TY - JOUR AU - Fong, Allan AU - Boxley, Christian AU - Schubel, Laura AU - Gallagher, Christopher AU - AuBuchon, Katarina AU - Arem, Hannah PY - 2025/1/17 TI - Identifying Complex Scheduling Patterns Among Patients With Cancer With Transportation and Housing Needs: Feasibility Pilot Study JO - JMIR Cancer SP - e57715 VL - 11 KW - patient scheduling KW - scheduling complexities KW - temporal data mining KW - dataset KW - breast cancer KW - social determinant of health KW - oncology KW - metastasis KW - cancer patient KW - social support KW - community health worker KW - housing need KW - care KW - transportation KW - algorithm N2 - Background: Patients with cancer frequently encounter complex treatment pathways, often characterized by challenges with coordinating and scheduling appointments at various specialty services and locations. Identifying patients who might benefit from scheduling and social support from community health workers or patient navigators is largely determined on a case-by-case basis and is resource intensive. Objective: This study aims to propose a novel algorithm to use scheduling data to identify complex scheduling patterns among patients with transportation and housing needs. Methods: We present a novel algorithm to calculate scheduling complexity from patient scheduling data. We define patient scheduling complexity as an aggregation of sequence, resolution, and facility components. Schedule sequence complexity is the degree to which appointments are scheduled and arrived to in a nonchronological order. Resolution complexity is the degree of no shows or canceled appointments. Location complexity reflects the proportion of appointment dates at 2 or more different locations. Schedule complexity captures deviations from chronological order, unresolved appointments, and coordination across multiple locations. We apply the scheduling complexity algorithm to scheduling data from 38 patients with breast cancer enrolled in a 6-month comorbidity management intervention at an urban hospital in the Washington, DC area that serves low-income patients. We compare the scheduling complexity metric with count-based metrics: arrived ratio, rescheduled ratio, canceled ratio, and no-show ratio. We defined an aggregate count-based adjustment metric as the harmonic mean of rescheduled ratio, canceled ratio, and no-show ratio. A low count-based adjustment metric would indicate that a patient has fewer disruptions or changes in their appointment scheduling. Results: The patients had a median of 88 unique appointments (IQR 60.3), 62 arrived appointments (IQR 47.8), 13 rescheduled appointments (IQR 13.5), 9 canceled appointments (IQR 10), and 1.5 missed appointments (IQR 5). There was no statistically significant difference in count-based adjustments and scheduling complexity bins (?24=6.296, P=.18). In total, 5 patients exhibited high scheduling complexity with low count-based adjustments. A total of 2 patients exhibited high count-based adjustments with low scheduling complexity. Out of the 15 patients that indicated transportation or housing insecurity issues in conversations with community health workers, 86.7% (13/15) patients were identified as medium or high scheduling complexity while 60% (9/15) were identified as medium or high count-based adjustments. Conclusions: Scheduling complexity identifies patients with complex but nonchronological scheduling behaviors who would be missed by traditional count-based metrics. This study shows a potential link between transportation and housing needs with schedule complexity. Scheduling complexity can complement count-based metrics when identifying patients who might need additional care coordination support especially as it relates to transportation and housing needs. Trial Registration: ClinicalTrials.gov NCT04836221; https://clinicaltrials.gov/study/NCT04836221 UR - https://cancer.jmir.org/2025/1/e57715 UR - http://dx.doi.org/10.2196/57715 ID - info:doi/10.2196/57715 ER - TY - JOUR AU - Boulton, Ann Kelsie AU - Hilton, Makana AU - Sutton, Emilia AU - Guastella, John Adam PY - 2025/1/1 TI - Apps and Digital Resources for Child Neurodevelopment, Mental Health, and Well-Being: Review, Evaluation, and Reflection on Current Resources JO - J Med Internet Res SP - e58693 VL - 27 KW - digital tools KW - neurodevelopmental conditions KW - mental health KW - digital health KW - implementation KW - digital interventions KW - child neurodevelopment KW - digital technology KW - mobile phone N2 - Background: An increase in the prevalence of neurodevelopmental conditions worldwide, alongside resource constraints within clinical services, has led to increased interest in health information technologies, such as apps and digital resources. Digital tools are often viewed as a solution to bridge this divide and to increase supports for families. There is, however, a paucity of research that has evaluated digital health tools, their potential benefits for child neurodevelopment and associated concerns (eg, mental health, well-being), and their benefit for families. Objective: This study conducted the first review of existing mobile apps and digital resources targeted at supporting the needs of children with developmental concerns or neurodevelopmental conditions. Methods: We identified 3435 separate resources, of which 112 (43 apps and 69 digital resources) met the criteria. These resources were categorized according to their purpose or target and were then reviewed based on their engagement, information