%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