JMIR Formative Research

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EISSN : 2561-326X
Published by: JMIR Publications (10.2196)
Total articles ≅ 1,206
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Nisha K Jose, Clint Vaz, ,
Published: 13 May 2022
JMIR Formative Research, Volume 6; https://doi.org/10.2196/37124

Abstract:
Background: India has the greatest burden of tuberculosis (TB). However, over 15% of the people on antitubercular therapy (ATT) in India are nonadherent. Several adherence monitoring techniques deployed in India to enhance ATT adherence have had modest effects. Increased adoption of mobile phones and other technologies pose potential solutions to measuring and intervening in ATT adherence. Several technology-based interventions around ATT adherence have been demonstrated in other countries. Objective: The objective of our study was to understand the acceptance of mobile phone adherence supports for ATT using self-administered quantitative measures among patients with TB in South India. Methods: This exploratory study was conducted at a TB treatment center (TTC) at a tertiary care center in Thrissur District, Kerala, India. We recruited 100 patients with TB on ATT using convenience sampling after obtaining written informed consent. Trained study staff administered the questionnaire in Malayalam, commonly spoken in Kerala, India. We used frequency, mean, median, and SD or IQR to describe the data. Results: Of the 100 participants diagnosed with TB on ATT, 90% used mobile phones routinely, and 84% owned a mobile phone. Ninety-five percent of participants knew how to use the calling function, while 65% of them did not know how to use the SMS function on their mobile phone. Overall, 89% of the participants did not consider mobile phone–based ATT adherence interventions an intrusion in their privacy, and 93% did not fear stigma if the adherence reminder was received by someone else. Most (95%) of the study participants preferred mobile phone reminders instead of directly observed treatment, short-course. Voice calls (n=80, 80%) were the more preferred reminder modality than SMS reminders (n=5, 5%). Conclusions: Mobile phones are likely an acceptable platform to deliver ATT adherence interventions among individuals with TB in South India. Preference of voice call reminders may inform the architecture of future adherence interventions surrounding ATT in South India.
Kristen Zentner, , Paige Ethridge, ,
Published: 13 May 2022
JMIR Formative Research, Volume 6; https://doi.org/10.2196/35535

Abstract:
Background: The COVID-19 pandemic has resulted in unprecedented uptake of telepsychology services; however, clinicians have mixed attitudes toward virtual technologies. Objective: This study (1) explored clinicians’ experiences of and intentions to use video, telephone, and in-person services, and (2) tested the utility of the unified theory of acceptance and use of technology (UTAUT) to predict clinicians’ intentions to offer telepsychology after the COVID-19 pandemic. Methods: Clinician satisfaction and therapeutic alliance were compared across in-person, video, and telephone services, while technology attitudes and intention to use after the pandemic were compared across video and telephone services among 118 addiction and mental health clinicians during the COVID-19 pandemic. Results: Clinicians reported more positive experiences with in-person services than both virtual technologies; further, clinicians reported greater positive experiences, attitudes, and intentions to use video services than telephone services across measures. Based on the UTAUT, performance expectancy positively predicted concurrent intentions to use video services (β=0.46; P<.001) and telephone services (β=0.35; P<.001) after the pandemic. Social influence (β=0.24; P=.004) and facilitating conditions (β=0.19; P=.03) additionally predicted the intention to use telephone services. Conclusions: Clinicians rated in-person services more positively than virtual technologies, with video services perceived more positively than telephone services. Performance expectancy was the primary facilitator of the uptake of both virtual modalities.
Published: 13 May 2022
JMIR Formative Research, Volume 6; https://doi.org/10.2196/34021

