K nudging %K behavioral intervention %K digital health %K email %K health equity %K cancer screening %D 2022 %7 28.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Preventive screenings such as mammograms promote health and detect disease. However, mammogram attendance lags clinical guidelines, with roughly one-quarter of women not completing their recommended mammograms. A scalable digital health intervention leveraging behavioral science and reinforcement learning and delivered via email was implemented in a US health system to promote uptake of recommended mammograms among patients who were 1 or more years overdue for the screening (ie, 2 or more years from last mammogram). Objective: The aim of this study was to establish the feasibility of a reinforcement learning–enabled mammography digital health intervention delivered via email. The research aims included understanding the intervention’s reach and ability to elicit behavioral outcomes of scheduling and attending mammograms, as well as understanding reach and behavioral outcomes for women of different ages, races, educational attainment levels, and household incomes. Methods: The digital health intervention was implemented in a large Catholic health system in the Midwestern United States and targeted the system’s existing patients who had not received a recommended mammogram in 2 or more years. From August 2020 to July 2022, 139,164 eligible women received behavioral science–based email messages assembled and delivered by a reinforcement learning model to encourage clinically recommended mammograms. Target outcome behaviors included scheduling and ultimately attending the mammogram appointment. Results: In total, 139,164 women received at least one intervention email during the study period, and 81.52% engaged with at least one email. Deliverability of emails exceeded 98%. Among message recipients, 24.99% scheduled mammograms and 22.02% attended mammograms (88.08% attendance rate among women who scheduled appointments). Results indicate no practical differences in the frequency at which people engage with the intervention or take action following a message based on their age, race, educational attainment, or household income, suggesting the intervention may equitably drive mammography across diverse populations. Conclusions: The reinforcement learning–enabled email intervention is feasible to implement in a health system to engage patients who are overdue for their mammograms to schedule and attend a recommended screening. In this feasibility study, the intervention was associated with scheduling and attending mammograms for patients who were significantly overdue for recommended screening. Moreover, the intervention showed proportionate reach across demographic subpopulations. This suggests that the intervention may be effective at engaging patients of many different backgrounds who are overdue for screening. Future research will establish the effectiveness of this type of intervention compared to typical health system outreach to patients who have not had recommended screenings as well as identify ways to enhance its reach and impact. %M 36441579 %R 10.2196/42343 %U https://formative.jmir.org/2022/11/e42343 %U https://doi.org/10.2196/42343 %U http://www.ncbi.nlm.nih.gov/pubmed/36441579 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 4 %P e40600 %T Esophagogastroduodenoscopy Screening Intentions During the COVID-19 Pandemic in Japan: Web-Based Survey %A Akahane,Takemi %A Nakanishi,Yasuhiro %A Yoshiji,Hitoshi %A Akahane,Manabu %+ Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan, 81 744223051, stakemi@naramed-u.ac.jp %K COVID-19 %K cancer screening %K esophagogastroduodenoscopy %K EGD %K intention %K survey %K cancer %K Japan %K screening %K men %K women %K anxiety %K information %K infection %D 2022 %7 11.11.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: The number of people undergoing cancer screening decreased during the COVID-19 pandemic. The pandemic may have affected the willingness and motivation of undergoing cancer screening by those eligible for it. Objective: This study aims to clarify the effect of the COVID-19 pandemic on the intention to undergo cancer and esophagogastroduodenoscopy (EGD) screening. Methods: We performed a web-based survey on the intention to undergo screening among 1236 men and women aged 20-79 years. The numbers of participants by sex and 10-year age groups were equal. The survey was conducted in January 2021, during which the government declared a state of emergency because of the third wave of the COVID-19 pandemic in Japan. Emergency declarations were issued in 11 prefectures among all the 47 prefectures in Japan. Results: In total, 66.1% (817/1236) of the participants felt anxious about undergoing screening due to COVID-19. More women than men were anxious about undergoing screening. By modality, EGD had the highest percentage of participants with anxiety due to COVID-19. Regarding the intention to change the participants’ appointment for screening, the most common strategies were to book an appointment for a time during nonpeak hours, postpone the appointment to a later date, and change the mode of transportation. In addition, 35.8% (442/1236) of the participants were willing to cancel this year’s screening appointment. Among the 1236 participants, 757 (61.2%) were scheduled for screening in 2020. Of the 757 participants in this subgroup, 68% (n=515) did not change the schedule, 6.1% (n=46) cancelled, and 26% (n=197) made some changes, including changing the appointment date, hospital, or mode of transportation. Among the 296 participants scheduled for EGD screening, 18.9% (n=56) made some changes, 5.7% (n=17) cancelled on their own, and 2.7% (n=8) cancelled on the hospital’s order. Based on the previous screening results, the percentage of participants who felt anxious about EGD due to the COVID-19 pandemic was higher in the order of those who had not undergone screening and those who were judged to be in need of further examination in screening but did not visit a hospital for it. In the logistic regression analysis, the factors associated with anxiety about EGD screening due to the COVID-19 pandemic were “viral infection prevention measures,” “waiting time,” “fees (medical expenses),” “mode of transportation,” “worry about my social position if I contracted COVID-19,” and “perceived the risk of gastric cancer.” However, “residence in declared emergency area” was not associated with EGD anxiety due to COVID-19. Conclusions: Excessive anxiety about COVID-19 may lead to serious outcomes, such as a “decreasing intention to undergo EGD screening,” and it is necessary to thoroughly implement infection prevention measures and provide correct information to examinees. %M 36343187 %R 10.2196/40600 %U https://cancer.jmir.org/2022/4/e40600 %U https://doi.org/10.2196/40600 %U http://www.ncbi.nlm.nih.gov/pubmed/36343187 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e35962 %T Evaluation of a Web-Based Culturally Sensitive Educational Video to Facilitate Informed Cervical Cancer Screening Decisions Among Turkish- and Moroccan-Dutch Women Aged 30 to 60 Years: Randomized Intervention Study %A Hamdiui,Nora %A Stein,Mart L %A van Steenbergen,Jim %A Crutzen,Rik %A Bouman,Martine %A Khan,Abresham %A Çetin,Miyase N %A Timen,Aura %A van den Muijsenbergh,Maria %+ National Coordination Centre for Communicable Disease Control, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Postbus 1, Bilthoven, 3720 BA, Netherlands, 31 088 689 7000, nora.hamdiui@rivm.nl %K cervical cancer %K screening %K informed decision-making %K web-based intervention %K culturally sensitive educational video %K Turkish %K Moroccan %K The Netherlands %D 2022 %7 26.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: In the Netherlands, since 1996, a national cervical cancer (CC) screening program has been implemented for women aged 30 to 60 years. Regional screening organizations send an invitation letter and information brochure in Dutch to the home addresses of targeted women every 5 years. Although this screening is free of charge, Turkish- and Moroccan-Dutch women, especially, show low screening participation and limited informed decision-making (IDM). As Turkish- and Moroccan-Dutch women indicated their need for information on the practical, emotional, cultural, and religious aspects of CC screening, we developed a culturally sensitive educational video (CSEV) as an addition to the current information brochure. Objective: In this study, we aimed to evaluate the added effect of the CSEV on IDM regarding CC screening participation among Turkish and Moroccan women aged 30 to 60 years in the Netherlands through a randomized intervention study. Methods: Initial respondents were recruited via several social media platforms and invited to complete a web-based questionnaire. Following respondent-driven sampling, respondents were asked to recruit a number of peers from their social networks to complete the same questionnaire. Respondents were randomly assigned to the control (current information brochure) or intervention condition (brochure and CSEV). We measured respondents’ knowledge and attitude regarding CC screening and their intention to participate in the next CC screening round before and after the control or intervention condition. We evaluated the added effect of the CSEV (above the brochure) on their knowledge, attitude, intention, and IDM using intention-to-treat analyses. Results: The final sample (n=1564) included 686 (43.86%) Turkish and 878 (56.14%) Moroccan-Dutch women. Of this sample, 50.7% (793/1564) were randomized to the control group (350/793, 44.1% Turkish and 443/793, 55.9% Moroccan) and 49.3% (771/1564) to the intervention group (336/771, 43.6% Turkish and 435/771, 56.4% Moroccan). Among the Turkish-Dutch women, 33.1% (116/350) of the control respondents and 40.5% (136/336) of the intervention respondents consulted the brochure (not statistically significant). Among Moroccan-Dutch women, these percentages were 28.2% (125/443) and 37.9% (165/435), respectively (P=.003). Of all intervention respondents, 96.1% (323/336; Turkish) and 84.4% (367/435; Moroccan) consulted the CSEV. The CSEV resulted in more positive screening attitudes among Moroccan-Dutch women than the brochure (323/435, 74.3% vs 303/443, 68.4%; P=.07). Women, who had never participated in CC screening before, showed significantly more often a positive attitude toward CC screening compared with the control group (P=.01). Conclusions: Our short and easily implementable CSEV resulted in more positive screening attitudes, especially in Moroccan-Dutch women. As the CSEV was also watched far more often than the current brochure was read, this intervention can contribute to better reach and more informed CC screening decisions among Turkish- and Moroccan-Dutch women. Trial Registration: International Clinical Trial Registry Platform NL8453; https://tinyurl.com/2dvbjxvc %M 36287585 %R 10.2196/35962 %U https://www.jmir.org/2022/10/e35962 %U https://doi.org/10.2196/35962 %U http://www.ncbi.nlm.nih.gov/pubmed/36287585 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e34055 %T An Accessible Communication System for Population-Based Genetic Testing: Development and Usability Study %A Coffin,Tara %A Bowen,Deborah %A Swisher,Elizabeth %A Lu,Karen %A Rayes,Nadine %A Norquist,Barbara %A Blank,Stephanie %A Levine,Douglas %A Bakkum-Gamez,Jamie %A Fleming,Gini %A Olopade,Olufunmilayo %A D’Andrea,Alan %A Nebgen,Denise %A Peterson,Christine %A Munsell,Mark %A Gavin,Kathleen %A Lechner,Rebecca %A Crase,Jamie %A Polinsky,Deborah %A Romero,Iris %+ University of Washington, 1400 NE Campus Parkway, Seattle, WA, 98195-4550, United States, 1 206 543 2100, tbcoffin@uw.edu %K genetic testing %K internet %K social media %K accessibility %D 2022 %7 17.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Genetic testing uptake is low, despite the well-established connection between pathogenic variants in certain cancer-linked susceptibility genes and ovarian cancer risk. Given that most major insurers cover genetic testing for those with a family history suggestive of hereditary cancer, the issue may lie in access to genetic testing. Remotely accessible web-based communication systems may improve awareness, and uptake, of genetic testing services. Objective: This study aims to present the development and formative evaluation of the multistep web-based communication system required to support the implementation of, and access to, genetic testing. Methods: While designing the multistep web-based communication system, we considered various barriers and facilitators to genetic testing, guided by dimensions of accessibility. In addition to conducting usability testing, we performed ongoing assessments focusing on the function of the web-based system and participant response rates, with the goal of continuing to make modifications to the web-based communication system as it is in use. Results: The combined approach of usability testing and expert user experience consultation resulted in several modifications to the multistep web-based communication system, including changes that related to imagery and content, web accessibility, and general organization of the web-based system. All recommendations were made with the goal of improving the overall accessibility of the web-based communication system. Conclusions: A multistep web-based communication system appears to be an effective way to address many potential barriers to access, which may otherwise make genetic testing difficult for at-risk individuals to participate in. Importantly, some dimensions of access were easy to assess before study recruitment, but other aspects of the communication system required ongoing assessment during the implementation process of the Making Genetic Testing Accessible study. %M 36251350 %R 10.2196/34055 %U https://formative.jmir.org/2022/10/e34055 %U https://doi.org/10.2196/34055 %U http://www.ncbi.nlm.nih.gov/pubmed/36251350 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 3 %P e34264 %T Assessing Information Available for Health Professionals and Potential Participants on Lung Cancer Screening Program Websites: Cross-sectional Study %A Dodd,Rachael H %A Zhang,Chenyue %A Sharman,Ashleigh R %A Carlton,Julie %A Tang,Ruijin %A Rankin,Nicole M %+ School of Public Health, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building, Room 127A, Sydney, 2006, Australia, 61 2 9351 5102, rachael.dodd@sydney.edu.au %K lung cancer screening %K communication %K recommendation %K lung cancer %K cancer %K cross-sectional study %K cancer screening %K screening program %K screening %D 2022 %7 30.8.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Lung cancer is the leading cause of cancer death worldwide. The US Preventive Services Task Force (USPSTF) updated recommendations for lung cancer screening in 2021, adjusting the age of screening to 50 years (from 55 years) and reducing the number of pack-years used to estimate total firsthand cigarette smoke exposure to 20 (from 30). With many individuals using the internet to find health care information, it is important to understand what information is available for individuals contemplating lung cancer screening. Objective: This study aimed to assess the eligibility criteria and information available on lung cancer screening program websites for both health professionals and potential screening participants. Methods: A descriptive cross-sectional analysis of 151 lung cancer screening program websites of academic (n=76) and community medical centers (n=75) in the United States with information for health professionals and potential screening participants was conducted in March 2021. Presentation of eligibility criteria for potential screening participants and presence of information available specific to health professionals about lung cancer screening were the primary outcomes. Secondary outcomes included presentation of information about cost and smoking cessation, inclusion of an online risk assessment tool, mention of any clinical guidelines, and use of multimedia to present information. Results: Eligibility criteria for lung cancer screening was included in nearly all 151 websites (n=142, 94%), as well as age range (n=139, 92.1%) and smoking history (n=141, 93.4%). Age was only consistent with the latest recommendations in 14.5% (n=22) of websites, and no websites had updated smoking history. Half the websites (n=76, 50.3%) mentioned screening costs as related to the type of insurance held. A total of 23 (15.2%) websites featured an online assessment tool to determine eligibility. The same proportion (n=23, 15.2%) hosted information specifically for health professionals. In total, 44 (29.1%) websites referred to smoking cessation, and 46 (30.5%) websites used multimedia to present information, such as short videos or podcasts. Conclusions: Most websites of US lung cancer screening programs provide information about eligibility criteria, but this is not consistent and has not been updated across all websites following the latest USPSTF recommendations. Online resources require updating to present standardized information that is accessible for all. %M 36040773 %R 10.2196/34264 %U https://cancer.jmir.org/2022/3/e34264 %U https://doi.org/10.2196/34264 %U http://www.ncbi.nlm.nih.gov/pubmed/36040773 %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 %@ 2369-1999 %I JMIR Publications %V 8 %N 3 %P e32370 %T Public Policies and Programs for the Prevention and Control of Breast Cancer in Latin American Women: Scoping Review %A Ramos Herrera,Igor Martín %A Lemus Flores,María Guadalupe %A Reyna Sevilla,Antonio %A González Castañeda,Miguel Ernesto %A Torres Gutiérrez,Fernando Adolfo %A Crocker Sagastume,René Cristóbal %A Robles Pastrana,Juan De Dios %A Vázquez Castellanos,José Luis %+ Department of Public Health, University of Guadalajara, Sierra Mojada 950, Guadalajara, 44290, Mexico, 52 3336262462, gs.antonioreyna@gmail.com %K breast cancer %K scoping review %K public policy %K prevention programs %K systematic review %D 2022 %7 6.7.2022 %9 Review %J JMIR Cancer %G English %X Background: Breast cancer has positioned itself worldwide as one of the main public health problems, especially in Latin America. In some countries, several programs for the prevention and control of breast cancer in women have been developed and implemented on a permanent basis, but there are no public reports on the policies that originated such programs. Objective: A scoping review of scientific publications that identify the type, extent, and scope of policies and programs for the prevention and control of breast cancer in Latin American women was performed, and the main results were presented in this paper. Methods: This scoping review was carried out according to the method by Arksey and O’Malley based on 3 fundamental questions about breast cancer prevention and control policies in Latin America: their type, extent and scope, and reference framework. The search period was from 2000 to 2019, and the search was carried out in the following databases: MEDLINE (PubMed), MEDLINE (EbscoHost), CINAHL (EbscoHost), Academic Search Complete (EbscoHost), ISI Web of Science (Science Citation Index), and Scopus in English, Spanish, and Portuguese, and Scielo, Cochrane, and MEDES-MEDicina in Spanish and Portuguese. Of the 743 studies found, 20 (2.7%) were selected, which were analyzed using descriptive statistics and qualitative content analysis. Results: The selected studies identified several Latin American countries that have generated policies and programs to prevent and control breast cancer in women, focusing mainly on risk communication, prevention and timely detection, effective access to health services, improvement of the screening process, and evaluation of screening programs. Evaluation criteria and greater participation of civil society in policy design and program execution are still lacking. This could undoubtedly help eliminate existing barriers to effective action. Conclusions: Although several Latin American countries have generated public policies and action programs for the prevention and control of breast cancer, a pending issue is the evaluation of the results to analyze the effectiveness and impact of their implementation given the magnitude of the public health problem it represents and because women and civil society play an important role in its prevention and control. International Registered Report Identifier (IRRID): RR2-10.2196/12624 %M 35793130 %R 10.2196/32370 %U https://cancer.jmir.org/2022/3/e32370 %U https://doi.org/10.2196/32370 %U http://www.ncbi.nlm.nih.gov/pubmed/35793130 %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 %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e34715 %T The Effect of a Web-Based Cervical Cancer Survivor’s Story on Parents' Behavior and Willingness to Consider Human Papillomavirus Vaccination for Daughters: Randomized Controlled Trial %A Suzuki,Yukio %A Sukegawa,Akiko %A Ueda,Yutaka %A Sekine,Masayuki %A Enomoto,Takayuki %A Melamed,Alexander %A Wright,Jason D %A Miyagi,Etsuko %+ Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan, 81 45 787 2800, yetii@yokohama-cu.ac.jp %K human papilloma virus vaccination %K vaccination %K vaccine %K vaccine hesitancy %K cancer survivor %K narrative story %K web based %K randomized controlled trial %K RCT %K HPV %K human papilloma virus %K virus %K hesitancy %K cancer %K willingness %K behavior %K parent %D 2022 %7 25.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Providing adequate information to parents who have children eligible for human papillomavirus (HPV) vaccination is essential to overcoming vaccine hesitancy in Japan, where the government recommendation has been suspended. However, prior trials assessing the effect of brief educational tools have shown only limited effects on increasing the willingness of parents to vaccinate their daughters. Objective: The aim of this trial is to assess the effect of a cervical cancer survivor’s story on the willingness of parents to get HPV vaccination for their daughters. Methods: In this double-blinded, randomized controlled trial (RCT) implemented online, we enrolled 2175 participants aged 30-59 years in March 2020 via a webpage and provided them with a questionnaire related to the following aspects: awareness regarding HPV infection and HPV vaccination, and willingness for HPV vaccination. Participants were randomly assigned (1:1) to see a short film on a cervical cancer survivor or nothing, stratified by sex (male vs female) and willingness for HPV vaccination prior to randomization (yes vs no). The primary endpoint was the rate of parents who agreed for HPV vaccination for their daughters. The secondary endpoint was the rate of parents who agreed for HPV vaccination for their daughters and the HPV vaccination rate at 3 months. The risk ratio (RR) was used to assess the interventional effect. Results: Of 2175 participants, 1266 (58.2%) were men and 909 (41.8%) were women. A total of 191 (8.8%) participants were willing to consider HPV vaccination prior to randomization. Only 339 (15.6%) participants were aware of the benefits of HPV vaccination. In contrast, 562 (25.8%) participants were aware of the adverse events of HPV vaccination. Although only 476 (21.9%) of the respondents displayed a willingness to vaccinate their daughters for HPV, there were 7.5% more respondents in the intervention group with this willingness immediately after watching the short film (RR 1.41, 95% CI 1.20-1.66). In a subanalysis, the willingness in males to vaccinate daughters was significantly higher in the intervention group (RR 1.50, 95% CI 1.25-1.81); however, such a difference was not observed among females (RR 1.21, 95% CI 0.88-1.66). In the follow-up survey at 3 months, 1807 (83.1%) participants responded. Of these, 149 (8.2%) responded that they had had their daughters receive vaccination during the 3 months, even though we could not see the effect of the intervention: 77 (7.9%) in the intervention group and 72 (8.7%) in the control group. Conclusions: A cervical cancer survivor’s story increases immediate willingness to consider HPV vaccination, but the effect does not last for 3 months. Furthermore, this narrative approach to parents does not increase vaccination rates in children eligible for HPV vaccination. Trial Registration: UMIN Clinical Trials Registry UMIN000039273; https://tinyurl.com/bdzjp4yf %M 35421848 %R 10.2196/34715 %U https://publichealth.jmir.org/2022/5/e34715 %U https://doi.org/10.2196/34715 %U http://www.ncbi.nlm.nih.gov/pubmed/35421848 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e29039 %T A Veteran-Centric Web-Based Decision Aid for Lung Cancer Screening: Usability Analysis %A Schapira,Marilyn M %A Chhatre,Sumedha %A Prigge,Jason M %A Meline,Jessica %A Kaminstein,Dana %A Rodriguez,Keri L %A Fraenkel,Liana %A Kravetz,Jeffrey D %A Whittle,Jeff %A Bastian,Lori A %A Vachani,Anil %A Akers,Scott %A Schrand,Susan %A Ibarra,Jennifer V %A Asan,Onur %+ Center for Health Equity Research and Promotion, Michael J Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA, 19104, United States, 1 2158982022, mschap@pennmedicine.upenn.edu %K lung cancer screening %K decision aid %K usability %K implementation %K cancer screening %K shared decision-making %K veterans %K patient engagement %K mobile phone %D 2022 %7 8.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based tools developed to facilitate a shared decision-making (SDM) process may facilitate the implementation of lung cancer screening (LCS), an evidence-based intervention to improve cancer outcomes. Veterans have specific risk factors and shared experiences that affect the benefits and potential harms of LCS and thus may value a veteran-centric LCS decision tool (LCSDecTool). Objective: This study aims to conduct usability testing of an LCSDecTool designed for veterans receiving care at a Veteran Affairs medical center. Methods: Usability testing of the LCSDecTool was conducted in a prototype version (phase 1) and a high-fidelity version (phase 2). A total of 18 veterans and 8 clinicians participated in phase 1, and 43 veterans participated in phase 2. Quantitative outcomes from the users included the System Usability Scale (SUS) and the End User Computing Satisfaction (EUCS) in phase 1 and the SUS, EUCS, and Patient Engagement scale in phase 2. Qualitative data were obtained from observations of user sessions and brief interviews. The results of phase 1 informed the modifications of the prototype for the high-fidelity version. Phase 2 usability testing took place in the context of a pilot hybrid type 1 effectiveness-implementation trial. Results: In the phase 1 prototype usability testing, the mean SUS score (potential range: 0-100) was 81.90 (SD 9.80), corresponding to an excellent level of usability. The mean EUCS score (potential range: 1-5) was 4.30 (SD 0.71). In the phase 2 high-fidelity usability testing, the mean SUS score was 65.76 (SD 15.23), corresponding to a good level of usability. The mean EUCS score was 3.91 (SD 0.95); and the mean Patient Engagement scale score (potential range 1 [low] to 5 [high]) was 4.62 (SD 0.67). The median time to completion in minutes was 13 (IQR 10-16). A thematic analysis of user statements documented during phase 2 high-fidelity usability testing identified the following themes: a low baseline level of awareness and knowledge about LCS increased after use of the LCSDecTool; users sought more detailed descriptions about the LCS process; the LCSDecTool was generally easy to use, but specific navigation challenges remained; some users noted difficulty understanding medical terms used in the LCSDecTool; and use of the tool evoked veterans’ struggles with prior attempts at smoking cessation. Conclusions: Our findings support the development and use of this eHealth technology in the primary care clinical setting as a way to engage veterans, inform them about a new cancer control screening test, and prepare them to participate in an SDM discussion with their provider. %M 35394433 %R 10.2196/29039 %U https://formative.jmir.org/2022/4/e29039 %U https://doi.org/10.2196/29039 %U http://www.ncbi.nlm.nih.gov/pubmed/35394433 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e32399 %T Implementation of a Web-Based Tool for Shared Decision-making in Lung Cancer Screening: Mixed Methods Quality Improvement Evaluation %A Lowery,Julie %A Fagerlin,Angela %A Larkin,Angela R %A Wiener,Renda S %A Skurla,Sarah E %A Caverly,Tanner J %+ Center for Clinical Management Research, Ann Arbor VA Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, United States, 1 303 587 1038, tcaverly@med.umich.edu %K shared decision-making %K lung cancer %K screening %K clinical decision support %K academic detailing %K quality improvement %K implementation %D 2022 %7 1.