@Article{info:doi/10.2196/73226,
author="Qiang, Shiqi
and Zhang, Haitao
and Liao, Yang
and Zhang, Yue
and Gu, Yanfen
and Wang, Yiyan
and Xu, Zehui
and Shi, Hui
and Han, Nuo
and Yu, Haiping",
title="Application of Large Language Models in Stroke Rehabilitation Health Education: 2-Phase Study",
journal="J Med Internet Res",
year="2025",
month="Jul",
day="22",
volume="27",
pages="e73226",
keywords="large language models",
keywords="stroke",
keywords="artificial intelligence",
keywords="home rehabilitation",
keywords="health education.",
abstract="Background: Stroke is a leading cause of disability and death worldwide, with home-based rehabilitation playing a crucial role in improving patient prognosis and quality of life. Traditional health education often lacks precision, personalization, and accessibility. In contrast, large language models (LLMs) are gaining attention for their potential in medical health education, owing to their advanced natural language processing capabilities. However, the effectiveness of LLMs in home-based stroke rehabilitation remains uncertain. Objective: This study evaluates the effectiveness of 4 LLMs---ChatGPT-4, MedGo, Qwen, and ERNIE Bot---selected for their diversity in model type, clinical relevance, and accessibility at the time of study design in home-based stroke rehabilitation. The aim is to offer patients with stroke more precise and secure health education pathways while exploring the feasibility of using LLMs to guide health education. Methods: In the first phase of this study, a literature review and expert interviews identified 15 common questions and 2 clinical cases relevant to patients with stroke in home-based rehabilitation. These were input into 4 LLMs for simulated consultations. Six medical experts (2 clinicians, 2 nursing specialists, and 2 rehabilitation therapists) evaluated the LLM-generated responses using a Likert 5-point scale, assessing accuracy, completeness, readability, safety, and humanity. In the second phase, the top 2 performing models from phase 1 were selected. Thirty patients with stroke undergoing home-based rehabilitation were recruited. Each patient asked both models 3 questions, rated the responses using a satisfaction scale, and assessed readability, text length, and recommended reading age using a Chinese readability analysis tool. Data were analyzed using one-way ANOVA, post hoc Tukey Honestly Significant Difference tests, and paired t tests. Results: The results revealed significant differences across the 4 models in 5 dimensions: accuracy (P=.002), completeness (P<.001), readability (P=.04), safety (P=.007), and humanity (P<.001). ChatGPT-4 outperformed all models in each dimension, with scores for accuracy (mean 4.28, SD 0.84), completeness (mean 4.35, SD 0.75), readability (mean 4.28, SD 0.85), safety (mean 4.38, SD0.81), and user-friendliness (mean 4.65, SD 0.66). MedGo excelled in accuracy (mean 4.06, SD 0.78) and completeness (mean 4.06, SD 0.74). Qwen and ERNIE Bot scored significantly lower across all 5 dimensions than ChatGPT-4 and MedGo. ChatGPT-4 generated the longest responses (mean 1338.35, SD 236.03) and had the highest readability score (mean 12.88). In the second phase, ChatGPT-4 performed the best overall, while MedGo provided the clearest responses. Conclusions: LLMs, particularly ChatGPT-4 and MedGo, demonstrated promising performance in home-based stroke rehabilitation education. However, discrepancies between expert and patient evaluations highlight the need for improved alignment with patient comprehension and expectations. Enhancing clinical accuracy, readability, and oversight mechanisms will be essential for future real-world integration. ",
doi="10.2196/73226",
url="https://www.jmir.org/2025/1/e73226"
}


@Article{info:doi/10.2196/68817,
author="King, C. Ryan
and Samaan, S. Jamil
and Haquang, Joseph
and Bharani, Vishnu
and Margolis, Samuel
and Srinivasan, Nitin
and Peng, Yuxin
and Yeo, Hui Yee
and Ghashghaei, Roxana",
title="Improving the Readability of Institutional Heart Failure--Related Patient Education Materials Using GPT-4: Observational Study",
journal="JMIR Cardio",
year="2025",
month="Jul",
day="8",
volume="9",
pages="e68817",
keywords="patient education",
keywords="heart failure",
keywords="artificial intelligence",
keywords="large language models",
keywords="ChatGPT",
keywords="GPT-4",
keywords="health literacy",
keywords="readability",
abstract="Background: Heart failure management involves comprehensive lifestyle modifications such as daily weights, fluid and sodium restriction, and blood pressure monitoring, placing additional responsibility on patients and caregivers, with successful adherence often requiring extensive counseling and understandable patient education materials (PEMs). Prior research has shown PEMs related to cardiovascular disease often exceed the American Medical Association's fifth- to sixth-grade recommended reading level. The large language model (LLM) ChatGPT may be a useful tool for improving PEM readability. Objective: We aim to assess the readability of heart failure--related PEMs from prominent cardiology institutions and evaluate GPT-4's ability to improve these metrics while maintaining accuracy and comprehensiveness. Methods: A total of 143 heart failure--related PEMs were collected from the websites of the top 10 institutions listed on the 2022?2023 US News \& World Report for ``Best Hospitals for Cardiology, Heart \& Vascular Surgery.'' PEMs were individually entered into GPT-4 (version updated July 20, 2023), preceded by the prompt, ``Please explain the following in simpler terms.'' Readability was assessed using the Flesch Reading Ease score, Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook Index, and Automated Readability Index. The accuracy and comprehensiveness of revised GPT-4 PEMs were assessed by a board-certified cardiologist. Results: For 143 institutional heart failure--related PEMs analyzed, the median FKGL was 10.3 (IQR 7.9-13.1; high school sophomore) compared to 7.3 (IQR 6.1-8.5; seventh grade) for GPT-4's revised PEMs (P<.001). Of the 143 institutional PEMs, there were 13 (9.1\%) below the sixth-grade reading level, which improved to 33 (23.1\%) after revision by GPT-4 (P<.001). No revised GPT-4 PEMs were graded as less accurate or less comprehensive compared to institutional PEMs. A total of 33 (23.1\%) GPT-4 PEMs were graded as more comprehensive. Conclusions: GPT-4 significantly improved the readability of institutional heart failure--related PEMs. The model may be a promising adjunct resource in addition to care provided by a licensed health care professional for patients living with heart failure. Further rigorous testing and validation is needed to investigate its safety, efficacy, and impact on patient health literacy. ",
doi="10.2196/68817",
url="https://cardio.jmir.org/2025/1/e68817"
}


@Article{info:doi/10.2196/56053,
author="Juan, Stephanie
and Harxhi, Ante
and Kaul, Simrati
and Woods, Breeana
and Tran, Monica
and Geonnotti, Gabrielle
and Gupta, Archit
and Dean, Emily
and Saunders, E. Cassandra
and Payne, Gloria",
title="Optimization of the Care4Today Digital Health Platform to Enhance Self-Reporting of Medication Adherence and Health Experiences in Patients With Coronary or Peripheral Artery Disease: Mixed Methods Study",
journal="JMIR Cardio",
year="2025",
month="Mar",
day="17",
volume="9",
pages="e56053",
keywords="app",
keywords="cardiovascular disease",
keywords="Care4Today",
keywords="coronary artery disease",
keywords="digital health",
keywords="health tracker",
keywords="medication reminder",
keywords="mobile health",
keywords="mHealth",
keywords="qualitative",
keywords="peripheral artery disease",
abstract="Background: Care4Today is a digital health platform developed by Johnson \& Johnson comprising a patient mobile app (Care4Today Connect), a health care provider (HCP) portal, and an educational website. It aims to improve medication adherence; enable self-reporting of health experiences; provide patient education; enhance connection with HCPs; and facilitate data and analytics learning across disease areas, including cardiovascular disease. Objective: This study aimed to gather patient feedback on Care4Today Connect, specifically the coronary artery disease (CAD) and peripheral artery disease (PAD) module, and to cocreate and validate features with patients to optimize the app experience for those with CAD, PAD, or both. Methods: We conducted 3 research engagements between November 2022 and May 2023. Participants were US-based adults recruited and consented through the sponsor's Patient Engagement Research Council program. Participants self-reported a diagnosis of cardiovascular disease, and in some cases, specifically, CAD, PAD, or both. Part 1, internet survey, posed quantitative questions with Likert-scale answer options about existing app features. Part 2, virtual focus group, and part 3, virtual individual interviews, both used semistructured qualitative discussion to cocreate and validate new app enhancements. The quantitative data from part 1 was evaluated descriptively to categorize mobile health app use, confidence in the ability to use the app, and motivations for app use. The qualitative discussions from parts 2 and 3 were synthesized to understand participants' app needs and preferences to inform an optimal app experience. Results: The response rate for part 1, internet survey, was 67\% (37/55). Most participants felt at least somewhat confident using the app after seeing the newly added app tutorial (33/37, 89\%), and at least somewhat confident in their ability to earn points for completing activities using app instructions (33/37, 89\%). In part 2, virtual focus group (n=3), and part 3, virtual individual interviews (n=8), participants collectively preferred to enhance the app with (1) the ability to automatically add medication data for tracking and (2) the ability to receive relevant care team feedback on their self-reported health experiences. Participants would be willing to spend 10-15 minutes a day tracking 4-5 health experiences, especially those requested by their HCP. Conclusions: Participants prefer apps that can reduce user burden and provide information relevant to them. Care4Today Connect can optimize the user experience for patients with CAD, PAD, or both with the automatic addition of medication data for tracking and in-app care team feedback on patient self-reported health experiences. ",
doi="10.2196/56053",
url="https://cardio.jmir.org/2025/1/e56053"
}


@Article{info:doi/10.2196/72675,
author="Yang, Alina",
title="Pediatric Hearts and Minds: Reimagining Health Education Through Play and Narrative",
journal="JMIR Pediatr Parent",
year="2025",
month="Mar",
day="13",
volume="8",
pages="e72675",
keywords="congenital heart disease",
keywords="children health literacy",
keywords="health education",
keywords="health education interventions",
keywords="patient-centered care",
keywords="design",
keywords="pediatric",
keywords="PRISMA",
doi="10.2196/72675",
url="https://pediatrics.jmir.org/2025/1/e72675"
}


@Article{info:doi/10.2196/65685,
author="Shi, Xiaoyu
and Wang, Yijun
and Wang, Yuhong
and Wang, Jun
and Peng, Chen
and Cheng, Siyi
and Song, Lingpeng
and Li, Rui
and Guo, Fuding
and Li, Zeyan
and Duan, Shoupeng
and Yang, Xiaomeng
and Zhou, Liping
and Jiang, Hong
and Yu, Lilei",
title="The Effectiveness of Digital Animation--Based Multistage Education for Patients With Atrial Fibrillation Catheter Ablation: Randomized Clinical Trial",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="11",
volume="27",
pages="e65685",
keywords="animation education",
keywords="digital health care",
keywords="atrial fibrillation",
keywords="catheter ablation",
keywords="video",
keywords="mHealth",
keywords="digital care",
keywords="digital health",
keywords="digital animation",
keywords="randomized clinical trial",
keywords="RCT",
keywords="digital education",
keywords="outpatient",
keywords="AFCA",
keywords="atrial fibrillation catheter ablation",
keywords="therapeutic",
keywords="cardiac arrhythmia",
keywords="Asian",
keywords="animations",
keywords="comics",
abstract="Background: Digital education for outpatient patients with atrial fibrillation (AF) has gradually increased. However, research on digital education for patients undergoing atrial fibrillation catheter ablation (AFCA) is limited. Objective: This study aimed to develop a novel digital animation-based multistage education system and evaluate its quality-of-life benefits for patients with AFCA. Methods: This randomized controlled clinical trial included 208 patients with AF who underwent catheter ablation in the Department of Cardiology at Renmin Hospital of Wuhan University between January 2022 and August 2023. The patients were randomly assigned to the digital animation intervention (n=104) and standard treatment (n=104) groups. The primary outcome was the difference in the quality of life of patients with atrial fibrillation (AF-QoL-18) scores at 3 months. Secondary outcomes included differences in scores on the 5-item Medication Adherence Report Scale (MARS-5), Self-rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) at 3 months. Results: In the digital animation intervention group, the AF-QoL-18 score increased from 38.02 (SD 6.52) to 47.77 (SD 5.74), the MARS-5 score increased from 17.04 (SD 3.03) to 20.13 (SD 2.12), the SAS score decreased from 52.82 (SD 8.08) to 45.39 (SD 6.13), and the SDS score decreased from 54.12 (SD 6.13) to 45.47 (SD 5.94), 3 months post discharge from the hospital. In the conventional treatment group, the AF-QoL-18 score increased from 36.97 (SD 7.00) to 45.31 (SD 5.71), the MARS-5 score increased from 17.14 (SD 3.01) to 18.47 (SD 2.79), the SAS score decreased from 51.83 (SD 7.74) to 47.31 (SD 5.87), and the SDS score decreased from 52.78 (SD 5.21) to 45.37 (SD 6.18). The mean difference in AF-QoL-18 score change between the 2 groups was 1.41 (95\% CI 2.42-0.40, P=.006) at 3 months. The mean difference in MARS-5 score change was 1.76 (95\% CI 2.42-1.10, P<.001). The mean difference in SAS score was --2.91 (95\% CI --3.88 to --1.95, P<.001). Additionally, the mean difference in SDS score was --1.23 (95\% CI --0.02 to --2.44, P=.047). Conclusions: Our study introduces a novel digital animation educational approach that provides multidimensional, easily understandable, and multistage education for patients with AF undergoing catheter ablation. This educational model effectively improves postoperative anxiety, depression, medication adherence, and quality of life in patients at 3 months post discharge. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400081673; https://www.chictr.org.cn/showproj.html?proj=201059 ",
doi="10.2196/65685",
url="https://www.jmir.org/2025/1/e65685"
}