Abstract:
Background: Digital health interventions have been shown to improve data quality and health services in low- and middle-income countries (LMICs). Nonetheless, in LMICs, systematic assessments of time saved with the use of digital tools are rare. We ran a set of cluster-randomized controlled trials as part of the implementation of a digital maternal and child health registry (eRegistry) in the West Bank, Palestine. Objective: In the eRegTime study, we compared time spent on health information management in clinics that use the eRegistry versus the existing paper-based documentation system. Methods: Intervention (eRegistry) and control (paper documentation) arms were defined by a stratified random subsample of primary health care clinics from the concurrent eRegQual trial. We used time-motion methodology to collect data on antenatal care service provision. Four observers used handheld tablets to record time-use data during one working day per clinic. We estimated relative time spent on health information management for booking and follow-up visits and on client care using mixed-effects linear regression. Results: In total, 22 of the 24 included clinics (12 intervention, 10 control) contributed data; no antenatal care visits occurred in the other two clinics during the study period. A total of 123 and 118 consultations of new pregnancy registrations and follow-up antenatal care visits were observed in the intervention and control groups, respectively. Average time spent on health information management for follow-up antenatal care visits in eRegistry clinics was 5.72 minutes versus 8.10 minutes in control clinics (adjusted relative time 0.69, 95% CI 0.60-0.79; P<.001), and 15.26 minutes versus 18.91 minutes (adjusted relative time 0.96, 95% CI 0.61-1.50; P=.85) for booking visits. The average time spent on documentation, a subcategory of health information management, was 5.50 minutes in eRegistry clinics versus 8.48 minutes in control clinics (adjusted relative time 0.68, 95% CI 0.56-0.83; P<.001). While the average time spent on client care was 5.01 minutes in eRegistry clinics versus 4.91 minutes in control clinics, some uncertainty remains, and the CI was consistent with eRegistry clinics using less, the same, or more time on client care compared to those that use paper (adjusted relative time 0.85, 95% CI 0.64-1.13; P=.27). Conclusions: The eRegistry captures digital data at point of care during client consultations and generates automated routine reports based on the clinical data entered. Markedly less time (plausibly a saving of at least 18%) was spent on health information management in eRegistry clinics compared to those that use paper-based documentation. This is likely explained by the fact that the eRegistry requires lesser repetitive documentation work than paper-based systems. Adoption of eRegistry-like systems in comparable settings may save valuable and scarce health care resources. Trial Registration: ISRCTN registry ISRCTN18008445; https://doi.org/10.1186/ISRCTN18008445 International Registered Report Identifier (IRRID): RR2-10.2196/13653
Pravesh Sharma, Anthony R Sinicrope, , Tabetha A Brockman, Nicole M Reinicke, Ian W West, Liana M Wiepert, Amy E Glasgow, Lindsey R Sangaralingham, Ashley L Holland, et al.
Published: 13 May 2022
JMIR Formative Research, Volume 6; https://doi.org/10.2196/37012

Abstract:
Background: During the COVID-19 pandemic, to prevent the spread of the virus, federal regulatory barriers around telemedicine were lifted, and health care institutions encouraged patients to use telemedicine, including video appointments. Many patients, however, still chose face-2-face (f2f) appointments for nonemergent clinical care. Objective: We explored patients’ personal and environmental barriers to the use of video appointments from April 2020 to December 2020. Methods: We conducted qualitative telephone interviews of Mayo Clinic patients who attended f2f appointments at the Mayo Clinic from April 2020 to December 2020 but did not utilize Mayo Clinic video appointment services during that time frame. Results: We found that, although most patients were concerned about preventing COVID-19 transmission, they trusted Mayo Clinic to keep them safe when attending f2f appointments. Many expressed that a video appointment made it difficult to establish rapport with their providers. Other common barriers to video appointments were perceived therapeutic benefits of f2f appointments, low digital literacy, and concerns about privacy and security. Conclusions: Our study provides an in-depth investigation into barriers to engaging in video appointments for nonemergent clinical care in the context of the COVID-19 pandemic. Our findings corroborate many barriers prevalent in the prepandemic literature and suggest that rapport barriers need to be analyzed and problem-solved at a granular level.
Published: 13 May 2022
JMIR Formative Research, Volume 6; https://doi.org/10.2196/36821