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Lung cancer risk and life expectancy vary substantially across patients eligible for low-dose computed tomography lung cancer screening (LCS), which has important consequences for optimizing LCS decisions for different patients. To account for this heterogeneity during decision-making, web-based decision support tools are needed to enable quick calculations and streamline the process of obtaining individualized information that more accurately informs patient-clinician LCS discussions. We created DecisionPrecision, a clinician-facing web-based decision support tool, to help tailor the LCS discussion to a patient’s individualized lung cancer risk and estimated net benefit. Objective: The objective of our study is to test two strategies for implementing DecisionPrecision in primary care at eight Veterans Affairs medical centers: a quality improvement (QI) training approach and academic detailing (AD). Methods: Phase 1 comprised a multisite, cluster randomized trial comparing the effectiveness of standard implementation (adding a link to DecisionPrecision in the electronic health record vs standard implementation plus the Learn, Engage, Act, and Process [LEAP] QI training program). The primary outcome measure was the use of DecisionPrecision at each site before versus after LEAP QI training. The second phase of the study examined the potential effectiveness of AD as an implementation strategy for DecisionPrecision at all 8 medical centers. Outcomes were assessed by comparing absolute tool use before and after AD visits and conducting semistructured interviews with a subset of primary care physicians (PCPs) following the AD visits. Results: Phase 1 findings showed that sites that participated in the LEAP QI training program used DecisionPrecision significantly more often than the standard implementation sites (tool used 190.3, SD 174.8 times on average over 6 months at LEAP sites vs 3.5 SD 3.7 at standard sites; P<.001). However, this finding was confounded by the lack of screening coordinators at standard implementation sites. In phase 2, there was no difference in the 6-month tool use between before and after AD (95% CI −5.06 to 6.40; P=.82). Follow-up interviews with PCPs indicated that the AD strategy increased provider awareness and appreciation for the benefits of the tool. However, other priorities and limited time prevented PCPs from using them during routine clinical visits. Conclusions: The phase 1 findings did not provide conclusive evidence of the benefit of a QI training approach for implementing a decision support tool for LCS among PCPs. In addition, phase 2 findings showed that our light-touch, single-visit AD strategy did not increase tool use. To enable tool use by PCPs, prediction-based tools must be fully automated and integrated into electronic health records, thereby helping providers personalize LCS discussions among their many competing demands. PCPs also need more time to engage in shared decision-making discussions with their patients. Trial Registration: ClinicalTrials.gov NCT02765412; https://clinicaltrials.gov/ct2/show/NCT02765412 %M 35363144 %R 10.2196/32399 %U https://humanfactors.jmir.org/2022/2/e32399 %U https://doi.org/10.2196/32399 %U http://www.ncbi.nlm.nih.gov/pubmed/35363144 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 3 %P e33006 %T Web-Based Skin Cancer Assessment and Classification Using Machine Learning and Mobile Computerized Adaptive Testing in a Rasch Model: Development Study %A Yang,Ting-Ya %A Chien,Tsair-Wei %A Lai,Feng-Jie %+ Department of Dermatology, Chi-Mei Medical Center, 901, Zhonghua Rd, Yongkang District, Tainan, 710, Taiwan, 886 6 2812811 ext 57109, lai.fengjie@gmail.com %K skin cancer assessment %K computerized adaptive testing %K naïve Bayes %K k-nearest neighbors %K logistic regression %K Rasch partial credit model %K receiver operating characteristic curve %K mobile phone %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Web-based computerized adaptive testing (CAT) implementation of the skin cancer (SC) risk scale could substantially reduce participant burden without compromising measurement precision. However, the CAT of SC classification has not been reported in academics thus far. Objective: We aim to build a CAT-based model using machine learning to develop an app for automatic classification of SC to help patients assess the risk at an early stage. Methods: We extracted data from a population-based Australian cohort study of SC risk (N=43,794) using the Rasch simulation scheme. All 30 feature items were calibrated using the Rasch partial credit model. A total of 1000 cases following a normal distribution (mean 0, SD 1) based on the item and threshold difficulties were simulated using three techniques of machine learning—naïve Bayes, k-nearest neighbors, and logistic regression—to compare the model accuracy in training and testing data sets with a proportion of 70:30, where the former was used to predict the latter. We calculated the sensitivity, specificity, receiver operating characteristic curve (area under the curve [AUC]), and CIs along with the accuracy and precision across the proposed models for comparison. An app that classifies the SC risk of the respondent was developed. Results: We observed that the 30-item k-nearest neighbors model yielded higher AUC values of 99% and 91% for the 700 training and 300 testing cases, respectively, than its 2 counterparts using the hold-out validation but had lower AUC values of 85% (95% CI 83%-87%) in the k-fold cross-validation and that an app that predicts SC classification for patients was successfully developed and demonstrated in this study. Conclusions: The 30-item SC prediction model, combined with the Rasch web-based CAT, is recommended for classifying SC in patients. An app we developed to help patients self-assess SC risk at an early stage is required for application in the future. %M 35262505 %R 10.2196/33006 %U https://medinform.jmir.org/2022/3/e33006 %U https://doi.org/10.2196/33006 %U http://www.ncbi.nlm.nih.gov/pubmed/35262505 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e29124 %T Novel Interactive Tool for Breast and Ovarian Cancer Risk Assessment (Bright Pink Assess Your Risk): Development and Usability Study %A Hibler,Elizabeth A %A Fought,Angela J %A Kershaw,Kiarri N %A Molsberry,Rebecca %A Nowakowski,Virginia %A Lindner,Deborah %+ Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, United States, 1 3125031178, elizabeth.hibler@northwestern.edu %K breast cancer %K ovarian cancer %K risk assessment %K genetic testing %D 2022 %7 24.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The lifetime risk of breast and ovarian cancer is significantly higher among women with genetic susceptibility or a strong family history. However, current risk assessment tools and clinical practices may identify only 10% of asymptomatic carriers of susceptibility genes. Bright Pink developed the Assess Your Risk (AYR) tool to estimate breast and ovarian cancer risk through a user-friendly, informative web-based quiz for risk assessment at the population level. Objective: This study aims to present the AYR tool, describe AYR users, and present evidence that AYR works as expected by comparing classification using the AYR tool with gold standard genetic testing guidelines. Methods: The AYR is a recently developed population-level risk assessment tool that includes 26 questions based on the National Comprehensive Cancer Network (NCCN) guidelines and factors from other commonly used risk assessment tools. We included all women who completed the AYR between November 2018 and January 2019, with the exception of self-reported cancer or no knowledge of family history. We compared AYR classifications with those that were independently created using NCCN criteria using measures of validity and the McNemar test. Results: There were 143,657 AYR completions, and most participants were either at increased or average risk for breast cancer or ovarian cancer (137,315/143,657, 95.59%). Using our estimates of increased and average risk as the gold standard, based on the NCCN guidelines, we estimated the sensitivity and specificity for the AYR algorithm–generated risk categories as 100% and 89.9%, respectively (P<.001). The specificity improved when we considered the additional questions asked by the AYR to define increased risk, which were not examined by the NCCN criteria. By race, ethnicity, and age group; we found that the lowest observed specificity was for the Asian race (85.9%) and the 30 to 39 years age group (87.6%) for the AYR-generated categories compared with the NCCN criteria. Conclusions: These results demonstrate that Bright Pink’s AYR is an accurate tool for use by the general population to identify women at increased risk of breast and ovarian cancer. We plan to validate the tool longitudinally in future studies, including the impact of race, ethnicity, and age on breast and ovarian cancer risk assessment. %M 35200148 %R 10.2196/29124 %U https://www.jmir.org/2022/2/e29124 %U https://doi.org/10.2196/29124 %U http://www.ncbi.nlm.nih.gov/pubmed/35200148 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e34392 %T Cancer Screening Recommendations During the COVID-19 Pandemic: Scoping Review %A Shah,Sumit K %A McElfish,Pearl A %+ College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Avenue, Fayetteville, AR, 72703, United States, 1 (479) 713 8680, pamcelfish@uams.edu %K COVID-19 %K cancer prevention and early detection %K cancer screenings %K breast cancer screening %K cervical cancer screening %K colorectal cancer screening %D 2022 %7 24.2.2022 %9 Review %J JMIR Cancer %G English %X Background: Cancer screening tests are recommended to prevent cancer-associated mortality by detecting precancerous and cancerous lesions in early stages. The COVID-19 pandemic disrupted the use of preventive health care services. Although there was an increase in the number of cancer screening tests beginning in late 2020, screenings remained 29% to 36% lower than in the prepandemic era. Objective: The aim of this review is to assist health care providers in identifying approaches for prioritizing patients and increasing breast, cervical, and colorectal cancer screening during the uncertainty of the COVID-19 pandemic. Methods: We used the scoping review framework to identify articles on PubMed and EBSCO databases. A total of 403 articles were identified, and 23 articles were selected for this review. The literature review ranged from January 1, 2020, to September 30, 2021. Results: The articles included two primary categories of recommendations: (1) risk stratification and triage to prioritize screenings and (2) alternative methods to conduct cancer screenings. Risk stratification and triage recommendations focused on prioritizing high-risk patients with an abnormal or suspicious result on the previous screening test, patients in certain age groups and sex, patients with a personal medical or family cancer history, patients that are currently symptomatic, and patients that are predisposed to hereditary cancers and cancer-causing mutations. Other recommended strategies included identifying areas facing the most disparities, creating algorithms and using artificial intelligence to create cancer risk scores, leveraging in-person visits to assess cancer risk, and providing the option of open access screenings where patients can schedule screenings and can be assigned a priority category by health care staff. Some recommended using telemedicine to categorize patients and determine screening eligibility for patients with new complaints. Several articles noted the importance of implementing preventive measures such as COVID-19 screening prior to the procedures, maintaining hygiene measures, and social distancing in waiting rooms. Alternative screening methods that do not require an in-person clinic visit and can effectively screen patients for cancers included mailing self-collection sampling kits for cervical and colorectal cancers, and implementing or expanding mobile screening units. Conclusions: Although the COVID-19 pandemic had devastating effects on population health globally, it could be an opportunity to adapt and evolve cancer screening methods. Disruption often creates innovation, and focus on alternative methods for cancer screenings may help reach rural and underresourced areas after the pandemic has ended. %M 35142621 %R 10.2196/34392 %U https://cancer.jmir.org/2022/1/e34392 %U https://doi.org/10.2196/34392 %U http://www.ncbi.nlm.nih.gov/pubmed/35142621 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 2 %P e19877 %T Use of a Smartphone Self-assessment App for a Tobacco-Induced Disease (COPD, Cardiovascular Diseases, Cancer) Screening Strategy and to Encourage Smoking Cessation: Observational Study %A Stavaux,Edouard %A Goupil,François %A Barreau,Guillaume %A Septans,Anne Lise %A Dautzenberg,Bertrand %A Foulet-Rogé,Armelle %A Padilla,Norbert %A Urban,Thierry %A Denis,Fabrice %+ Institut Inter-Regional de Cancérologie Jean Bernard, 9 rue Beauverger, Le Mans, 72000, France, 33 684190480, f.denis@ilcgroupe.fr %K smoking cessation %K mobile health %K self-assessment, lung cancer %K early detection %K tobacco-induced pathologies %D 2022 %7 23.2.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Patient self-assessment via a mobile app detects actionable symptoms and has been shown to detect lung cancer relapses early, thereby lengthening survival. Objective: The purpose of this study was to assess the incidence of chief symptoms associated with the main tobacco-induced pathologies in both current and ex-smokers through a self-assessment smartphone app and to evaluate the app’s capacity to encourage users to quit smoking or reduce consumption, as well as its impact on early lung cancer stages at the time of diagnosis. Methods: Current and ex-smokers were recruited through an advertising campaign in Sarthe county (France) proposing the free download of a smartphone app. App users were asked to answer 13 questions related to symptoms associated with tobacco-induced diseases (chronic obstructive pulmonary disease [COPD], cardiovascular diseases, cancer). In the event of any positive answer, a message was displayed recommending the user to consult a physician. In addition, they were asked about smoking cessation intention before and after answering these 13 questions. Finally, incidence of stage 1 or 2 lung cancers diagnosed during the launch period of our application was evaluated by comparing data from various sources to those from the same period during the previous year. Results: Of the 5671 users who were eligible for evaluation, an alert was sent to the majority (4118/5671, 72.6%), with a higher incidence for current smokers (2833/3679, 77.0% vs 1298/1992, 65.2%; P<.001). The most frequent symptoms triggering the notifications were fatigue (2023/5671, 35.7%), cough (1658/5671, 29.2%), dyspnea (1502/5671, 26.5%), and persistent chest pain (1286/5671, 22.7%). Of the current smokers, 14.0% (515/3679) showed symptoms suggesting COPD, 15.5% (571/3679) showed symptoms suggesting stable angina, 12.4% (455/3679) probably had lower extremity artery disease, and 6.8% (249/3679) had possible cancer. Of the users, 36.5% (1343/3679) claimed that they thought about quitting smoking, and 48.7% (1795/3679) had thought about reducing their consumption. Surgery-eligible stage 1 and 2 lung cancer incidence was 24% (14/58) during the study period versus 9% (5/54) during the previous year in Sarthe county (P=.04), whereas it remained unchanged in the neighboring county of Maine-et-Loire. Conclusions: A majority of current and ex-smokers showed worrying symptoms, and the use of a self-assessment smartphone app may drive a majority of smokers toward the intention of smoking cessation or decreasing consumption. A randomized study should be performed to confirm this intention and to support the potential increase of symptomatic lung cancer detection at early, surgery-accessible stages. Trial Registration: ClinicalTrials.gov NCT04048954; https://www.clinicaltrials.gov/ct2/show/NCT04048954 %M 35195530 %R 10.2196/19877 %U https://publichealth.jmir.org/2022/2/e19877 %U https://doi.org/10.2196/19877 %U http://www.ncbi.nlm.nih.gov/pubmed/35195530 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e30340 %T Parents’ Experience With a Mobile Health Intervention to Influence Human Papillomavirus Vaccination Decision Making: Mixed Methods Study %A Becker,Elisabeth RB %A Shegog,Ross %A Savas,Lara S %A Frost,Erica L %A Coan,Sharon P %A Healy,C Mary %A Spinner,Stanley W %A Vernon,Sally W %+ University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX, 77030, United States, 1 (713) 500 9677, elisabethrbecker@gmail.com %K human papillomavirus %K vaccination %K user experience %K parent %K mHealth %K HPV %K vaccine %K HPV vaccine %K parenting %K pediatrics %K sexual health %K cervical cancer %K adolescents %K mHealth %K app %K application %D 2022 %7 21.2.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Human papillomavirus (HPV)-attributed cancers are preventable, yet HPV vaccination rates severely lag behind other adolescent vaccinations. HPVcancerFree (HPVCF) is a mobile health (mHealth) intervention developed to influence parental HPV vaccination decision making by raising awareness of HPV, reducing HPV vaccination barriers, and enabling HPV vaccination scheduling and reminders through a smartphone app. Evaluating the user experience of mHealth interventions is a vital component in assessing their quality and success but tends to be underreported in mHealth intervention evaluation. Objective: We aimed to evaluate the user experience of HPVCF, an HPV cancer prevention app designed for a pediatric clinic network, using mixed methods data collected from log files, survey measures, and qualitative feedback. Methods: Study data were evaluated from parents in a large US pediatric clinic network using HPVCF in the treatment study condition of a group randomized controlled trial. Log data captured HPVCF retention and use. Postintervention rating scales and items assessed HPVCF utility, usefulness, understandability, appeal, credibility, and perceived impact. Overall quality was evaluated using the user version of the Mobile Application Rating Scale (uMars). Open-ended responses assessed parent recommendations for HPVCF enhancement. Results: The 98 parents were mainly female (n=94, 96%), 41 (5.67) years of age, college educated (n=55, 56%), and White and non-Hispanic (n=55, 56%) and had private health insurance for their children (n=75, 77%). Parents used HPVCF 197 times, with the average visit duration approximating 3.5 minutes. The uMARS app quality score was positively skewed (4.2/5.0). Mean ratings were highest for information (4.46 [SD 0.53]) and lowest for engagement (3.74 [SD 0.69]). In addition, of 95 parents, 45 (47%) rated HPVCF as helpful in HPV vaccination decision making and 16 (17%) attributed HPV vaccine initiation to HPVCF. Parents reported that HPVCF increased their awareness (84/95, 88%), knowledge (84/95, 88%), and HPV vaccination intentions (64/95, 67%). Most of the 98 parents rated the 4 HPVCF components as useful (72-92 [73%-94%]). Parents also agreed that HPVCF is clear (86/95, 91%), accurate (86/95, 91%), and more helpful than other HPV vaccine information they had received (89/95, 94%) and that they would recommend it to others (81/95, 85%). In addition, parents suggested ways to increase awareness and engagement with the app, along with opportunities to enhance the content and functionality. Conclusions: HPVCF was well received by parents and performed well on indicators of quality, usefulness, utility, credibility, and perceived impact. This study contributes a multimethod and multimeasure evaluation to the growing body of literature focused on assessing the user experience of patient-focused technology-mediated applications for HPV education. %M 35188469 %R 10.2196/30340 %U https://pediatrics.jmir.org/2022/1/e30340 %U https://doi.org/10.2196/30340 %U http://www.ncbi.nlm.nih.gov/pubmed/35188469 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e31172 %T Exploring Middle School Students’ Perspectives on Using Serious Games for Cancer Prevention Education: Focus Group Study %A Abraham,Olufunmilola %A Szela,Lisa %A Khan,Mahnoor %A Geddam,Amrita %+ Social & Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, 777 Highland Ave, Madison, WI, 53705, United States, 1 608 263 4498, olufunmilola.abraham@wisc.edu %K adolescents %K adolescent education %K adolescent health %K older children %K middle school students %K cancer awareness %K cancer education %K cancer prevention %K health education %K serious games %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Cancer in the United States is a leading cause of mortality. Educating adolescents about cancer risks can improve awareness and introduce healthy lifestyle habits. Public health efforts have made significant progress in easing the burden of cancer through the promotion of early screening and healthy lifestyle advocacy. However, there are limited interventions that educate the adolescent population about cancer prevention. Previous studies have demonstrated the effectiveness of serious games (SGs) to teach adolescents about healthy lifestyle choices, but few research efforts have examined the utility of using SGs to educate youth specifically on cancer prevention. Objective: This study aimed to investigate middle school students’ preferences for the use of SGs for cancer prevention education. The study also characterized the students’ perceptions of desired game design features for a cancer prevention SG. Methods: Focus groups were held to allow adolescents to review a game playbook and discuss gaming behaviors and preferences for an SG for cancer education. The game playbook was developed based on “Cancer, Clear & Simple,” a curriculum intended to educate individuals about cancer, prevention, self-care, screening, and detection. In the game, the player learns that they have cancer and is given the opportunity to go back in time to reduce their cancer risk. A focus group discussion guide was developed and consisted of questions about aspects of the playbook and the participants’ gaming experience. The participants were eligible if they were 12 to 14 years old, could speak and understand English, and had parents who could read English or Spanish. Each focus group consisted of 5 to 10 persons. The focus groups were audio recorded and professionally transcribed; they were then analyzed content-wise and thematically by 2 study team members. Intercoder reliability (kappa coefficient) among the coders was reported as 0.97. The prevalent codes were identified and categorized into themes and subthemes. Results: A total of 18 focus groups were held with 139 participants from a Wisconsin middle school. Most participants had at least “some” gaming experience. Three major themes were identified, which were educational video games, game content, and purpose of game. The participants preferred customizable characters and realistic story lines that allowed players to make choices that affect the characters’ outcomes. Middle school students also preferred SGs over other educational methods such as lectures, books, videos, and websites. The participants desired SGs to be available across multiple platforms and suggested the use of SGs for cancer education in their school. Conclusions: Older children and adolescents consider SGs to be an entertaining tool to learn about cancer prevention and risk factors. Their design preferences should be considered to create a cancer education SG that is acceptable and engaging for youth. %M 34643533 %R 10.2196/31172 %U https://games.jmir.org/2022/1/e31172 %U https://doi.org/10.2196/31172 %U http://www.ncbi.nlm.nih.gov/pubmed/34643533 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e29635 %T Health Care Providers’ and Professionals’ Experiences With Telehealth Oncology Implementation During the COVID-19 Pandemic: A Qualitative Study %A Turner,Kea %A Bobonis Babilonia,Margarita %A Naso,Cristina %A Nguyen,Oliver %A Gonzalez,Brian D %A Oswald,Laura B %A Robinson,Edmondo %A Elston Lafata,Jennifer %A Ferguson,Robert J %A Alishahi Tabriz,Amir %A Patel,Krupal B %A Hallanger-Johnson,Julie %A Aldawoodi,Nasrin %A Hong,Young-Rock %A Jim,Heather S L %A Spiess,Philippe E %+ Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612-9416, United States, 1 (813) 745 5213, kea.turner@moffitt.org %K telehealth %K telemedicine %K teleoncology %K digital health %K remote monitoring %K cancer %K oncology %K coronavirus disease %K COVID-19 %D 2022 %7 19.