Evaluation of Internet-Based Interventions on Waist Circumference Reduction: A Meta-Analysis

Seo, Dong-Chul,Niu, Jingjing JMIR Publications Inc. 2015 Journal of medical Internet research Vol.17 No.7

<P><B>Background</B></P><P>Internet-based interventions are more cost-effective than conventional interventions and can provide immediate, easy-to-access, and individually tailored support for behavior change. Waist circumference is a strong predictor of an increased risk for a host of diseases, such as hypertension, diabetes, and dyslipidemia, independent of body mass index. To date, no study has examined the effect of Internet-based lifestyle interventions on waist circumference change.</P><P><B>Objective</B></P><P>This study aimed to systematically review the effect of Internet-based interventions on waist circumference change among adults.</P><P><B>Methods</B></P><P>This meta-analysis reviewed randomized controlled trials (N=31 trials and 8442 participants) that used the Internet as a main intervention approach and reported changes in waist circumference.</P><P><B>Results</B></P><P>Internet-based interventions showed a significant reduction in waist circumference (mean change –2.99 cm, 95% CI −3.68 to −2.30, I<SUP>2</SUP>=93.3%) and significantly better effects on waist circumference loss (mean loss 2.38 cm, 95% CI 1.61-3.25, I<SUP>2</SUP>=97.2%) than minimal interventions such as information-only groups. Meta-regression results showed that baseline waist circumference, gender, and the presence of social support in the intervention were significantly associated with waist circumference reduction.</P><P><B>Conclusions</B></P><P>Internet-based interventions have a significant and promising effect on waist circumference change. Incorporating social support into an Internet-based intervention appears to be useful in reducing waist circumference. Considerable heterogeneity exists among the effects of Internet-based interventions. The design of an intervention may have a significant impact on the effectiveness of the intervention.</P>

Trusting Social Media as a Source of Health Information: Online Surveys Comparing the United States, Korea, and Hong Kong

Song, Hayeon,Omori, Kikuko,Kim, Jihyun,Tenzek, Kelly E,Hawkins, Jennifer Morey,Lin, Wan-Ying,Kim, Yong-Chan,Jung, Joo-Young JMIR Publications Inc. 2016 Journal of medical Internet research Vol.18 No.3

<P><B>Background</B></P><P>The Internet has increasingly become a popular source of health information by connecting individuals with health content, experts, and support. More and more, individuals turn to social media and Internet sites to share health information and experiences. Although online health information seeking occurs worldwide, limited empirical studies exist examining cross-cultural differences in perceptions about user-generated, experience-based information compared to expertise-based information sources.</P><P><B>Objective</B></P><P>To investigate if cultural variations exist in patterns of online health information seeking, specifically in perceptions of online health information sources. It was hypothesized that Koreans and Hongkongers, compared to Americans, would be more likely to trust and use experience-based knowledge shared in social Internet sites, such as social media and online support groups. Conversely, Americans, compared to Koreans and Hongkongers, would value expertise-based knowledge prepared and approved by doctors or professional health providers more.</P><P><B>Methods</B></P><P>Survey questionnaires were developed in English first and then translated into Korean and Chinese. The back-translation method ensured the standardization of questions. Surveys were administered using a standardized recruitment strategy and data collection methods.</P><P><B>Results</B></P><P>A total of 826 participants living in metropolitan areas from the United States (n=301), Korea (n=179), and Hong Kong (n=337) participated in the study. We found significant cultural differences in information processing preferences for online health information. A planned contrast test revealed that Koreans and Hongkongers showed more trust in experience-based health information sources (blogs: <I>t</I><SUB>451.50</SUB>=11.21, <I>P</I><.001; online support group: <I>t</I><SUB>455.71</SUB>=9.30, <I>P</I><.001; social networking sites [SNS]: <I>t</I><SUB>466.75</SUB>=11.36, <I>P</I><.001) and also reported using blogs (<I>t</I><SUB>515.31</SUB>=6.67, <I>P</I><.001) and SNS (<I>t</I><SUB>529.22</SUB>=4.51, <I>P</I><.001) more frequently than Americans. Americans showed a stronger preference for using expertise-based information sources (eg, WebMD and CDC) compared to Koreans and Hongkongers (<I>t</I><SUB>360.02</SUB>=3.01, <I>P</I>=.003). Trust in expertise-based information sources was universal, demonstrating no cultural differences (Brown-Forsythe <I>F</I><SUB>2,654</SUB>=1.82, <I>P</I>=.16). Culture also contributed significantly to differences in searching information on behalf of family members (<I>t</I><SUB>480.38</SUB>=5.99, <I>P</I><.001) as well as to the goals of information searching.</P><P><B>Conclusions</B></P><P>This research found significant cultural differences in information processing preferences for online health information. Further discussion is included regarding effective communication strategies in providing quality health information.</P>