Abstract:
Background: “Essential Coaching for Every Mother” is a Canadian text message–based program that sends daily messages to mothers for 6 weeks after they give birth. There is a need to explore the program’s effectiveness in terms of the participants’ experience to guide refinement and modification. Objective: This study aimed to describe the process evaluation of the Essential Coaching for Every Mother randomized controlled trial through an evaluation of the research implementation extent and quality. Methods: Participants were recruited from Nova Scotia, Canada, between January 5 and August 1, 2021. Enrolled participants were randomized into the intervention or control group. Participants randomized to the intervention group received standard care along with the Essential Coaching for Every Mother program’s text messages related to newborn and maternal care for the first 6 weeks after giving birth, while the control group received standard care. Usage data were collected from the SMS text message program used, and participants completed web-based questionnaires at 6 weeks after birth. Quantitative data and qualitative responses to open-ended questions were used to triangulate findings. Quantitative data were summarized using means, SDs, and percentages, as appropriate, while qualitative data were analyzed using thematic analysis. Results: Of the 295 unique initial contacts, 150 mothers were eligible and completed the baseline survey to be enrolled in the study (intervention, n=78; control, n=72). Of those randomized into the intervention group, 75 (96%) completed the 6-week follow-up survey to provide feedback on the program. In total, 48 (62%) intervention participants received all messages as designed in the Essential Coaching for Every Mother program, with participants who enrolled late missing on average 4.7 (range 1-12) messages. Intervention participants reported an 89% satisfaction rate with the program, and 100% of participants would recommend the program to other new mothers. Participants liked how the program made them feel, the format, appropriate timing of messages, and content while disliking the frequency of messages and gaps in content. Participants also provided suggestions for future improvement. Conclusions: Our process evaluation has provided a comprehensive understanding of interest in the program as well as identified preference for program components. The findings of this study will be used to update future iterations of the Essential Coaching for Every Mother program. Trial Registration: ClincalTrials.gov NCT04730570; https://clinicaltrials.gov/ct2/show/NCT04730570
Published: 12 May 2022
JMIR Formative Research, Volume 6; https://doi.org/10.2196/34436

Abstract:
Background: Affective characteristics are associated with depression severity, course, and prognosis. Patients’ affect captured by clinicians during sessions may provide a rich source of information that more naturally aligns with the depression course and patient-desired depression outcomes. Objective: In this paper, we propose an information extraction vocabulary used to pilot the feasibility and reliability of identifying clinician-recorded patient affective states in clinical notes from electronic health records. Methods: Affect and mood were annotated in 147 clinical notes of 109 patients by 2 independent coders across 3 pilots. Intercoder discrepancies were settled by a third coder. This reference annotation set was used to test a proof-of-concept natural language processing (NLP) system using a named entity recognition approach. Results: Concepts were frequently addressed in templated format and free text in clinical notes. Annotated data demonstrated that affective characteristics were identified in 87.8% (129/147) of the notes, while mood was identified in 97.3% (143/147) of the notes. The intercoder reliability was consistently good across the pilots (interannotator agreement [IAA] >70%). The final NLP system showed good reliability with the final reference annotation set (mood IAA=85.8%; affect IAA=80.9%). Conclusions: Affect and mood can be reliably identified in clinician reports and are good targets for NLP. We discuss several next steps to expand on this proof of concept and the value of this research for depression clinical research.
Ruchita S Pendse, , Preetika Sharma, Alka Ahuja, Darshan Hosapatna Basavarajappa, , Ankita Kankaria, Pushpendra Singh, Vijay Kumar, , et al.
Published: 12 May 2022
JMIR Formative Research, Volume 6; https://doi.org/10.2196/34852