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Rapid implementation of telehealth for cancer care during COVID-19 required innovative and adaptive solutions among oncology health care providers and professionals (HPPs). Objective: The aim of this qualitative study was to explore oncology HPPs’ experiences with telehealth implementation during the COVID-19 pandemic. Methods: This study was conducted at Moffitt Cancer Center (Moffitt), an NCI (National Cancer Institute)-Designated Comprehensive Cancer Center. Prior to COVID-19, Moffitt piloted telehealth visits on a limited basis. After COVID-19, Moffitt rapidly expanded telehealth visits. Telehealth visits included real-time videoconferencing between HPPs and patients and virtual check-ins (ie, brief communication with an HPP by telephone only). We conducted semistructured interviews with 40 oncology HPPs who implemented telehealth during COVID-19. The interviews were recorded, transcribed verbatim, and analyzed for themes using Dedoose software (version 4.12). Results: Approximately half of the 40 participants were physicians (n=22, 55%), and one-quarter of the participants were advanced practice providers (n=10, 25%). Other participants included social workers (n=3, 8%), psychologists (n=2, 5%), dieticians (n=2, 5%), and a pharmacist (n=1, 3%). Five key themes were identified: (1) establishing and maintaining patient-HPP relationships, (2) coordinating care with other HPPs and informal caregivers, (3) adapting in-person assessments for telehealth, (4) developing workflows and allocating resources, and (5) future recommendations. Participants described innovative strategies for implementing telehealth, such as coordinating interdisciplinary visits with multiple HPPs and inviting informal caregivers (eg, spouse) to participate in telehealth visits. Health care workers discussed key challenges, such as workflow integration, lack of physical exam and biometric data, and overcoming the digital divide (eg, telehealth accessibility among patients with communication-related disabilities). Participants recommended policy advocacy to support telehealth (eg, medical licensure policies) and monitoring how telehealth affects patient outcomes and health care delivery. Conclusions: To support telehealth growth, implementation strategies are needed to ensure that HPPs and patients have the tools necessary to effectively engage in telehealth. At the same time, cancer care organizations will need to engage in advocacy to ensure that policies are supportive of oncology telehealth and develop systems to monitor the impact of telehealth on patient outcomes, health care quality, costs, and equity. %M 34907900 %R 10.2196/29635 %U https://www.jmir.org/2022/1/e29635 %U https://doi.org/10.2196/29635 %U http://www.ncbi.nlm.nih.gov/pubmed/34907900 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e29494 %T An Interactive Voice Response System to Increase Physical Activity and Prevent Cancer in the Rural Alabama Black Belt: Design and Usability Study %A Thirumalai,Mohanraj %A Brown,Nashira %A Niranjan,Soumya %A Townsend,Sh'Nese %A Powell,Mary Anne %A Neal,Whitney %A Schleicher,Erica %A Raparla,Venkatadri %A Oster,Robert %A Demark-Wahnefried,Wendy %A Pekmezi,Dori %+ Department of Health Services Administration, School of Health Professions, University of Birmingham at Alabama, SHPB #590E, 1716 9th Avenue South, Birmingham, AL, 35244, United States, 1 2059347189, mohanraj@uab.edu %K interactive voice response systems %K usability %K exercise %K physical activity %K rural health %K telehealth %D 2022 %7 4.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Increased physical activity (PA) levels are associated with reduced risk and improved survival for several cancers; however, most Americans engage in less than the recommended levels of PA. Using interactive voice response (IVR) systems to provide personalized health education and counseling may represent a high-reach, low-cost strategy for addressing physical inactivity and cancer disparities in disproportionately burdened rural regions. However, there has been a paucity of research conducted in this area to date. Objective: The aim of this study is to design, develop, and test the usability of an IVR system aimed at increasing PA levels in the rural Alabama Black Belt. Methods: A pilot version of the IVR system was used to assess initial feasibility and acceptability. Detailed exit interviews were conducted to elicit participant feedback, which helped inform the development of a substantially upgraded in-house IVR system. This refined IVR system was then subjected to a sequential explanatory mixed methods evaluation. Participating rural county coordinators and research staff (N=10) tested the usability of the IVR system features for 2 weeks and then completed the System Usability Scale and qualitative semistructured interviews. Results: The study sample comprised mostly African American people, women, rural county coordinators, and research staff (N=10). Participants rated the IVR system with a mean score of 81 (SD 5) on the System Usability Scale, implying excellent usability. In total, 5 overarching themes emerged from the qualitative interviews: likes or dislikes of the intervention, barriers to or facilitators of PA, technical difficulties, quality of calls, and suggestions for intervention improvement. Message framing on step feedback, call completion incentives, and incremental goal-setting challenges were areas identified for improvement. The positive areas highlighted in the interviews included the personalized call schedules, flexibility to call in or receive a call, ability to make up for missed calls, narration, and PA tips. Conclusions: The usability testing and feedback received from the rural county coordinators and research staff helped inform a final round of refinement to the IVR system before use in a large randomized controlled trial. This study stresses the importance of usability testing of all digital health interventions and the benefits it can offer to the intervention. %M 34982714 %R 10.2196/29494 %U https://humanfactors.jmir.org/2022/1/e29494 %U https://doi.org/10.2196/29494 %U http://www.ncbi.nlm.nih.gov/pubmed/34982714 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e34502 %T Evaluation of the Efficacy of a Smoking Cessation Intervention for Cervical Cancer Survivors and Women With High-Grade Cervical Dysplasia: Protocol for a Randomized Controlled Trial %A Jones,Sarah R %A Vidrine,Damon J %A Wetter,David W %A Shih,Ya-Chen Tina %A Sutton,Steven K %A Ramondetta,Lois M %A Elting,Linda S %A Walker,Joan L %A Smith,Katie M %A Frank-Pearce,Summer G %A Li,Yisheng %A Simmons,Vani N %A Vidrine,Jennifer I %+ Tobacco Research & Intervention Program, Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4115 E Fowler Avenue, Tampa, FL, 33617, United States, 1 813 745 8764, jennifer.vidrine@moffitt.org %K smoking cessation %K cervical cancer %K cancer survivor %K motivation %K tobacco treatment %K cancer %K smoking %K RCT %K randomized controlled trial %K cognitive behavior %K intervention %D 2021 %7 30.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The prevalence of smoking among cervical cancer survivors is strikingly high, yet no smoking cessation interventions to date have specifically targeted this population. This paper describes the study design, methods, and data analysis plans for a randomized clinical trial designed to evaluate the efficacy of a theoretically and empirically based Motivation And Problem Solving (MAPS) approach for promoting and facilitating smoking cessation among cervical cancer survivors. MAPS is a comprehensive, dynamic, and holistic intervention that incorporates empirically supported cognitive behavioral and social cognitive theory–based treatment strategies within an overarching motivational framework. MAPS is designed to be appropriate for all smokers regardless of their motivation to change and views motivation as dynamically fluctuating from moment to moment throughout the behavior change process. Objective: This 2-group randomized controlled trial compares the efficacy of standard treatment to MAPS in facilitating smoking cessation among women with a history of high-grade cervical dysplasia or cervical cancer. Methods: Participants (N=202) are current smokers with a history of high-grade cervical dysplasia or cervical cancer recruited nationally and randomly assigned to one of two treatment conditions: (1) standard treatment (ST) or (2) MAPS. ST consists of repeated letters referring participants to their state’s tobacco cessation quitline, standard self-help materials, and free nicotine replacement therapy when ready to quit. MAPS has all ST components along with 6 proactive telephone counseling sessions delivered over 12 months. The primary outcome is abstinence from tobacco at 18 months. Secondary outcomes include abstinence over time across all assessment points, abstinence at other individual assessment time points, quit attempts, cigarettes per day, and use of state quitlines. Hypothesized treatment mechanisms and cost-effectiveness will also be evaluated. Results: This study was approved by the institutional review boards at the University of Texas MD Anderson Cancer Center, the University of Oklahoma Health Sciences Center, and Moffitt Cancer Center. Participant enrollment concluded at Moffitt Cancer Center in January 2020, and follow-up data collection was completed in July 2021. Data analysis is ongoing. Conclusions: This study will yield crucial information regarding the efficacy and cost-effectiveness of a MAPS approach for smoking cessation tailored to the specific needs of women with a history of high-grade cervical dysplasia or cervical cancer. Findings indicating that MAPS has substantially greater efficacy than existing evidence-based tobacco cessation treatments would have tremendous public health significance. Trial Registration: ClinicalTrials.gov NCT02157610; https://clinicaltrials.gov/ct2/show/NCT02157610 International Registered Report Identifier (IRRID): DERR1-10.2196/34502 %M 34967755 %R 10.2196/34502 %U https://www.researchprotocols.org/2021/12/e34502 %U https://doi.org/10.2196/34502 %U http://www.ncbi.nlm.nih.gov/pubmed/34967755 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e26356 %T Personalized Reminders for Immunization Using Short Messaging Systems to Improve Human Papillomavirus Vaccination Series Completion: Parallel-Group Randomized Trial %A Wynn,Chelsea S %A Catallozzi,Marina %A Kolff,Chelsea A %A Holleran,Stephen %A Meyer,Dodi %A Ramakrishnan,Rajasekhar %A Stockwell,Melissa S %+ Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, 622 W 168th St, VC 417, New York, NY, 10032, United States, 1 212 342 5732, mss2112@cumc.columbia.edu %K text messaging %K mobile reminders %K human papillomavirus %K adolescent %K text reminders %K vaccine completion %K vaccine decision-making %K vaccine education %K transtheoretical model %K mobile phone %K smartphone %K mHealth %K mobile health %K minority health %D 2021 %7 27.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Completion rates among adolescents who initiate the human papillomavirus (HPV) vaccine 3-dose series are low. SMS text message vaccine reminders are effective, but less is known about the best types for HPV series completion or the ability to assess and target vaccine decision-making stage. Objective: The aim of this study is to compare the effectiveness of HPV vaccine series completion in minority adolescents who received precision and educational versus conventional SMS text message reminders. Methods: Enrolled parents of adolescents aged 9-17 years who received the first HPV vaccine dose at 1 of the 4 academic-affiliated community health clinics in New York City were randomized 1:1 to 1 of the 2 parallel, unblinded arms: precision SMS text messages (which included stage-targeted educational information, next dose due date, and site-specific walk-in hours) or conventional SMS text messages without educational information. Randomization was stratified according to gender, age, and language. The primary outcome was series completion within 12 months. In post hoc analysis, enrollees were compared with concurrent nonenrollees and historical controls. Results: Overall, 956 parents were enrolled in the study. The precision (475 families) and conventional (481 families) SMS text message arms had similarly high series completion rates (344/475, 72.4% vs 364/481, 75.7%). A total of 42 days after the first dose, two-thirds of families, not initially in the preparation stage, moved to preparation or vaccinated stage. Those in either SMS text message arm had significantly higher completion rates than nonenrollees (708/1503, 47.1% vs 679/1503, 45.17%; P<.001). Even after removing those needing only 2 HPV doses, adolescents receiving any SMS text messages had higher completion rates than historical controls (337/2823, 11.93% vs 981/2823, 34.75%; P<.001). A population-wide effect was seen from 2014 to 2016, above historical trends. Conclusions: SMS text message reminders led to timely HPV vaccine series completion in a low-income, urban, minority study population and also led to population-wide effects. Educational information did not provide an added benefit to this population. Trial Registration: ClinicalTrials.gov NCT02236273; https://clinicaltrials.gov/ct2/show/NCT02236273 %M 34958306 %R 10.2196/26356 %U https://mhealth.jmir.org/2021/12/e26356 %U https://doi.org/10.2196/26356 %U http://www.ncbi.nlm.nih.gov/pubmed/34958306 %0 Journal Article %@ 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 e31860 %T Increasing Participation Rates in Germany’s Skin Cancer Screening Program (HELIOS): Protocol for a Mixed Methods Study %A Steeb,Theresa %A Heppt,Markus V %A Erdmann,Michael %A Wessely,Anja %A Klug,Stefanie J %A Berking,Carola %+ Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Ulmenweg 18, Erlangen, 91054, Germany, 49 1318545852, theresa.steeb@uk-erlangen.de %K skin cancer %K melanoma %K squamous cell carcinoma %K basal cell carcinoma %K screening %K early detection %K focus group %K mixed methods %K cross-sectional study %K prevention %D 2021 %7 13.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: In 2008, a nationwide skin cancer screening (SCS) program was implemented in Germany. However, participation rates remain low. Objective: The overall objective of the HELIOS study is to identify subgroup-specific invitation and communication strategies to increase informed SCS participation in Germany. Methods: Focus group discussions will be performed in Erlangen, Germany, to explore potential invitation and communication strategies as well as possible barriers and motivating factors to participate in SCS. Male and female patients of different age groups who have already been diagnosed with skin cancer, as well as participants without a prior diagnosis of skin cancer, will be invited. Based on these results, an online questionnaire will be developed to identify subgroup-specific invitation strategies. A random sample of 2500 persons from the general population aged >35 years from the Munich area will be contacted to complete the questionnaire. Besides descriptive analysis, multinomial logistic regression will be performed. Additionally, a cluster analysis will be conducted to discover patterns or similarities among the participants. Results: Recruitment for the focus group studies started in February 2021 and is ongoing. As of August 2021, we have enrolled 39 participants. We expect to end enrollment in the qualitative study in September 2021 and to finish the analysis in December 2021. The second part of the study will then start in January 2022. Conclusions: The results of this project will enable us to derive improved and more efficient invitation and communication strategies for SCS. These may be implemented in the future to facilitate increased SCS uptake and early skin cancer detection. International Registered Report Identifier (IRRID): DERR1-10.2196/31860 %M 34898465 %R 10.2196/31860 %U https://www.researchprotocols.org/2021/12/e31860 %U https://doi.org/10.2196/31860 %U http://www.ncbi.nlm.nih.gov/pubmed/34898465 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 12 %P e27072 %T The Effect of Automated Mammogram Orders Paired With Electronic Invitations to Self-schedule on Mammogram Scheduling Outcomes: Observational Cohort Comparison %A North,Frederick %A Nelson,Elissa M %A Buss,Rebecca J %A Majerus,Rebecca J %A Thompson,Matthew C %A Crum,Brian A %+ Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States, 1 507 284 2511, north.frederick@mayo.edu %K electronic health record %K schedule %K patient appointment %K preventive health service %K office visit %K outpatient care %K mammogram %K software tool %K computer software application %K mobile applications %K self-schedule %K app %K EHR %K screening %K diagnostic %K cancer %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Screening mammography is recommended for the early detection of breast cancer. The processes for ordering screening mammography often rely on a health care provider order and a scheduler to arrange the time and location of breast imaging. Self-scheduling after automated ordering of screening mammograms may offer a more efficient and convenient way to schedule screening mammograms. Objective: The aim of this study was to determine the use, outcomes, and efficiency of an automated mammogram ordering and invitation process paired with self-scheduling. Methods: We examined appointment data from 12 months of scheduled mammogram appointments, starting in September 2019 when a web and mobile app self-scheduling process for screening mammograms was made available for the Mayo Clinic primary care practice. Patients registered to the Mayo Clinic Patient Online Services could view the schedules and book their mammogram appointment via the web or a mobile app. Self-scheduling required no telephone calls or staff appointment schedulers. We examined uptake (count and percentage of patients utilizing self-scheduling), number of appointment actions taken by self-schedulers and by those using staff schedulers, no-show outcomes, scheduling efficiency, and weekend and after-hours use of self-scheduling. Results: For patients who were registered to patient online services and had screening mammogram appointment activity, 15.3% (14,387/93,901) used the web or mobile app to do either some mammogram self-scheduling or self-cancelling appointment actions. Approximately 24.4% (3285/13,454) of self-scheduling occurred after normal business hours/on weekends. Approximately 9.3% (8736/93,901) of the patients used self-scheduling/cancelling exclusively. For self-scheduled mammograms, there were 5.7% (536/9433) no-shows compared to 4.6% (3590/77,531) no-shows in staff-scheduled mammograms (unadjusted odds ratio 1.24, 95% CI 1.13-1.36; P<.001). The odds ratio of no-shows for self-scheduled mammograms to staff-scheduled mammograms decreased to 1.12 (95% CI 1.02-1.23; P=.02) when adjusted for age, race, and ethnicity. On average, since there were only 0.197 staff-scheduler actions for each finalized self-scheduled appointment, staff schedulers were rarely used to redo or “clean up” self-scheduled appointments. Exclusively self-scheduled appointments were significantly more efficient than staff-scheduled appointments. Self-schedulers experienced a single appointment step process (one and done) for 93.5% (7553/8079) of their finalized appointments; only 74.5% (52,804/70,839) of staff-scheduled finalized appointments had a similar one-step appointment process (P<.001). For staff-scheduled appointments, 25.5% (18,035/70,839) of the finalized appointments took multiple appointment steps. For finalized appointments that were exclusively self-scheduled, only 6.5% (526/8079) took multiple appointment steps. The staff-scheduled to self-scheduled odds ratio of taking multiple steps for a finalized screening mammogram appointment was 4.9 (95% CI 4.48-5.37; P<.001). Conclusions: Screening mammograms can be efficiently self-scheduled but may be associated with a slight increase in no-shows. Self-scheduling can decrease staff scheduler work and can be convenient for patients who want to manage their appointment scheduling activity after business hours or on weekends. %M 34878997 %R 10.2196/27072 %U https://medinform.jmir.org/2021/12/e27072 %U https://doi.org/10.2196/27072 %U http://www.ncbi.nlm.nih.gov/pubmed/34878997 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e28393 %T Cross-Cultural Modification Strategies for Instruments Measuring Health Beliefs About Cancer Screening: Systematic Review %A Lei,Fang %A Lee,Eunice %+ University of California, Los Angeles, Factor Bldg, 700 Tiverton Dr, Los Angeles, CA, 90095, United States, 1 3107330963, alicelf@ucla.edu %K cancer screening %K health beliefs %K instrument modification %K strategy %K systematic review %D 2021 %7 18.11.2021 %9 Review %J JMIR Cancer %G English %X Background: Modification is an important process by which to adapt an instrument to be used for another culture. However, it is not fully understood how best to modify an instrument to be used appropriately in another culture. Objective: This study aims to synthesize the modification strategies used in the cross-cultural adaptation process for instruments measuring health beliefs about cancer screening. Methods: A systematic review design was used for conducting this study. Keywords including constructs about instrument modification, health belief, and cancer screening were searched in the PubMed, Google Scholar, CINAHL, and PsycINFO databases. Bowling’s checklist was used to evaluate methodological rigor of the included articles. Results were reported using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) approach with a narrative method. Results: A total of 1312 articles were initially identified in the databases. After removing duplications and assessing titles, abstracts, and texts of the articles, 18 studies met the inclusion criteria for the study. Based on Flaherty’s cultural equivalence model, strategies used in the modification process included rephrasing items and response options to achieve semantic equivalence; changing subjects of items, changing wording of items, adding items, and deleting items to achieve content equivalence; adding subscales and items and deleting subscales and items to achieve criterion equivalence. Solutions used to resolve disagreements in the modification process included consultation with experts or literature search, following the majority, and consultation with the author who developed the scales. Conclusions: This study provides guidance for researchers who want to modify an instrument to be used in another culture. It can potentially give cross-cultural researchers insight into modification strategies and a better understanding of the modification process in cross-cultural instrument adaptation. More research could be done to help researchers better modify cross-cultural instruments to achieve cultural equivalence. %M 34792474 %R 10.2196/28393 %U https://cancer.jmir.org/2021/4/e28393 %U https://doi.org/10.2196/28393 %U http://www.ncbi.nlm.nih.gov/pubmed/34792474 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e24936 %T Role of 18F-Fluorodeoxyglucose–Positron Emission Tomography/Computed Tomography Imaging in the Prediction of Prognosis in Patients With Indolent Lymphoma: Prospective Study %A AlShehry,Nawal Faiez %A Shanker,Raja %A Zaidi,Syed Ziauddin Ahmed %A AlGhmlas,Fahad %A Motabi,Ibraheem Hussein %A Iqbal,Shahid %A Butt,Ahmad Ali %A AlShehri,Hassan %A Tailor,Imran Khan %A Altaf,Syed Yasir %A AlGhamdi,Mubarak %A Marie,Mohammed %A AlFayez,Mansour %A Al Zahrani,Kamal %A Dwaimah,Mohammed %A Al-Halouli,Tahani %A Al-Shakweer,Wafaa %A AlShehery,Maied Zaher %A Zaidi,Abdul Rehman Zia %A Gill,Atta Munawar %A Albtoosh,Belal Mohammed %A Ahmed,Musab %+ Department of Adult Hematology/Bone Marrow Transplantation, King Fahad Medical City, Comprehensive Cancer Center, PO Box 59046, Riyadh, 11525, Saudi Arabia, 966 112889999 ext 23040, nalshehry@kfmc.med.sa %K positron emission tomography %K lymphoma %K prognosis %K indolent lymphoma %K SUVmax %K Deauville criteria %D 2021 %7 12.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The role of fluorodeoxyglucose–positron emission tomography/computed tomography (FDG-PET/CT) in indolent lymphoma has been minimally studied. Objective: This study aims to assess the value of FDG-PET/CT in predicting the prognosis of indolent lymphoma. Methods: We prospectively recruited 42 patients with indolent lymphoma. A total of 2 patients were excluded, and 40 underwent baseline PET/CT and follow-up at various time points. A total of 9 patients were observed only, 7 received 4 doses of rituximab alone, and 24 received chemoimmunotherapy. Metabolic response on follow-up PET/CT was assessed using the maximum standardized uptake value (SUVmax) and Deauville criteria (DC). We aimed to obtain the best SUVmax and DC to predict optimal survival rates, risk stratification, and optimize therapeutic strategies. The mean follow-up from the initial diagnosis was 33.83 months. Results: SUVmax <4.35 at interim PET/CT provided the best discrimination, with a progression-free survival (PFS) of 100% and a median survival time of 106.67 months compared with SUVmax ≥4.35 (P=.04), which had a PFS of 43.8% and a median survival time of 50.17 months. This cutoff was also valuable in predicting overall survival at baseline, that is, 100% overall survival with baseline SUVmax <4.35, versus 58.4% for SUVmax ≥4.35 (P=.13). The overall survival of patients with a baseline DC score <3.0 was 100%, with a median overall survival of 106.67 months. Conclusions: We demonstrated the utility of PET/CT in indolent lymphomas. SUVmax (<4.35 vs ≥4.35) on interim PET/CT performed best in predicting PFS. %M 34508363 %R 10.2196/24936 %U https://formative.jmir.org/2021/11/e24936 %U https://doi.org/10.2196/24936 %U http://www.ncbi.nlm.nih.gov/pubmed/34508363 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e26898 %T Improving the Prognosis of Pancreatic Cancer Through Early Detection: Protocol for a Prospective Observational Study %A Yamada,Reiko %A Isaji,Shuji %A Fujii,Takehiro %A Mizuno,Shugo %A Kishiwada,Masashi %A Murata,Yasuhiro %A Hayasaki,Aoi %A Inoue,Hiroyuki %A Umeda,Yuhei %A Tanaka,Kyosuke %A Hamada,Yasuhiko %A Tsuboi,Junya %A Kato,Toshio %A Kondo,Yoshihiro %A Matsuda,Shinsuke %A Watanabe,Noriko %A Ogura,Toru %A Tamaru,Satoshi %+ Clinical Research Support Center, Mie University Hospital, 2-174, Edobashi, Tsu, Japan, 81 59 232 1111 ext 7606, reiko-t@clin.medic.mie-u.ac.jp %K pancreatic cancer %K prognosis %K early diagnosis %K risk factors %K scoring system %K referral %D 2021 %7 22.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Pancreatic cancer is associated with high mortality and its rates of detection are very low; as such, the disease is typically diagnosed at an advanced stage. A number of risk factors for pancreatic cancer have been reported and may be used to identify individuals at high risk for the development of this disease. Objective: The aim of this prospective, observational trial is to evaluate a scoring metric for systematic early detection of pancreatic cancer in Mie Prefecture, Japan. Methods: Eligible patients aged 20 years and older will be referred from participating clinics in the Tsu City area to the Faculty of Medicine, Gastroenterology, and Hepatology at Mie University Graduate School, until September 30, 2022. Participants will undergo a detailed examination for pancreatic cancer. Data collection will include diagnostic and follow-up imaging data and disease staging information. Results: The study was initiated in September 2020 and aims to recruit at least 150 patients in a 2-year period. Recruitment of patients is currently still underway. Final data analysis is expected to be complete by March 2025. Conclusions: This study will provide insights into the feasibility of using a scoring system for the early detection of pancreatic cancer, thus potentially improving the survival outcomes of diagnosed patients. Trial Registration: UMIN-CTR Clinical Trials Registry UMIN000041624; https://tinyurl.com/94tbbn3s International Registered Report Identifier (IRRID): DERR1-10.2196/26898 %M 34677132 %R 10.2196/26898 %U https://www.researchprotocols.org/2021/10/e26898 %U https://doi.org/10.2196/26898 %U http://www.ncbi.nlm.nih.gov/pubmed/34677132 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29885 %T Factors Influencing the Popularity of a Health-Related Answer on a Chinese Question-and-Answer Website: Case Study %A Li,Jinhui %A Zheng,Han %A Duan,Xu %+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, #05-10, WKWSCI Building, 31 Nanyang Link, Singapore, 637718, Singapore, 65 86691766, han019@e.ntu.edu.sg %K answer-response behaviors %K Zhihu %K HPV vaccine information %K content features %K context features %K contributor features %D 2021 %7 28.