Development of an Obesity Management Ontology Based on the Nursing Process for the Mobile-Device Domain

Kim, Hyun-Young,Park, Hyeoun-Ae,Min, Yul Ha,Jeon, Eunjoo JMIR Publications Inc. 2013 Journal of medical Internet research Vol.15 No.6

<P><B>Background</B></P><P>Lifestyle modification is the most important factor in the management of obesity. It is therefore essential to enhance client participation in voluntary and continuous weight control.</P><P><B>Objective</B></P><P>The aim of this study was to develop an obesity management ontology for application in the mobile-device domain. We considered the concepts of client participation in behavioral modification for obesity management and focused on minimizing the amount of information exchange between the application and the database when providing tailored interventions.</P><P><B>Methods</B></P><P>An obesity management ontology was developed in seven phases: (1) defining the scope of obesity management, (2) selecting a foundational ontology, (3) extracting the concepts, (4) assigning relationships between these concepts, (5) evaluating representative layers of ontology content, (6) representing the ontology formally with Protégé, and (7) developing a prototype application for obesity management.</P><P><B>Results</B></P><P>Behavioral interventions, dietary advice, and physical activity were proposed as obesity management strategies. The nursing process was selected as a foundation of ontology, representing the obesity management process. We extracted 127 concepts, which included assessment data (eg, sex, body mass index, and waist circumference), inferred data to represent nursing diagnoses and evaluations (eg, degree of and reason for obesity, and success or failure of lifestyle modifications), and implementation (eg, education and advice). The relationship linking concepts were “part of”, “instance of”, “derives of”, “derives into”, “has plan”, “followed by”, and “has intention”. The concepts and relationships were formally represented using Protégé. The evaluation score of the obesity management ontology was 4.5 out of 5. An Android-based obesity management application comprising both agent and client parts was developed.</P><P><B>Conclusions</B></P><P>We have developed an ontology for representing obesity management with the nursing process as a foundation of ontology.</P>

Daily Collection of Self-Reporting Sleep Disturbance Data via a Smartphone App in Breast Cancer Patients Receiving Chemotherapy: A Feasibility Study

Min, Yul Ha,Lee, Jong Won,Shin, Yong-Wook,Jo, Min-Woo,Sohn, Guiyun,Lee, Jae-Ho,Lee, Guna,Jung, Kyung Hae,Sung, Joohon,Ko, Beom Seok,Yu, Jong-Han,Kim, Hee Jeong,Son, Byung Ho,Ahn, Sei Hyun JMIR Publications Inc. 2014 Journal of medical Internet research Vol.16 No.5

<P><B>Background</B></P><P>Improvements in mobile telecommunication technologies have enabled clinicians to collect patient-reported outcome (PRO) data more frequently, but there is as yet limited evidence regarding the frequency with which PRO data can be collected via smartphone applications (apps) in breast cancer patients receiving chemotherapy.</P><P><B>Objective</B></P><P>The primary objective of this study was to determine the feasibility of an app for sleep disturbance-related data collection from breast cancer patients receiving chemotherapy. A secondary objective was to identify the variables associated with better compliance in order to identify the optimal subgroups to include in future studies of smartphone-based interventions.</P><P><B>Methods</B></P><P>Between March 2013 and July 2013, patients who planned to receive neoadjuvant chemotherapy for breast cancer at Asan Medical Center who had access to a smartphone app were enrolled just before the start of their chemotherapy and asked to self-report their sleep patterns, anxiety severity, and mood status via a smartphone app on a daily basis during the 90-day study period. Push notifications were sent to participants daily at 9 am and 7 pm. Data regarding the patients’ demographics, interval from enrollment to first self-report, baseline Beck’s Depression Inventory (BDI) score, and health-related quality of life score (as assessed using the EuroQol Five Dimensional [EQ5D-3L] questionnaire) were collected to ascertain the factors associated with compliance with the self-reporting process.</P><P><B>Results</B></P><P>A total of 30 participants (mean age 45 years, SD 6; range 35-65 years) were analyzed in this study. In total, 2700 daily push notifications were sent to these 30 participants over the 90-day study period via their smartphones, resulting in the collection of 1215 self-reporting sleep-disturbance data items (overall compliance rate=45.0%, 1215/2700). The median value of individual patient-level reporting rates was 41.1% (range 6.7-95.6%). The longitudinal day-level compliance curve fell to 50.0% at day 34 and reached a nadir of 13.3% at day 90. The cumulative longitudinal compliance curve exhibited a steady decrease by about 50% at day 70 and continued to fall to 45% on day 90. Women without any form of employment exhibited the higher compliance rate. There was no association between any of the other patient characteristics (ie, demographics, and BDI and EQ5D-3L scores) and compliance. The mean individual patient-level reporting rate was higher for the subgroup with a 1-day lag time, defined as starting to self-report on the day immediately after enrollment, than for those with a lag of 2 or more days (51.6%, SD 24.0 and 29.6%, SD 25.3, respectively; <I>P</I>=.03).</P><P><B>Conclusions</B></P><P>The 90-day longitudinal collection of daily self-reporting sleep-disturbance data via a smartphone app was found to be feasible. Further research should focus on how to sustain compliance with this self-reporting for a longer time and select subpopulations with higher rates of compliance for mobile health care.</P>