@Article{info:doi/10.2196/63818,
author="Barbazi, Neda
and Shin, Youn Ji
and Hiremath, Gurumurthy
and Lauff, Anne Carlye",
title="Developing Assessments for Key Stakeholders in Pediatric Congenital Heart Disease: Qualitative Pilot Study to Inform Designing of a Medical Education Toy",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="27",
volume="9",
pages="e63818",
keywords="assessment",
keywords="congenital heart disease",
keywords="children health literacy",
keywords="health education",
keywords="caregiving",
keywords="patient-centered care",
keywords="design",
keywords="qualitative pilot",
keywords="children health",
keywords="educational interventions",
abstract="Background: Congenital heart disease (CHD) is a birth defect of the heart that requires long-term care and often leads to additional health complications. Effective educational strategies are essential for improving health literacy and care outcomes. Despite affecting around 40,000 children annually in the United States, there is a gap in understanding children's health literacy, parental educational burdens, and the efficiency of health care providers in delivering education. Objective: This qualitative pilot study aims to develop tailored assessment tools to evaluate educational needs and burdens among children with CHD, their parents, and health care providers. These assessments will inform the design of medical education toys to enhance health management and outcomes for pediatric patients with CHD and key stakeholders. Methods: Through stakeholder feedback from pediatric patients with CHD, parents, and health care providers, we developed three tailored assessments in two phases: (1) iterative development of the assessment tools and (2) pilot testing. In the first phase, we defined key concepts, conducted a literature review, and created initial drafts of the assessments. During the pilot-testing phase, 12 participants were recruited at the M Health Fairview Pediatric Specialty Clinic for Cardiology---Explorer in Minneapolis, Minnesota, United States. We gathered feedback using qualitative methods, including cognitive interviews such as think-aloud techniques, verbal probing, and observations of nonverbal cues. The data were analyzed to identify the strengths and weaknesses of each assessment item and areas for improvement. Results: The 12 participants included children with CHD (n=5), parents (n=4), and health care providers (n=3). The results showed the feasibility and effectiveness of the tailored assessments. Participants showed high levels of engagement and found the assessment items relevant to their education needs. Iterative revisions based on participant feedback improved the assessments' clarity, relevance, and engagement for all stakeholders, including children with CHD. Conclusions: This pilot study emphasizes the importance of iterative assessment development, focusing on multistakeholder engagement. The insights gained from the development process will guide the creation of tailored assessments and inform the development of child-led educational interventions for pediatric populations with CHD. ",
doi="10.2196/63818",
url="https://formative.jmir.org/2025/1/e63818"
}


@Article{info:doi/10.2196/64814,
author="Barbazi, Neda
and Shin, Youn Ji
and Hiremath, Gurumurthy
and Lauff, Anne Carlye",
title="Exploring Health Educational Interventions for Children With Congenital Heart Disease: Scoping Review",
journal="JMIR Pediatr Parent",
year="2025",
month="Jan",
day="24",
volume="8",
pages="e64814",
keywords="congenital heart disease",
keywords="children health literacy",
keywords="health education",
keywords="health education interventions",
keywords="patient-centered care",
keywords="design",
keywords="pediatric",
keywords="PRISMA",
abstract="Background: Congenital heart disease (CHD) is the most common birth defect, affecting 40,000 births annually in the United States. Despite advances in medical care, CHD is often a chronic condition requiring continuous management and education. Effective care management depends on children's understanding of their condition. This highlights the need for targeted health educational interventions to enhance health literacy among children with CHD. Objective: This scoping review aims to map and explore existing health educational interventions for children with CHD. The review identifies the types of interventions, target populations, delivery methods, and assessed outcomes. The goal is to consolidate fragmented research, identify gaps, and establish future research agendas. Methods: Comprehensive searches were conducted in February 2024 using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) framework across multiple databases: APA PsycINFO, MedlinePlus via Ovid, Web of Science, ACM Digital Library, Scopus, and EBSCOhost (CINAHL Complete, CINAHL Ultimate, Health Source: Nursing/Academic Edition, and ERIC). The search covered health care, design, and human-computer interaction disciplines to capture the interdisciplinary nature of CHD health educational interventions. There was no predefined time limit due to the limited number of relevant studies. Eligible studies were in English, published in peer-reviewed journals, and focused on primary data about educational health interventions for children with CHD. We extracted and synthesized data using thematic analysis. Results: The review identified 11 studies: 9 randomized controlled trials and 2 observational studies. These used 6 educational strategies: 3D patient-specific models (n=3), habit formation interventions (n=2), empowerment-based health education programs (n=2), rehabilitation interventions (n=2), web-based portals (n=1), and videotape presentations (n=1). Interventions ranged from brief outpatient sessions to 1.5-year programs, with follow-up from none to 24 months. Studies aimed to improve coping, self-management, and knowledge for children with CHD and their families. The most frequently used assessment method was the independent samples t test (n=4) for pre- and postassessments, and all 11 studies used questionnaires, 8 of which incorporated qualitative feedback. The target participants for these interventions were children aged 13 years and older (n=3), parents (n=2), and children of various ages and their parents (n=6). Outcomes included improved children's health literacy, reduced parental burden, and increased health care provider efficiency. Conclusions: This review underscores the critical need for tailored educational interventions for children with CHD. Current research mainly focuses on adolescents and relies heavily on parental involvement, possibly overlooking the specific needs of younger children younger than 13 years of age. It is essential to develop engaging, age-appropriate interventions that actively involve children with CHD in their health care journey. Effective health educational interventions are crucial in empowering these young patients and improving their long-term health outcomes. ",
doi="10.2196/64814",
url="https://pediatrics.jmir.org/2025/1/e64814"
}


@Article{info:doi/10.2196/63941,
author="Simioni, Lisa
and Tessitore, Elena
and Hagberg, Hamdi
and Schneider-Paccot, Aur{\'e}lie
and Blondon, Katherine
and Gschwind, Liliane
and Meyer, Philippe
and Ehrler, Frederic",
title="Cardiomeds, an mHealth App for Self-Management to Support Swiss Patients With Heart Failure: 2-Stage Mixed Methods Usability Study",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="15",
volume="9",
pages="e63941",
keywords="usability",
keywords="medication",
keywords="mobile health",
keywords="mHealth",
keywords="Cardiomeds",
keywords="mobile app",
keywords="patient empowerment",
keywords="eHealth",
keywords="smartphone",
keywords="heart failure",
keywords="HF",
keywords="chronic disease",
keywords="interactive",
keywords="self-monitoring",
keywords="usability test",
keywords="mobile phone",
abstract="Background: Mobile health apps have shown promising results in improving self-management of several chronic diseases in patients. We have developed a mobile health app (Cardiomeds) dedicated to patients with heart failure (HF). This app includes an interactive medication list; daily self-monitoring of symptoms, weight, blood pressure, and heart rate; and educational information on HF delivered through various formats. Objective: This study aimed to perform a mixed methods usability study of Cardiomeds. Methods: Smartphone users with HF were recruited from the HF outpatient clinic at the University Hospital of Geneva. The usability test was conducted in 2 stages, with modifications made to the app after the first stage to address major usability issues. Each stage required 10 participants to perform 14 tasks, such as entering vital signs, entering a new medication and time of intake, or finding information about HF. Each task was timed, sessions were recorded, and all data were anonymized. After completing the tasks, patients completed the System Usability Scale 10-item questionnaire and answered 5 open questions about their perceptions of Cardiomeds. Results: Twenty patients with HF, 75\% (15/20) of whom were men, with a mean age of 55 years, were included in this study. The average time to complete all 14 tasks was 18 (SD 5.7) minutes. Manual medication entry was the most time-consuming task, taking an average of 154.40 (SD 68.08) seconds in the first stage, 103.10 (SD 42.76) seconds in the second stage, and 128 (SD 63) seconds overall. The mean overall success rate was 77\% (SD 0.23\%) for the first stage and 94\% (SD 0.07\%) for the second stage. A total of 30\% (3/10) of participants in the first stage completed all tasks without any help compared with 50\% (5/10) of participants during the second stage. The average System Usability Scale score was 80\% (SD 17\%), showing a slight increase from 79\% (SD 16\%) in the first stage to 80\% (SD 28\%) in the second stage, which qualifies the app as ``good'' in terms of usability. Between the 2 stages, part of the app interface was redesigned to address the key issues identified in the first stage. Despite these improvements, problems related to guidance were frequent and comprised 36\% (8/22) of the problems in the first stage and 40\% (6/15) in the second stage. In response to open questions, 85\% (17/20) of the participants responded that they would like to use the app when it became available. Conclusions: The usability test indicated that Cardiomeds is a suitable and user-friendly app for patients with HF. The app will be further tested in a randomized clinical trial (2022-00731) after acute HF hospitalization to assess its impact on patients' knowledge about HF, self-care, and quality of life. ",
doi="10.2196/63941",
url="https://formative.jmir.org/2025/1/e63941",
url="http://www.ncbi.nlm.nih.gov/pubmed/39813081"
}


@Article{info:doi/10.2196/53696,
author="Khoshnaw, Sara
and Panzarasa, Pietro
and De Simoni, Anna",
title="Metaphor Diffusion in Online Health Communities: Infodemiology Study in a Stroke Online Health Community",
journal="JMIR Cardio",
year="2024",
month="Dec",
day="17",
volume="8",
pages="e53696",
keywords="online health community",
keywords="social capital",
keywords="metaphor",
keywords="stroke",
keywords="OHC",
keywords="novelty",
keywords="passive analysis",
keywords="stroke survivor",
keywords="self-promotion",
keywords="post-stroke",
keywords="information diffusion",
abstract="Background: Online health communities (OHCs) enable patients to create social ties with people with similar health conditions outside their existing social networks. Harnessing mechanisms of information diffusion in OHCs has attracted attention for its ability to improve illness self-management without the use of health care resources. Objective: We aimed to analyze the novelty of a metaphor used for the first time in an OHC, assess how it can facilitate self-management of post-stroke symptoms, describe its appearance over time, and classify its diffusion mechanisms. Methods: We conducted a passive analysis of posts written by UK stroke survivors and their family members in an online stroke community between 2004 and 2011. Posts including the term ``legacy of stroke'' were identified. Information diffusion was classified according to self-promotion or viral spread mechanisms and diffusion depth (the number of users the information spreads out to). Linguistic analysis was performed through the British National Corpus and the Google search engine. Results: Post-stroke symptoms were referred to as ``legacy of stroke.'' This metaphor was novel and appeared for the first time in the OHC in the second out of a total of 3459 threads. The metaphor was written by user A, who attributed it to a stroke consultant explaining post-stroke fatigue. This user was a ``superuser'' (ie, a user with high posting activity) and self-promoted the metaphor throughout the years in response to posts written by other users, in 51 separate threads. In total, 7 users subsequently used the metaphor, contributing to its viral diffusion, of which 3 were superusers themselves. Superusers achieved the higher diffusion depths (maximum of 3). Of the 7 users, 3 had been part of threads where user A mentioned the metaphor, while 2 users had been part of discussion threads in unrelated conversations. In total, 2 users had not been part of threads with any of the other users, suggesting that the metaphor was acquired through prior lurking activity. Conclusions: Metaphors that are considered helpful by patients with stroke to come to terms with their symptoms can diffuse in OHCs through both self-promotion and social (or viral) spreading, with the main driver of diffusion being the superuser trait. Lurking activity (the most common behavior in OHCs) contributed to the diffusion of information. As an increasing number of patients with long-term conditions join OHCs to find others with similar health-related concerns, improving clinicians' and researchers' awareness of the diffusion of metaphors that facilitate self-management in health social media may be beneficial beyond the individual patient. ",
doi="10.2196/53696",
url="https://cardio.jmir.org/2024/1/e53696"
}


@Article{info:doi/10.2196/58419,
author="Pogrebnoy, Dina
and Ashton, Lee
and Beh, A. Brian
and Burke, Meredith
and Cullen, Richard
and Czerenkowski, Jude
and Davey, Julie
and Dennett, M. Amy
and English, Kevin
and Godecke, Erin
and Harper, Nicole
and Lynch, Elizabeth
and MacDonald-Wicks, Lesley
and Patterson, Amanda
and Ramage, Emily
and Schelfhaut, Ben
and Simpson, B. Dawn
and Zacharia, Karly
and English, Coralie",
title="Adapting a Telehealth Physical Activity and Diet Intervention to a Co-Designed Website for Self-Management After Stroke: Tutorial",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="22",
volume="26",
pages="e58419",
keywords="stroke",
keywords="secondary prevention",
keywords="co-design",
keywords="how-to guide, website development",
keywords="accessibility",
keywords="navigation",
keywords="self-management",
doi="10.2196/58419",
url="https://www.jmir.org/2024/1/e58419"
}


@Article{info:doi/10.2196/58316,
author="Bello, Oneyi Medina
and Mammino, Michael Kevin
and Vernon, Anthony Mark
and Wakeman, G. Daniel
and Denmon, Aerius Chanse
and Krishnamurthy, Crystal Lisa
and Krishnamurthy, Venkatagiri
and McGregor, Matthew Keith
and Novak, Samuel Thomas
and Nocera, Robert Joe",
title="Graded Intensity Aerobic Exercise to Improve Cerebrovascular Function and Performance in Older Veterans: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="26",
volume="13",
pages="e58316",
keywords="aerobic exercise",
keywords="exercise",
keywords="functional magnetic resonance imaging",
keywords="fMRI",
keywords="veterans",
keywords="quality of life",
keywords="sedentary lifestyle",
keywords="elderly",
keywords="geriatrics",
keywords="geriatric",
keywords="older adults",
keywords="cardiovascular disease",
keywords="health promotion",
keywords="aging",
keywords="cognitive",
keywords="cognitive health",
keywords="physical health",
abstract="Background: Growing health care challenges resulting from a rapidly expanding aging population necessitate examining effective rehabilitation techniques that mitigate age-related comorbidity and improve quality of life. To date, exercise is one of a few proven interventions known to attenuate age-related declines in cognitive and sensorimotor functions critical to sustained independence. Objective: This work aims to implement a multimodal imaging approach to better understand the mechanistic underpinnings of the beneficial exercise-induced adaptations to sedentary older adults' brains and behaviors. Due to the complex cerebral and vascular dynamics that encompass neuroplastic change with aging and exercise, we propose an imaging protocol that will model exercise-induced changes to cerebral perfusion, cerebral vascular reactivity (CVR), and cognitive and sensorimotor task-dependent functional magnetic resonance imaging (fMRI) after prescribed exercise. Methods: Sedentary older adults (aged 65-80 years) were randomly assigned to either a 12-week aerobic-based interval-based cycling intervention or a 12-week balance and stretching intervention. Assessments of cardiovascular fitness used the YMCA submaximal VO2 test, basal cerebral perfusion using arterial spin labeling (ASL), CVR using hypercapnic fMRI, and cortical activation using fMRI during verbal fluency and motor tapping tasks. A battery of cognitive-executive and motor function tasks outside the scanning environment will be performed before and after the interventions. Results: Our studies and others show that improved cardiovascular fitness in older adults results in improved outcomes related to physical and cognitive health as well as quality of life. A consistent but unexplained finding in many of these studies is a change in cortical activation patterns during task-based fMRI, which corresponds with improved task performance (cognitive-executive and motor). We hypothesize that the 12-week aerobic exercise intervention will increase basal perfusion and improve CVR through a greater magnitude of reactivity in brain areas susceptible to neural and vascular decline (inferior frontal and motor cortices) in previously sedentary older adults. To differentiate between neural and vascular adaptations in these regions, we will map changes in basal perfusion and CVR over the inferior frontal and the motor cortices---regions we have previously shown to be beneficially altered during fMRI BOLD (blood oxygen level dependent), such as verbal fluency and motor tapping, through improved cardiovascular fitness. Conclusions: Exercise is one of the most impactful interventions for improving physical and cognitive health in aging. This study aims to better understand the mechanistic underpinnings of improved health and function of the cerebrovascular system. If our hypothesis of improved perfusion and cerebrovascular reactivity following a 12-week aerobic exercise intervention is supported, it would add critically important insights into the potential of exercise to improve brain health in aging and could inform exercise prescription for older adults at risk for neurodegenerative disease brought on by cerebrovascular dysfunction. Trial Registration: ClinicalTrials.gov NCT05932069; https://clinicaltrials.gov/study/NCT05932069 International Registered Report Identifier (IRRID): DERR1-10.2196/58316 ",
doi="10.2196/58316",
url="https://www.researchprotocols.org/2024/1/e58316"
}