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Social question-and-answer (Q&A) sites have become an important venue for individuals to obtain and share human papillomavirus (HPV) vaccine knowledge. Objective: This study aims to examine how different features of an HPV vaccine–related answer are associated with users’ response behaviors on social Q&A websites. Methods: A total of 2953 answers and 270 corresponding questions regarding the HPV vaccine were collected from a leading Chinese social Q&A platform, Zhihu. Three types of key features, including content, context, and contributor, were extracted and coded. Negative binomial regression models were used to examine their impact on the vote and comment count of an HPV vaccine–related answer. Results: The findings showed that both content length and vividness were positively related to the response behaviors of HPV vaccine–related answers. In addition, compared with answers under the question theme benefits and risks, answers under the question theme vaccination experience received fewer votes and answers under the theme news opinions received more votes but fewer comments. The effects of characteristics of contributors were also supported, suggesting that answers from a male contributor with more followers and no professional identity would attract more votes and comments from community members. The significant interaction effect between content and context features further showed that long and vivid answers about HPV vaccination experience were more likely to receive votes and comments of users than those about benefits and risks. Conclusions: The study provides a complete picture of the underlying mechanism behind response behaviors of users toward HPV vaccine–related answers on social Q&A websites. The results help health community organizers develop better strategies for building and maintaining a vibrant web-based community for communicating HPV vaccine knowledge. %M 34581675 %R 10.2196/29885 %U https://www.jmir.org/2021/9/e29885 %U https://doi.org/10.2196/29885 %U http://www.ncbi.nlm.nih.gov/pubmed/34581675 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e29694 %T Reactivity to UV Radiation Exposure Monitoring Using Personal Exposure Devices for Skin Cancer Prevention: Longitudinal Observational Study %A Parsons,Bridget G %A Nagelhout,Elizabeth S %A Wankier,Ali P %A Hu,Nan %A Lensink,Riley %A Zhu,Angela %A Nottingham,Katy %A Grossman,Douglas %A Jensen,Jakob D %A Wu,Yelena P %+ Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, United States, 1 801 213 5653, yelena.wu@utah.edu %K ultraviolet radiation exposure %K wearable device %K melanoma %K melanoma prevention %K mHealth %K digital health %K eHealth %K UVR monitoring %K mobile phone %D 2021 %7 28.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Emerging UV radiation (UVR) monitoring devices may present an opportunity to integrate such technology into skin cancer prevention interventions. However, little is known about the effects of using a wearable UVR monitor on adults’ and children’s sun protection–related behaviors and attitudes (eg, cancer worry and perceived risk). Understanding the potential role of reactivity and seasonal effects will help inform the use of objective monitors in the context of skin cancer prevention research, including intervention studies. Objective: The aim of this study is to examine the potential reactivity associated with a wearable personal UVR monitor, specifically the effects associated with reported sun-protective behaviors and skin cancer–related attitudes, which are often the targets of skin cancer preventive interventions. Methods: Child-parent dyads (n=97 dyads) were asked to wear a UVR monitoring device during waking hours for 2 weeks. Participants were asked to sync the device daily with a smartphone app that stored the UVR exposure data. Participants were blinded to their UVR exposure data during the 2-week period; thus, the smartphone app provided no feedback to the participants on their UVR exposure. Participants completed self-report questionnaires assessing sun-protective behaviors, sunburn, tanning, skin self-examination, skin cancer–related knowledge, perceived risk, cancer worry, response efficacy, and intentions to change behaviors over the 2-week period. Linear regressions were conducted to investigate changes in the outcomes over time and to account for the role of the season of study participation. Results: Regression results revealed that there was a significant decrease over time for several sun protection outcomes in children, including time spent outdoors on weekends (P=.02) and weekdays (P=.008), sunscreen use (P=.03), reapplication (P<.001), and unintentional tanning (P<.001). There were no significant changes over time in children’s and parents’ UVR exposure, sunburn occurrence, or sun protection attitudes. Season of participation was associated with several outcomes, including lower sunscreen use (P<.001), reapplication (P<.001), sunburns (P=.01), intentions to change sun-protective behaviors (P=.02), and intentional (P=.008) and unintentional tanning (P=.01) for participants who participated in the fall versus the summer. Conclusions: The findings from this study suggest that daily use of a UVR monitoring device over a 2-week period may result in changes in certain sun-protective behaviors. These results highlight the importance of identifying and addressing potential reactivity to UVR monitoring devices, especially in the context of skin cancer preventive intervention research. Ultimately, objectively assessed UVR exposure could be integrated into the outcome assessment for future testing of skin cancer prevention interventions. %M 34581683 %R 10.2196/29694 %U https://mhealth.jmir.org/2021/9/e29694 %U https://doi.org/10.2196/29694 %U http://www.ncbi.nlm.nih.gov/pubmed/34581683 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28355 %T Effect of a Brief Web-Based Educational Intervention on Willingness to Consider Human Papillomavirus Vaccination for Children in Japan: Randomized Controlled Trial %A Suzuki,Yukio %A Sukegawa,Akiko %A Ueda,Yutaka %A Sekine,Masayuki %A Enomoto,Takayuki %A Miyagi,Etsuko %+ Department of Obstetrics and Gynecology, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan, 81 45 787 2800, yetii@yokohama-cu.ac.jp %K human papillomavirus %K human papillomavirus vaccination %K behavioral insights %K behavioral change %K web-based randomized controlled trial %D 2021 %7 27.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The human papillomavirus (HPV) vaccination rate in Japan has fallen to nearly zero since the suspension of governmental proactive recommendations in 2013, owing to the development of purported adverse events. Objective: This study aimed to evaluate the effects of a brief web-based educational intervention using the theory of behavioral insights on the willingness of adults to consider the HPV vaccine for their daughters and sons. Methods: We recruited 1660 participants aged 20 years or older in March 2018 via a webpage and provided them with a 10-item questionnaire related to the following aspects: awareness regarding HPV infection and vaccination, willingness for immunization, and actions for prevention. We randomly stratified participants based on sex and age with or without a brief educational intervention involving scientific information presented in an easy-to-read format. Results: Only 484 (29.2%) of the respondents were aware of the benefits of HPV vaccination. Although only 352 (21.2%) of the respondents displayed a willingness for immunization of their daughters, there were 40 (4.8%) more respondents in the intervention group with this willingness (adjusted odds ratio [aOR] 1.32, 95% CI 1.04-1.69). In a subanalysis, the willingness toward vaccination for daughters in men was significantly higher in the intervention group (aOR 1.46, 95% CI 1.05-2.02). However, such a difference was not observed among women (aOR 1.20, 95% CI 0.83-1.73). Conclusions: This study suggests that a brief web-based educational intervention increases the willingness of adults to consider the HPV vaccine for their children, especially among men. Thus, providing adequate information to men may be a useful strategy to improve the currently low rates of HPV vaccination. Trial Registration: UMIN Clinical Trials Registry UMIN000049745 (UMIN-CTR); https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000049745 %M 34569941 %R 10.2196/28355 %U https://www.jmir.org/2021/9/e28355 %U https://doi.org/10.2196/28355 %U http://www.ncbi.nlm.nih.gov/pubmed/34569941 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28869 %T Effect of Digital Care Platforms on Quality of Care for Oncological Patients and Barriers and Facilitators for Their Implementation: Systematic Review %A Hopstaken,Jana S %A Verweij,Lynn %A van Laarhoven,Cees J H M %A Blijlevens,Nicole M A %A Stommel,Martijn W J %A Hermens,Rosella P M G %+ Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 10, Nijmegen, 6525 GA, Netherlands, 31 024 36 680 86, jana.hopstaken@radboudumc.nl %K digital care platforms %K cancer care %K eHealth %K telemedicine %K health care services %K fragmentation of care %K health care fragmentation %K oncology %K quality of care %K barriers %K facilitators %K patient experience %D 2021 %7 24.9.2021 %9 Review %J J Med Internet Res %G English %X Background: Oncological health care services are challenged by the increasing number of cancer survivors, long-term follow-up care, and fragmentation of care. Digital care platforms are potential tools to deliver affordable, patient-centered oncological care. Previous reviews evaluated only one feature of a digital care platform or did not evaluate the effect on enhancement of information, self-efficacy, continuity of care, or patient- and health care provider–reported experiences. Additionally, they have not focused on the barriers and facilitators for implementation of a digital care platform in oncological care. Objective: The aim of this systematic review was to collect the best available evidence of the effect of a digital care platform on quality of care parameters such as enhancement of available information, self-efficacy, continuity of care, and patient- and health care provider–reported experiences. Additionally, barriers and facilitators for implementation of digital care platforms were analyzed. Methods: The PubMed (Medline), Embase, CINAHL, and Cochrane Library databases were searched for the period from January 2000 to May 2020 for studies assessing the effect of a digital care platform on the predefined outcome parameters in oncological patients and studies describing barriers and facilitators for implementation. Synthesis of the results was performed qualitatively. Barriers and facilitators were categorized according to the framework of Grol and Wensing. The Mixed Methods Appraisal Tool was used for critical appraisal of the studies. Results: Seventeen studies were included for final analysis, comprising 8 clinical studies on the effectiveness of the digital care platform and 13 studies describing barriers and facilitators. Usage of a digital care platform appeared to enhance the availability of information and self-efficacy. There were no data available on the effect of a digital care platform on the continuity of care. However, based on focus group interviews, digital care platforms could potentially improve continuity of care by optimizing the exchange of patient information across institutes. Patient-reported experiences such as satisfaction with the platform were considerably positive. Most barriers for implementation were identified at the professional level, such as the concern for increased workload and unattended release of medical information to patients. Most facilitators were found at the patient and innovation levels, such as improved patient-doctor communication and patient empowerment. There were few barriers and facilitators mentioned at the economic and political levels. Conclusions: The use of digital care platforms is associated with better quality of care through enhancement of availability of information and increased self-efficacy for oncological patients. The numerous facilitators identified at the patient level illustrate that patients are positive toward a digital care platform. However, despite these favorable results, robust evidence concerning the effectiveness of digital care platforms, especially from high-quality studies, is still lacking. Future studies should therefore aim to further investigate the effectiveness of digital care platforms, and the barriers and facilitators to their implementation at the economic and political levels. %M 34559057 %R 10.2196/28869 %U https://www.jmir.org/2021/9/e28869 %U https://doi.org/10.2196/28869 %U http://www.ncbi.nlm.nih.gov/pubmed/34559057 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27576 %T A Smartphone-Based App to Improve Adjuvant Treatment Adherence to Multidisciplinary Decisions in Patients With Early-Stage Breast Cancer: Observational Study %A Yu,Jing %A Wu,Jiayi %A Huang,Ou %A Chen,Xiaosong %A Shen,Kunwei %+ Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China, 86 13564497086, chenxiaosong0156@hotmail.com %K breast cancer %K adherence %K multidisciplinary treatment %K adjuvant treatment %K smartphone-based app %K mobile phone %D 2021 %7 16.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Multidisciplinary treatment (MDT) and adjuvant therapy are associated with improved survival rates in breast cancer. However, nonadherence to MDT decisions is common in patients. We developed a smartphone-based app that can facilitate the full-course management of patients after surgery. Objective: This study aims to investigate the influence factors of treatment nonadherence and to determine whether this smartphone-based app can improve the compliance rate with MDTs. Methods: Patients who had received a diagnosis of invasive breast cancer and had undergone MDT between March 2013 and May 2019 were included. Patients were classified into 3 groups: Pre-App cohort (November 2017, before the launch of the app); App nonused, cohort (after November 2017 but not using the app); and App used cohort (after November 2017 and using the app). Univariate and multivariate analyses were performed to identify the factors related to MDT adherence. Compliance with specific adjuvant treatments, including chemotherapy, radiotherapy, endocrine therapy, and targeted therapy, was also evaluated. Results: A total of 4475 patients were included, with Pre-App, App nonused, and App used cohorts comprising 2966 (66.28%), 861 (19.24%), and 648 (14.48%) patients, respectively. Overall, 15.53% (695/4475) patients did not receive MDT recommendations; the noncompliance rate ranged from 27.4% (75/273) in 2013 to 8.8% (44/500) in 2019. Multivariate analysis demonstrated that app use was independently associated with adherence to adjuvant treatment. Compared with the patients in the Pre-App cohort, patients in the App used cohort were less likely to deviate from MDT recommendations (odds ratio [OR] 0.61, 95% CI 0.43-0.87; P=.007); no significant difference was found in the App nonused cohort (P=.77). Moreover, app use decreased the noncompliance rate for adjuvant chemotherapy (OR 0.41, 95% CI 0.27-0.65; P<.001) and radiotherapy (OR 0.49, 95% CI 0.25-0.96; P=.04), but not for anti-HER2 therapy (P=.76) or endocrine therapy (P=.39). Conclusions: This smartphone-based app can increase MDT adherence in patients undergoing adjuvant therapy; this was more obvious for adjuvant chemotherapy and radiotherapy. %M 34528890 %R 10.2196/27576 %U https://www.jmir.org/2021/9/e27576 %U https://doi.org/10.2196/27576 %U http://www.ncbi.nlm.nih.gov/pubmed/34528890 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e30451 %T Identifying False Human Papillomavirus (HPV) Vaccine Information and Corresponding Risk Perceptions From Twitter: Advanced Predictive Models %A Tomaszewski,Tre %A Morales,Alex %A Lourentzou,Ismini %A Caskey,Rachel %A Liu,Bing %A Schwartz,Alan %A Chin,Jessie %+ School of Information Sciences, University of Illinois at Urbana-Champaign, 501 E Daniel St, Champaign, IL, 61820, United States, 1 217 333 0125, chin5@illinois.edu %K misinformation %K disinformation %K social media %K HPV %K human papillomavirus vaccination %K vaccination %K causality mining %K cause %K effect %K risk perceptions %K vaccine %K perception %K risk %K Twitter %K machine learning %K natural language processing %K cervical cancer %D 2021 %7 9.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The vaccination uptake rates of the human papillomavirus (HPV) vaccine remain low despite the fact that the effectiveness of HPV vaccines has been established for more than a decade. Vaccine hesitancy is in part due to false information about HPV vaccines on social media. Combating false HPV vaccine information is a reasonable step to addressing vaccine hesitancy. Objective: Given the substantial harm of false HPV vaccine information, there is an urgent need to identify false social media messages before it goes viral. The goal of the study is to develop a systematic and generalizable approach to identifying false HPV vaccine information on social media. Methods: This study used machine learning and natural language processing to develop a series of classification models and causality mining methods to identify and examine true and false HPV vaccine–related information on Twitter. Results: We found that the convolutional neural network model outperformed all other models in identifying tweets containing false HPV vaccine–related information (F score=91.95). We also developed completely unsupervised causality mining models to identify HPV vaccine candidate effects for capturing risk perceptions of HPV vaccines. Furthermore, we found that false information contained mostly loss-framed messages focusing on the potential risk of vaccines covering a variety of topics using more diverse vocabulary, while true information contained both gain- and loss-framed messages focusing on the effectiveness of vaccines covering fewer topics using relatively limited vocabulary. Conclusions: Our research demonstrated the feasibility and effectiveness of using predictive models to identify false HPV vaccine information and its risk perceptions on social media. %M 34499043 %R 10.2196/30451 %U https://www.jmir.org/2021/9/e30451 %U https://doi.org/10.2196/30451 %U http://www.ncbi.nlm.nih.gov/pubmed/34499043 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 3 %P e30430 %T Prostate Cancer Risk Calculators for Healthy Populations: Systematic Review %A Bandala-Jacques,Antonio %A Castellanos Esquivel,Kevin Daniel %A Pérez-Hurtado,Fernanda %A Hernández-Silva,Cristobal %A Reynoso-Noverón,Nancy %+ Centro de Investigación en Prevención, Instituto Nacional de Cancerología, San Fernando 22, Belisario Domínguez, Mexico City, Mexico, 52 552 737 9184, nrn231002@yahoo.com.mx %K prostate cancer %K risk calculator %K risk reduction %D 2021 %7 3.9.2021 %9 Review %J JMIR Cancer %G English %X Background: Screening for prostate cancer has long been a debated, complex topic. The use of risk calculators for prostate cancer is recommended for determining patients’ individual risk of cancer and the subsequent need for a prostate biopsy. These tools could lead to better discrimination of patients in need of invasive diagnostic procedures and optimized allocation of health care resources Objective: The goal of the research was to systematically review available literature on the performance of current prostate cancer risk calculators in healthy populations by comparing the relative impact of individual items on different cohorts and on the models’ overall performance. Methods: We performed a systematic review of available prostate cancer risk calculators targeted at healthy populations. We included studies published from January 2000 to March 2021 in English, Spanish, French, Portuguese, or German. Two reviewers independently decided for or against inclusion based on abstracts. A third reviewer intervened in case of disagreements. From the selected titles, we extracted information regarding the purpose of the manuscript, analyzed calculators, population for which it was calibrated, included risk factors, and the model’s overall accuracy. Results: We included a total of 18 calculators from 53 different manuscripts. The most commonly analyzed ones were the Prostate Cancer Prevention Trial (PCPT) and European Randomized Study on Prostate Cancer (ERSPC) risk calculators developed from North American and European cohorts, respectively. Both calculators provided high diagnostic ability of aggressive prostate cancer (AUC as high as 0.798 for PCPT and 0.91 for ERSPC). We found 9 calculators developed from scratch for specific populations that reached a diagnostic ability as high as 0.938. The most commonly included risk factors in the calculators were age, prostate specific antigen levels, and digital rectal examination findings. Additional calculators included race and detailed personal and family history. Conclusions: Both the PCPR and ERSPC risk calculators have been successfully adapted for cohorts other than the ones they were originally created for with no loss of diagnostic ability. Furthermore, designing calculators from scratch considering each population’s sociocultural differences has resulted in risk tools that can be well adapted to be valid in more patients. The best risk calculator for prostate cancer will be that which has been calibrated for its intended population and can be easily reproduced and implemented. Trial Registration: PROSPERO CRD42021242110; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=242110 %M 34477564 %R 10.2196/30430 %U https://cancer.jmir.org/2021/3/e30430 %U https://doi.org/10.2196/30430 %U http://www.ncbi.nlm.nih.gov/pubmed/34477564 %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 %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e29387 %T Public Interest and Behavior Change in the United States Regarding Colorectal Cancer Following the Death of Chadwick Boseman: Infodemiology Investigation of Internet Search Trends Nationally and in At-Risk Areas %A Sajjadi,Nicholas B %A Feldman,Kaylea %A Shepard,Samuel %A Reddy,Arjun K %A Torgerson,Trevor %A Hartwell,Micah %A Vassar,Matt %+ Office of Medical Student Research, College of Osteopathic Medicine, Oklahoma State University Center for Health Sciences, 1111 W 17th Street, Tulsa, OK, 74107, United States, 1 9185821972, nicholas.sajjadi@okstate.edu %K Google Trends %K colerectal cancer %K search analytics %K public health %K data analytics %K Chadwick Boseman %K Twitter %K infodemiology %D 2021 %7 26.8.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Colorectal cancer (CRC) has the third highest cancer mortality rate in the United States. Enhanced screening has reduced mortality rates; however, certain populations remain at high risk, notably African Americans. Raising awareness among at-risk populations may lead to improved CRC outcomes. The influence of celebrity death and illness is an important driver of public awareness. As such, the death of actor Chadwick Boseman from CRC may have influenced CRC awareness. Objective: We sought to assess the influence of Chadwick Boseman’s death on public interest in CRC in the United States, evidenced by internet searches, website traffic, and donations to prominent cancer organizations. Methods: We used an auto-regressive integrated moving average model to forecast Google searching trends for the topic “Colorectal cancer” in the United States. We performed bivariate and multivariable regressions on state-wise CRC incidence rate and percent Black population. We obtained data from the American Cancer Society (ACS) and the Colon Cancer Foundation (CCF) for information regarding changes in website traffic and donations. Results: The expected national relative search volume (RSV) for colorectal cancer was 2.71 (95% CI 1.76-3.66), reflecting a 3590% (95% CI 2632%-5582%) increase compared to the expected values. With multivariable regression, the statewise RSV increased for each percent Black population by 1.09 (SE 0.18, P<.001), with 42% of the variance explained (P<.001). The American Cancer Society reported a 58,000% increase in CRC-related website traffic the weekend following Chadwick Boseman’s death compared to the weekend before. The Colon Cancer Foundation reported a 331% increase in donations and a 144% increase in revenue in the month following Boseman’s death compared to the month prior. Conclusions: Our results suggest that Chadwick Boseman’s death was associated with substantial increases in awareness of CRC. Increased awareness of CRC may support earlier detection and better prognoses. %M 37114199 %R 10.2196/29387 %U https://infodemiology.jmir.org/2021/1/e29387 %U https://doi.org/10.2196/29387 %U http://www.ncbi.nlm.nih.gov/pubmed/37114199 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 2 %P e22583 %T Patients’ Experiences of Using Skin Self-monitoring Apps With People at Higher Risk of Melanoma: Qualitative Study %A Habgood,Emily %A McCormack,Christopher %A Walter,Fiona M %A Emery,Jon D %+ Department of General Practice and Centre for Cancer Research, University of Melbourne, Level 10 Grattan Street, Melbourne, 3000, Australia, 61 0385597044, emily.habgood@unimelb.edu.au %K melanoma %K skin cancer %K early detection %K mobile apps %K qualitative %K mHealth %K mobile phone %D 2021 %7 13.8.2021 %9 Original Paper %J JMIR Dermatol %G English %X Background: Melanoma is the fourth most commonly diagnosed cancer in Australia. Up to 75% of melanomas are first detected by patients or their family or friends. Many mobile apps for melanoma exist, including apps to encourage skin self-monitoring to improve the likelihood of early detection. Previous research in this area has focused on their development, diagnostic accuracy, or validation. Little is known about patients’ views and experiences of using these apps. Objective: This study aims to understand patients’ views and experiences of using commercially available melanoma skin self-monitoring mobile apps for a period of 3 months. Methods: This qualitative study was conducted in two populations: primary care (where the MelatoolsQ tool was used to identify patients who were at increased risk of melanoma) and secondary care (where patients had a previous diagnosis of melanoma, stages T0-T3a). Participants downloaded 2 of the 4 mobile apps for skin self-monitoring (SkinVision, UMSkinCheck, Mole Monitor, or MySkinPal) and were encouraged to use them for 3 months. After 3 months, a semistructured interview was conducted with participants to discuss their experiences of using the skin self-monitoring mobile apps. Results: A total of 54 participants were recruited in the study, with 37% (20) of participants from primary care and 62% (34) from secondary care. Interviews were conducted with 34 participants when data saturation was reached. Most participants did not use the apps at all (n=12) or tried them once but did not continue (n=14). Only 8 participants used the apps to assist with skin self-monitoring for the entire duration of the study. Patients discussed the apps in the context of the importance of early detection and their current skin self-monitoring behaviors. A range of features of perceived quality of each app affected engagement to support skin self-monitoring. Participants described their skin self-monitoring routines and potential mismatches with the app reminders. They also described the technical and practical difficulties experienced when using the apps for skin self-monitoring. The app’s positioning within existing relationships with health care providers was crucial to understand the use of the apps. Conclusions: This study of patients at increased risk of melanoma highlights several barriers to engagement with apps to support skin self-monitoring. The results highlight the wide-ranging and dynamic influences on engagement with mobile apps, which extend beyond app design and relate to broader contextual factors about skin self-monitoring routines and relationships with health care providers. %M 37632821 %R 10.2196/22583 %U https://derma.jmir.org/2021/2/e22583 %U https://doi.org/10.2196/22583 %U http://www.ncbi.nlm.nih.gov/pubmed/37632821 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e26256 %T Artificial Intelligence–Based Prediction of Lung Cancer Risk Using Nonimaging Electronic Medical Records: Deep Learning Approach %A Yeh,Marvin Chia-Han %A Wang,Yu-Hsiang %A Yang,Hsuan-Chia %A Bai,Kuan-Jen %A Wang,Hsiao-Han %A Li,Yu-Chuan Jack %+ Department of Dermatology, Wan Fang Hospital, Taipei Medical University, No 111, Section 3, Xinglong Road, Wenshan District, Taipei, 116, Taiwan, 886 29307930 ext 2980, jaak88@gmail.com %K artificial intelligence %K lung cancer screening %K electronic medical record %D 2021 %7 3.