Activities on Facebook Reveal the Depressive State of Users

Park, Sungkyu,Lee, Sang Won,Kwak, Jinah,Cha, Meeyoung,Jeong, Bumseok JMIR Publications Inc. 2013 Journal of medical Internet research Vol.15 No.10

<P><B>Background</B></P><P>As online social media have become prominent, much effort has been spent on identifying users with depressive symptoms in order to aim at early diagnosis, treatment, and even prevention by using various online social media. In this paper, we focused on Facebook to discern any correlations between the platform’s features and users’ depressive symptoms. This work may be helpful in trying to reach and detect large numbers of depressed individuals more easily.</P><P><B>Objective</B></P><P>Our goal was to develop a Web application and identify depressive symptom–related features from users of Facebook, a popular social networking platform.</P><P><B>Methods</B></P><P>55 Facebook users (male=40, female=15, mean age 24.43, SD 3.90) were recruited through advertisement fliers distributed to students in a large university in Korea. Using EmotionDiary, the Facebook application we developed, we evaluated depressive symptoms using the Center for Epidemiological Studies-Depression (CES-D) scale. We also provided tips and facts about depression to participants and measured their responses using EmotionDiary. To identify the Facebook features related to depression, correlation analyses were performed between CES-D and participants’ responses to tips and facts or Facebook social features. Last, we interviewed depressed participants (CES-D≥25) to assess their depressive symptoms by a psychiatrist.</P><P><B>Results</B></P><P>Facebook activities had predictive power in distinguishing depressed and nondepressed individuals. Participants’ response to tips and facts, which can be explained by the number of app tips viewed and app points, had a positive correlation (<I>P</I>=.04 for both cases), whereas the number of friends and location tags had a negative correlation with the CES-D scale (<I>P</I>=.08 and <I>P</I>=.045 respectively). Furthermore, in finding group differences in Facebook social activities, app tips viewed and app points resulted in significant differences (<I>P</I>=.01 and <I>P</I>=.03 respectively) between probably depressed and nondepressed individuals.</P><P><B>Conclusions</B></P><P>Our results using EmotionDiary demonstrated that the more depressed one is, the more one will read tips and facts about depression. We also confirmed depressed individuals had significantly fewer interactions with others (eg, decreased number of friends and location tagging). Our app, EmotionDiary, can successfully evaluate depressive symptoms as well as provide useful tips and facts to users. These results open the door for examining Facebook activities to identify depressed individuals. We aim to conduct the experiment in multiple cultures as well.</P>

Evaluation of Internet-Based Interventions on Waist Circumference Reduction: A Meta-Analysis

강민아,김융석,배현아,서동철,이승윤 JMIR PUBLICATIONS, INC 2015 JOURNAL OF MEDICAL INTERNET RESEARCH Vol.17 No.7

Smoking Cessation Apps for Smartphones: Content Analysis With the Self-Determination Theory

Choi, Jounghwa,Noh, Ghee-Young,Park, Dong-Jin JMIR Publications Inc. 2014 Journal of medical Internet research Vol.16 No.2