@Article{info:doi/10.2196/54909,
author="Heinert, W. Sara
and Guzman-Baez, Kelvin
and Aamir, Affan
and Penugonda, Ananya
and Crabtree, F. Benjamin
and Greene, Kathryn
and Heckman, J. Carolyn
and Levy, Phillip
and Strickland, Ohman Pamela
and Hudson, V. Shawna",
title="Developing a Youth-Led Digital Hypertension Education Intervention for Adults With Hypertension: Qualitative Study on Refinement and Acceptability",
journal="JMIR Form Res",
year="2024",
month="Sep",
day="6",
volume="8",
pages="e54909",
keywords="hypertension",
keywords="adolescents",
keywords="adults",
keywords="emergency department",
keywords="digital health intervention",
keywords="dyad intervention",
keywords="intervention development",
keywords="qualitative research",
keywords="youth",
keywords="adolescent",
keywords="teen",
keywords="teens",
keywords="teenager",
keywords="teenagers",
keywords="adult",
keywords="youth-led",
keywords="digital health",
keywords="health education",
keywords="refinement",
keywords="acceptability",
keywords="USA",
keywords="United States",
keywords="care navigation",
keywords="effectiveness",
keywords="formative study",
keywords="prototype",
keywords="self-guided",
keywords="online module",
keywords="online modules",
keywords="engagement",
keywords="blood pressure",
keywords="health knowledge",
keywords="health promotion",
keywords="nutrition education",
keywords="support intervention",
keywords="support",
keywords="supports",
abstract="Background: Hypertension affects one-third of adults in the United States and is the leading risk factor for death. Underserved populations are seen disproportionately in the emergency department (ED) and tend to have worse blood pressure (BP) control. For adults, a lack of hypertension knowledge is a common barrier to hypertension control, while social support is a strong facilitator, and providing information that is culturally sensitive and relevant is especially important in this context. The youth experience increased confidence when given the responsibility to provide health education and care navigation to others. As such, we planned a randomized controlled trial (RCT) for the effectiveness of a digital youth-led hypertension education intervention for adult patients in the ED with hypertension, focusing on change in BP and hypertension knowledge. Objective: In preparation for an RCT, we conducted a formative study to determine acceptable and easily comprehensible ways to present hypertension information to adults with hypertension and optimal ways to engage youth to support adults on how to achieve better hypertension control. Methods: After creating an intervention prototype with 6 weekly self-guided hypertension online modules, we recruited 12 youth (adolescents, aged 15-18 years) for 3 focus groups and 10 adult ED patients with hypertension for individual online interviews to garner feedback on the prototype. After completing a brief questionnaire, participants were asked about experiences with hypertension, preferences for a hypertension education intervention, and acceptability, feasibility, obstacles, and solutions for intervention implementation with youth and adults. The moderator described and showed participants the prototyped intervention process and materials and asked for feedback. Questionnaire data were descriptively summarized, and qualitative data were analyzed using the template organizing style of analysis by 3 study team members. Results: Participants showed great interest in the intervention prototype, thought their peers would find it acceptable, and appreciated its involvement of youth. Youth with family members with hypertension reported that their family members need more support for their hypertension. Youth suggested adding more nutrition education activities to the intervention, such as a sodium tracker and examples of high-sodium foods. Adults discussed the need for a hypertension support intervention for themselves and the expected benefits to youth. They mentioned the overwhelming amount of hypertension information available and appreciated the intervention's concise content presentation. They suggested adding more mental health and smoking cessation resources, information about specific hypertension medications, and adding active links for health care information. Conclusions: Based on focus groups and interviews with participants, a youth-led digital hypertension intervention is an acceptable strategy to engage both adults with hypertension and youth. Incorporating participant suggestions into the intervention may improve its clarity, engagement, and impact when used in a subsequent RCT. ",
doi="10.2196/54909",
url="https://formative.jmir.org/2024/1/e54909",
url="http://www.ncbi.nlm.nih.gov/pubmed/39240662"
}


@Article{info:doi/10.2196/51513,
author="Gong, Xun
and Chen, Meijuan
and Ning, Lihong
and Zeng, Lingzhong
and Dong, Bo",
title="The Quality of Short Videos as a Source of Coronary Heart Disease Information on TikTok: Cross-Sectional Study",
journal="JMIR Form Res",
year="2024",
month="Sep",
day="3",
volume="8",
pages="e51513",
keywords="coronary heart disease",
keywords="content quality",
keywords="social media",
keywords="short-video platform",
keywords="TikTok",
abstract="Background: Coronary heart disease (CHD) is a leading cause of death worldwide and imposes a significant economic burden. TikTok has risen as a favored platform within the social media sphere for disseminating CHD-related information and stands as a pivotal resource for patients seeking knowledge about CHD. However, the quality of such content on TikTok remains largely unexplored. Objective: This study aims to assess the quality of information conveyed in TikTok CHD-related videos. Methods: A comprehensive cross-sectional study was undertaken on TikTok videos related to CHD. The sources of the videos were identified and analyzed. The comprehensiveness of content was assessed through 6 questions addressing the definition, signs and symptoms, risk factors, evaluation, management, and outcomes. The quality of the videos was assessed using 3 standardized evaluative instruments: DISCERN, the Journal of the American Medical Association (JAMA) benchmarks, and the Global Quality Scale (GQS). Furthermore, correlative analyses between video quality and characteristics of the uploaders and the videos themselves were conducted. Results: The search yielded 145 CHD-related videos from TikTok, predominantly uploaded by health professionals (n=128, 88.3\%), followed by news agencies (n=6, 4.1\%), nonprofit organizations (n=10, 6.9\%), and for-profit organizations (n=1, 0.7\%). Content comprehensiveness achieved a median score of 3 (IQR 2-4). Median values for the DISCERN, JAMA, and GQS evaluations across all videos stood at 27 (IQR 24-32), 2 (IQR 2-2), and 2 (IQR 2-3), respectively. Videos from health professionals and nonprofit organizations attained significantly superior JAMA scores in comparison to those of news agencies (P<.001 and P=.02, respectively), whereas GQS scores for videos from health professionals were also notably higher than those from news agencies (P=.048). Within health professionals, cardiologists demonstrated discernibly enhanced performance over noncardiologists in both DISCERN and GQS assessments (P=.02). Correlative analyses unveiled positive correlations between video quality and uploader metrics, encompassing the positive correlations between the number of followers; total likes; average likes per video; and established quality indices such as DISCERN, JAMA, or GQS scores. Similar investigations relating to video attributes showed correlations between user engagement factors---likes, comments, collections, shares---and the aforementioned quality indicators. In contrast, a negative correlation emerged between the number of days since upload and quality indices, while a longer video duration corresponded positively with higher DISCERN and GQS scores. Conclusions: The quality of the videos was generally poor, with significant disparities based on source category. The content comprehensiveness coverage proved insufficient, casting doubts on the reliability and quality of the information relayed through these videos. Among health professionals, video contributions from cardiologists exhibited superior quality compared to noncardiologists. As TikTok's role in health information dissemination expands, ensuring accurate and reliable content is crucial to better meet patients' needs for CHD information that conventional health education fails to fulfill. ",
doi="10.2196/51513",
url="https://formative.jmir.org/2024/1/e51513"
}


@Article{info:doi/10.2196/56380,
author="Miki, Takahiro
and Yamada, Junya
and Ishida, Shinpei
and Sakui, Daisuke
and Kanai, Masashi
and Hagiwara, Yuta",
title="Exploring the Feasibility and Initial Impact of an mHealth-Based Disease Management Program for Chronic Ischemic Heart Disease: Formative Study",
journal="JMIR Form Res",
year="2024",
month="Aug",
day="22",
volume="8",
pages="e56380",
keywords="mobile health",
keywords="chronic ischemic heart disease",
keywords="disease management program",
keywords="mobile phone",
keywords="behavior change",
abstract="Background: Ischemic heart disease (IHD) is a leading cause of morbidity and mortality worldwide, requiring innovative management strategies. Traditional disease management programs often struggle to maintain patient engagement and ensure long-term adherence to lifestyle modifications and treatment plans. Mobile health (mHealth) technologies have emerged as a promising approach to address these challenges by providing continuous, personalized support and monitoring. However, the reported use and effectiveness of mHealth in the management of chronic diseases, such as IHD, have not been fully explored. Objective: The primary aim of this study was to evaluate the feasibility and initial impact of an mHealth-based disease management program on coronary risk factors, specifically focusing on low-density lipoprotein cholesterol (LDL-C) levels, in individuals with chronic IHD. This formative study assessed changes in LDL-C and other metabolic health indicators over a 6-month period to determine the initial impact of the program on promoting cardiovascular health and lifestyle modification. Methods: This study was conducted using data from 266 individuals enrolled in an mHealth-based disease management program between December 2018 and October 2022. Eligibility was based on a documented history of IHD, with participants undergoing a comprehensive cardiac risk assessment before enrollment. The program included biweekly telephone sessions, health tracking via a smartphone app, and regular progress reports to physicians. The study measured change in LDL-C levels as the primary outcome, with secondary outcomes including body weight, triglyceride levels, and other metabolic health indicators. Statistical analysis used paired 2-tailed t tests and stratified analyses to assess the impact of the program. Results: Participants experienced a significant reduction in LDL-C, with LDL-C levels decreasing from a mean of 98.82 (SD 40.92) mg/dL to 86.62 (SD 39.86) mg/dL (P<.001). The intervention was particularly effective in individuals with high baseline LDL-C levels. Additional improvements were seen in body weight and triglyceride levels, suggesting a broader impact on metabolic health. Program adherence and engagement metrics suggested high participant satisfaction and compliance. Conclusions: The results of this study suggest that the mHealth-based disease management program is feasible and has an initial positive impact on reducing LDL-C levels and improving metabolic health in individuals with chronic IHD. However, the study design does not allow for a definitive conclusion regarding whether mHealth-based disease management programs are more effective than traditional face-to-face care. Future studies are needed to further validate these findings and to examine the comparative effectiveness of these interventions in more detail. ",
doi="10.2196/56380",
url="https://formative.jmir.org/2024/1/e56380"
}


@Article{info:doi/10.2196/55403,
author="Cui, Nannan
and Lu, Yuting
and Cao, Yelin
and Chen, Xiaofan
and Fu, Shuiqiao
and Su, Qun",
title="Quality Assessment of TikTok as a Source of Information About Mitral Valve Regurgitation in China: Cross-Sectional Study",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="20",
volume="26",
pages="e55403",
keywords="mitral valve regurgitation",
keywords="video quality",
keywords="TikTok",
keywords="Journal of American Medical Association",
keywords="JAMA",
keywords="Global Quality Score",
keywords="GQS",
keywords="PEMAT- A/V",
keywords="Spearman correlation analysis",
keywords="Poisson regression analysis",
abstract="Background: In China, mitral valve regurgitation (MR) is the most common cardiovascular valve disease. However, patients in China typically experience a high incidence of this condition, coupled with a low level of health knowledge and a relatively low rate of surgical treatment. TikTok hosts a vast amount of content related to diseases and health knowledge, providing viewers with access to relevant information. However, there has been no investigation or evaluation of the quality of videos specifically addressing MR. Objective: This study aims to assess the quality of videos about MR on TikTok in China. Methods: A cross-sectional study was conducted on the Chinese version of TikTok on September 9, 2023. The top 100 videos on MR were included and evaluated using quantitative scoring tools such as the modified DISCERN (mDISCERN), the Journal of the American Medical Association (JAMA) benchmark criteria, the Global Quality Score (GQS), and the Patient Education Materials Assessment Tool for Audio-Visual Content (PEMAT-A/V). Correlation and stepwise regression analyses were performed to examine the relationships between video quality and various characteristics. Results: We obtained 88 valid video files, of which most (n=81, 92\%) were uploaded by certified physicians, primarily cardiac surgeons, and cardiologists. News agencies/organizations and physicians had higher GQS scores compared with individuals (news agencies/organizations vs individuals, P=.001; physicians vs individuals, P=.03). Additionally, news agencies/organizations had higher PEMAT understandability scores than individuals (P=.01). Videos focused on disease knowledge scored higher in GQS (P<.001), PEMAT understandability (P<.001), and PEMAT actionability (P<.001) compared with videos covering surgical cases. PEMAT actionability scores were higher for outpatient cases compared with surgical cases (P<.001). Additionally, videos focused on surgical techniques had lower PEMAT actionability scores than those about disease knowledge (P=.04). The strongest correlations observed were between thumbs up and comments (r=0.92, P<.001), thumbs up and favorites (r=0.89, P<.001), thumbs up and shares (r=0.87, P<.001), comments and favorites (r=0.81, P<.001), comments and shares (r=0.87, P<.001), and favorites and shares (r=0.83, P<.001). Stepwise regression analysis identified ``length (P<.001),'' ``content (P<.001),'' and ``physicians (P=.004)'' as significant predictors of GQS. The final model (model 3) explained 50.1\% of the variance in GQSs. The predictive equation for GQS is as follows: GQS = 3.230 ? 0.294 {\texttimes} content ? 0.274 {\texttimes} physicians + 0.005 {\texttimes} length. This model was statistically significant (P=.004) and showed no issues with multicollinearity or autocorrelation. Conclusions: Our study reveals that while most MR-related videos on TikTok were uploaded by certified physicians, ensuring professional and scientific content, the overall quality scores were suboptimal. Despite the educational value of these videos, the guidance provided was often insufficient. The predictive equation for GQS developed from our analysis offers valuable insights but should be applied with caution beyond the study context. It suggests that creators should focus on improving both the content and presentation of their videos to enhance the quality of health information shared on social media. ",
doi="10.2196/55403",
url="https://www.jmir.org/2024/1/e55403",
url="http://www.ncbi.nlm.nih.gov/pubmed/39163110"
}