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Artificial intelligence approaches can integrate complex features and can be used to predict a patient’s risk of developing lung cancer, thereby decreasing the need for unnecessary and expensive diagnostic interventions. Objective: The aim of this study was to use electronic medical records to prescreen patients who are at risk of developing lung cancer. Methods: We randomly selected 2 million participants from the Taiwan National Health Insurance Research Database who received care between 1999 and 2013. We built a predictive lung cancer screening model with neural networks that were trained and validated using pre-2012 data, and we tested the model prospectively on post-2012 data. An age- and gender-matched subgroup that was 10 times larger than the original lung cancer group was used to assess the predictive power of the electronic medical record. Discrimination (area under the receiver operating characteristic curve [AUC]) and calibration analyses were performed. Results: The analysis included 11,617 patients with lung cancer and 1,423,154 control patients. The model achieved AUCs of 0.90 for the overall population and 0.87 in patients ≥55 years of age. The AUC in the matched subgroup was 0.82. The positive predictive value was highest (14.3%) among people aged ≥55 years with a pre-existing history of lung disease. Conclusions: Our model achieved excellent performance in predicting lung cancer within 1 year and has potential to be deployed for digital patient screening. Convolution neural networks facilitate the effective use of EMRs to identify individuals at high risk for developing lung cancer. %M 34342588 %R 10.2196/26256 %U https://www.jmir.org/2021/8/e26256 %U https://doi.org/10.2196/26256 %U http://www.ncbi.nlm.nih.gov/pubmed/34342588 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e28147 %T Use of Social Media for Cancer Prevention Through Neighborhood Social Cohesion: Protocol for a Feasibility Study %A Oakley-Girvan,Ingrid %A Watterson,Jessica L %A Jones,Cheryl %A Houghton,Lauren C %A Gibbons,Marley P %A Gokal,Kajal %A Magsamen-Conrad,Kate %+ Medable, 525 University Ave, Palo Alto, CA, 94301, United States, 1 4086562948, ingrid@medable.com %K social cohesion %K mothers %K neighborhood %K physical activity %K social media %K social %K behavior %K health outcomes %K socioeconomic status %K community health %K chronic disease %K social network %K feasibility %K wellbeing %K cancer %D 2021 %7 30.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social cohesion is associated with healthier behaviors and better health outcomes, and therefore may offer a mechanism for promoting better health. Low socioeconomic status (SES) communities face higher rates of chronic disease due to both community- and individual-level factors. Objective: The aim of this study is to leverage social cohesion to promote healthier behaviors and prevent chronic disease in a low SES community. This protocol outlines the methodology for a pilot study to assess the feasibility of an intervention (Free Time For Wellness [FT4W]) using a social networking platform (Nextdoor) with mothers living in an urban, low-income community to improve social cohesion and promote healthy behaviors. Methods: The study will involve three phases: (I) co-designing the intervention with mothers in the neighborhoods of interest, (II) implementing the intervention with community leaders through the social networking platform, and (III) evaluating the intervention’s feasibility. Phase I of the study will include qualitative data collection and analysis from in-depth, semistructured interviews and a co-design group session with mothers. Phases II and III of the study include a pre- and postintervention survey of participating mothers. Neighborhood-level data on social cohesion will also be collected to enable comparison of outcomes between neighborhoods with higher and lower baseline social cohesion. Results: As of March 2021, recruitment and data collection for this study are complete. This protocol outlines our original study plan, although the final enrollment numbers and intervention implementation deviated from our initial planned methodology that is outlined in this protocol. These implementation learnings will be shared in subsequent publications of our study results. Conclusions: Ultimately, this study aims to: (1) determine the barriers and facilitators to finding free time for wellness among a population of low-income mothers to inform the co-design process, and (2) implement and study the feasibility of an intervention that leverages social cohesion to promote physical activity in a community of low-income mothers. The results of this study will provide preliminary feasibility evidence to inform a larger effectiveness trial, and will further our understanding of how social cohesion might influence well-being. International Registered Report Identifier (IRRID): RR1-10.2196/28147 %M 34328445 %R 10.2196/28147 %U https://www.researchprotocols.org/2021/7/e28147 %U https://doi.org/10.2196/28147 %U http://www.ncbi.nlm.nih.gov/pubmed/34328445 %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 %@ 2369-1999 %I JMIR Publications %V 7 %N 3 %P e28527 %T Search Behavior Regarding Cancer Susceptibility Genes Using a Clinical Decision Support Tool for Gene-Specific Penetrance: Content Analysis %A Yin,Kanhua %A Zhou,Jingan %A Singh,Preeti %A Wang,Jin %A Braun,Danielle %A Hughes,Kevin S %+ Division of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7, Boston, MA, 02114, United States, 1 617 724 0048, kshughes@partners.org %K genetic testing %K pathogenic variant %K germline %K risk communication %K online health %K digital health %K cancer data %K genetics %K online tool %K bioinformatics %K web tool %K cancer %D 2021 %7 13.7.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Genetic testing for germline cancer susceptibility genes is widely available. The Ask2Me.org (All Syndromes Known to Man Evaluator) tool is a clinical decision support tool that provides evidence-based risk predictions for individuals with pathogenic variants in cancer susceptibility genes. Objective: The aim of this study was to understand the search behavior of the Ask2Me.org tool users, identify the patterns of queries entered, and discuss how to further improve the tool. Methods: We analyzed the Ask2Me.org user-generated queries collected between December 12, 2018, and October 8, 2019. The gene frequencies of the user-generated queries were compared with previously published panel testing data to assess the correspondence between usage and prevalence of pathogenic variants. The frequencies of prior cancer in the user-generated queries were compared with the most recent US population–based cancer incidence. Results: A total of 10,085 search queries were evaluated. The average age submitted in the queries was 48.8 (SD 16.5) years, and 84.1% (8478/10,085) of the submitted queries were for females. BRCA2 (1671/10,085, 16.6%), BRCA1 (1627/10,085, 16.1%), CHEK2 (994/10,085, 9.9%), ATM (662/10,085, 6.6%), and APC (492/10,085, 4.9%) were the top 5 genes searched by users. There was a strong linear correlation between genes queried by users and the frequency of pathogenic variants reported in published panel testing data (r=0.95, r2=0.90, P<.001). Over half of the queries (5343/10,085, 53.0%) included a prior personal history of cancer. The frequencies of prior cancers in the queries on females were strongly correlated with US cancer incidences (r=0.97, r2=0.95, P<.001), while the same correlation was weaker among the queries on males (r=0.69, r2=0.47, P=.02). Conclusions: The patients entered in the Ask2Me.org tool are a representative cohort of patients with pathogenic variants in cancer susceptibility genes in the United States. While a majority of the queries were on breast cancer susceptibility genes, users also queried susceptibility genes with lower prevalence, which may represent a transformation from single gene testing to multigene panel testing. Owing to these changing tides, more efforts are needed to improve evidence-based clinical decision support tools to better aid clinicians and their practice. %M 34255640 %R 10.2196/28527 %U https://cancer.jmir.org/2021/3/e28527 %U https://doi.org/10.2196/28527 %U http://www.ncbi.nlm.nih.gov/pubmed/34255640 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e28952 %T A Web-Based Intervention to Increase Smokers’ Intentions to Participate in a Cessation Study Offered at the Point of Lung Screening: Factorial Randomized Trial %A Neil,Jordan M %A Chang,Yuchiao %A Goshe,Brett %A Rigotti,Nancy %A Gonzalez,Irina %A Hawari,Saif %A Ballini,Lauren %A Haas,Jennifer S %A Marotta,Caylin %A Wint,Amy %A Harris,Kim %A Crute,Sydney %A Flores,Efren %A Park,Elyse R %+ Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, 1404, Oklahoma City, OK, 73104, United States, 1 6034430743, jordan-neil@ouhsc.edu %K clinical trials recruitment %K digital outreach %K message design experiment %K smoking cessation %K lung cancer screening %K prospect theory %D 2021 %7 30.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Screen ASSIST is a cessation trial offered to current smokers at the point of lung cancer screening. Because of the unique position of promoting a prevention behavior (smoking cessation) within the context of a detection behavior (lung cancer screening), this study employed prospect theory to design and formatively evaluate a targeted recruitment video prior to trial launch. Objective: The aim of this study was to identify which message frames were most effective at promoting intent to participate in a smoking cessation study. Methods: Participants were recruited from a proprietary opt-in online panel company and randomized to a 2 (benefits of quitting vs risks of continuing to smoke at the time of lung screening; BvR) × 2 (gains of participating vs losses of not participating in a cessation study; GvL) message design experiment (N=314). The primary outcome was self-assessed intent to participate in a smoking cessation study. Message effectiveness and lung cancer risk perception measures were also collected. Analysis of variance examined the main effect of the 2 message factors and a least absolute shrinkage and selection operator (LASSO) approach identified predictors of intent to participate in a multivariable model. A mediation analysis was conducted to determine the direct and indirect effects of message factors on intent to participate in a cessation study. Results: A total of 296 participants completed the intervention. There were no significant differences in intent to participate in a smoking cessation study between message frames (P=.12 and P=.61). In the multivariable model, quit importance (P<.001), perceived message relevance (P<.001), and affective risk response (ie, worry about developing lung cancer; P<.001) were significant predictors of intent to participate. The benefits of quitting frame significantly increased affective risk response (Meanbenefits 2.60 vs Meanrisk 2.40; P=.03), which mediated the relationship between message frame and intent to participate (b=0.24; 95% CI 0.01-0.47; P=.03). Conclusions: This study provides theoretical and practical guidance on how to design and evaluate proactive recruitment messages for a cessation trial. Based on our findings, we conclude that heavy smokers are more responsive to recruitment messages that frame the benefits of quitting as it increased affective risk response, which predicted greater intention to participate in a smoking cessation study. %M 34255651 %R 10.2196/28952 %U https://formative.jmir.org/2021/6/e28952 %U https://doi.org/10.2196/28952 %U http://www.ncbi.nlm.nih.gov/pubmed/34255651 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e23839 %T Perceptions of Racially and Ethnically Diverse Women at High Risk of Breast Cancer Regarding the Use of a Web-Based Decision Aid for Chemoprevention: Qualitative Study Nested Within a Randomized Controlled Trial %A Jones,Tarsha %A Guzman,Ashlee %A Silverman,Thomas %A Freeman,Katherine %A Kukafka,Rita %A Crew,Katherine %+ Florida Atlantic University, 777 Glades Road, Boca Raton, FL, 33431, United States, 1 561 297 4975, Jonest@health.fau.edu %K breast cancer %K chemoprevention %K qualitative %K decision support %K cancer %K estrogen receptor %K web-based %K cancer risk %D 2021 %7 8.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Chemopreventive agents such as selective estrogen receptor modulators and aromatase inhibitors have proven efficacy in reducing breast cancer risk by 41% to 79% in high-risk women. Women at high risk of developing breast cancer face the complex decision of whether to take selective estrogen receptor modulators or aromatase inhibitors for breast cancer chemoprevention. RealRisks is a patient-centered, web-based decision aid (DA) designed to promote the understanding of breast cancer risk and to engage diverse women in planning a preference-sensitive course of decision making about taking chemoprevention. Objective: This study aims to understand the perceptions of women at high risk of developing breast cancer regarding their experience with using RealRisks—a DA designed to promote the uptake of breast cancer chemoprevention—and to understand their information needs. Methods: We completed enrollment to a randomized controlled trial among 300 racially and ethnically diverse women at high risk of breast cancer who were assigned to standard educational materials alone or such materials in combination with RealRisks. We conducted semistructured interviews with a subset of 21 high-risk women enrolled in the intervention arm of the randomized controlled trial who initially accessed the tool (on average, 1 year earlier) to understand how they interacted with the tool. All interviews were audio recorded, transcribed verbatim, and compared with digital audio recordings to ensure the accuracy of the content. We used content analysis to generate themes. Results: The mean age of the 21 participants was 58.5 (SD 10.1) years. The participants were 5% (1/21) Asian, 24% (5/21) Black or African American, and 71% (15/21) White; 10% (2/21) of participants were Hispanic or Latina. All participants reported using RealRisks after being granted access to the DA. In total, 4 overarching themes emerged from the qualitative analyses: the acceptability of the intervention, specifically endorsed elements of the DA, recommendations for improvements, and information needs. All women found RealRisks to be acceptable and considered it to be helpful (21/21, 100%). Most women (13/21, 62%) reported that RealRisks was easy to navigate, user-friendly, and easily accessible on the web. The majority of women (18/21, 86%) felt that RealRisks improved their knowledge about breast cancer risk and chemoprevention options and that RealRisks informed their (17/21, 81%) decision about whether or not to take chemoprevention. Some women (9/21, 43%) shared recommendations for improvements, as they wanted more tailoring based on user characteristics, felt that the DA was targeting a narrow population of Hispanic or Latina by using graphic novel–style narratives, wanted more understandable terminology, and felt that the tool placed a strong emphasis on chemoprevention drugs. Conclusions: This qualitative study demonstrated the acceptability of the RealRisks web-based DA among a diverse group of high-risk women, who provided some recommendations for improvement. %M 34100769 %R 10.2196/23839 %U https://www.jmir.org/2021/6/e23839 %U https://doi.org/10.2196/23839 %U http://www.ncbi.nlm.nih.gov/pubmed/34100769 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 1 %P e24652 %T A Virtual Reality Game to Change Sun Protection Behavior and Prevent Cancer: User-Centered Design Approach %A Horsham,Caitlin %A Dutton-Regester,Ken %A Antrobus,Jodie %A Goldston,Andrew %A Price,Harley %A Ford,Helen %A Hacker,Elke %+ School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, 4059, Australia, 61 731389674, elke.hacker@qut.edu.au %K virtual reality %K gamification %K primary prevention %K health promotion %K skin cancer %K mobile phone %D 2021 %7 25.3.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Public health sun safety campaigns introduced during the 1980s have successfully reduced skin cancer rates in Australia. Despite this success, high rates of sunburn continue to be reported by youth and young adults. As such, new strategies to reinforce sun protection approaches in this demographic are needed. Objective: This study aims to develop a virtual reality (VR) game containing preventive skin cancer messaging and to assess the safety and satisfaction of the design based on end user feedback. Methods: Using a two-phase design approach, we created a prototype VR game that immersed the player inside the human body while being confronted with growing cancer cells. The first design phase involved defining the problem, identifying stakeholders, choosing the technology platform, brainstorming, and designing esthetic elements. In the second design phase, we tested the prototype VR experience with stakeholders and end users in focus groups and interviews, with feedback incorporated into refining and improving the design. Results: The focus groups and interviews were conducted with 18 participants. Qualitative feedback indicated high levels of satisfaction, with all participants reporting the VR game as engaging. A total of 11% (2/8) of participants reported a side effect of feeling nauseous during the experience. The end user feedback identified game improvements, suggesting an extended multistage experience with visual transitions to other environments and interactions involving cancer causation. The implementation of the VR game identified challenges in sharing VR equipment and hygiene issues. Conclusions: This study presents key findings highlighting the design and implementation approaches for a VR health intervention primarily aimed at improving sun protection behaviors. This design approach can be applied to other health prevention programs in the future. %M 33764308 %R 10.2196/24652 %U https://games.jmir.org/2021/1/e24652 %U https://doi.org/10.2196/24652 %U http://www.ncbi.nlm.nih.gov/pubmed/33764308 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 3 %P e18269 %T Comparative Analysis of Paper-Based and Web-Based Versions of the National Comprehensive Cancer Network-Functional Assessment of Cancer Therapy-Breast Cancer Symptom Index (NFBSI-16) Questionnaire in Breast Cancer Patients: Randomized Crossover Study %A Ma,Jinfei %A Zou,Zihao %A Pazo,Emmanuel Eric %A Moutari,Salissou %A Liu,Ye %A Jin,Feng %+ Department of Breast Surgery, The First Affiliated Hospital of China Medical University, No 155 Nanjing Road, Heping District, Shenyang, 110001, China, 86 18040031101, jinfeng@cmu.edu.cn %K breast cancer %K NFBSI-16 %K patient-reported outcome %K reproducibility %K test-retest reliability %K web-based questionnaire %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Breast cancer remains the most common neoplasm diagnosed among women in China and globally. Health-related questionnaire assessments in research and clinical oncology settings have gained prominence. The National Comprehensive Cancer Network–Functional Assessment of Cancer Therapy–Breast Cancer Symptom Index (NFBSI-16) is a rapid and powerful tool to help evaluate disease- or treatment-related symptoms, both physical and emotional, in patients with breast cancer for clinical and research purposes. Prevalence of individual smartphones provides a potential web-based approach to administrating the questionnaire; however, the reliability of the NFBSI-16 in electronic format has not been assessed. Objective: This study aimed to assess the reliability of a web-based NFBSI-16 questionnaire in breast cancer patients undergoing systematic treatment with a prospective open-label randomized crossover study design. Methods: We recruited random patients with breast cancer under systematic treatment from the central hospital registry to complete both paper- and web-based versions of the questionnaires. Both versions of the questionnaires were self-assessed. Patients were randomly assigned to group A (paper-based first and web-based second) or group B (web-based first and paper-based second). A total of 354 patients were included in the analysis (group A: n=177, group B: n=177). Descriptive sociodemographic characteristics, reliability and agreement rates for single items, subscales, and total score were analyzed using the Wilcoxon test. The Lin concordance correlation coefficient (CCC) and Spearman and Kendall τ rank correlations were used to assess test-retest reliability. Results: Test-retest reliability measured with CCCs was 0.94 for the total NFBSI-16 score. Significant correlations (Spearman ρ) were documented for all 4 subscales—Disease-Related Symptoms Subscale–Physical (ρ=0.93), Disease-Related Symptoms Subscale–Emotional (ρ=0.85), Treatment Side Effects Subscale (ρ=0.95), and Function and Well-Being Subscale (ρ=0.91)—and total NFBSI-16 score (ρ=0.94). Mean differences of the test and retest were all close to zero (≤0.06). The parallel test-retest reliability of subscales with the Wilcoxon test comparing individual items found GP3 (item 5) to be significantly different (P=.02). A majority of the participants in this study (255/354, 72.0%) preferred the web-based over the paper-based version. Conclusions: The web-based version of the NFBSI-16 questionnaire is an excellent tool for monitoring individual breast cancer patients under treatment, with the majority of participants preferring it over the paper-based version. %M 33650978 %R 10.2196/18269 %U https://medinform.jmir.org/2021/3/e18269 %U https://doi.org/10.2196/18269 %U http://www.ncbi.nlm.nih.gov/pubmed/33650978 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e25184 %T Preliminary Screening for Hereditary Breast and Ovarian Cancer Using a Chatbot Augmented Intelligence Genetic Counselor: Development and Feasibility Study %A Sato,Ann %A Haneda,Eri %A Suganuma,Nobuyasu %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 artificial intelligence %K augmented intelligence %K hereditary cancer %K familial cancer %K IBM Watson %K preliminary screening %K cancer %K genetics %K chatbot %K screening %K feasibility %D 2021 %7 5.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Breast cancer is the most common form of cancer in Japan; genetic background and hereditary breast and ovarian cancer (HBOC) are implicated. The key to HBOC diagnosis involves screening to identify high-risk individuals. However, genetic medicine is still developing; thus, many patients who may potentially benefit from genetic medicine have not yet been identified. Objective: This study’s objective is to develop a chatbot system that uses augmented intelligence for HBOC screening to determine whether patients meet the National Comprehensive Cancer Network (NCCN) BRCA1/2 testing criteria. Methods: The system was evaluated by a doctor specializing in genetic medicine and certified genetic counselors. We prepared 3 scenarios and created a conversation with the chatbot to reflect each one. Then we evaluated chatbot feasibility, the required time, the medical accuracy of conversations and family history, and the final result. Results: The times required for the conversation were 7 minutes for scenario 1, 15 minutes for scenario 2, and 16 minutes for scenario 3. Scenarios 1 and 2 met the BRCA1/2 testing criteria, but scenario 3 did not, and this result was consistent with the findings of 3 experts who retrospectively reviewed conversations with the chatbot according to the 3 scenarios. A family history comparison ascertained by the chatbot with the actual scenarios revealed that each result was consistent with each scenario. From a genetic medicine perspective, no errors were noted by the 3 experts. Conclusions: This study demonstrated that chatbot systems could be applied to preliminary genetic medicine screening for HBOC. %M 33544084 %R 10.2196/25184 %U https://formative.jmir.org/2021/2/e25184 %U https://doi.org/10.2196/25184 %U http://www.ncbi.nlm.nih.gov/pubmed/33544084 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e23318 %T Adherence of Internet-Based Cancer Risk Assessment Tools to Best Practices in Risk Communication: Content Analysis %A Waters,Erika A %A Foust,Jeremy L %A Scherer,Laura D %A McQueen,Amy %A Taber,Jennifer M %+ Washington University School of Medicine, 600 S Euclid Ave, Campus Box 8100, Saint Louis, MO, 63110, United States, 1 3147475705, waterse@wustl.edu %K health communication %K personalized medicine %K internet %K risk assessment %D 2021 %7 25.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based risk assessment tools offer a potential avenue for people to learn about their cancer risk and adopt risk-reducing behaviors. However, little is known about whether internet-based risk assessment tools adhere to scientific evidence for what constitutes good risk communication strategies. Furthermore, their quality may vary from a user experience perspective. Objective: This study aims to understand the extent to which current best practices in risk communication have been applied to internet-based cancer risk assessment tools. Methods: We conducted a search on August 6, 2019, to identify websites that provided personalized assessments of cancer risk or the likelihood of developing cancer. Each website (N=39) was coded according to standardized criteria and focused on 3 categories: general website characteristics, accessibility and credibility, and risk communication formats and strategies. Results: Some best practices in risk communication were more frequently adhered to by websites. First, we found that undefined medical terminology was widespread, impeding comprehension for those with limited health literacy. For example, 90% (35/39) of websites included technical language that the general public may find difficult to understand, yet only 23% (9/39) indicated that medical professionals were their intended audience. Second, websites lacked sufficient information for users to determine the credibility of the risk assessment, making it difficult to judge the scientific validity of their risk. For instance, only 59% (23/39) of websites referenced the scientific model used to calculate the user’s cancer risk. Third, practices known to foster unbiased risk comprehension, such as adding qualitative labels to quantitative numbers, were used by only 15% (6/39) of websites. Conclusions: Limitations in risk communication strategies used by internet-based cancer risk assessment tools were common. By observing best practices, these tools could limit confusion and cultivate understanding to help people make informed decisions and motivate people to engage in risk-reducing behaviors. %M 33492238 %U http://www.jmir.org/2021/1/e23318/ %U http://www.ncbi.nlm.nih.gov/pubmed/33492238 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e23669 %T Mining Electronic Health Records to Promote the Reach of Digital Interventions for Cancer Prevention Through Proactive Electronic Outreach: Protocol for the Mixed Methods OptiMine Study %A Amato,Michael S %A El-Toukhy,Sherine %A Abroms,Lorien C %A Goodfellow,Henry %A Ramsey,Alex T %A Brown,Tracey %A Jopling,Helena %A Khadjesari,Zarnie %+ Behavioural and Implementation Science research group, School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom, 44 1603 59 7648, Z.Khadjesari@uea.ac.uk %K EHR %K electronic health record %K smoking cessation %K alcohol reduction %K proactive outreach %K proactive messages %K electronic messages %D 2020 %7 31.