<P><B>Background</B></P><P>Smartphones are increasingly receiving attention from public health scholars and practitioners as a means to assist individuals’ health management. A number of smartphone apps for smoking cessation are also available; however, little effort has been made to evaluate the content and functions of these apps employing a theoretical framework.</P><P><B>Objective</B></P><P>The present study aims to analyze and evaluate the contents of smoking cessation apps available in South Korea employing the self-determination theory (SDT) as a theoretical framework for analysis. This study analyzes the extent to which smoking cessation apps have features that satisfy the basic needs identified in the SDT, which stimulate autonomous motivation. The type of motivational goal content manifested in the apps and how the goal content was framed are also explored. By assessing the features of smoking cessation apps based on the SDT, this study aims to offer direction for improvement for these apps.</P><P><B>Methods</B></P><P>Out of 309 apps identified from the iTunes store and Google Play (excluding 27 duplications), 175 apps were randomly drawn and analyzed. The coding scheme was drafted by the authors based on the SDT and gain/loss framing theory and was further finely tuned through the process of coder training and by establishing intercoder reliability. Once the intercoder reliability was established, the coders divided up the rest of the sample and coded them independently.</P><P><B>Results</B></P><P>The analysis revealed that most apps (94.3%, 165/175) had at least one feature that tapped at least 1 of the 3 basic needs. Only 18 of 175 apps (10.3%) addressed all 3 basic needs. For goal content, money (53.7%, 94/175) showed the highest frequency, followed by health (32.0%, 56/175), time (7.4%, 13/175), and appearance (1.1%, 2/175), suggesting that extrinsic goals are more dominantly presented in smoking cessation apps. For the framing of goal content, gain framing appeared more frequently (41.7%, 73/175).</P><P><B>Conclusions</B></P><P>The results suggest that these smoking cessation apps may not sufficiently stimulate autonomous motivation; a small number of apps addressed all 3 basic needs suggested by the SDT (ie, autonomy, competence, and relatedness). The apps also tended to present extrinsic goal content (primarily in terms of money) over intrinsic ones (ie, health) by primarily adopting gain framing. Implications of these findings for public health practitioners and consumers are discussed.</P>

Validation and Reliability of a Smartphone Application for the International Prostate Symptom Score Questionnaire: A Randomized Repeated Measures Crossover Study

Kim, Jae Heon,Kwon, Soon-Sun,Shim, Sung Ryul,Sun, Hwa Yeon,Ko, Young Myoung,Chun, Dong-Il,Yang, Won Jae,Song, Yun Seob JMIR Publications Inc. 2014 Journal of medical Internet research Vol.16 No.2

<P><B>Background</B></P><P>Smartphone-based assessment may be a useful diagnostic and monitoring tool for patients. There have been many attempts to create a smartphone diagnostic tool for clinical use in various medical fields but few have demonstrated scientific validity.</P><P><B>Objective</B></P><P>The purpose of this study was to develop a smartphone application of the International Prostate Symptom Score (IPSS) and to demonstrate its validity and reliability.</P><P><B>Methods</B></P><P>From June 2012 to May 2013, a total of 1581 male participants (≥40 years old), with or without lower urinary tract symptoms (LUTS), visited our urology clinic via the health improvement center at Soonchunhyang University Hospital (Republic of Korea) and were enrolled in this study. A randomized repeated measures crossover design was employed using a smartphone application of the IPSS and the conventional paper form of the IPSS. Paired <I>t</I> test under a hypothesis of non-inferior trial was conducted. For the reliability test, the intraclass correlation coefficient (ICC) was measured.</P><P><B>Results</B></P><P>The total score of the IPSS (<I>P</I>=.289) and each item of the IPSS (<I>P</I>=.157-1.000) showed no differences between the paper version and the smartphone version of the IPSS. The mild, moderate, and severe LUTS groups showed no differences between the two versions of the IPSS. A significant correlation was noted in the total group (ICC=.935, <I>P</I><.001). The mild, moderate, and severe LUTS groups also showed significant correlations (ICC=.616, .549, and .548 respectively, all <I>P</I><.001).There was selection bias in this study, as only participants who had smartphones could participate.</P><P><B>Conclusions</B></P><P>The validity and reliability of the smartphone application version were comparable to the conventional paper version of the IPSS. The smartphone application of the IPSS could be an effective method for measuring lower urinary tract symptoms.</P>

The Korean eHealth Literacy Scale (K-eHEALS): Reliability and Validity Testing in Younger Adults Recruited Online

Chung, SeonYoon,Park, Bu Kyung,Nahm, Eun-Shim JMIR Publications Inc. 2018 Journal of medical Internet research Vol.20 No.4