@Article{info:doi/10.2196/59948,
author="Carter, Carter Jocelyn A.
and Swack, Natalia
and Isselbacher, Eric
and Donelan, Karen
and Thorndike, Anne",
title="Feasibility, Acceptability, and Preliminary Effectiveness of a Combined Digital Platform and Community Health Worker Intervention for Patients With Heart Failure: Pilot Randomized Controlled Trial",
journal="JMIR Cardio",
year="2024",
month="Aug",
day="8",
volume="8",
pages="e59948",
keywords="heart failure",
keywords="heart",
keywords="cardiology",
keywords="failure",
keywords="clinical pilot trial",
keywords="digital platform",
keywords="home",
keywords="digital health",
keywords="remote monitoring",
keywords="monitoring",
keywords="home-based care",
keywords="community health workers",
keywords="social needs care",
keywords="randomized controlled trial",
keywords="controlled trials",
keywords="feasibility",
keywords="usability",
keywords="acceptability",
keywords="social needs",
abstract="Background: Heart failure (HF) is a burdensome condition and a leading cause of 30-day hospital readmissions in the United States. Clinical and social factors are key drivers of hospitalization. These 2 strategies, digital platforms and home-based social needs care, have shown preliminary effectiveness in improving adherence to clinical care plans and reducing acute care use in HF. Few studies, if any, have tested combining these 2 strategies in a single intervention. Objective: This study aims to perform a pilot randomized controlled trial assessing the acceptability, feasibility, and preliminary effectiveness of a 30-day digitally-enabled community health worker (CHW) intervention in HF. Methods: Adults hospitalized with a diagnosis of HF at an academic hospital were randomly assigned to receive digitally-enabled CHW care (intervention; digital platform +CHW) or CHW-enhanced usual care (control; CHW only) for 30 days after hospital discharge. Primary outcomes were feasibility (use of the platform) and acceptability (willingness to use the platform in the future). Secondary outcomes assessed preliminary effectiveness (30-day readmissions, emergency department visits, and missed clinic appointments). Results: A total of 56 participants were randomized (control: n=31; intervention: n=25) and 47 participants (control: n=28; intervention: n=19) completed all trial activities. Intervention participants who completed trial activities wore the digital sensor on 78\% of study days with mean use of 11.4 (SD 4.6) hours/day, completed symptom questionnaires on 75\% of study days, used the blood pressure monitor 1.1 (SD 0.19) times/day, and used the digital weight scale 1 (SD 0.13) time/day. Of intervention participants, 100\% responded very or somewhat true to the statement ``If I have access to the [platform] moving forward, I will use it.'' Some (n=9, 47\%) intervention participants indicated they required support to use the digital platform. A total of 19 (100\%) intervention participants and 25 (89\%) control participants had ?5 CHW interactions during the 30-day study period. All intervention (n=19, 100\%) and control (n=26, 93\%) participants who completed trial activities indicated their CHW interactions were ``very satisfying.'' In the full sample (N=56), fewer participants in the intervention group were readmitted 30 days after hospital discharge compared to the control group (n=3, 12\% vs n=8, 26\%; P=.12). Both arms had similar rates of missed clinic appointments and emergency department visits. Conclusions: This pilot trial of a digitally-enabled CHW intervention for HF demonstrated feasibility, acceptability, and a clinically relevant reduction in 30-day readmissions among participants who received the intervention. Additional investigation is needed in a larger trial to determine the effect of this intervention on HF home management and clinical outcomes. Trial Registration: Clinicaltrials.gov NCT05130008; https://clinicaltrials.gov/study/NCT05130008 International Registered Report Identifier (IRRID): RR2-10.2196/55687 ",
doi="10.2196/59948",
url="https://cardio.jmir.org/2024/1/e59948",
url="http://www.ncbi.nlm.nih.gov/pubmed/38959294"
}


@Article{info:doi/10.2196/57058,
author="Sassone, Biagio
and Fuca', Giuseppe
and Pedaci, Mario
and Lugli, Roberta
and Bertagnin, Enrico
and Virzi', Santo
and Bovina, Manuela
and Pasanisi, Giovanni
and Mandini, Simona
and Myers, Jonathan
and Tolomeo, Paolo",
title="Analysis of Demographic and Socioeconomic Factors Influencing Adherence to a Web-Based Intervention Among Patients After Acute Coronary Syndrome: Prospective Observational Cohort Study",
journal="JMIR Cardio",
year="2024",
month="Aug",
day="2",
volume="8",
pages="e57058",
keywords="telemedicine",
keywords="digital literacy",
keywords="digital health",
keywords="acute coronary syndrome",
keywords="older age",
keywords="caregiver",
keywords="socioeconomic",
keywords="educational",
keywords="mobile phone",
abstract="Background: Although telemedicine has been proven to have significant potential for improving care for patients with cardiac problems, there remains a substantial risk of introducing disparities linked to the use of digital technology, especially for older or socially vulnerable subgroups. Objective: We investigated factors influencing adherence to a telemedicine-delivered health education intervention in patients with ischemia, emphasizing demographic and socioeconomic considerations. Methods: We conducted a descriptive, observational, prospective cohort study in consecutive patients referred to our cardiology center for acute coronary syndrome, from February 2022 to January 2023. Patients were invited to join a web-based health educational meeting (WHEM) after hospital discharge, as part of a secondary prevention program. The WHEM sessions were scheduled monthly and used a teleconference software program for remote synchronous videoconferencing, accessible through a standard computer, tablet, or smartphone based on patient preference or availability. Results: Out of the 252 patients (median age 70, IQR 61.0-77.3 years; n=189, 75\% male), 98 (38.8\%) declined the invitation to participate in the WHEM. The reasons for nonacceptance were mainly challenges in handling digital technology (70/98, 71.4\%), followed by a lack of confidence in telemedicine as an integrative tool for managing their medical condition (45/98, 45.9\%), and a lack of internet-connected devices (43/98, 43.8\%). Out of the 154 patients who agreed to participate in the WHEM, 40 (25.9\%) were unable to attend. Univariable logistic regression analysis showed that the presence of a caregiver with digital proficiency and a higher education level was associated with an increased likelihood of attendance to the WHEM, while the converse was true for increasing age and female sex. After multivariable adjustment, higher education level (odds ratio [OR] 2.26, 95\% CI 1.53-3.32; P<.001) and caregiver with digital proficiency (OR 12.83, 95\% CI 5.93-27.75; P<.001) remained independently associated with the outcome. The model discrimination was good even when corrected for optimism (optimism-corrected C-index=0.812), as was the agreement between observed and predicted probability of participation (optimism-corrected calibration intercept=0.010 and slope=0.948). Conclusions: This study identifies a notable lack of suitability for a specific cohort of patients with ischemia to participate in our telemedicine intervention, emphasizing the risk of digital marginalization for a significant portion of the population. Addressing low digital literacy rates among patients or their informal caregivers and overcoming cultural bias against remote care were identified as critical issues in our study findings to facilitate the broader adoption of telemedicine as an inclusive tool in health care. ",
doi="10.2196/57058",
url="https://cardio.jmir.org/2024/1/e57058",
url="http://www.ncbi.nlm.nih.gov/pubmed/38912920"
}


@Article{info:doi/10.2196/54317,
author="Hutchinson, Anastasia
and Khaw, Damien
and Malmstrom-Zinkel, Annika
and Winter, Natalie
and Dowling, Chantelle
and Botti, Mari
and McDonall, Joanne",
title="Embedding the Use of Patient Multimedia Educational Resources Into Cardiac Acute Care: Prospective Observational Study",
journal="JMIR Nursing",
year="2024",
month="Jul",
day="18",
volume="7",
pages="e54317",
keywords="patient participation",
keywords="digital technology",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="digital health",
keywords="smartphone",
keywords="smartphones",
keywords="multimedia",
keywords="patient education",
keywords="education",
keywords="educational",
keywords="educate",
keywords="patient engagement",
keywords="nursing",
keywords="cardiac surgery",
keywords="cardiology",
keywords="cardiac",
keywords="cardio",
keywords="CCU",
keywords="cardiac care unit",
keywords="CCC",
keywords="complex cardiac care",
keywords="coronary care nursing",
keywords="nurse",
keywords="COVID-19",
keywords="SARS-COV-2",
keywords="Coronavirus",
keywords="severe acute respiratory syndrome",
keywords="Coronavirus infections",
keywords="novel Coronavirus",
abstract="Background: Multimedia interventions may play an important role in improving patient care and reducing the time constraints of patient-clinician encounters. The ``MyStay Cardiac'' multimedia resource is an innovative program designed to be accessed by adult patients undergoing cardiac surgery. Objective: The purpose of this study was to evaluate the uptake of the MyStay Cardiac both during and following the COVID-19 pandemic. Methods: A prospective observational study design was used that involved the evaluation of program usage data available from the digital interface of the multimedia program. Data on usage patterns were analyzed for a 30-month period between August 2020 and January 2023. Usage patterns were compared during and following the lifting of COVID-19 pandemic restrictions. Uptake of the MyStay Cardiac was measured via the type and extent of user activity data captured by the web-based information system. Results: Intensive care unit recovery information was the most accessed information, being viewed in approximately 7 of 10 usage sessions. Ward recovery (n=124/343, 36.2\%), goal (n=114/343, 33.2\%), and exercise (n=102/343, 29.7\%) information were routinely accessed. Most sessions involved users exclusively viewing text-based information (n=210/343, 61.2\%). However, in over one-third of sessions (n=132/342, 38.5\%), users accessed video information. Most usage sessions occurred during the COVID-19 restriction phase of the study (August 2020-December 2021). Sessions in which video (P=.02, phi=0.124) and audio (P=.006, phi=0.161) media were accessed were significantly more likely to occur in the restriction phase compared to the postrestriction phase. Conclusions: This study found that the use of digital multimedia resources to support patient education was well received and integrated into their practice by cardiac nurses working in acute care during the COVID-19 pandemic. There was a pattern for greater usage of the MyStay Cardiac during the COVID-19 pandemic when access to the health service for nonfrontline, essential workers was limited. ",
doi="10.2196/54317",
url="https://nursing.jmir.org/2024/1/e54317",
url="http://www.ncbi.nlm.nih.gov/pubmed/39024556"
}


@Article{info:doi/10.2196/53421,
author="King, C. Ryan
and Samaan, S. Jamil
and Yeo, Hui Yee
and Peng, Yuxin
and Kunkel, C. David
and Habib, A. Ali
and Ghashghaei, Roxana",
title="A Multidisciplinary Assessment of ChatGPT's Knowledge of Amyloidosis: Observational Study",
journal="JMIR Cardio",
year="2024",
month="Apr",
day="19",
volume="8",
pages="e53421",
keywords="amyloidosis",
keywords="ChatGPT",
keywords="large language models",
keywords="cardiology",
keywords="gastroenterology",
keywords="neurology",
keywords="artificial intelligence",
keywords="multidisciplinary care",
keywords="assessment",
keywords="patient education",
keywords="large language model",
keywords="accuracy",
keywords="reliability",
keywords="accessibility",
keywords="educational resources",
keywords="dissemination",
keywords="gastroenterologist",
keywords="cardiologist",
keywords="medical society",
keywords="institution",
keywords="institutions",
keywords="Facebook",
keywords="neurologist",
keywords="reproducibility",
keywords="amyloidosis-related",
abstract="Background: Amyloidosis, a rare multisystem condition, often requires complex, multidisciplinary care. Its low prevalence underscores the importance of efforts to ensure the availability of high-quality patient education materials for better outcomes. ChatGPT (OpenAI) is a large language model powered by artificial intelligence that offers a potential avenue for disseminating accurate, reliable, and accessible educational resources for both patients and providers. Its user-friendly interface, engaging conversational responses, and the capability for users to ask follow-up questions make it a promising future tool in delivering accurate and tailored information to patients. Objective: We performed a multidisciplinary assessment of the accuracy, reproducibility, and readability of ChatGPT in answering questions related to amyloidosis. Methods: In total, 98 amyloidosis questions related to cardiology, gastroenterology, and neurology were curated from medical societies, institutions, and amyloidosis Facebook support groups and inputted into ChatGPT-3.5 and ChatGPT-4. Cardiology- and gastroenterology-related responses were independently graded by a board-certified cardiologist and gastroenterologist, respectively, who specialize in amyloidosis. These 2 reviewers (RG and DCK) also graded general questions for which disagreements were resolved with discussion. Neurology-related responses were graded by a board-certified neurologist (AAH) who specializes in amyloidosis. Reviewers used the following grading scale: (1) comprehensive, (2) correct but inadequate, (3) some correct and some incorrect, and (4) completely incorrect. Questions were stratified by categories for further analysis. Reproducibility was assessed by inputting each question twice into each model. The readability of ChatGPT-4 responses was also evaluated using the Textstat library in Python (Python Software Foundation) and the Textstat readability package in R software (R Foundation for Statistical Computing). Results: ChatGPT-4 (n=98) provided 93 (95\%) responses with accurate information, and 82 (84\%) were comprehensive. ChatGPT-3.5 (n=83) provided 74 (89\%) responses with accurate information, and 66 (79\%) were comprehensive. When examined by question category, ChatGTP-4 and ChatGPT-3.5 provided 53 (95\%) and 48 (86\%) comprehensive responses, respectively, to ``general questions'' (n=56). When examined by subject, ChatGPT-4 and ChatGPT-3.5 performed best in response to cardiology questions (n=12) with both models producing 10 (83\%) comprehensive responses. For gastroenterology (n=15), ChatGPT-4 received comprehensive grades for 9 (60\%) responses, and ChatGPT-3.5 provided 8 (53\%) responses. Overall, 96 of 98 (98\%) responses for ChatGPT-4 and 73 of 83 (88\%) for ChatGPT-3.5 were reproducible. The readability of ChatGPT-4's responses ranged from 10th to beyond graduate US grade levels with an average of 15.5 (SD 1.9). Conclusions: Large language models are a promising tool for accurate and reliable health information for patients living with amyloidosis. However, ChatGPT's responses exceeded the American Medical Association's recommended fifth- to sixth-grade reading level. Future studies focusing on improving response accuracy and readability are warranted. Prior to widespread implementation, the technology's limitations and ethical implications must be further explored to ensure patient safety and equitable implementation. ",
doi="10.2196/53421",
url="https://cardio.jmir.org/2024/1/e53421",
url="http://www.ncbi.nlm.nih.gov/pubmed/38640472"
}