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital behavior change interventions have demonstrated effectiveness for smoking cessation and reducing alcohol intake, which ultimately reduce cancer risk. Leveraging electronic health records (EHR) to identify at-risk patients and increasing the reach of digital interventions through proactive electronic outreach provide a novel approach that may increase the number of individuals who engage with evidence-based treatment. Objective: This study aims to increase the reach of digital behavior change interventions by implementing a proactive electronic message system for smoking cessation and alcohol reduction among a large, at-risk population identified through an acute hospital EHR. Methods: This protocol describes a 3-phase, mixed-methods implementation study to assess the acceptability, feasibility, and reach of a proactive electronic message system to digital interventions using a hospital’s EHR system to identify eligible patients. In Phase 1, we will conduct focus group discussions with patients and hospital staff to assess the overall acceptability of the electronic message system. In Phase 2, we will conduct a descriptive analysis of the patient population in the hospital EHR regarding target risk behaviors and other person-level characteristics to determine the project’s feasibility and potential reach. In Phase 3, we will send proactive messages to patients identified as smokers or risky drinkers. Messages will encourage and provide access to behavior change mobile apps via an embedded link; the primary outcome will be the proportion of participants who click on the link to access information about the apps. Results: At the time of initial protocol submission, data collection was complete, but analysis had not begun. This study was funded by Cancer Research UK from April 2019 to March 2020. Health Research Authority approval was granted in June 2019. Conclusions: Increasing the reach of digital behavior change interventions can improve population health by reducing the burden of preventable death and disease. International Registered Report Identifier (IRRID): DERR1-10.2196/23669 %M 33382041 %R 10.2196/23669 %U http://www.researchprotocols.org/2020/12/e23669/ %U https://doi.org/10.2196/23669 %U http://www.ncbi.nlm.nih.gov/pubmed/33382041 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e21582 %T Use of Social Media to Promote Cancer Screening and Early Diagnosis: Scoping Review %A Plackett,Ruth %A Kaushal,Aradhna %A Kassianos,Angelos P %A Cross,Aaron %A Lewins,Douglas %A Sheringham,Jessica %A Waller,Jo %A von Wagner,Christian %+ Department of Applied Health Research, University College London, 1-19 Torrington Place,, Bloomsbury, London, WC1E 7HB, United Kingdom, 44 20 3108 3242, ruth.plackett.15@ucl.ac.uk %K social media %K review %K cancer %K campaign %K health promotion %K public health %K early detection of cancer %K cancer screening %K health care disparities %D 2020 %7 9.11.2020 %9 Review %J J Med Internet Res %G English %X Background: Social media is commonly used in public health interventions to promote cancer screening and early diagnosis, as it can rapidly deliver targeted public health messages to large numbers of people. However, there is currently little understanding of the breadth of social media interventions and evaluations, whether they are effective, and how they might improve outcomes. Objective: This scoping review aimed to map the evidence for social media interventions to improve cancer screening and early diagnosis, including their impact on behavior change and how they facilitate behavior change. Methods: Five databases and the grey literature were searched to identify qualitative and quantitative evaluations of social media interventions targeting cancer screening and early diagnosis. Two reviewers independently reviewed each abstract. Data extraction was carried out by one author and verified by a second author. Data on engagement was extracted using an adapted version of the key performance indicators and metrics related to social media use in health promotion. Insights, exposure, reach, and differing levels of engagement, including behavior change, were measured. The behavior change technique taxonomy was used to identify how interventions facilitated behavior change. Results: Of the 23 publications and reports included, the majority (16/23, 70%) evaluated national cancer awareness campaigns (eg, breast cancer awareness month). Most interventions delivered information via Twitter (13/23, 57%), targeted breast cancer (12/23, 52%), and measured exposure, reach, and low- to medium-level user engagement, such as number of likes (9/23, 39%). There were fewer articles about colorectal and lung cancer than about breast and prostate cancer campaigns. One study found that interventions had less reach and engagement from ethnic minority groups. A small number of articles (5/23, 22%) suggested that some types of social media interventions might improve high-level engagement, such as intended and actual uptake of screening. Behavior change techniques, such as providing social support and emphasizing the consequences of cancer, were used to engage users. Many national campaigns delivered fundraising messages rather than actionable health messages. Conclusions: The limited evidence suggests that social media interventions may improve cancer screening and early diagnosis. Use of evaluation frameworks for social media interventions could help researchers plan more robust evaluations that measure behavior change. We need a greater understanding of who engages with these interventions to know whether social media can be used to reduce some health inequalities in cancer screening and early diagnosis. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-033592 %M 33164907 %R 10.2196/21582 %U http://www.jmir.org/2020/11/e21582/ %U https://doi.org/10.2196/21582 %U http://www.ncbi.nlm.nih.gov/pubmed/33164907 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e17050 %T Computer-Tailored Decision Support Tool for Lung Cancer Screening: Community-Based Pilot Randomized Controlled Trial %A Carter-Harris,Lisa %A Comer,Robert Skipworth %A Slaven II,James E %A Monahan,Patrick O %A Vode,Emilee %A Hanna,Nasser H %A Ceppa,DuyKhanh Pham %A Rawl,Susan M %+ Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, United States, 1 6468880040, carterl@mskcc.org %K lung cancer screening %K informed decision-making %K shared decision-making %K patient decision aid %K patient education %D 2020 %7 3.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Lung cancer screening is a US Preventive Services Task Force Grade B recommendation that has been shown to decrease lung cancer-related mortality by approximately 20%. However, making the decision to screen, or not, for lung cancer is a complex decision because there are potential risks (eg, false positive results, overdiagnosis). Shared decision making was incorporated into the lung cancer screening guideline and, for the first time, is a requirement for reimbursement of a cancer screening test from Medicare. Awareness of lung cancer screening remains low in both the general and screening-eligible populations. When a screening-eligible person visits their clinician never having heard about lung cancer screening, engaging in shared decision making to arrive at an informed decision can be a challenge. Methods to effectively prepare patients for these clinical encounters and support both patients and clinicians to engage in these important discussions are needed. Objective: The aim of the study was to estimate the effects of a computer-tailored decision support tool that meets the certification criteria of the International Patient Decision Aid Standards that will prepare individuals and support shared decision making in lung cancer screening decisions. Methods: A pilot randomized controlled trial with a community-based sample of 60 screening-eligible participants who have never been screened for lung cancer was conducted. Approximately half of the participants (n=31) were randomized to view LungTalk—a web-based tailored computer program—while the other half (n=29) viewed generic information about lung cancer screening from the American Cancer Society. The outcomes that were compared included lung cancer and screening knowledge, lung cancer screening health beliefs (perceived risk, perceived benefits, perceived barriers, and self-efficacy), and perception of being prepared to engage in a discussion about lung cancer screening with their clinician. Results: Knowledge scores increased significantly for both groups with greater improvement noted in the group receiving LungTalk (2.33 vs 1.14 mean change). Perceived self-efficacy and perceived benefits improved in the theoretically expected directions. Conclusions: LungTalk goes beyond other decision tools by addressing lung health broadly, in the context of performing a low-dose computed tomography of the chest that has the potential to uncover other conditions of concern beyond lung cancer, to more comprehensively educate the individual, and extends the work of nontailored decision aids in the field by introducing tailoring algorithms and message framing based upon smoking status in order to determine what components of the intervention drive behavior change when an individual is informed and makes the decision whether to be screened or not to be screened for lung cancer. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8694 %M 33141096 %R 10.2196/17050 %U https://www.jmir.org/2020/11/e17050 %U https://doi.org/10.2196/17050 %U http://www.ncbi.nlm.nih.gov/pubmed/33141096 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 2 %P e21697 %T The Impact of COVID-19 on Cancer Screening: Challenges and Opportunities %A Cancino,Ramon S %A Su,Zhaohui %A Mesa,Ruben %A Tomlinson,Gail E %A Wang,Jing %+ Department of Family & Community Medicine, Joe R & Teresa Lozano Long School of Medicine, UT Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, United States, 1 2165710888, cancinor@uthscsa.edu %K cancer %K screening %K COVID-19 %K coronavirus %K telemedicine %K social determinants %K health %K education %K training %K social media %K campaign %K branding %K cobranding %D 2020 %7 29.10.2020 %9 Viewpoint %J JMIR Cancer %G English %X Cancer is a leading cause of death in the United States and across the globe. Cancer screening is an effective preventive measure that can reduce cancer incidence and mortality. While cancer screening is integral to cancer control and prevention, due to the COVID-19 outbreak many screenings have either been canceled or postponed, leaving a vast number of patients without access to recommended health care services. This disruption to cancer screening services may have a significant impact on patients, health care practitioners, and health systems. In this paper, we aim to offer a comprehensive view of the impact of COVID-19 on cancer screening. We present the challenges COVID-19 has exerted on patients, health care practitioners, and health systems as well as potential opportunities that could help address these challenges. %M 33027039 %R 10.2196/21697 %U http://cancer.jmir.org/2020/2/e21697/ %U https://doi.org/10.2196/21697 %U http://www.ncbi.nlm.nih.gov/pubmed/33027039 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 10 %P e21093 %T Qualitative Evidence Synthesis on Self-Collection for Human Papillomavirus–Based Cervical Screening: Protocol for Systematic Review %A Camara,Hawa %A Zhang,Ye %A Lafferty,Lise %A Vallely,Andrew %A Guy,Rebecca %A Kelly-Hanku,Angela %+ The Kirby Institute, UNSW Sydney, Wallace Wurth Building, Kensington, Australia, 61 0478118162, camhaw@gmail.com %K self-collection %K HPV-based testing %K cervical screening %K qualitative evidence synthesis %K protocol %K systematic review %D 2020 %7 22.10.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cervical cancer is the fourth most common cancer affecting women worldwide. In the 1980s, it was found that the sexually transmitted disease human papillomavirus causes over 90% of all cervical cancer cases. Since that discovery, diagnostic technologies have been developed for the detection of human papillomavirus DNA in cervical samples. However, significant sociocultural and structural barriers remain. Considerable strides have taken place in recent years to address these barriers, such as the self-collection for human papillomavirus–based cervical screening method. Objective: The purpose of this review is to synthesize qualitative evidence around the self-collection method and identify strategies to increase acceptability and feasibility in different settings. This qualitative synthesis will be used to better understand how to conceptualize and implement more effective, accessible, and socially and culturally acceptable cervical screening programs and policies globally. Methods: A systematic search will be conducted in Global Health, Cochrane, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ProQuest, ScienceDirect, EMBASE, EMCARE, Medline (OVID), Scopus, and Web of Science. Published and peer-reviewed articles will be included. Two reviewers will independently screen and assess the studies. The data will be coded and analyzed using a thematic synthesis process. The socioecological model will be used to organize emergent themes at the micro and macro levels. The results will be presented in narrative and tabular form. Results: The article search and data extraction were completed in May 2020. The data were analyzed in June 2020. The review will be submitted for publication in Fall 2020. Conclusions: This review will present the global evidence of the perspectives and experiences of various key stakeholders and how these perspectives and experiences impact their decision-making process to perform or accept self-collection for human papillomavirus–based cervical screening. The review will provide guidance to implementation researchers as well as implications for future research. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019109073; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=109073 International Registered Report Identifier (IRRID): DERR1-10.2196/21093 %M 33090114 %R 10.2196/21093 %U https://www.researchprotocols.org/2020/10/e21093 %U https://doi.org/10.2196/21093 %U http://www.ncbi.nlm.nih.gov/pubmed/33090114 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e18556 %T Research Participants’ Perspectives on Using an Electronic Portal for Engagement and Data Collection: Focus Group Results From a Large Epidemiologic Cohort %A Rees-Punia,Erika %A Patel,Alpa V %A Beckwitt,Asher %A Leach,Corinne R %A Gapstur,Susan M %A Smith,Tenbroeck G %+ American Cancer Society, 250 Williams St, Atlanta, GA, 30303, United States, 1 4049823684, erika.rees-punia@cancer.org %K focus groups %K health information technology %K epidemiologic studies %D 2020 %7 1.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Epidemiologic cohort studies have begun to leverage electronic research participant portals to facilitate data collection, integrate wearable technologies, lower costs, and engage participants. However, little is known about the acceptability of portal use by research participants. Objective: The aim of this study is to conduct focus groups among a sample of Cancer Prevention Study-3 (CPS-3) participants to better understand their preferences and concerns about research portals. Methods: CPS-3 participants were stratified based on sex, race and ethnicity, age, and cancer status, and randomly invited to participate. Focus groups used an exploratory case design with semistructured guides to prompt discussion. Using a constant comparison technique, transcripts were assigned codes to identify themes. Results: Participants (31/59, 52% women; 52/59, 88% White/non-Latinx) were favorably disposed toward using a research participant portal to take surveys, communicate with the study staff, and upload data. Most participants indicated that a portal would be beneficial and convenient but expressed concerns over data safety. Participants stressed the importance of an easy-to-use and trustworthy portal that is compatible with mobile devices. Conclusions: In addition to being beneficial to researchers, portals may also benefit participants as long as the portals are secure and simple. Participants believe that portals can provide convenient ways to report data and remain connected to the study. %M 33001033 %R 10.2196/18556 %U https://www.jmir.org/2020/10/e18556 %U https://doi.org/10.2196/18556 %U http://www.ncbi.nlm.nih.gov/pubmed/33001033 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 9 %P e21584 %T Breast Self-Examination System Using Multifaceted Trustworthiness: Observational Study %A Khana,Rajes %A Mahinderjit Singh,Manmeet %A Damanhoori,Faten %A Mustaffa,Norlia %+ Universiti Sains Malaysia, Jalan Sungai Dua, Gelugor, Penang, 11800, Malaysia, 60 46533888, manmeet@usm.my %K trust %K trustworthiness %K multifaceted trust %K breast self-examination %K breast cancer %K health care system %K social media %D 2020 %7 23.9.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Breast cancer is the leading cause of mortality among women worldwide. However, female patients often feel reluctant and embarrassed about meeting physicians in person to discuss their intimate body parts, and prefer to use social media for such interactions. Indeed, the number of patients and physicians interacting and seeking information related to breast cancer on social media has been growing. However, a physician may behave inappropriately on social media by sharing a patient’s personal medical data excessively with colleagues or the public. Such an act would reduce the physician’s trustworthiness from the patient’s perspective. The multifaceted trust model is currently most commonly used for investigating social media interactions, which facilitates its enhanced adoption in the context of breast self-examination. The characteristics of the multifaceted trust model go beyond being personalized, context-dependent, and transitive. This model is more user-centric, which allows any user to evaluate the interaction process. Thus, in this study, we explored and evaluated use of the multifaceted trust model for breast self-examination as a more suitable trust model for patient-physician social media interactions in breast cancer screening. Objective: The objectives of this study were: (1) to identify the trustworthiness indicators that are suitable for a breast self-examination system, (2) design and propose a breast self-examination system, and (3) evaluate the multifaceted trustworthiness interaction between patients and physicians. Methods: We used a qualitative study design based on open-ended interviews with 32 participants (16 outpatients and 16 physicians). The interview started with an introduction to the research objective and an explanation of the steps on how to use the proposed breast self-examination system. The breast self-examination system was then evaluated by asking the patient to rate their trustworthiness with the physician after the consultation. The evaluation was also based on monitoring the activity in the chat room (interactions between physicians and patients) during daily meetings, weekly meetings, and the articles posted by the physician in the forum. Results: Based on the interview sessions with 16 physicians and 16 patients on using the breast self-examination system, honesty had a strong positive correlation (r=0.91) with trustworthiness, followed by credibility (r=0.85), confidence (r=0.79), and faith (r=0.79). In addition, belief (r=0.75), competency (r=0.73), and reliability (r=0.73) were strongly correlated with trustworthiness, with the lowest correlation found for reputation (r=0.72). The correlation among trustworthiness indicators was significant (P<.001). Moreover, the trust level of a patient for a particular physician was found to increase after several interactions. Conclusions: Multifaceted trustworthiness has a significant impact on a breast self-examination system. Evaluation of trustworthiness indicators helps to ensure a trustworthy system and ethical interaction between a patient and physician. A new patient can obtain a consultation by referring to the best physician according to preference of other patients. Patients can also trust a physician based on another patient’s recommendation regarding the physician’s trust level. The correlation analysis further showed that the most preferred trustworthiness indicator is honesty. %M 32965225 %R 10.2196/21584 %U https://medinform.jmir.org/2020/9/e21584 %U https://doi.org/10.2196/21584 %U http://www.ncbi.nlm.nih.gov/pubmed/32965225 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e21243 %T Testing Wearable UV Sensors to Improve Sun Protection in Young Adults at an Outdoor Festival: Field Study %A Horsham,Caitlin %A Antrobus,Jodie %A Olsen,Catherine M %A Ford,Helen %A Abernethy,David %A Hacker,Elke %+ School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, 4059, Australia, 61 731389674, elke.hacker@qut.edu.au %K melanoma %K health promotion %K public health %K preventive medicine %K sunlight %K sunburn %K adolescents %D 2020 %7 16.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Australia and New Zealand have the highest skin cancer incidence rates worldwide, and sun exposure is the main risk factor for developing skin cancer. Sun exposure during childhood and adolescence is a critical factor in developing skin cancer later in life. Objective: This study aims to test the effectiveness of wearable UV sensors to increase sun protection habits (SPH) and prevent sunburn in adolescents. Methods: During the weeklong school leavers outdoor festival (November 2019) at the Gold Coast, Australia, registered attendees aged 15-19 years were recruited into the field study. Participants were provided with a wearable UV sensor and free sunscreen. The primary outcome was sun exposure practices using the SPH index. Secondary outcomes were self-reported sunburns, sunscreen use, and satisfaction with the wearable UV sensor. Results: A total of 663 participants were enrolled in the study, and complete data were available for 188 participants (188/663, 28.4% response rate). Participants provided with a wearable UV sensor significantly improved their use of sunglasses (P=.004) and sunscreen use both on the face (P<.001) and on other parts of the body (P=.005). However, the use of long-sleeve shirts (P<.001) and the use of a hat (P<.001) decreased. During the study period, 31.4% (59/188) of the participants reported receiving one or more sunburns. Satisfaction with the wearable UV sensor was high, with 73.4% (138/188) of participants reporting the UV sensor was helpful to remind them to use sun protection. Conclusions: Devices that target health behaviors when outdoors, such as wearable UV sensors, may improve use of sunscreen and sunglasses in adolescents. %M 32936083 %R 10.2196/21243 %U http://mhealth.jmir.org/2020/9/e21243/ %U https://doi.org/10.2196/21243 %U http://www.ncbi.nlm.nih.gov/pubmed/32936083 %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 %@ 1929-0748 %I JMIR Publications %V 9 %N 8 %P e17516 %T Effects of Alternative Offers of Screening Sigmoidoscopy and Colonoscopy on Utilization and Yield of Endoscopic Screening for Colorectal Neoplasms: Protocol of the DARIO Randomized Trial %A Schrotz-King,Petra %A Hoffmeister,Michael %A Sauer,Peter %A Schaible,Anja %A Brenner,Hermann %+ Division of Preventive Oncology, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 460, Heidelberg, 69120, Germany, 49 6221 56 35970 ext 56, petra.schrotz-king@nct-heidelberg.de %K cross-sectional study %K prospective randomized controlled two-arm intervention trial %K endoscopy %K screening colonoscopy %K screening sigmoidoscopy %K neoplasms %K liquid and tissue biobank %K human biosamples %K early detection markers %K blood %K stool %K urine %K saliva %K tissue %K prevention and early detection program %D 2020 %7 5.8.