Abstract:
Background: As mobile phone uptake in India continues to grow, there is also continued interest in mobile platform–based interventions for health education. There is a significant gender gap in mobile phone access—women’s access to mobile phones is constrained by economic and social barriers. Pregnancy and postpartum care is one of many targets for mobile health (mHealth) interventions that particularly rely upon women’s access to and facility with mobile phone use. Objective: We aimed to describe the dynamics and patterns of married pregnant and postpartum women’s mobile phone access and use (among both phone owners and nonowners) who participated in an mHealth postpartum care intervention and to identify potential barriers to their participation in mobile platform–based interventions. Methods: A secondary analysis was performed on mixed methods data obtained for a pilot mHealth intervention for postpartum care of mothers in rural Punjab from July 2020 to February 2021. Two formative sources included exploratory in-depth interviews among postpartum women (n=20; 1-3 months postpartum) and quantitative maternal health survey among women who were pregnant or who had recently given birth (n=102). We also utilized mixed methods intervention assessment data from early postpartum women who participated in the pilot intervention (n=29), including intervention moderator perspectives. Qualitative and quantitative analyses were performed, and pertinent findings were grouped thematically. Results: The majority of women owned a phone (maternal health survey: 75/102, 74%; demographic survey: 17/29, 59%), though approximately half (53/102, 52%) still reported sharing phones with other family members. Sharing a phone with female family members typically allowed for better access than sharing with male family members. Some households had strict preferences against daughters-in-law having phones, or otherwise significantly restricted women’s phone access. Others reported concerns about phone use–related health hazards for mother and infant during the pregnancy or postpartum period. Conclusions: These findings suggest nuance regarding what is meant by women’s phone ownership and access—there were numerous additional constraints on women’s use of phones, particularly during pregnancy and the postpartum period. Future research and mHealth interventions should probe these domains to better understand the dynamics governing women’s access, use, and fluency with mobile phones to optimally design mHealth interventions.
Cameron Nereim, , Michael Rich
Published: 12 May 2022
JMIR Formative Research, Volume 6; https://doi.org/10.2196/30900

Abstract:
Background: Increasing youth mental health problems over time correlate with increasing rates of social media use (SMU); however, a proposed contributory relationship remains unproven. To better understand how SMU impacts mental health requires a more nuanced understanding of the relationship between different patterns of SMU and specific individual factors. Studies suggest that more active forms of SMU may offer mental health benefits when compared with more passive forms. Furthermore, the literature suggests important differences in patterns of SMU and affective states among those identifying as racial and ethnic minorities. Objective: Using ecological momentary assessment (EMA), this study aims to investigate potential differences in affective states during active and passive forms of SMU and whether such differences vary by race and ethnicity. Methods: We recruited patients seeking care at a large urban adolescent medicine clinic who exhibited at least mild depressive symptoms based on Patient Health Questionnaire-9 (PHQ-9) scores. Participants completed an enrollment survey and a 7-day EMA protocol, receiving 5 EMA questionnaires per day, which assessed real time SMU behaviors and affective states using the Positive and Negative Affect Schedule–Expanded form subscales. To correct for nonindependent data with EMA responses clustered within individuals, data were analyzed using mixed-effects modeling, allowing for a random intercept at the individual level to examine associations between EMA-reported SMU and affective states while adjusting results for age, gender, race and ethnicity, PHQ-9 score, and EMA response rate. Results: A racially and ethnically diverse group of 55 adolescents aged 14 to 19 years provided a total of 976 EMA responses, averaging 17.76 (SD 8.76) responses per participant, with a response rate of 51.15%. Participants reported higher mean levels of negative affect during active SMU (F1,215=3.86; SE 0.05; t1,215=1.96; P=.05) and lower mean levels of positive affect during passive SMU (F1,369=3.90; SE 0.09; t1,369=–1.98; P=.049). However, within different racial and ethnic groups, higher levels of negative affect during moments of active SMU were seen only among Black non-Hispanic participants: F1,81=6.31; SE 0.05; t81=2.51; P=.01). Similarly, lower levels of positive affect during passive SMU were seen only among White non-Hispanic participants (F1,295=10.52; SE 0.13; t295=–3.24; P=.001). Conclusions: Although in aggregate, adolescents with depressive symptoms experienced more negative affect during active SMU and less positive affect during passive SMU, these mean outcomes were driven solely by greater negative affect during active SMU by Black non-Hispanic participants and lower positive affect during passive SMU by White non-Hispanic participants. Differences in intentionality, content, context, and expectations of SMU among youths across racial and ethnic groups may result in different affective outcomes. Exploration of the interactions among cultural differences in SMU strategies and characteristics will be critical to furthering our understanding of the impact of SMU on youth mental health.
Published: 12 May 2022
JMIR Formative Research, Volume 6; https://doi.org/10.2196/34104