@Article{info:doi/10.2196/52583,
author="Kent-Marvick, Jacqueline
and Gibson, Bryan
and Bristol, A. Alycia
and St Clair, Stephanie
and Simonsen, E. Sara",
title="Tailoring of Health-Promotion Video Messaging for Reproductive-Aged Women at Risk for Developing Cardiometabolic Disease: Qualitative Focus-Groups Study",
journal="JMIR Form Res",
year="2024",
month="Mar",
day="5",
volume="8",
pages="e52583",
keywords="cardiometabolic disease",
keywords="type 2 diabetes mellitus",
keywords="gestational diabetes mellitus",
keywords="hypertensive disorder of pregnancy",
keywords="prediabetes",
keywords="obesity",
keywords="women's health",
keywords="lifestyle change",
keywords="health promotion technology",
keywords="qualitative research",
abstract="Background: Targeting reproductive-aged women at high risk for type 2 diabetes (T2D) provides an opportunity for prevention earlier in the life course. A woman's experiences during her reproductive years may have a large impact on her future risk of T2D. Her risk is 7 to 10 times higher if she has had gestational diabetes (GDM). Despite these risks, T2D is preventable. Evidence-based programs, such as the National Diabetes Prevention Program (DPP), can reduce the risk of developing T2D by nearly 60\%. However, only 0.4\% of adults with prediabetes have participated in the DPP to date and reproductive-aged women are 50\% less likely to participate than older women. In prior work, our team developed a mobile 360{\textdegree} video to address diabetes risk awareness and promote DPP enrollment among at-risk adults; this video was not designed, however, for reproductive-aged women. Objective: This study aims to obtain feedback from reproductive-aged women with cardiometabolic disease risk about a 360{\textdegree} video designed to promote enrollment in the DPP, and to gather suggestions about tailoring video messages to reproductive-aged women. Methods: Focus groups and a qualitative descriptive approach were used. Women with at least 1 previous pregnancy, aged 18 to 40 years, participated in one of three focus groups stratified by the following health risks: (1) a history of GDM or a hypertensive disorder of pregnancy, (2) a diagnosis of prediabetes, or (3) a BMI classified as obese. Focus-group questions addressed several topics; this report shared findings regarding video feedback. The 3 focus-group discussions were conducted via Zoom and were recorded and transcribed for analysis. Deductive codes were used to identify concepts related to the research question and inductive codes were created for novel insights shared by participants. The codes were then organized into categories and themes. Results: The main themes identified were positive feedback, negative feedback, centering motherhood, and the importance of storytelling. While some participants said the video produced a sense of urgency for health-behavior change, all participants agreed that design changes could improve the video's motivating effect on health-behavior change in reproductive-aged women. Participants felt a tailored video should recognize the complexities of being a mother and how these dynamics contribute to women's difficulty engaging in healthy behaviors without stirring feelings of guilt. Women desired a video with a positive, problem-solving perspective, and recommended live links as clickable resources for practical solutions promoting health behavior change. Women suggested using storytelling, both to describe how complications experienced during pregnancy impact long-term health and to motivate health behavior change. Conclusions: Reproductive-aged women require tailored lifestyle-change messaging that addresses barriers commonly encountered by this population (eg, parenting or work responsibilities). Moreover, messaging should prioritize a positive tone that harnesses storytelling and human connection while offering realistic solutions. ",
doi="10.2196/52583",
url="https://formative.jmir.org/2024/1/e52583",
url="http://www.ncbi.nlm.nih.gov/pubmed/38441920"
}


@Article{info:doi/10.2196/49590,
author="Kapoor, Alok
and Patel, Parth
and Chennupati, Soumya
and Mbusa, Daniel
and Sadiq, Hammad
and Rampam, Sanjeev
and Leung, Robert
and Miller, Megan
and Vargas, Rivera Kevin
and Fry, Patrick
and Lowe, Martin Mary
and Catalano, Christina
and Harrison, Charles
and Catanzaro, Nicholas John
and Crawford, Sybil
and Smith, Marie Anne",
title="Comparing the Efficacy of Targeted and Blast Portal Messaging in Message Opening Rate and Anticoagulation Initiation in Patients With Atrial Fibrillation in the Preventing Preventable Strokes Study II: Prospective Cohort Study",
journal="JMIR Cardio",
year="2024",
month="Jan",
day="24",
volume="8",
pages="e49590",
keywords="anticoagulants",
keywords="atrial fibrillation",
keywords="humans",
keywords="outpatients",
keywords="patient education as topic",
keywords="patient portals",
abstract="Background: The gap in anticoagulation use among patients with atrial fibrillation (AF) is a major public health threat. Inadequate patient education contributes to this gap. Patient portal--based messaging linked to educational materials may help bridge this gap, but the most effective messaging approach is unknown. Objective: This study aims to compare the responsiveness of patients with AF to an AF or anticoagulation educational message between 2 portal messaging approaches: sending messages targeted at patients with upcoming outpatient appointments 1 week before their scheduled appointment (targeted) versus sending messages to all eligible patients in 1 blast, regardless of appointment scheduling status (blast), at 2 different health systems: the University of Massachusetts Chan Medical School (UMass) and the University of Florida College of Medicine-Jacksonville (UFL). Methods: Using the 2 approaches, we sent patient portal messages to patients with AF and grouped patients by high-risk patients on anticoagulation (group 1), high-risk patients off anticoagulation (group 2), and low-risk patients who may become eligible for anticoagulation in the future (group 3). Risk was classified based on the congestive heart failure, hypertension, age ?75 years, diabetes mellitus, stroke, vascular disease, age between 65 and 74 years, and sex category (CHA2DS2-VASc) score. The messages contained a link to the Upbeat website of the Heart Rhythm Society, which displays print and video materials about AF and anticoagulation. We then tracked message opening, review of the website, anticoagulation use, and administered patient surveys across messaging approaches and sites using Epic Systems (Epic Systems Corporation) electronic health record data and Google website traffic analytics. We then conducted chi-square tests to compare potential differences in the proportion of patients opening messages and other evaluation metrics, adjusting for potential confounders. All statistical analyses were performed in SAS (version 9.4; SAS Institute). Results: We sent 1686 targeted messages and 1450 blast messages. Message opening was significantly higher with the targeted approach for patients on anticoagulation (723/1156, 62.5\% vs 382/668, 57.2\%; P=.005) and trended the same in patients off anticoagulation; subsequent website reviews did not differ by messaging approach. More patients off anticoagulation at baseline started anticoagulation with the targeted approach than the blast approach (adjusted percentage 9.3\% vs 2.1\%; P<.001). Conclusions: Patients were more responsive in terms of message opening and subsequent anticoagulation initiation with the targeted approach. ",
doi="10.2196/49590",
url="https://cardio.jmir.org/2024/1/e49590",
url="http://www.ncbi.nlm.nih.gov/pubmed/38265849"
}


@Article{info:doi/10.2196/35945,
author="Bas-Sarmiento, Pilar
and Fern{\'a}ndez-Guti{\'e}rrez, Martina
and Poza-M{\'e}ndez, Miriam
and Mar{\'i}n-Paz, Jes{\'u}s Antonio
and Paloma-Castro, Olga
and Romero-S{\'a}nchez, Manuel Jos{\'e}
and ",
title="Development and Effectiveness of a Mobile Health Intervention in Improving Health Literacy and Self-management of Patients With Multimorbidity and Heart Failure: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Apr",
day="29",
volume="11",
number="4",
pages="e35945",
keywords="complex health needs",
keywords="health literacy",
keywords="heart failure",
keywords="mHealth",
keywords="multimorbidity",
abstract="Background: Patients with multimorbidity and complex health needs are defined as a priority by the World Health Organization (WHO) and the European Union. There is a need to develop appropriate strategies with effective measures to meet the challenge of chronicity, reorienting national health systems. The increasing expansion of mobile health (mHealth) interventions in patient communication, the reduction of health inequalities, improved access to health care resources, adherence to treatment, and self-care of chronic diseases all point to an optimistic outlook. However, only few mobile apps demonstrate their effectiveness in these patients, which is diminished when they are not based on evidence, or when they are not designed by and for users with different levels of health literacy (HL). Objective: This study aims to evaluate the efficacy of an mHealth intervention relative to routine clinical practice in improving HL and self-management in patients with multimorbidity with heart failure (HF) and complex health needs. Methods: This is a randomized, multicenter, blinded clinical trial evaluating 2 groups, namely, a control group (standard clinical practice) and an intervention group (standard clinical practice and an ad hoc designed mHealth intervention previously developed), for 12 months. Results: The contents of the mHealth intervention will address user-perceived needs based on the development of user stories regarding diet, physical exercise, cardiac rehabilitation, therapeutic adherence, warning signs and symptoms, and emotional management. These contents have been validated by expert consensus. The creation and development of the contents of the mHealth intervention (app) took 18 months and was completed during 2021. The mobile app is expected to be developed by the end of 2022, after which it will be applied to the experimental group as an adjunct to standard clinical care during 12 months. Conclusions: The trial will demonstrate whether the mobile app improves HL and self-management in patients with HF and complex health needs, improves therapeutic adherence, and reduces hospital admissions. This study can serve as a starting point for developing other mHealth tools in other pathologies and for their generalization to other contexts. Trial Registration: ClinicalTrials.gov NCT04725526; https://tinyurl.com/bd8va27w International Registered Report Identifier (IRRID): DERR1-10.2196/35945 ",
doi="10.2196/35945",
url="https://www.researchprotocols.org/2022/4/e35945",
url="http://www.ncbi.nlm.nih.gov/pubmed/35486437"
}


@Article{info:doi/10.2196/34946,
author="Castela Forte, Jos{\'e}
and Gannamani, Rahul
and Folkertsma, Pytrik
and Kumaraswamy, Sridhar
and Mount, Sarah
and van Dam, Sipko
and Hoogsteen, Jan",
title="Changes in Blood Lipid Levels After a Digitally Enabled Cardiometabolic Preventive Health Program: Pre-Post Study in an Adult Dutch General Population Cohort",
journal="JMIR Cardio",
year="2022",
month="Mar",
day="23",
volume="6",
number="1",
pages="e34946",
keywords="cholesterol",
keywords="lifestyle intervention",
keywords="prevention",
keywords="hypercholesterolemia",
keywords="digital health",
abstract="Background: Despite widespread education, many individuals fail to follow basic health behaviors such as consuming a healthy diet and exercising. Positive changes in lifestyle habits are associated with improvements in multiple cardiometabolic health risk factors, including lipid levels. Digital lifestyle interventions have been suggested as a viable complement or potential alternative to conventional health behavior change strategies. However, the benefit of digital preventive interventions for lipid levels in a preventive health context remains unclear. Objective: This observational study aimed to determine how the levels of lipids, namely total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, non-HDL cholesterol, and triglycerides, changed over time in a Dutch general population cohort undergoing a digital preventive health program. Moreover, we looked to establish associations between lifestyle factors at baseline and lipid levels. Methods: We included 348 adults from the Dutch general population who underwent a digitally enabled preventive health program at Ancora Health between January 2020 and October 2021. Upon enrollment, participants underwent a baseline assessment involving a comprehensive lifestyle questionnaire, a blood biochemistry panel, physical measurements, and cardiopulmonary fitness measurements. Thereafter, users underwent a lifestyle coaching program and could access the digital application to register and track health behaviors, weight, and anthropometric data at any time. Lipid levels were categorized as normal, elevated, high, and clinical dyslipidemia according to accepted international standards. If at least one lipid marker was high or HDL was low, participants received specific coaching and advice for cardiometabolic health. We retrospectively analyzed the mean and percentage changes in lipid markers in users who were remeasured after a cardiometabolic health--focused intervention, and studied the association between baseline user lifestyle characteristics and having normal lipid levels. Results: In our cohort, 199 (57.2\%) participants had dyslipidemia at baseline, of which 104 participants were advised to follow a cardiometabolic health--focused intervention. Eating more amounts of favorable food groups and being more active were associated with normal lipid profiles. Among the participants who underwent remeasurement 9 months after intervention completion, 57\% (17/30), 61\% (19/31), 56\% (15/27), 82\% (9/11), and 100\% (8/8) showed improvements at remeasurement for total, LDL, HDL, and non-HDL cholesterol, and triglycerides, respectively. Moreover, between 35.3\% and 77.8\% showed a return to normal levels. In those with high lipid levels at baseline, total cholesterol decreased by 0.5 mmol/L (7.5\%), LDL cholesterol decreased by 0.39 mmol/L (10.0\%), non-HDL cholesterol decreased by 0.44 mmol/L (8.3\%), triglycerides decreased by 0.97 mmol/L (32.0\%), and HDL increased by 0.17 mmol/L (15.6\%), after the intervention. Conclusions: A cardiometabolic screening program in a general population cohort identified a significant portion of individuals with subclinical and clinical lipid levels. Individuals who, after screening, actively engaged in a cardiometabolic health--focused lifestyle program improved their lipid levels. ",
doi="10.2196/34946",
url="https://cardio.jmir.org/2022/1/e34946",
url="http://www.ncbi.nlm.nih.gov/pubmed/35319473"
}


@Article{info:doi/10.2196/29473,
author="Aardoom, J. Jiska
and Hilt, D. Alexander
and Woudenberg, Tamar
and Chavannes, H. Niels
and Atsma, E. Douwe",
title="A Preoperative Virtual Reality App for Patients Scheduled for Cardiac Catheterization: Pre--Post Questionnaire Study Examining Feasibility, Usability, and Acceptability",
journal="JMIR Cardio",
year="2022",
month="Feb",
day="22",
volume="6",
number="1",
pages="e29473",
keywords="virtual reality",
keywords="cardiac catheterization",
keywords="stress inoculation training",
keywords="preoperative anxiety",
keywords="acceptability",
keywords="feasibility",
keywords="presence",
keywords="immersive tendencies",
keywords="patient education",
keywords="mobile phone",
abstract="Background: Pre- and postoperative anxiety is a common phenomenon associated with negative postoperative outcomes. Symptoms of posttraumatic stress disorder, such as fear, nightmares, and sleep deprivation, are prevalent in approximately 30\% to 50\% of patients following discharge from intensive care units after cardiac surgery. Preliminary evidence suggests a promising role of virtual reality (VR) in preventing stress-related reactions using stress inoculation training. Such training enables cognitive preparation of individuals for stressful situations, thereby becoming more tolerant and resistant to stress, subsequently reducing the risk of potential negative psychological consequences. This study investigated a preoperative VR app---Pre-View---aimed at better informing and preparing patients for cardiac catheterization. Objective: This study aims to assess the feasibility, usability, and acceptability of Pre-View in patients undergoing cardiac catheterization. Methods: Eligible participants were adults scheduled for elective cardiac catheterization. Pre-View comprised an interactive virtual representation of the whole care process related to cardiac catheterization, from entering the hospital for admission to postprocedural stay and discharge. These processes were represented through 360{\textdegree} videos and interactive photos. Self-report questionnaires were completed at baseline (ie, before catheterization and after undergoing the VR experience) and after cardiac catheterization. Outcome measures included user experience and satisfaction, VR presence and immersive tendencies, and user friendliness. The perceived effectiveness was assessed exploratively. Results: A total of 8 individuals, with a mean age of 67 (SD 7.5) years, participated in this study. Half of them underwent the VR experience at the hospital and the other half at home. Participants reported high levels of presence in the virtual environment (Presence Questionnaire score: mean 129.1, SD 13.4). The usability of Pre-View was well evaluated (System Usability Scale score: mean 89.1, SD 12.0), and patient satisfaction was high (Client Satisfaction Questionnaire score: mean 27.1, SD 3.2). Usability and satisfaction scores were higher for participants who underwent Pre-View at home versus those who underwent Pre-View at the hospital, although the latter group was significantly older; 72.8 versus 61.3, respectively. All participants reported Pre-View to be effective in terms of feeling better informed about the care process of cardiac catheterization. Most participants (7/8, 88\%) reported Pre-View to be effective in terms of feeling better prepared for cardiac catheterization, acknowledging the potential of Pre-View in reducing negative psychological consequences after catheterization. Conclusions: The results provide initial support for the feasibility and acceptability of a preoperative VR app, creating a virtual environment that supports patient education and preparation for upcoming cardiac catheterization. More studies are needed to further investigate the effects of VR as a tool to better prepare patients for medical procedures, its effectiveness in reducing negative patient outcomes (eg, anxiety, stress, and postoperative recovery outcomes), and the generalizability of effects across different settings and patient populations. ",
doi="10.2196/29473",
url="https://cardio.jmir.org/2022/1/e29473",
url="http://www.ncbi.nlm.nih.gov/pubmed/35191839"
}