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Flexible sigmoidoscopy and colonoscopy are recommended screening options for colorectal cancer (CRC). Despite colonoscopy being offered for CRC screening in Germany, the uptake of this offer has been very limited. Objective: The objective of this study was to assess the potential for increasing use of endoscopic CRC screening and the detection of advanced colorectal neoplasms by offering the choice between use of flexible sigmoidoscopy and colonoscopy. Methods: The DARIO study includes a cross-sectional study (part I), followed by a prospective 2-arm randomized controlled intervention trial (part II) with an associated biobank study (part III). Participation is possible in part I of the DARIO study only, parts I and II, or all 3 study parts. After obtaining informed consent from the municipalities, 12,000 people, aged 50-54 years, from the Rhine-Neckar region in Germany were randomly selected from residential lists of the responsible population registries and invited to complete a standardized questionnaire to investigate the nature, frequency, timing, and results of previous CRC screening and eventual diagnostic colonoscopies. In study part II participants from study part I with no colonoscopy in the preceding 5 years are randomized into 2 arms: arm A offering screening colonoscopy only, and arm B offering both options, either screening colonoscopy or screening sigmoidoscopy. The primary endpoint is the proportion of participants in whom colorectal neoplasms >0.5 cm are detected and removed at screening endoscopy. The secondary endpoints are the detection rate of any neoplasm and use of any endoscopic screening. Part III of the study will use samples from participants in study part II to construct a liquid and tissue biobank for the evaluation of less invasive methods of early detection of colon cancer and for the more detailed characterization of the detected neoplasms. Blood, urine, stool, and saliva samples are taken before the endoscopy. Tissue samples are obtained from the neoplasms removed during endoscopy. Results: A total of 10,568 from 12,000 randomly selected women and men aged 50-54 years living in the Rhine-Neckar-Region of Germany have been invited for participation. The remaining 1432 (11.93%) could not be invited because they reached the age of 55 at the time of contact. Of those invited, 2785/10,568 (26.35%) participated in study part I; 53.60% (1493/2785) of these participants were female. Study parts II and III are ongoing. Conclusions: This study will answer the question if alternative offers of either screening sigmoidoscopy or screening colonoscopy will increase utilization and effectiveness of endoscopic CRC screening compared with an exclusive offer of screening colonoscopy. In addition, alternative noninvasive screening tests will be developed and validated. Trial Registration: German Clinical Trials Register DRKS00018932; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00018932 International Registered Report Identifier (IRRID): DERR1-10.2196/17516 %M 32755890 %R 10.2196/17516 %U https://www.researchprotocols.org/2020/8/e17516 %U https://doi.org/10.2196/17516 %U http://www.ncbi.nlm.nih.gov/pubmed/32755890 %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 %@ 1929-073X %I JMIR Publications %V 9 %N 3 %P e15911 %T Effect of Health Care Provider Delays on Short-Term Outcomes in Patients With Colorectal Cancer: Multicenter Population-Based Observational Study %A Abdulaal,Ahmed %A Arhi,Chanpreet %A Ziprin,Paul %+ Imperial College London, Department of Surgery and Cancer, St Mary's Hospital Campus, Praed Street, London, W2 1NY, United Kingdom, 44 0754513315, ahmed.abdulaal@nhs.net %K surgery %K cancer %K colorectal %K delay %D 2020 %7 17.7.2020 %9 Original Paper %J Interact J Med Res %G English %X Background: The United Kingdom has lower survival figures for all types of cancers compared to many European countries despite similar national expenditures on health. This discrepancy may be linked to long diagnostic and treatment delays. Objective: The aim of this study was to determine whether delays experienced by patients with colorectal cancer (CRC) affect their survival. Methods: This observational study utilized the Somerset Cancer Register to identify patients with CRC who were diagnosed on the basis of positive histology findings. The effects of diagnostic and treatment delays and their subdivisions on outcomes were investigated using Cox proportional hazards regression. Kaplan-Meier plots were used to illustrate group differences. Results: A total of 648 patients (375 males, 57.9% males) were included in this study. We found that neither diagnostic delay nor treatment delay had an effect on the overall survival in patients with CRC (χ23=1.5, P=.68; χ23=0.6, P=.90, respectively). Similarly, treatment delays did not affect the outcomes in patients with CRC (χ23=5.5, P=.14). The initial Cox regression analysis showed that patients with CRC who had short diagnostic delays were less likely to die than those experiencing long delays (hazard ratio 0.165, 95% CI 0.044-0.616; P=.007). However, this result was nonsignificant following sensitivity analysis. Conclusions: Diagnostic and treatment delays had no effect on the survival of this cohort of patients with CRC. The utility of the 2-week wait referral system is therefore questioned. Timely screening with subsequent early referral and access to diagnostics may have a more beneficial effect. %M 32706666 %R 10.2196/15911 %U https://www.i-jmr.org/2020/3/e15911 %U https://doi.org/10.2196/15911 %U http://www.ncbi.nlm.nih.gov/pubmed/32706666 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e16701 %T Web-Based Health Information Following the Renewal of the Cervical Screening Program in Australia: Evaluation of Readability, Understandability, and Credibility %A Mac,Olivia A %A Thayre,Amy %A Tan,Shumei %A Dodd,Rachael H %+ School of Public Health, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building, Sydney, 2006, Australia, 61 293515102, rachael.dodd@sydney.edu.au %K cervical screening %K internet %K consumer health information %K Australia %K papillomavirus infections %D 2020 %7 26.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Three main changes were implemented in the Australian National Cervical Screening Program (NCSP) in December 2017: an increase in the recommended age to start screening, extended screening intervals, and change from the Papanicolaou (Pap) test to primary human papillomavirus screening (cervical screening test). The internet is a readily accessible source of information to explain the reasons for these changes to the public. It is important that web-based health information about changes to national screening programs is accessible and understandable for the general population. Objective: This study aimed to evaluate Australian web-based resources that provide information about the changes to the cervical screening program. Methods: The term cervical screening was searched in 3 search engines. The first 10 relevant results across the first 3 pages of each search engine were selected. Overall, 2 authors independently evaluated each website for readability (Flesch Reading Ease [FRE], Flesch-Kincaid Grade Level, and Simple Measure of Gobbledygook [SMOG] index), quality of information (Patient Education Materials Assessment Tool [PEMAT] for printable materials), credibility (Journal of the American Medical Association [JAMA] benchmark criteria and presence of Health on the Net Foundation code of conduct [HONcode] certification), website design, and usability with 5 simulation questions to assess the relevance of information. A descriptive analysis was conducted for the readability measures, PEMAT, and the JAMA benchmark criteria. Results: Of the 49 websites identified in the search, 15 were eligible for inclusion. The consumer-focused websites were classed as fairly difficult to read (mean FRE score 51.8, SD 13.3). The highest FRE score (easiest to read) was 70.4 (Cancer Council Australia Cervical Screening Consumer Site), and the lowest FRE score (most difficult to read) was 33.0 (NCSP Clinical Guidelines). A total of 9 consumer-focused websites and 4 health care provider–focused websites met the recommended threshold (sixth to eighth grade; SMOG index) for readability. The mean PEMAT understandability scores were 87.7% (SD 6.0%) for consumer-focused websites and 64.9% (SD 13.8%) for health care provider–focused websites. The mean actionability scores were 58.1% (SD 19.1%) for consumer-focused websites and 36.7% (SD 11.0%) for health care provider–focused websites. Moreover, 9 consumer-focused and 3 health care provider–focused websites scored above 70% for understandability, and 2 consumer-focused websites had an actionability score above 70%. A total of 3 websites met all 4 of the JAMA benchmark criteria, and 2 websites displayed the HONcode. Conclusions: It is important for women to have access to information that is at an appropriate reading level to better understand the implications of the changes to the cervical screening program. These findings can help health care providers direct their patients toward websites that provide information on cervical screening that is written at accessible reading levels and has high understandability. %M 32442134 %R 10.2196/16701 %U http://www.jmir.org/2020/6/e16701/ %U https://doi.org/10.2196/16701 %U http://www.ncbi.nlm.nih.gov/pubmed/32442134 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e17372 %T Enhanced Patient Education for Colonic Polyp and Adenoma Detection: Meta-Analysis of Randomized Controlled Trials %A Tian,Xu %A Xu,Ling-Li %A Liu,Xiao-Ling %A Chen,Wei-Qing %+ Chongqing University Cancer Hospital, 181 Hanyu Road, Shapingba District, Chongqing, 400030, China, 86 18222275023, CQCH_ChenWQ@163.com %K colonoscopy %K bowel preparation %K patient education %K polyp detection rate %K adenoma detection rate %K meta-analysis %D 2020 %7 1.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To improve patients’ comprehension of bowel preparation instructions before colonoscopy, enhanced patient education (EPE) such as cartoon pictures or other visual aids, phone calls, mobile apps, multimedia education and social media apps have been proposed. However, it is uncertain whether EPE can increase the detection rate of colonic polyps and adenomas. Objective: This meta-analysis aimed to evaluate the efficacy of EPE in detecting colonic polyps and adenomas. Methods: We searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from their inception to June 2019 for the identification of trials comparing the EPE with standard patient education for outpatients undergoing colonoscopy. We used a random effects model to calculate summary estimates of the polyp detection rate (defined as the number of patients with at least one polyp divided by the total number of patients undergoing selective colonoscopy), adenoma detection rate (defined as the number of patients with at least one adenoma divided by the total number of patients undergoing selective colonoscopy), advanced adenoma detection rate (defined as the number of patients with at least one advanced adenoma divided by the total number of patients undergoing selective colonoscopy), sessile serrated adenoma detection rate (defined as the number of patients with at least one sessile serrated adenoma divided by the total number of patients undergoing selective colonoscopy), cancer detection rate (defined as the number of patients with at least one cancer divided by the total number of patients undergoing selective colonoscopy), or adenoma detection rate - plus (defined as the number of additional adenomas found after the first adenoma per colonoscopy). Moreover, we conducted trial sequential analysis (TSA) to determine the robustness of summary estimates of all primary outcomes. Results: We included 10 randomized controlled trials enrolling 4560 participants for analysis. The meta-analysis suggested that EPE was associated with an increased polyp detection rate (9 trials; 3781 participants; risk ratio [RR] 1.19, 95% CI 1.05-1.35; P<.05; I2=42%) and adenoma detection rate (5 trials; 2133 participants; RR 1.37, 95% CI 1.15-1.64; P<.001; I2=0%), which were established by TSA. Pooled result from the inverse-variance model illustrated an increase in the sessile serrated adenoma detection rate (3 trials; 1248 participants; odds ratio 1.76, 95% CI 1.22-2.53; P<.05; I2=0%). One trial suggested an increase in the adenoma detection rate - plus (RR 4.39, 95% CI 2.91-6.61; P<.001). Pooled estimates from 3 (1649 participants) and 2 trials (1375 participants) generated no evidence of statistical difference for the advanced adenoma detection rate and cancer detection rate, respectively. Conclusions: The current evidence indicates that EPE should be recommended to instruct bowel preparation in patients undergoing colonoscopy because it can increase the polyp detection rate, adenoma detection rate, and sessile serrated adenoma detection rate. However, further trials are warranted to determine the efficacy of EPE for advanced adenoma detection rate, adenoma detection rate - plus, and cancer detection rate because of limited data. %M 32347798 %R 10.2196/17372 %U https://mhealth.jmir.org/2020/6/e17372 %U https://doi.org/10.2196/17372 %U http://www.ncbi.nlm.nih.gov/pubmed/32347798 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e17079 %T Internet of Things Smart Sunscreen Station: Descriptive Proof-of-Concept Study %A Ford,Helen %A Herbert,Jeremy %A Horsham,Caitlin %A Wall,Alexander %A Hacker,Elke %+ Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, 4059, Australia, 61 731389674, elke.hacker@qut.edu.au %K skin neoplasms %K melanoma %K health promotion %K public health %K preventive medicine %K web applications %D 2020 %7 28.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Skin cancer is the most prevalent but also most preventable cancer in Australia. Outdoor workers are at increased risk of developing skin cancer, and improvements in sun protection are needed. Sunscreen, when applied at the recommended concentration (2 mg/cm2), has been shown to block the harmful molecular effects of ultraviolet radiation in vivo. However, sunscreen is often not applied, reapplied sufficiently, or stored adequately to yield protection and reduce sunburns. Objective: The primary aim of this study was to test an Internet of Things approach by deploying a smart sunscreen station to an outdoor regional mining site. Methods: We deployed a smart sunscreen station and examined the key technological considerations including connectivity, security, and data management systems. Results: The smart sunscreen station was deployed for 12 days at a mining workplace (Dalby, Australia). The smart sunscreen station’s electrical components remained operational during field testing, and data were received by the message queuing telemetry transport server automatically at the end of each day of field testing (12/12 days, 100% connectivity). Conclusions: This study highlights that an Internet of Things technology approach can successfully measure sunscreen usage and temperature storage conditions. %M 32463378 %R 10.2196/17079 %U http://www.jmir.org/2020/5/e17079/ %U https://doi.org/10.2196/17079 %U http://www.ncbi.nlm.nih.gov/pubmed/32463378 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 3 %N 1 %P e15711 %T The Feasibility and Acceptability of Using a Wearable UV Radiation Exposure Monitoring Device in Adults and Children: Cross-Sectional Questionnaire Study %A Nagelhout,Elizabeth Sela %A Lensink,Riley %A Zhu,Angela %A Parsons,Bridget G %A Jensen,Jakob D %A Wu,Yelena P %+ Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, United States, 1 8012135653, yelena.wu@utah.edu %K ultraviolet radiation exposure %K wearable device %K melanoma %K melanoma prevention %D 2020 %7 29.4.2020 %9 Original Paper %J JMIR Dermatol %G English %X Background: In the United States, melanoma is the fifth most common type of cancer. Reducing UV radiation (UVR) exposure is essential for the prevention of melanoma. The assessment of individual-level UVR exposure using wearable technology is a promising method to monitor and reduce UVR exposure. However, the feasibility and acceptability of using wearable UVR monitoring devices have not been assessed. Objective: This study aimed to assess the feasibility and acceptability of using a commercially available UVR monitoring wearable device in adults and children. Methods: We recruited families (1 parent and 1 child) to test a new, commercially available UVR monitoring device (namely, Shade). Participants wore Shade for 2 weeks and completed questionnaires assessing the feasibility and acceptability of wearing the device. Qualitative analyses were conducted to summarize participants’ open-ended responses regarding device feasibility. Results: A total of 194 individuals (97 adults and 97 children) participated in this study. The participating children were aged, on average, 12.7 years. Overall, adults and children reported moderate satisfaction with wearing Shade. The feasibility of the use of Shade was adequate, with 73% (65/89) of adults and 61% (54/89) of children reporting that they wore the device “all of the time they were outside.” Through open-ended responses, participants reported that the device was easy to use, was compact, and increased their awareness about their exposure to UVR. Conclusions: Adults and children can feasibly use a wearable UVR monitoring device, and the use of the device was acceptable to participants. The device could be integrated into melanoma preventive interventions to increase individuals’ and families’ awareness of UVR exposure and to facilitate the use of recommended melanoma preventive strategies. %M 33043275 %R 10.2196/15711 %U http://derma.jmir.org/2020/1/e15711/ %U https://doi.org/10.2196/15711 %U http://www.ncbi.nlm.nih.gov/pubmed/33043275 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 4 %P e16413 %T Effect of Various Invitation Schemes on the Use of Fecal Immunochemical Tests for Colorectal Cancer Screening: Protocol for a Randomized Controlled Trial %A Gruner,Laura Fiona %A Hoffmeister,Michael %A Ludwig,Leopold %A Brenner,Hermann %+ Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, Heidelberg, 69120, Germany, 49 6221 42 1300, h.brenner@dkfz.de %K colorectal cancer %K early detection %K screening %K fecal immunochemical test (FIT) %K invitation %K Germany %D 2020 %7 3.4.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Fecal occult blood testing has been offered for many years in the German health care system, but participation rates have been notoriously low. Objective: The aim of this study is to evaluate the effect of various personal invitation schemes on the use of fecal immunochemical tests (FITs) in persons aged 50-54 years. Methods: This study consists of a three-armed randomized controlled trial: (1) arm A: an invitation letter from a health insurance plan including a FIT test kit, (2) arm B: an invitation letter from a health insurance plan including an offer to receive a free FIT test kit by mail upon easy-to-handle request (ie, by internet, fax, or reply mail), and (3) arm C: an information letter on an existing colonoscopy offer (ie, control). Within arms A and B, a random selection of 50% of the study population will receive reminder letters, the effects of which are to be evaluated in a substudy. Results: A total of 17,532 persons aged 50-54 years in a statutory health insurance plan in the southwest of Germany—AOK Baden-Wuerttemberg—were sent an initial invitation, and 5825 reminder letters were sent out. The primary end point is FIT usage within 1 year from receipt of invitation or information letter. The main secondary end points include gender-specific FIT usage within 1 year, rates of positive test results, rates of colonoscopies following a positive test result, and detection rates of advanced neoplasms. The study was launched in September 2017. Data collection and workup were completed in fall 2019. Conclusions: This randomized controlled trial will provide important empirical evidence for enhancing colorectal cancer screening offers in the German health care system. Trial Registration: German Clinical Trials Register (DRKS) DRKS00011858; https://bit.ly/2UBTIdt International Registered Report Identifier (IRRID): DERR1-10.2196/16413 %M 32242518 %R 10.2196/16413 %U https://www.researchprotocols.org/2020/4/e16413 %U https://doi.org/10.2196/16413 %U http://www.ncbi.nlm.nih.gov/pubmed/32242518 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e15863 %T Effectiveness of One-Way Text Messaging on Attendance to Follow-Up Cervical Cancer Screening Among Human Papillomavirus–Positive Tanzanian Women (Connected2Care): Parallel-Group Randomized Controlled Trial %A Linde,Ditte S %A Andersen,Marianne S %A Mwaiselage,Julius %A Manongi,Rachel %A Kjaer,Susanne K %A Rasch,Vibeke %+ Department of Clinical Research, University of Southern Denmark, Kløvervænget 10, 10th Fl, Odense, 5000, Denmark, 45 61666564, dsondergaard@health.sdu.dk %K telemedicine %K cervical cancer %K HPV %K early detection of cancer %K Africa %D 2020 %7 2.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Rapid human papillomavirus (HPV) DNA testing is an emerging cervical cancer screening strategy in resource-limited countries, yet it requires follow-up of women who test HPV positive. Objective: This study aimed to determine if one-way text messages improved attendance to a 14-month follow-up cervical cancer screening among HPV-positive women. Methods: This multicenter, parallel-group randomized controlled trial was conducted at 3 hospitals in Tanzania. Eligible participants were aged between 25 and 60 years, had tested positive to a rapid HPV test during a patient-initiated screening, had been informed of their HPV result, and had a private mobile phone with a valid number. Participants were randomly assigned in a 1:1 ratio to the intervention or control group through an incorporated algorithm in the text message system. The intervention group received one-way text messages, and the control group received no text messages. The primary outcome was attendance at a 14-month health provider-initiated follow-up screening. Participants were not blinded, but outcome assessors were. The analysis was based on intention to treat. Results: Between August 2015 and July 2017, 4080 women were screened for cervical cancer, of which 705 were included in this trial—358 women were allocated to the intervention group, and 347 women were allocated to the control group. Moreover, 16 women were excluded before the analysis because they developed cervical cancer or died (8 from each group). In the intervention group, 24.0% (84/350) women attended their follow-up screening, and in the control group, 23.8% (80/335) women attended their follow-up screening (risk ratio 1.02, 95% CI 0.79-1.33). Conclusions: Attendance to a health provider-initiated follow-up cervical cancer screening among HPV-positive women was strikingly low, and one-way text messages did not improve the attendance rate. Implementation of rapid HPV testing as a primary screening method at the clinic level entails the challenge of ensuring a proper follow-up of women. Trial Registration: ClinicalTrials.gov NCT02509702; https://clinicaltrials.gov/ct2/show/NCT02509702. International Registered Report Identifier (IRRID): RR2-10.2196/10.2196/15863 %M 32238335 %R 10.2196/15863 %U http://www.jmir.org/2020/4/e15863/ %U https://doi.org/10.2196/15863 %U http://www.ncbi.nlm.nih.gov/pubmed/32238335 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e16467 %T Quantitative Screening of Cervical Cancers for Low-Resource Settings: Pilot Study of Smartphone-Based Endoscopic Visual Inspection After Acetic Acid Using Machine Learning Techniques %A Bae,Jung Kweon %A Roh,Hyun-Jin %A You,Joon S %A Kim,Kyungbin %A Ahn,Yujin %A Askaruly,Sanzhar %A Park,Kibeom %A Yang,Hyunmo %A Jang,Gil-Jin %A Moon,Kyung Hyun %A Jung,Woonggyu %+ Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Rm#709, 110 Bldg, 50 Unist-gil, Ulsan, 44919, Republic of Korea, 82 1084640110, wgjung@unist.ac.kr %K smartphone-based endoscope %K smartphone VIA %K machine learning %K cervical cancer screening %K low-resource settings %D 2020 %7 11.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Approximately 90% of global cervical cancer (CC) is mostly found in low- and middle-income countries. In most cases, CC can be detected early through routine screening programs, including a cytology-based test. However, it is logistically difficult to offer this program in low-resource settings due to limited resources and infrastructure, and few trained experts. A visual inspection following the application of acetic acid (VIA) has been widely promoted and is routinely recommended as a viable form of CC screening in resource-constrained countries. Digital images of the cervix have been acquired during VIA procedure with better quality assurance and visualization, leading to higher diagnostic accuracy and reduction of the variability of detection rate. However, a colposcope is bulky, expensive, electricity-dependent, and needs routine maintenance, and to confirm the grade of abnormality through its images, a specialist must be present. Recently, smartphone-based imaging systems have made a significant impact on the practice of medicine by offering a cost-effective, rapid, and noninvasive method of evaluation. Furthermore, computer-aided analyses, including image processing–based methods and machine learning techniques, have also shown great potential for a high impact on medicinal evaluations. Objective: In this study, we demonstrate a new quantitative CC screening technique and implement a machine learning algorithm for smartphone-based endoscopic VIA. We also evaluated the diagnostic performance and practicability of the approach based on the results compared to the gold standard and from physicians’ interpretation. Methods: A smartphone-based endoscope system was developed and applied to the VIA screening. A total of 20 patients were recruited for this study to evaluate the system. Overall, five were healthy, and 15 were patients who had shown a low to high grade of cervical intraepithelial neoplasia (CIN) from both colposcopy and cytology tests. Endoscopic VIA images were obtained before a loop electrosurgical excision procedure for patients with abnormal tissues, and their histology tissues were collected. Endoscopic VIA images were assessed by four expert physicians relative to the gold standard of histopathology. Also, VIA features were extracted from multiple steps of image processing techniques to find the differences between abnormal (CIN2+) and normal (≤CIN1). By using the extracted features, the performance of different machine learning classifiers, such as k-nearest neighbors (KNN), support vector machine, and decision tree (DT), were compared to find the best algorithm for VIA. After determining the best performing classifying model, it was used to evaluate the screening performance of VIA. Results: An average accuracy of 78%, with a Cohen kappa of 0.571, was observed for the evaluation of the system by four physicians. Through image processing, 240 sliced images were obtained from the cervicogram at each clock position, and five features of VIA were extracted. Among the three models, KNN showed the best performance for finding VIA within holdout 10-fold cross-validation, with an accuracy of 78.3%, area under the curve of 0.807, a specificity of 80.3%, and a sensitivity of 75.0%, respectively. The trained model performed using an unprovided data set resulted in an accuracy of 80.8%, specificity of 84.1%, and sensitivity of 71.9%. Predictions were visualized with intuitive color labels, indicating the normal/abnormal tissue using a circular clock-type segmentation. Calculating the overlapped abnormal tissues between the gold standard and predicted value, the KNN model overperformed the average assessments of physicians for finding VIA. Conclusions: We explored the potential of the smartphone-based endoscopic VIA as an evaluation technique and used the cervicogram to evaluate normal/abnormal tissue using machine learning techniques. The results of this study demonstrate its potential as a screening tool in low-resource settings. %M 32159521 %R 10.2196/16467 %U http://mhealth.jmir.org/2020/3/e16467/ %U https://doi.org/10.2196/16467 %U http://www.ncbi.nlm.nih.gov/pubmed/32159521 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 3 %P e16334 %T Performance of Computer-Aided Diagnosis in Ultrasonography for Detection of Breast Lesions Less and More Than 2 cm: Prospective Comparative Study %A Yongping,Liang %A Zhou,Ping %A Juan,Zhang %A Yongfeng,Zhao %A Liu,Wengang %A Shi,Yifan %+ The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Hexiyuelu District, Changsha, Hunan, 410013, China, 86 13974809881, zhouping1000@hotmail.com %K ultrasonography %K breast neoplasm %K breast imaging reporting and data system (BI-RADS) %K breast neoplasms diagnosis %K cancer screening %K computer diagnostic aid %D 2020 %7 2.3.