Abstract:
Background: Climate change, driven by human activity, is rapidly changing our environment and posing an increased risk to human health. Local governments must adapt their cities and prepare for increased periods of extreme heat and ensure that marginalized populations do not suffer detrimental health outcomes. Heat warnings traditionally rely on outdoor temperature data which may not reflect indoor temperatures experienced by individuals. Smart thermostats could be a novel and highly scalable data source for heat wave monitoring. Objective: The objective of this study was to explore whether smart thermostats can be used to measure indoor temperature during a heat wave and identify houses experiencing indoor temperatures above 26°C. Methods: We used secondary data—indoor temperature data recorded by ecobee smart thermostats during the Quebec heat waves of 2018 that claimed 66 lives, outdoor temperature data from Environment Canada weather stations, and indoor temperature data from 768 Quebec households. We performed descriptive statistical analyses to compare indoor temperatures differences between air conditioned and non–air conditioned houses in Montreal, Gatineau, and surrounding areas from June 1 to August 31, 2018. Results: There were significant differences in indoor temperature between houses with and without air conditioning on both heat wave and non–heat wave days (P<.001). Households without air conditioning consistently recorded daily temperatures above common indoor temperature standards. High indoor temperatures persisted for an average of 4 hours per day in non–air conditioned houses. Conclusions: Our findings were consistent with current literature on building warming and heat retention during heat waves, which contribute to increased risk of heat-related illnesses. Indoor temperatures can be captured continuously using smart thermostats across a large population. When integrated with local heat health action plans, these data could be used to strengthen existing heat alert response systems and enhance emergency medical service responses.
Harita S Shah, , Alejandra Flores-Miller, Katherine H Phillips, Kathleen R Page, Ana Cervantes,
Published: 12 May 2022
JMIR Formative Research, Volume 6; https://doi.org/10.2196/35764

Abstract:
Background: Latino communities are among the most heavily impacted populations by the COVID-19 pandemic in the United States due to intersectional barriers to care. Crowdsourcing open contests can be an effective means of community engagement but have not been well studied in Latino populations nor in addressing the COVID-19 pandemic. Objective: The aims of this study are to (1) implement and evaluate a crowdsourcing open contest to solicit a name for a COVID-19 social marketing campaign for Latino populations in Maryland and (2) conduct a thematic analysis of submitted entries to guide campaign messaging. Methods: To assess the level of community engagement in this crowdsourcing open contest, we used descriptive statistics to analyze data on entries, votes, and demographic characteristics of participants. The submitted text was analyzed through inductive thematic analysis. Results: We received 74 entries within a 2-week period. The top 10 entries were chosen by community judges and the winner was decided by popular vote. We received 383 votes within 1 week. The most common themes were collective efficacy, self-efficacy, and perceived benefits of COVID-19 testing. We used these themes to directly inform our social marketing intervention and found that advertisements based on these themes became the highest performing. Conclusions: Crowdsourcing open contests are an effective means of community engagement and an agile tool for guiding interventions to address COVID-19, including in populations impacted by health care disparities, such as Latino communities. The thematic analysis of contest entries can be a valuable strategy to inform the development of social marketing campaign materials.
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