@Article{info:doi/10.2196/31284,
author="Pearson, Keon
and Ngo, Summer
and Ekpo, Eson
and Sarraju, Ashish
and Baird, Grayson
and Knowles, Joshua
and Rodriguez, Fatima",
title="Online Patient Education Materials Related to Lipoprotein(a): Readability Assessment",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="11",
volume="24",
number="1",
pages="e31284",
keywords="lipoprotein(a)",
keywords="readability",
keywords="online patient education material",
keywords="health education",
keywords="health literacy",
abstract="Background: Lipoprotein(a) (Lp(a)) is a highly proatherogenic lipid fraction that is a clinically significant risk modifier. Patients wanting to learn more about Lp(a) are likely to use online patient educational materials (OPEMs). However, the readability of OPEMs may exceed the health literacy of the public. Objective: This study aims to assess the readability of OPEMs related to Lp(a). We hypothesized that the readability of these online materials would exceed the sixth grade level recommended by the American Medical Association. Methods: Using an online search engine, we queried the top 20 search results from 10 commonly used Lp(a)-related search terms to identify a total of 200 websites. We excluded duplicate websites, advertised results, research journal articles, or non--patient-directed materials, such as those intended only for health professionals or researchers. Grade level readability was calculated using 5 standard readability metrics (automated readability index, SMOG index, Coleman-Liau index, Gunning Fog score, Flesch-Kincaid score) to produce robust point (mean) and interval (CI) estimates of readability. Generalized estimating equations were used to model grade level readability by each search term, with the 5 readability scores nested within each OPEM. Results: A total of 27 unique websites were identified for analysis. The average readability score for the aggregated results was a 12.2 (95\% CI 10.9798-13.3978) grade level. OPEMs were grouped into 6 categories by primary source: industry, lay press, research foundation and nonprofit organizations, university or government, clinic, and other. The most readable category was OPEMs published by universities or government agencies (9.0, 95\% CI 6.8-11.3). The least readable OPEMs on average were the ones published by the lay press (13.0, 95\% CI 11.2-14.8). All categories exceeded the sixth grade reading level recommended by the American Medical Association. Conclusions: Lack of access to readable OPEMs may disproportionately affect patients with low health literacy. Ensuring that online content is understandable by broad audiences is a necessary component of increasing the impact of novel therapeutics and recommendations regarding Lp(a). ",
doi="10.2196/31284",
url="https://www.jmir.org/2022/1/e31284",
url="http://www.ncbi.nlm.nih.gov/pubmed/35014955"
}


@Article{info:doi/10.2196/22557,
author="Ghorbani, Banafsheh
and Jackson, C. Alun
and Noorchenarboo, Mohammad
and Mandegar, H. Mohammad
and Sharifi, Farshad
and Mirmoghtadaie, Zohrehsadat
and Bahramnezhad, Fatemeh",
title="Comparing the Effects of Gamification and Teach-Back Training Methods on Adherence to a Therapeutic Regimen in Patients After Coronary Artery Bypass Graft Surgery: Randomized Clinical Trial",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="10",
volume="23",
number="12",
pages="e22557",
keywords="teach back",
keywords="gamification",
keywords="treatment regimen",
keywords="coronary artery bypass graft",
keywords="patient training",
abstract="Background: Patients undergoing coronary artery bypass graft surgery (CABGS) may fail to adhere to their treatment regimen for many reasons. Among these, one of the most important reasons for nonadherence is the inadequate training of such patients or training using inappropriate methods. Objective: This study aimed to compare the effect of gamification and teach-back training methods on adherence to a therapeutic regimen in patients after CABGS. Methods: This randomized clinical trial was conducted on 123 patients undergoing CABGS in Tehran, Iran, in 2019. Training was provided to the teach-back group individually. In the gamification group, an app developed for the purpose was installed on each patient's smartphone, with training given via this device. The control group received usual care, or routine training. Adherence to the therapeutic regimen was assessed using a questionnaire on adherence to a therapeutic regimen (physical activity and dietary regimen) and an adherence scale as a pretest and a 1-month posttest. Results: One-way analysis of variance (ANOVA) for comparing the mean scores of teach-back and gamification training methods showed that the mean normalized scores for the dietary regimen (P<.001, F=71.80), movement regimen (P<.001, F=124.53), and medication regimen (P<.001, F=9.66) before and after intervention were significantly different between the teach-back, gamification, and control groups. In addition, the results of the Dunnett test showed that the teach-back and gamification groups were significantly different from the control group in all three treatment regimen methods. There was no statistically significant difference in adherence to the therapeutic regimen between the teach-back and control groups. Conclusions: Based on the results of this study, the use of teach-back and gamification training approaches may be suggested for patients after CABGS to facilitate adherence to the therapeutic regimen. Trial Registration: Iranian Registry of Clinical Trials IRCT20111203008286N8; https://en.irct.ir/trial/41507 ",
doi="10.2196/22557",
url="https://www.jmir.org/2021/12/e22557",
url="http://www.ncbi.nlm.nih.gov/pubmed/34890346"
}


@Article{info:doi/10.2196/23285,
author="Choi, Yeon Jah
and Kim, Bak Ji
and Lee, Sunki
and Lee, Seo-Joon
and Shin, Eon Seung
and Park, Hyun Se
and Park, Jin Eun
and Kim, Woohyeun
and Na, Oh Jin
and Choi, Ung Cheol
and Rha, Seung-Woon
and Park, Gyu Chang
and Seo, Seog Hong
and Ahn, Jeonghoon
and Jeong, Hyun-Ghang
and Kim, Ju Eung",
title="A Smartphone App (AnSim) With Various Types and Forms of Messages Using the Transtheoretical Model for Cardiac Rehabilitation in Patients With Coronary Artery Disease: Development and Usability Study",
journal="JMIR Med Inform",
year="2021",
month="Dec",
day="7",
volume="9",
number="12",
pages="e23285",
keywords="cardiac rehabilitation",
keywords="smartphone app",
keywords="coronary heart disease",
abstract="Background: Despite strong evidence of clinical benefit, cardiac rehabilitation (CR) programs are currently underutilized and smartphone-based CR strategies are thought to address this unmet need. However, data regarding the detailed process of development are scarce. Objective: This study focused on the development of a smartphone-based, patient-specific, messaging app for patients who have undergone percutaneous coronary intervention (PCI). Methods: The AnSim app was developed in collaboration with a multidisciplinary team that included cardiologists, psychiatrists, nurses, pharmacists, nutritionists, and rehabilitation doctors and therapists. First, a focus group interview was conducted, and the narratives of the patients were analyzed to identify their needs and preferences. Based on the results, health care experts and clinicians drafted messages into 5 categories: (1) general information regarding cardiovascular health and medications, (2) nutrition, (3) physical activity, (4) destressing, and (5) smoking cessation. In each category, 90 messages were developed according to 3 simplified steps of the transtheoretical model of behavioral change: (1) precontemplation, (2) contemplation and preparation, and (3) action and maintenance. After an internal review and feedback from potential users, a bank of 450 messages was developed. Results: The focus interview was conducted with 8 patients with PCI within 1 year, and 450 messages, including various forms of multimedia, were developed based on the transtheoretical model of behavioral change in each category. Positive feedback was obtained from the potential users (n=458). The mean Likert scale score was 3.95 (SD 0.39) and 3.91 (SD 0.39) for readability and usefulness, respectively, and several messages were refined based on the feedback. Finally, the patient-specific message delivery system was developed according to the baseline characteristics and stages of behavioral change in each participant. Conclusions: We developed an app (AnSim), which includes a bank of 450 patient-specific messages, that provides various medical information and CR programs regarding coronary heart disease. The detailed process of multidisciplinary collaboration over the course of the study provides a scientific basis for various medical professionals planning smartphone-based clinical research. ",
doi="10.2196/23285",
url="https://medinform.jmir.org/2021/12/e23285",
url="http://www.ncbi.nlm.nih.gov/pubmed/34878987"
}


@Article{info:doi/10.2196/32351,
author="Montgomery, M. Robert
and Boucher, M. Eliane
and Honomichl, D. Ryan
and Powell, A. Tyler
and Guyton, L. Sharelle
and Bernecker, L. Samantha
and Stoeckl, Elizabeth Sarah
and Parks, C. Acacia",
title="The Effects of a Digital Mental Health Intervention in Adults With Cardiovascular Disease Risk Factors: Analysis of Real-World User Data",
journal="JMIR Cardio",
year="2021",
month="Nov",
day="19",
volume="5",
number="2",
pages="e32351",
keywords="digital mental health",
keywords="digital health",
keywords="mobile apps",
keywords="mobile health",
keywords="internet-based intervention",
keywords="happiness",
keywords="subjective well-being",
keywords="anxiety",
keywords="cardiovascular health",
keywords="high blood pressure",
keywords="high cholesterol",
keywords="diabetes",
keywords="cardiovascular disease risk",
keywords="real-world data",
abstract="Background: The American Heart Association has identified poor mental health as a key barrier to healthy behavior change for those with cardiovascular disease (CVD) risk factors such as high blood pressure, high cholesterol, and diabetes. Digital mental health interventions, like those delivered via the internet to computers or smartphones, may provide a scalable solution to improving the mental and physical health of this population. Happify is one such intervention and has demonstrated evidence of efficacy for improving aspects of mental health in both the general population and in users with chronic conditions. Objective: The objectives of this analysis of real-world data from Happify users with self-reported CVD risk factors, including high blood pressure and cholesterol, diabetes, and heart disease, were to examine whether these users would report improvements in subjective well-being and anxiety over time (H1) and use of Happify as recommended would be associated with significantly greater improvement in subjective well-being and anxiety over time compared to less-than-recommended usage (H2). Methods: Data were obtained from existing Happify users who reported the aforementioned CVD risk factors. The sample included 1803 users receiving at least 6 weeks' exposure to Happify (ranging from 42 days to 182 days) who completed at least one activity and two assessments within the app during that time. Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction, and anxiety was assessed with the Generalized Anxiety Disorder 2 (GAD-2). To evaluate H1, changes over time in both outcomes were assessed using mixed effects linear regression models, controlling for demographics and usage. For H2, an interaction term was added to the models to assess whether usage as recommended was associated with greater improvement over time. Results: Both hypotheses were supported. For both the Happify scale and GAD-2, the initial multivariable model without an interaction demonstrated an effect for time from baseline, and the addition of the interaction term between time and recommended use was significant as well. Conclusions: This analysis of real-world data provides preliminary evidence that Happify users with self-reported CVD risk factors including high blood pressure or cholesterol, diabetes, and heart disease experienced improved well-being and anxiety over time and that those who used Happify as recommended experienced greater improvements in these aspects of mental health than those who completed fewer activities. These findings extend previous research, which demonstrated that engagement with Happify as recommended was associated with improved well-being among physically healthy users and in those with chronic conditions, to a new population for whom mental health is especially critical: those at risk of developing CVD. ",
doi="10.2196/32351",
url="https://cardio.jmir.org/2021/2/e32351",
url="http://www.ncbi.nlm.nih.gov/pubmed/34806986"
}


@Article{info:doi/10.2196/28098,
author="Li, Xuan
and Chou, Shin-Yi
and Deily, E. Mary
and Qian, Mengcen",
title="Comparing the Impact of Online Ratings and Report Cards on Patient Choice of Cardiac Surgeon: Large Observational Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="28",
volume="23",
number="10",
pages="e28098",
keywords="online physician reviews",
keywords="report cards",
keywords="cardiac surgeons",
keywords="patient choice",
abstract="Background: Patients may use two information sources about a health care provider's quality: online physician reviews, which are written by patients to reflect their subjective experience, and report cards, which are based on objective health outcomes. Objective: The aim of this study was to examine the impact of online ratings on patient choice of cardiac surgeon compared to that of report cards. Methods: We obtained ratings from a leading physician review platform, Vitals; report card scores from Pennsylvania Cardiac Surgery Reports; and information about patients' choices of surgeons from inpatient records on coronary artery bypass graft (CABG) surgeries done in Pennsylvania from 2008 to 2017. We scraped all reviews posted on Vitals for surgeons who performed CABG surgeries in Pennsylvania during our study period. We linked the average overall rating and the most recent report card score at the time of a patient's surgery to the patient's record based on the surgeon's name, focusing on fee-for-service patients to avoid impacts of insurance networks on patient choices. We used random coefficient logit models with surgeon fixed effects to examine the impact of receiving a high online rating and a high report card score on patient choice of surgeon for CABG surgeries. Results: We found that a high online rating had positive and significant effects on patient utility, with limited variation in preferences across individuals, while the impact of a high report card score on patient choice was trivial and insignificant. About 70.13\% of patients considered no information on Vitals better than a low rating; the corresponding figure was 26.66\% for report card scores. The findings were robust to alternative choice set definitions and were not explained by surgeon attrition, referral effect, or admission status. Our results also show that the interaction effect of rating information and a time trend was positive and significant for online ratings, but small and insignificant for report cards. Conclusions: A patient's choice of surgeon is affected by both types of rating information; however, over the past decade, online ratings have become more influential, while the effect of report cards has remained trivial. Our findings call for information provision strategies that incorporate the advantages of both online ratings and report cards. ",
doi="10.2196/28098",
url="https://www.jmir.org/2021/10/e28098",
url="http://www.ncbi.nlm.nih.gov/pubmed/34709192"
}