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Computer-aided diagnosis (CAD) is used as an aid tool by radiologists on breast lesion diagnosis in ultrasonography. Previous studies demonstrated that CAD can improve the diagnosis performance of radiologists. However, the optimal use of CAD on breast lesions according to size (below or above 2 cm) has not been assessed. Objective: The aim of this study was to compare the performance of different radiologists using CAD to detect breast tumors less and more than 2 cm in size. Methods: We prospectively enrolled 261 consecutive patients (mean age 43 years; age range 17-70 years), including 398 lesions (148 lesions>2 cm, 79 malignant and 69 benign; 250 lesions≤2 cm, 71 malignant and 179 benign) with breast mass as the prominent symptom. One novice radiologist with 1 year of ultrasonography experience and one experienced radiologist with 5 years of ultrasonography experience were each assigned to read the ultrasonography images without CAD, and then again at a second reading while applying the CAD S-Detect. We then compared the diagnostic performance of the readers in the two readings (without and combined with CAD) with breast imaging. The McNemar test for paired data was used for statistical analysis. Results: For the novice reader, the area under the receiver operating characteristic curve (AUC) improved from 0.74 (95% CI 0.67-0.82) from the without-CAD mode to 0.88 (95% CI 0.83-0.93; P<.001) at the combined-CAD mode in lesions≤2 cm. For the experienced reader, the AUC improved from 0.84 (95% CI 0.77-0.90) to 0.90 (95% CI 0.86-0.94; P=.002). In lesions>2 cm, the AUC moderately decreased from 0.81 to 0.80 (novice reader) and from 0.90 to 0.82 (experienced reader). The sensitivity of the novice and experienced reader in lesions≤2 cm improved from 61.97% and 73.23% at the without-CAD mode to 90.14% and 97.18% (both P<.001) at the combined-CAD mode, respectively. Conclusions: S-Detect is a feasible diagnostic tool that can improve the sensitivity for both novice and experienced readers, while also improving the negative predictive value and AUC for lesions≤2 cm, demonstrating important application value in the clinical diagnosis of breast cancer. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800019649; http://www.chictr.org.cn/showprojen.aspx?proj=33094 %M 32130149 %R 10.2196/16334 %U https://medinform.jmir.org/2020/3/e16334 %U https://doi.org/10.2196/16334 %U http://www.ncbi.nlm.nih.gov/pubmed/32130149 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 1 %P e15487 %T Effectiveness of the ColorApp Mobile App for Health Education and Promotion for Colorectal Cancer: Quasi-Experimental Study %A Yaacob,Nor Azwany %A Mohamad Marzuki,Muhamad Fadhil %A Yaacob,Najib Majdi %A Ahmad,Shahrul Bariyah %A Abu Hassan,Muhammad Radzi %+ Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia, 60 9767 6622 ext 6621, azwany@usm.my %K colorectal cancer %K mobile app %K effectiveness %K knowledge %K attitude %D 2020 %7 25.2.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Lack of knowledge and poor attitude are barriers to colorectal cancer screening participation. Printed material, such as pamphlets and posters, have been the main approach in health education on disease prevention in Malaysia. Current information technology advancements have led to an increasing trend of the public reading from websites and mobile apps using their mobile phones. Thus, health information dissemination should also be diverted to websites and mobile apps. Increasing knowledge and awareness could increase screening participation and prevent late detection of diseases such as colorectal cancer. Objective: This study aimed to assess the effectiveness of the ColorApp mobile app in improving the knowledge and attitude on colorectal cancer among users aged 50 years and older, who are the population at risk for the disease in Kedah. Methods: A quasi-experimental study was conducted with 100 participants in Kedah, Malaysia. Participants from five randomly selected community empowerment programs in Kota Setar district were in the intervention group; Kuala Muda district was the control group. Participants were given a self-administered validated questionnaire on knowledge and attitudes toward colorectal cancer. A mobile app, ColorApp (Colorectal Cancer Application), was developed as a new educational tool for colorectal cancer prevention. The intervention group used the app for two weeks. The same questionnaire was redistributed to both groups after two weeks. The mean percentage scores for knowledge and attitude between groups were compared using repeated measure ANCOVA. Results: There was no significant difference in age, sex, highest education level, current occupation, and diabetic status between the two groups. The number of smokers was significantly higher in the intervention group compared with the control group and was controlled for during analysis. The intervention group showed a significantly higher mean knowledge score compared with the control group with regards to time (Huynh-Feldt: F1,95=19.81, P<.001). However, there was no significant difference in mean attitude scores between the intervention and control groups with regards to time (F1,95=0.36, P=.55). Conclusions: The ColorApp mobile app may be an adjunct approach in educating the public on colorectal cancer. %M 32130119 %R 10.2196/15487 %U https://humanfactors.jmir.org/2020/1/e15487 %U https://doi.org/10.2196/15487 %U http://www.ncbi.nlm.nih.gov/pubmed/32130119 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e14111 %T Challenges and Lessons Learned From a Mobile Health, Web-Based Human Papillomavirus Intervention for Female Korean American College Students: Feasibility Experimental Study %A Kim,Minjin %A Lee,Haeok %A Allison,Jeroan %+ University of Massachusetts Medical School, Department of Population and Quantitative Health Sciences, 368 Plantation Street, Worcester, MA, 01605, United States, 1 7202095559, minjin.kim2@umassmed.edu %K mHealth %K Web-based intervention %K fraud %K experimental design %D 2020 %7 29.1.2020 %9 Short Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) and Web-based research methods are becoming more commonplace for researchers. However, there is a lack of mHealth and Web-based human papillomavirus (HPV) prevention experimental studies that discuss potential issues that may arise. Objective: This study aimed to assess the feasibility of research procedures and discuss the challenges and lessons learned from an mHealth and Web-based HPV prevention experimental study targeting female Korean American college students in the United States. Methods: A pilot randomized controlled trial (RCT) was conducted in an mHealth and Web-based platform with 104 female Korean American college students aged 18-26 years between September 2016 and December 2016. Participants were randomized to either the experimental group (a storytelling video intervention) or the comparison group (a nonnarrative, information-based intervention). Outcomes included the feasibility of research procedures (recruitment, eligibility, randomization, and retention). Results: From September 2016 to October 2016, we recorded 225 entries in our initial eligibility survey. The eligibility rate was 54.2% (122/225). This study demonstrated a high recruitment rate (95.6%, 111/122) and retention rate (83.7%, 87/104) at the 2-month follow-up. Conclusions: Findings from this study demonstrated sufficient feasibility in terms of research procedures to justify a full-scale RCT. Given the increased possibility of invalid or misrepresentative entries in mHealth and Web-based studies, strategies for detection and prevention are critical. Trial Registration: ISRCTN Registry ISRCTN12175285; http://www.isrctn.com/ISRCTN12175285 %M 32012036 %R 10.2196/14111 %U http://formative.jmir.org/2020/1/e14111/ %U https://doi.org/10.2196/14111 %U http://www.ncbi.nlm.nih.gov/pubmed/32012036 %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 %@ 2291-9694 %I JMIR Publications %V 7 %N 3 %P e12660 %T Computer-Aided Detection for Breast Cancer Screening in Clinical Settings: Scoping Review %A Masud,Rafia %A Al-Rei,Mona %A Lokker,Cynthia %+ Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, CRL 137, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada, 1 905 525 9140 ext 22208, lokkerc@mcmaster.ca %K computer-aided detection %K machine learning %K screening mammography %K breast cancer %K radiology %K implementation %D 2019 %7 18.07.2019 %9 Review %J JMIR Med Inform %G English %X Background: With the growth of machine learning applications, the practice of medicine is evolving. Computer-aided detection (CAD) is a software technology that has become widespread in radiology practices, particularly in breast cancer screening for improving detection rates at earlier stages. Many studies have investigated the diagnostic accuracy of CAD, but its implementation in clinical settings has been largely overlooked. Objective: The aim of this scoping review was to summarize recent literature on the adoption and implementation of CAD during breast cancer screening by radiologists and to describe barriers and facilitators for CAD use. Methods: The MEDLINE database was searched for English, peer-reviewed articles that described CAD implementation, including barriers or facilitators, in breast cancer screening and were published between January 2010 and March 2018. Articles describing the diagnostic accuracy of CAD for breast cancer detection were excluded. The search returned 526 citations, which were reviewed in duplicate through abstract and full-text screening. Reference lists and cited references in the included studies were reviewed. Results: A total of nine articles met the inclusion criteria. The included articles showed that there is a tradeoff between the facilitators and barriers for CAD use. Facilitators for CAD use were improved breast cancer detection rates, increased profitability of breast imaging, and time saved by replacing double reading. Identified barriers were less favorable perceptions of CAD compared to double reading by radiologists, an increase in recall rates of patients for further testing, increased costs, and unclear effect on patient outcomes. Conclusions: There is a gap in the literature between CAD’s well-established diagnostic accuracy and its implementation and use by radiologists. Generally, the perceptions of radiologists have not been considered and details of implementation approaches for adoption of CAD have not been reported. The cost-effectiveness of CAD has not been well established for breast cancer screening in various populations. Further research is needed on how to best facilitate CAD in radiology practices in order to optimize patient outcomes, and the views of radiologists need to be better considered when advancing CAD use. %M 31322128 %R 10.2196/12660 %U http://medinform.jmir.org/2019/3/e12660/ %U https://doi.org/10.2196/12660 %U http://www.ncbi.nlm.nih.gov/pubmed/31322128 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e12242 %T What Patients Want in a Smartphone App That Supports Colonoscopy Preparation: Qualitative Study to Inform a User-Centered Smartphone App %A Sewitch,Maida J %A Fallone,Carlo A %A Ghali,Peter %A Lee,Ga Eun %+ Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve West, Montreal, QC, H4A 3S5, Canada, 1 514 934 1934 ext 44736, maida.sewitch@mcgill.ca %K colonoscopy %K early detection of cancer %K mobile health technology %K qualitative research %K smartphone %K user-centered %D 2019 %7 02.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The preparation for colonoscopy is elaborate and complex. In the context of colorectal cancer screening, up to 11% of patients do not keep their colonoscopy appointments and up to 33% of those attending their appointments have inadequately cleansed bowels that can delay cancer diagnosis and treatment. A smartphone app may be an acceptable and wide-reaching tool to improve patient adherence to colonoscopy. Objective: The aim of this qualitative study was to employ a user-centered approach to design the content and features of a smartphone app called colonAPPscopy to support individuals preparing for their colonoscopy appointments. Methods: We conducted 2 focus group discussions (FGDs) with gastroenterology patients treated at the McGill University Health Centre in Montreal, Canada. Patients were aged 50 to 75 years, were English- or French-speaking, and had undergone outpatient colonoscopy in the previous 3 months; they did not have inflammatory bowel disease or colorectal cancer. FGDs were 75 to 90 min, conducted by a trained facilitator, and audiotaped. Participants discussed the electronic health support tools they might use to help them prepare for the colonoscopy, the content needed for colonoscopy preparation, and the features that would make the smartphone app useful. Recordings of FGDs were transcribed and analyzed using thematic analysis to identify key user-defined content and features to inform the design of colonAPPscopy. Results: A total of 9 patients (7 male and 2 female) participated in one of 2 FGDs. Main content areas focused on bowel preparation instructions, medication restrictions, appointment logistics, communication, and postcolonoscopy expectations. Design features to make the app useful and engaging included minimization of data input, reminders and alerts for up to 7 days precolonoscopy, and visual aids. Participants wanted a smartphone app that comes from a trusted source, sends timely and tailored messages, provides reassurance, provides clear instructions, and is simple to use. Conclusions: Participants identified the need for postcolonoscopy information as well as reminders and alerts in the week before colonoscopy, novel content, and features that had not been included in previous smartphone-based strategies for colonoscopy preparation. The ability to tailor instructions made the smartphone app preferable to other modes of delivery. Study findings recognize the importance of including potential users in the development phase of building a smartphone app. %M 31125310 %R 10.2196/12242 %U https://mhealth.jmir.org/2019/7/e12242/ %U https://doi.org/10.2196/12242 %U http://www.ncbi.nlm.nih.gov/pubmed/31125310 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 1 %P e12307 %T A Thematic Analysis of Attitudes Toward Changes to Cervical Screening in Australia %A Dodd,Rachael H %A Obermair,Helena M %A McCaffery,Kirsten J %+ School of Public Health, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building, Sydney, 2006, Australia, 61 2 9351 5102, rachael.dodd@sydney.edu.au %K screening %K attitudes %K cervical cancer %K knowledge %D 2019 %7 11.04.2019 %9 Original Paper %J JMIR Cancer %G English %X Background: In December 2017, the Australian National Cervical Screening Program (NCSP) was changed to encompass a 5-yearly human papillomavirus (HPV) primary test for women aged 25 to 74 years. Public concerns about changes to screening programs has been demonstrated in other countries previously. Objective: The aim of the study was to explore in depth women’s understanding of and concerns about the specific changes to the Australian NCSP implemented in December 2017. Methods: A Web-based petition (Change.org) opposing the changes received over 70,000 signatures and nearly 20,000 comments from February to March 2017. Of 19,633 comments, a random sample of 10% (2000/19,633) were analyzed using content analysis (reported elsewhere). Comments relating directly to the specific changes to the program were further analyzed using qualitative thematic analysis. Results: Around one-third (34.55%; 691/2000) of the total comments were related to concerns about specific changes to the program. The greatest concern was that screening intervals would be too long and that cancer may not be detected in time for successful treatment. Missing cancer in younger women (aged <25 years) was also an important concern, perceiving younger women to remain at significant risk. Notably, concern was rarely expressed about the new test (the HPV test). Conclusions: Gaps in knowledge and understanding about changes to the program and the rationale behind these have caused health concerns among women. Worry about the extended screening interval indicates little understanding of the slow progression of the HPV infection to cervical cancer or the high rates of regression. Identification of these knowledge gaps can inform both deintensification of other cancer screening programs and practitioners, so that they are able to address these concerns with their patients. %M 30973340 %R 10.2196/12307 %U http://cancer.jmir.org/2019/1/e12307/ %U https://doi.org/10.2196/12307 %U http://www.ncbi.nlm.nih.gov/pubmed/30973340 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 2 %P e8540 %T FightHPV: Design and Evaluation of a Mobile Game to Raise Awareness About Human Papillomavirus and Nudge People to Take Action Against Cervical Cancer %A Ruiz-López,Tomás %A Sen,Sagar %A Jakobsen,Elisabeth %A Tropé,Ameli %A Castle,Philip E %A Hansen,Bo Terning %A Nygård,Mari %+ HPV Research Group, Department of Research, Cancer Registry of Norway, Ullernchausseen 64, 0379 Oslo, Norway, Oslo,, Norway, 47 95181886, mari.nygard@kreftregisteret.no %K papillomavirus vaccines %K educational technology %K uterine cervical neoplasms %K papillomavirus infections %K primary prevention %K secondary prevention %K early detection of cancer %K mobile applications %K health education %K learning %D 2019 %7 08.04.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: Human papillomavirus (HPV) is the most common sexually transmitted infection globally. High-risk HPV types can cause cervical cancer, other anogenital cancer, and oropharyngeal cancer; low-risk HPV types can cause genital warts. Cervical cancer is highly preventable through HPV vaccination and screening; however, a lack of awareness and knowledge of HPV and these preventive strategies represents an important barrier to reducing the burden of the disease. The rapid development and widespread use of mobile technologies in the last few years present an opportunity to overcome this lack of knowledge and create new, effective, and modern health communication strategies. Objective: This study aimed to describe the development of a mobile app called FightHPV, a game-based learning tool that educates mobile technology users about HPV, the disease risks associated with HPV infection, and existing preventive methods. Methods: The first version of FightHPV was improved in a design-development-evaluation loop, which incorporated feedback from a beta testing study of 40 participants, a first focus group of 6 participants aged between 40 and 50 years and a second focus group of 23 participants aged between 16 and 18 years. Gameplay data from the beta testing study were collected using Google Analytics (Google), whereas feedback from focus groups was evaluated qualitatively. Of the 29 focus group participants, 26 returned self-administered questionnaires. HPV knowledge before and after playing the game was evaluated in the 22 participants from the second focus group who returned a questionnaire. Results: FightHPV communicates concepts about HPV, associated diseases and their prevention by representing relationships among 14 characters in 6 episodes of 10 levels each, with each level being represented by a puzzle. Main concepts were reinforced with text explanations. Beta testing revealed that many players either failed or had to retry several times before succeeding at the more difficult levels in the game. It also revealed that players gave up at around level 47 of 60, which prompted the redesign of FightHPV to increase accessibility to all episodes. Focus group discussions led to several improvements in the user experience and dissemination of health information in the game, such as making all episodes available from the beginning of the game and rewriting the information in a more appealing way. Among the 26 focus group participants who returned a questionnaire, all stated that FightHPV is an appealing educational tool, 69% (18/26) reported that they liked the game, and 81% (21/26) stated that the game was challenging. We observed an increase in HPV knowledge after playing the game (P=.001). Conclusions: FightHPV was easy to access, use, and it increased awareness about HPV infection, its consequences, and preventive measures. FightHPV can be used to educate people to take action against HPV and cervical cancer. %M 30958271 %R 10.2196/games.8540 %U https://games.jmir.org/2019/2/e8540/ %U https://doi.org/10.2196/games.8540 %U http://www.ncbi.nlm.nih.gov/pubmed/30958271 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 1 %P e12480 %T Characterizing Trends in Human Papillomavirus Vaccine Discourse on Reddit (2007-2015): An Observational Study %A Lama,Yuki %A Hu,Dian %A Jamison,Amelia %A Quinn,Sandra Crouse %A Broniatowski,David A %+ Department of Family Science, School of Public Health, University of Maryland, 4200 Valley Drive, Bldg 225, College Park, MD, 20742, United States, 1 301 405 7574, lamay@terpmail.umd.edu %K papillomavirus infections %K prevention & control %K cancer prevention %K cervical cancer %K HPV %K vaccination %K papillomavirus vaccines %K immunology %K administration & dosage %K social media %K health communication %K infodemiology %D 2019 %7 18.3.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite the introduction of the human papillomavirus (HPV) vaccination as a preventive measure in 2006 for cervical and other cancers, uptake rates remain suboptimal, resulting in preventable cancer mortality. Social media, widely used for information seeking, can influence users’ knowledge and attitudes regarding HPV vaccination. Little is known regarding attitudes related to HPV vaccination on Reddit (a popular news aggregation site and online community), particularly related to cancer risk and sexual activity. Examining HPV vaccine–related messages on Reddit may provide insight into how HPV discussions are characterized on forums online and influence decision making related to vaccination. Objective: We observed how the HPV vaccine is characterized on Reddit over time and by user gender. Specifically, this study aimed to determine (1) if Reddit messages are more related to cancer risks or sexual behavior and (2) what other HPV vaccine–related discussion topics appear on Reddit. Methods: We gathered all public Reddit comments from January 2007 to September 2015. We manually annotated 400 messages to generate keywords and identify salient themes. We then measured the similarity between each comment and lists of keywords associated with sexual behavior and cancer risk using Latent Semantic Analysis (LSA). Next, we used Latent Dirichlet Allocation (LDA) to characterize remaining topics within the Reddit data. Results: We analyzed 22,729 messages containing the strings hpv or human papillomavirus and vaccin. LSA findings show that HPV vaccine discussions are significantly more related to cancer compared with sexual behavior from 2008 to 2015 (P<.001). We did not find a significant difference between genders in discussions of cancer and sexual activity (P>.05). LDA analyses demonstrated that although topics related to cancer risk and sexual activity were both frequently discussed (16.1% and 14.5% of word tokens, respectively), the majority of online discussions featured other topics. The most frequently discussed topic was politics associated with the vaccine (17.2%). Other topics included HPV disease and/or immunity (13.5%), the HPV vaccine schedule (11.5%), HPV vaccine side effects (9.7%), hyperlinks to outside sources (9.1%), and the risks and benefit of HPV vaccination (8.5%). Conclusions: Reddit discourse on HPV vaccine encompasses a broad range of topics among men and women, with HPV political debates and cancer risk making up the plurality of the discussion. Our findings demonstrated that women and men both discussed HPV, highlighting that Reddit users do not perceive HPV as an issue that only pertains to women. Given the increasing use of social media as a source of health information, these results can inform the development of targeted online health communication strategies to promote HPV vaccination to young adult users of Reddit. Analyzing online discussions on Reddit can inform health communication efforts by identifying relevant, important HPV-related topics among online communities. %R 10.2196/12480 %U http://publichealth.jmir.org/2019/1/e12480/ %U https://doi.org/10.2196/12480 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 1 %P e11938 %T Evaluating Information Quality of Revised Patient Education Information on Colonoscopy: It Is New But Is It Improved? %A Bernstein,Matthew Tyler %A Kong,James %A Sriranjan,Vaelan %A Reisdorf,Sofia %A Restall,Gayle %A Walker,John Roger %A Singh,Harminder %+ Department of Clinical Health Psychology, University of Manitoba, M4-Street Boniface Hospital, 409 Tache Ave, Winnipeg, MB, R2H2A6, Canada, 1 2042936286, umbernsm@myumanitoba.ca %K colonoscopy %K evaluation methodology %K information science %K information dissemination %K information literacy %D 2019 %7 20.02.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Previous research indicates that patients and their families have many questions about colonoscopy that are not fully answered by existing resources. We developed revised forms on colonoscopy bowel preparation and on the procedure itself. Objective: As the goal of the revised materials is to have improved information relative to currently available information, we were interested in how revised information compared with what is currently available in terms of information quality and patient preference. Methods: Participants were asked to review one at a time the Revised and Current versions of Colonoscopy bowel preparation instructions (study 1) and About Colonoscopy (study 2). The order of administration of the Revised and Current versions was randomly counterbalanced to assess order effects. Respondents rated each form along the following dimensions: amount, clarity, trustworthiness, readability and understandability, how new or familiar the information was, and reassurance. Participants were asked which form they preferred and 4 questions about why they preferred it. Open-ended questions asked participants to describe likes and dislikes of the forms and suggestions for improvement. Results: The study 1 and study 2 samples were similar. Overall, in study 1, 62.4% preferred the Revised form, 28.1% preferred the Current form, and 6.7% were not sure. Overall, in study 2, 50.5% preferred the Revised form, 31.1% preferred the Current form, and 18.4% were not sure. Almost 75% of those in study 1 who received the Revised form first, preferred it, compared with less than half of those who received it first in study 2. In study 1, 75% of those without previous colonoscopy experience preferred the Revised form, compared with more than half of those who had previously undergone a colonoscopy. The study 1 logistic regression analysis demonstrated that participants were more likely to prefer the Revised form if they had viewed it first and had no previous experience with colonoscopy. In study 2, none of the variables assessed were associated with a preference for the Revised form. In comparing the 2 forms head-to-head, participants who preferred the Revised form in study 1 rated it as clearer compared with those who preferred the Current form. Finally, many participants who preferred the Revised form indicated in the open-ended questions that they liked it because it had more information than the Current form and that it had good visual information. Conclusions: This study is one of the first to evaluate 2 different patient education resources in a head-to-head comparison using the same participants in a within-subjects design. This approach was useful in comparing revised educational information with current resources. Moving forward, this knowledge translation approach of a head-to-head comparison of 2 different information sources could be taken to develop and refine information sources on other health issues. %M 30785412 %R 10.2196/11938 %U http://www.i-jmr.org/2019/1/e11938/ %U https://doi.org/10.2196/11938 %U http://www.ncbi.nlm.nih.gov/pubmed/30785412 %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 643234293, mirjampot90@gmail.com %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