@Article{info:doi/10.2196/26732,
author="Kovoor, G. Joshua
and McIntyre, Daniel
and Chik, B. William W.
and Chow, K. Clara
and Thiagalingam, Aravinda",
title="Clinician-Created Educational Video Resources for Shared Decision-making in the Outpatient Management of Chronic Disease: Development and Evaluation Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="11",
volume="23",
number="10",
pages="e26732",
keywords="Shared decision-making",
keywords="chronic disease",
keywords="outpatients",
keywords="audiovisual aids",
keywords="atrial fibrillation",
keywords="educational technology",
keywords="teaching materials",
keywords="referral and consultation",
keywords="physician-patient relations",
keywords="physicians",
abstract="Background: The provision of reliable patient education is essential for shared decision-making. However, many clinicians are reluctant to use commonly available resources, as they are generic and may contain information of insufficient quality. Clinician-created educational materials, accessed during the waiting time prior to consultation, can potentially benefit clinical practice if developed in a time- and resource-efficient manner. Objective: The aim of this study is to evaluate the utility of educational videos in improving patient decision-making, as well as consultation satisfaction and anxiety, within the outpatient management of chronic disease (represented by atrial fibrillation). The approach involves clinicians creating audiovisual patient education in a time- and resource-efficient manner for opportunistic delivery, using mobile smart devices with internet access, during waiting time before consultation. Methods: We implemented this educational approach in outpatient clinics and collected patient responses through an electronic survey. The educational module was a web-based combination of 4 short videos viewed sequentially, followed by a patient experience survey using 5-point Likert scales and 0-100 visual analogue scales. The clinician developed the audiovisual module over a 2-day span while performing usual clinical tasks, using existing hardware and software resources (laptop and tablet). Patients presenting for the outpatient management of atrial fibrillation accessed the module during waiting time before their consultation using either a URL or Quick Response (QR) code on a provided tablet or their own mobile smart devices. The primary outcome of the study was the module's utility in improving patient decision-making ability, as measured on a 0-100 visual analogue scale. Secondary outcomes were the level of patient satisfaction with the videos, measured with 5-point Likert scales, in addition to the patient's value for clinician narration and the module's utility in improving anxiety and long-term treatment adherence, as represented on 0-100 visual analogue scales. Results: This study enrolled 116 patients presenting for the outpatient management of atrial fibrillation. The proportion of responses that were ``very satisfied'' with the educational video content across the 4 videos ranged from 93\% (86/92) to 96.3\% (104/108) and this was between 98\% (90/92) and 99.1\% (107/108) for ``satisfied'' or ``very satisfied.'' There were no reports of dissatisfaction for the first 3 videos, and only 1\% (1/92) of responders reported dissatisfaction for the fourth video. The median reported scores (on 0-100 visual analogue scales) were 90 (IQR 82.5-97) for improving patient decision-making, 89 (IQR 81-95) for reducing consultation anxiety, 90 (IQR 81-97) for improving treatment adherence, and 82 (IQR 70-90) for the clinician's narration adding benefit to the patient experience. Conclusions: Clinician-created educational videos for chronic disease management resulted in improvements in patient-reported informed decision-making ability and expected long-term treatment adherence, as well as anxiety reduction. This form of patient education was also time efficient as it used the sunk time cost of waiting time to provide education without requiring additional clinician input. ",
doi="10.2196/26732",
url="https://www.jmir.org/2021/10/e26732",
url="http://www.ncbi.nlm.nih.gov/pubmed/34633292"
}


@Article{info:doi/10.2196/21938,
author="Bruggmann, Christel
and Adjedj, Julien
and Sardy, Sylvain
and Muller, Olivier
and Voirol, Pierre
and Sadeghipour, Farshid",
title="Effects of the Interactive Web-Based Video ``Mon Coeur, Mon BASIC'' on Drug Adherence of Patients With Myocardial Infarction: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="30",
volume="23",
number="8",
pages="e21938",
keywords="acute coronary syndrome",
keywords="eHealth",
keywords="drug adherence",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Secondary prevention strategies after acute coronary syndrome (ACS) presentation with the use of drug combinations are essential to reduce the recurrence of cardiovascular events. However, lack of drug adherence is known to be common in this population and to be related to treatment failure. To improve drug adherence, we developed the ``Mon Coeur, Mon BASIC'' video. This online video has been specifically designed to inform patients about their disease and their current medications. Interactivity has been used to increase patient attention, and the video can also be viewed on smartphones and tablets. Objective: The objective of this study was to assess the long-term impact of an informative web-based video on drug adherence in patients admitted for an ACS. Methods: This randomized study was conducted with consecutive patients admitted to University Hospital of Lausanne for ACS. We randomized patients to an intervention group, which had access to the web-based video and a short interview with the pharmacist, and a control group receiving usual care. The primary outcome was the difference in drug adherence, assessed with the Adherence to Refills and Medication Scale (ARMS; 9 multiple-choice questions, scores ranging from 12 for perfect adherence to 48 for lack of adherence), between groups at 1, 3, and 6 months. We assessed the difference in ARMS score between both groups with the Wilcoxon rank sum test. Secondary outcomes were differences in knowledge, readmissions, and emergency room visits between groups and patients' satisfaction with the video. Results: Sixty patients were included at baseline. The median age of the participants was 59 years (IQR 49-69), and 85\% (51/60) were male. At 1 month, 51 patients participated in the follow-up, 50 patients participated at 3 months, and 47 patients participated at 6 months. The mean ARMS scores at 1 and 6 months did not differ between the intervention and control groups (13.24 vs 13.15, 13.52 vs 13.68, respectively). At 3 months, this score was significantly lower in the intervention group than in the control group (12.54 vs 13.75; P=.03). We observed significant increases in knowledge from baseline to 1 and 3 months, but not to 6 months, in the intervention group. Readmissions and emergency room visits have been very rare, and the proportion was not different among groups. Patients in the intervention group were highly satisfied with the video. Conclusions: Despite a lower sample size than we expected to reach, we observed that the ``Mon Coeur, Mon BASIC'' web-based interactive video improved patients' knowledge and seemed to have an impact on drug adherence. These results are encouraging, and the video will be offered to all patients admitted to our hospital with ACS. Trial Registration: ClinicalTrials.gov NCT03949608; https://clinicaltrials.gov/ct2/show/NCT03949608 ",
doi="10.2196/21938",
url="https://www.jmir.org/2021/8/e21938",
url="http://www.ncbi.nlm.nih.gov/pubmed/34459744"
}


@Article{info:doi/10.2196/25437,
author="Fija{\v c}ko, Nino
and Masterson Creber, Ruth
and Gosak, Lucija
and {\vS}tiglic, Gregor
and Egan, Dominic
and Chaka, Brian
and Debeljak, Nika
and Strnad, Matej
and Skok, Pavel",
title="Evaluating Quality, Usability, Evidence-Based Content, and Gamification Features in Mobile Learning Apps Designed to Teach Children Basic Life Support: Systematic Search in App Stores and Content Analysis",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jul",
day="20",
volume="9",
number="7",
pages="e25437",
keywords="cardiopulmonary resuscitation",
keywords="basic life support",
keywords="mobile learning",
keywords="mobile phone",
keywords="gamification",
keywords="schoolchildren",
abstract="Background: Globally, 3.7 million people die of sudden cardiac death annually. Following the World Health Organization endorsement of the Kids Save Lives statements, initiatives to train school-age children in basic life support (BLS) have been widespread. Mobile phone apps, combined with gamification, represent an opportunity for including mobile learning (m-learning) in teaching schoolchildren BLS as an additional teaching method; however, the quality of these apps is questionable. Objective: This study aims to systematically evaluate the quality, usability, evidence-based content, and gamification features (GFs) of commercially available m-learning apps for teaching guideline-directed BLS knowledge and skills to school-aged children. Methods: We searched the Google Play Store and Apple iOS App Store using multiple terms (eg, cardiopulmonary resuscitation [CPR] or BLS). Apps meeting the inclusion criteria were evaluated by 15 emergency health care professionals using the user version of the Mobile Application Rating Scale and System Usability Scale. We modified a five-finger mnemonic for teaching schoolchildren BLS and reviewed the apps' BLS content using standardized criteria based on three CPR guidelines. GFs in the apps were evaluated using a gamification taxonomy. Results: Of the 1207 potentially relevant apps, only 6 (0.49\%) met the inclusion criteria. Most apps were excluded because the content was not related to teaching schoolchildren BLS. The mean total scores for the user version of the Mobile Application Rating Scale and System Usability Scale score were 3.2/5 points (95\% CI 3.0-3.4) and 47.1/100 points (95\% CI 42.1-52.1), respectively. Half of the apps taught hands-only CPR, whereas the other half also included ventilation. All the apps indicated when to start chest compressions, and only 1 app taught BLS using an automated external defibrillator. Gamification was well integrated into the m-learning apps for teaching schoolchildren BLS, whereas the personal and fictional, educational, and performance gamification groups represented most GFs. Conclusions: Improving the quality and usability of BLS content in apps and combining them with GFs can offer educators novel m-learning tools to teach schoolchildren BLS skills. ",
doi="10.2196/25437",
url="https://mhealth.jmir.org/2021/7/e25437",
url="http://www.ncbi.nlm.nih.gov/pubmed/34283034"
}


@Article{info:doi/10.2196/23519,
author="Strauss, Shira
and Yacob, Michael
and Bhandari, Apoorva
and Jetty, Prasad",
title="Carotid Endarterectomy Versus Carotid Artery Stenting: Survey of the Quality, Readability, and Treatment Preference of Carotid Artery Disease Websites",
journal="Interact J Med Res",
year="2020",
month="Nov",
day="3",
volume="9",
number="4",
pages="e23519",
keywords="patient information",
keywords="carotid artery disease",
keywords="carotid endarterectomy",
keywords="carotid stenting",
keywords="carotid stenosis",
keywords="carotid surgery",
keywords="Google",
keywords="quality",
keywords="readability",
keywords="treatment",
keywords="preference",
keywords="online health information",
abstract="Background: The internet is becoming increasingly more important in the new era of patient self-education. Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are recognized interventions to treat patients with carotid artery stenosis. Using the Google search platform, patients encounter many websites with conflicting information, which are sometimes difficult to understand. This lack of accessibility creates uncertainty or bias toward interventions for carotid artery disease. The quality, readability, and treatment preference of carotid artery disease (CAD) websites have not yet been evaluated. Objective: This study aimed to explore the quality, readability, and treatment preference of CAD websites. Methods: We searched Google Canada for 10 CAD-related keywords. Returned links were assessed for publication date, medical specialty and industry affiliation, presence of randomized controlled trial data, differentiation by symptomatic status, and favored treatment. Website quality and readability were rated by the DISCERN instrument and Gunning Fog Index. Results: We identified 54 unique sites: 18 (33.3\%) by medical societies or individual physicians, 11 (20.4\%) by government organizations, 9 (16.7\%) by laypersons, and 1 (1.9\%) that was industry-sponsored. Of these sites, 26 (48.1\%) distinguished symptomatic from asymptomatic CAD. A majority of sites overall (57.4\%) and vascular-affiliated (72.7\%) favored CEA. In contrast, radiology- and cardiology-affiliated sites demonstrated the highest proportion of sites favoring CAS, though they were equally likely to favor CEA. A large proportion (21/54, 38.9\%) of sites received poor quality ratings (total DISCERN score <48), and the majority (41/54, 75.9\%) required a reading level greater than a high school senior. Conclusions: CAD websites are often produced by government organizations, medical societies, or physicians, especially vascular surgeons. Sites ranged in quality, readability, and differentiation by symptomatic status. Google searches of CAD-related terms are more likely to yield sites favoring CEA. Future research should determine the extent of website influence on CAD patients' treatment decisions. ",
doi="10.2196/23519",
url="http://www.i-jmr.org/2020/4/e23519/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33141097"
}


@Article{info:doi/10.2196/17312,
author="Br{\o}rs, Gunhild
and Wentzel-Larsen, Tore
and Dalen, H{\aa}vard
and Hansen, B. Tina
and Norman, D. Cameron
and Wahl, Astrid
and Norekv{\aa}l, M. Tone
and ",
title="Psychometric Properties of the Norwegian Version of the Electronic Health Literacy Scale (eHEALS) Among Patients After Percutaneous Coronary Intervention: Cross-Sectional Validation Study",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="28",
volume="22",
number="7",
pages="e17312",
keywords="eHealth literacy",
keywords="eHEALS",
keywords="health literacy",
keywords="percutaneous coronary intervention",
keywords="psychometric properties",
keywords="validation",
abstract="Background: Web-based technology has recently become an important source for sharing health information with patients after an acute cardiac event. Therefore, consideration of patients' perceived electronic health (eHealth) literacy skills is crucial for improving the delivery of patient-centered health information. Objective: The aim of this study was to translate and adapt the eHealth Literacy Scale (eHEALS) to conditions in Norway, and to determine its psychometric properties. More specifically, we set out to determine the reliability (internal consistency, test-retest) and construct validity (structural validity, hypotheses testing, and cross-cultural validity) of the eHEALS in self-report format administered to patients after percutaneous coronary intervention. Methods: The original English version of the eHEALS was translated into Norwegian following a widely used cross-cultural adaptation process. Internal consistency was calculated using Cronbach $\alpha$. The intraclass correlation coefficient (ICC) was used to assess the test-retest reliability. Confirmatory factor analysis (CFA) was performed for a priori-specified 1-, 2-, and 3-factor models. Demographic, health-related internet use, health literacy, and health status information was collected to examine correlations with eHEALS scores. Results: A total of 1695 patients after percutaneous coronary intervention were included in the validation analysis. The mean age was 66 years, and the majority of patients were men (1313, 77.46\%). Cronbach $\alpha$ for the eHEALS was >.99. The corresponding Cronbach $\alpha$ for the 2-week retest was .94. The test-retest ICC for eHEALS was 0.605 (95\% CI 0.419-0.743, P<.001). The CFA showed a modest model fit for the 1- and 2-factor models (root mean square error of approximation>0.06). After modifications in the 3-factor model, all of the goodness-of-fit indices indicated a good fit. There was a weak correlation with age (r=--0.206). Between-groups analysis of variance showed a difference according to educational groups and the eHEALS score, with a mean difference ranging from 2.24 (P=.002) to 4.61 (P<.001), and a higher eHEALS score was found for patients who were employed compared to those who were retired (mean difference 2.31, P<.001). The eHEALS score was also higher among patients who reported using the internet to find health information (95\% CI --21.40 to --17.21, P<.001), and there was a moderate correlation with the patients' perceived usefulness (r=0.587) and importance (r=0.574) of using the internet for health information. There were also moderate correlations identified between the eHEALS score and the health literacy domains appraisal of health information (r=0.380) and ability to find good health information (r=0.561). Weak correlations with the mental health composite score (r=0.116) and physical health composite score (r=0.116) were identified. Conclusions: This study provides new information on the psychometric properties of the eHEALS for patients after percutaneous coronary intervention, suggesting a multidimensional rather than unidimensional construct. However, the study also indicated a redundancy of items, indicating the need for further validation studies. Trial Registration: ClinicalTrials.gov NCT03810612; https://clinicaltrials.gov/ct2/show/NCT03810612 ",
doi="10.2196/17312",
url="https://www.jmir.org/2020/7/e17312",
url="http://www.ncbi.nlm.nih.gov/pubmed/32720900"
}


@Article{info:doi/10.2196/12134,
author="Athilingam, Ponrathi
and Jenkins, Bradlee
and Redding, A. Barbara",
title="Reading Level and Suitability of Congestive Heart Failure (CHF) Education in a Mobile App (CHF Info App): Descriptive Design Study",
journal="JMIR Aging",
year="2019",
month="Apr",
day="25",
volume="2",
number="1",
pages="e12134",
keywords="health literacy",
keywords="reading level",
keywords="patient education",
keywords="heart failure",
keywords="mobile app",
abstract="Background: Education at the time of diagnosis or at discharge after an index illness is a vital component of improving outcomes in congestive heart failure (CHF). About 90 million Americans have limited health literacy and have a readability level at or below a 5th-grade level, which could affect their understanding of education provided at the time of diagnosis or discharge from hospital. Objective: The aim of this paper was to assess the suitability and readability level of a mobile phone app, the CHF Info App. Methods: A descriptive design was used to assess the reading level and suitability of patient educational materials included in the CHF Info App. The suitability assessment of patient educational materials included in the CHF Info App was independently assessed by two of the authors using the 26-item Suitability Assessment of Materials (SAM) tool. The reading grade level for each of the 10 CHF educational modules included in the CHF Info App was assessed using the comprehensive online Text Readability Consensus Calculator based on the seven most-common readability formulas: the Flesch Reading Ease Formula, the Gunning Fog Index, the Flesch-Kincaid Grade Level Formula, the Coleman-Liau Index, the Simplified Measure of Gobbledygook Index, the Automated Readability Index, and the Linsear Write Formula. The reading level included the text-scale score, the ease-of-reading score, and the corresponding grade level. Results: The educational materials included in the CHF Info App ranged from a 5th-grade to an 8th-grade reading level, with a mean of a 6th-grade level, which is recommended by the American Medical Association. The SAM tool result demonstrated adequate-to-superior levels in all four components assessed, including content, appearance, visuals, and layout and design, with a total score of 77\%, indicating superior suitability. Conclusions: The authors conclude that the CHF Info App will be suitable and meet the recommended health literacy level for American adult learners. Further testing of the CHF Info App in a longitudinal study is warranted to determine improvement in CHF knowledge. ",
doi="10.2196/12134",
url="http://aging.jmir.org/2019/1/e12134/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518265"
}


@Article{info:doi/10.2196/11358,
author="Knoepke, E. Christopher
and Slack, Hogan D.
and Ingle, Pilar M.
and Matlock, D. Daniel
and Marzec, N. Lucas",
title="Quality of Medical Advice Provided Between Members of a Web-Based Message Board for Patients With Implantable Defibrillators: Mixed-Methods Study",
journal="JMIR Cardio",
year="2018",
month="Dec",
day="04",
volume="2",
number="2",
pages="e11358",
keywords="education of patients",
keywords="information sharing",
keywords="implantable cardioverter-defibrillator, data accuracy",
abstract="Background: Patients use Web-based medical information to understand medical conditions and treatments. A number of efforts have been made to understand the quality of professionally created content; however, none have described the quality of advice being provided between anonymous members of Web-based message boards. Objective: The objective of this study was to characterize the quality of medical information provided between members of an anonymous internet message board addressing treatment with an implantable cardioverter-defibrillator (ICD). Methods: We quantitatively analyzed 2 years of discussions using a mixed inductive-deductive framework, first, for instances in which members provided medical advice and, then, for the quality of the advice. Results: We identified 82 instances of medical advice within 127 discussions. Advice covered 6 topical areas: (1) Device information, (2) Programming, (3) Cardiovascular disease, (4) Lead management, (5) Activity restriction, and (6) Management of other conditions. Across all advice, 50\% (41/82) was deemed generally appropriate, 24\% (20/82) inappropriate for most patients, 6\% (5/82) controversial, and 20\% (16/82) without sufficient context. Proportions of quality categories varied between topical areas. We have included representative examples. Conclusions: The quality of advice shared between anonymous members of a message board regarding ICDs varied considerably according to topical area and the specificity of advice. This report provides a model to describe the quality of the available Web-based patient-generated material. ",
doi="10.2196/11358",
url="http://cardio.jmir.org/2018/2/e11358/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31758775"
}


@Article{info:doi/10.2196/10183,
author="Bashi, Nazli
and Hassanzadeh, Hamed
and Varnfield, Marlien
and Wee, Yong
and Walters, Darren
and Karunanithi, Mohanraj",
title="Multidisciplinary Smartphone-Based Interventions to Empower Patients With Acute Coronary Syndromes: Qualitative Study on Health Care Providers' Perspectives",
journal="JMIR Cardio",
year="2018",
month="Oct",
day="31",
volume="2",
number="2",
pages="e10183",
keywords="acute coronary syndrome",
keywords="focus group",
keywords="health care professionals",
keywords="mobile phone",
keywords="multidisciplinary",
keywords="thematic analysis",
abstract="Background: Postdischarge interventions are limited in patients with acute coronary syndrome (ACS) due to few scheduled visits to outpatient clinics and travel from remote areas. Smartphones have become a viable lifestyle technology to deliver educational and health interventions following discharge from hospital. Objective: The purpose of this study was to identify the requirements for the delivery of a mobile health intervention for the postdischarge management of patients with ACS via a multidisciplinary focus group. Methods: We conducted a focus group among health care professionals (n=10) from a large metropolitan hospital in May 2017. These participants from a multidisciplinary team contributed to a 1-hour discussion by responding to 8 questions relating to the applicability of smartphone-based educational and health interventions. Descriptive statistics of the focus group data were analyzed using SPSS. The qualitative data were analyzed according to relevant themes extracted from the focus group transcription, using a qualitative description software program (NVivo 11) and an ontology-based concept mapping approach. Results: The mean age of the participants was 47 (SD 8) years: 3 cardiologists; 2 nurse practitioners; 2 clinical nurses; 2 research scientists; and 1 physiotherapist. Of these participants, 70\% (7/10) had experience using electronic health intervention during their professional practice. A total of 7 major themes and their subthemes emerged from the qualitative analysis. Health care providers indicated that comprehensive education on diet, particularly providing daily meal plans, is critical for patients with ACS. In terms of ACS symptoms, a strong recommendation was to focus on educating patients instead of daily monitoring of chest pain and shortness of breathing due to subjectivity and insufficient information for clinicians. Participants pointed that monitoring health measures such as blood pressure and body weight may result in increased awareness of patient physical health, yet may not be sufficient to support patients with ACS via the smartphone-based intervention. Therefore, monitoring pain and emotional status along with other health measures was recommended. Real-time support via FaceTime or video conferencing was indicated as motivational and supportive for patient engagement and self-monitoring. The general demographics of patients with ACS being older, having a low educational level, and a lack of computer skills were identified as potential barriers for engagement with the smartphone-based intervention. Conclusions: A smartphone-based program that incorporates the identified educational materials and health interventions would motivate patients with ACS to engage in the multidisciplinary intervention and improve their health outcomes following discharge from hospital. ",
doi="10.2196/10183",
url="http://cardio.jmir.org/2018/2/e10183/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31758781"
}


@Article{info:doi/10.2196/10057,
author="Athilingam, Ponrathi
and Jenkins, Bradlee",
title="Mobile Phone Apps to Support Heart Failure Self-Care Management: Integrative Review",
journal="JMIR Cardio",
year="2018",
month="May",
day="02",
volume="2",
number="1",
pages="e10057",
keywords="heart failure",
keywords="self-care management",
keywords="mobile health",
abstract="Background: With an explosive growth in mobile health, an estimated 500 million patients are potentially using mHealth apps for supporting health and self-care of chronic diseases. Therefore, this review focused on mHealth apps for use among patients with heart failure. Objective: The aim of this integrative review was to identify and assess the functionalities of mHealth apps that provided usability and efficacy data and apps that are commercially available without supporting data, all of which are to support heart failure self-care management and thus impact heart failure outcomes. Methods: A search of published, peer-reviewed literature was conducted for studies of technology-based interventions that used mHealth apps specific for heart failure. The initial database search yielded 8597 citations. After filters for English language and heart failure, the final 487 abstracts was reviewed. After removing duplicates, a total of 18 articles that tested usability and efficacy of mobile apps for heart failure self-management were included for review. Google Play and Apple App Store were searched with specified criteria to identify mHealth apps for heart failure. A total of 26 commercially available apps specific for heart failure were identified and rated using the validated Mobile Application Rating Scale. Results: The review included studies with low-quality design and sample sizes ranging from 7 to 165 with a total sample size of 847 participants from all 18 studies. Nine studies assessed usability of the newly developed mobile health system. Six of the studies included are randomized controlled trials, and 4 studies are pilot randomized controlled trials with sample sizes of fewer than 40. There were inconsistencies in the self-care components tested, increasing bias. Thus, risk of bias was assessed using the Cochrane Collaboration's tool for risk of selection, performance, detection, attrition, and reporting biases. Most studies included in this review are underpowered and had high risk of bias across all categories. Three studies failed to provide enough information to allow for a complete assessment of bias, and thus had unknown or unclear risk of bias. This review on the commercially available apps demonstrated many incomplete apps, many apps with bugs, and several apps with low quality. Conclusions: The heterogeneity of study design, sample size, intervention components, and outcomes measured precluded the performance of a systematic review or meta-analysis, thus introducing bias of this review. Although the heart failure--related outcomes reported in this review vary, they demonstrated trends toward making an impact and offer a potentially cost-effective solution with 24/7 access to symptom monitoring as a point of care solution, promoting patient engagement in their own home care. ",
doi="10.2196/10057",
url="http://cardio.jmir.org/2018/1/e10057/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31758762"
}


@Article{info:doi/10.2196/jmir.8538,
author="Bonner, Carissa
and Fajardo, Anthony Michael
and Hui, Samuel
and Stubbs, Renee
and Trevena, Lyndal",
title="Clinical Validity, Understandability, and Actionability of Online Cardiovascular Disease Risk Calculators: Systematic Review",
journal="J Med Internet Res",
year="2018",
month="Feb",
day="01",
volume="20",
number="2",
pages="e29",
keywords="cardiovascular disease",
keywords="risk assessment",
keywords="risk communication",
keywords="risk formats",
abstract="Background: Online health information is particularly important for cardiovascular disease (CVD) prevention, where lifestyle changes are recommended until risk becomes high enough to warrant pharmacological intervention. Online information is abundant, but the quality is often poor and many people do not have adequate health literacy to access, understand, and use it effectively. Objective: This project aimed to review and evaluate the suitability of online CVD risk calculators for use by low health literate consumers in terms of clinical validity, understandability, and actionability. Methods: This systematic review of public websites from August to November 2016 used evaluation of clinical validity based on a high-risk patient profile and assessment of understandability and actionability using Patient Education Material Evaluation Tool for Print Materials. Results: A total of 67 unique webpages and 73 unique CVD risk calculators were identified. The same high-risk patient profile produced widely variable CVD risk estimates, ranging from as little as 3\% to as high as a 43\% risk of a CVD event over the next 10 years. One-quarter (25\%) of risk calculators did not specify what model these estimates were based on. The most common clinical model was Framingham (44\%), and most calculators (77\%) provided a 10-year CVD risk estimate. The calculators scored moderately on understandability (mean score 64\%) and poorly on actionability (mean score 19\%). The absolute percentage risk was stated in most (but not all) calculators (79\%), and only 18\% included graphical formats consistent with recommended risk communication guidelines. Conclusions: There is a plethora of online CVD risk calculators available, but they are not readily understandable and their actionability is poor. Entering the same clinical information produces widely varying results with little explanation. Developers need to address actionability as well as clinical validity and understandability to improve usefulness to consumers with low health literacy. ",
doi="10.2196/jmir.8538",
url="http://www.jmir.org/2018/2/e29/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29391344"
}


@Article{info:doi/10.2196/cardio.8025,
author="Johnson, M. Heather
and LaMantia, N. Jamie
and Brown, M. Colleen
and Warner, C. Ryan
and Zeller, M. Laura
and Haggart, C. Ryan
and Stonewall, Keven
and Lauver, R. Diane",
title="My Hypertension Education and Reaching Target (MyHEART): Development and Dissemination of a Patient-Centered Website for Young Adults with Hypertension",
journal="JMIR Cardio",
year="2017",
month="Sep",
day="25",
volume="1",
number="2",
pages="e5",
keywords="hypertension",
keywords="young adults",
keywords="World Wide Web",
keywords="quality improvement",
keywords="patient engagement",
abstract="Background: Young adults (18 to 39 years old) with hypertension have the lowest rates of blood pressure control (defined as blood pressure less than 140/90 mmHg) compared to other adult age groups. Approximately 1 in 15 young adults have high blood pressure, increasing their risk of future heart attack, stroke, congestive heart failure, and/or chronic kidney disease. Many young adults reported having few resources to address their needs for health education on managing cardiovascular risk. Objective: The goal of our study was to develop and disseminate a website with evidence-based, clinical information and health behavior resources tailored to young adults with hypertension. Methods: In collaboration with young adults, health systems, and community stakeholders, the My Hypertension Education and Reaching Target (MyHEART) website was created. A toolkit was also developed for clinicians and healthcare systems to disseminate the website within their organizations. The dissemination plan was guided by the Dissemination Planning Tool of the Agency for Healthcare Research and Quality (AHRQ). Results: Google Analytics data were acquired for January 1, 2017 to June 29, 2017. The MyHEART website received 1090 visits with 2130 page views; 18.99\% (207/1090) were returning visitors. The majority (55.96\%, 610/1090) approached the website through organic searches, 34.95\% (381/1090) accessed the MyHEART website directly, and 5.96\% (65/1090) approached through referrals from other sites. There was a spike in site visits around times of increased efforts to disseminate the website. Conclusions: The successfully implemented MyHEART website and toolkit reflect collaborative input from community and healthcare stakeholders to provide evidence-based, portable hypertension education to a hard-to-reach population. The MyHEART website and toolkit can support healthcare providers' education and counseling with young adults and organizations' hypertension population health goals. ",
doi="10.2196/cardio.8025",
url="http://cardio.jmir.org/2017/2/e5/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29664482"
}