quality, and evidence base using the Adapted Mobile App Rating Scale. Results: The most common condition of concern targeted by apps and digital resources was autism (19/112, 17% resources), with retrieved resources focusing on supporting challenging behaviors, promoting speech, language, and social development, and providing options for alternative and assistive communication. Other common areas of concern targeted by apps and digital resources included language and communication (16/112, 14.3%) and attention-deficit/hyperactivity disorder (11/112, 9.8%). Results showed that reviewed resources were engaging, with high levels of accessibility and functionality. Resources had various functions, including developmental or behavioral tasks targeted at children, assistive communication support, scheduling support, journaling, and advice, activities, and strategies for parents. The information quality of resources, such as credibility of source and evidence base was, however, mostly low. Apps and digital resources with good credibility and an existing evidence base were largely developed in partnership with research, health, or government institutions, and were rated significantly higher on overall quality compared with apps and digital resources not developed in partnership with such institutions (apps; t41=?4.35, P<.001; digital resources; t67=?4.95, P<.001). Conclusions: The lack of evidence base across resources means that it is extremely difficult to provide recommendations to families with respect to apps or digital resources that may support their needs. Frameworks for the development of new tools are discussed, highlighting the novel approaches required to demonstrate the efficacy of tools for improving outcomes for children and families. Such a framework requires collaboration with multiple stakeholders (software developers, researchers, regulatory bodies, clinicians, children, and families) and engagement across multiple levels of expertise (app development, implementation, and dissemination within services, policy, and clinical regulations), to harness the potential of digital health for improving outcomes and promoting support in child neurodevelopment, which at this juncture remains largely underdeveloped. UR - https://www.jmir.org/2025/1/e58693 UR - http://dx.doi.org/10.2196/58693 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58693 ER - TY - JOUR AU - Barría, Patricio AU - Andrade, Asterio AU - Gomez-Vargas, Daniel AU - Yelincic, Alejandro AU - Roberti, Flavio AU - Bahamonde, Eduardo AU - Aguilar, Rolando AU - Cordova, Bessie PY - 2024/10/16 TI - Multidisciplinary Home-Based Rehabilitation Program for Individuals With Disabilities: Longitudinal Observational Study JO - JMIR Rehabil Assist Technol SP - e59915 VL - 11 KW - rehabilitation KW - home-based therapy KW - physical therapy KW - psychological therapy KW - home physiotherapy KW - disabilities KW - occupational therapy KW - personalized care KW - patient care KW - motor disorder KW - mood disorder KW - motor function N2 - Background: Disability affects a significant portion of the global population nowadays, necessitating innovative approaches to access rehabilitation processes. Home-based rehabilitation has emerged as a beneficial approach, offering comfort and context-specific therapy. Objective: This study aims to evaluate the impact of a multidisciplinary home-based rehabilitation program for individuals with moderate neuromusculoskeletal disabilities in terms of motor function and mood. Methods: A total of 270 participants with median age of 66 (IQR 20-98) years were recruited from the National Disability Registry of Chile. The intervention involved a multidisciplinary team composed of 49 health care professionals providing personalized treatment plans over 4 months (32 sessions for physical therapy, 8 sessions for occupational therapy, 4 sessions for nutrition, 8 sessions for psychology, and 4 sessions for nursing and podiatry). This program also included 2 medical evaluations (at the beginning and the end) to monitor clinical progress in terms of motor function and mental health, using the Berg Balance Scale and Beck Depression Inventory, respectively. Results: The home-based rehabilitation program showed significant improvements (P<.001) in motor function and balance with a reduction in fall risk. Specifically, the Berg Balance Scale score decreased close to 15% after the home-based rehabilitation program for all enrolled participants. On the other hand, depression levels showed no significant changes (P=.27), with percentages of variation less than 8% between the 2 assessed conditions. In this sense, participants remained with the same mild depression level (14 of 63) concerning the Beck Depression Inventory score. Conclusions: This study concludes that personalized home-based rehabilitation programs are effective in enhancing motor function and balance, particularly in individuals with neurological conditions. On the other hand, the findings in terms of mood advocate for further exploration of psychological support within such programs to enhance overall patient well-being. Trial Registration: ClinicalTrials.gov NCT06537791; https://clinicaltrials.gov/study/NCT06537791 UR - https://rehab.jmir.org/2024/1/e59915 UR - http://dx.doi.org/10.2196/59915 UR - http://www.ncbi.nlm.nih.gov/pubmed/39412860 ID - info:doi/10.2196/59915 ER - TY - JOUR AU - Munce, EP Sarah PY - 2024/4/22 TI - Introducing JMIR Rehabilitation and Assistive Technologies: A Venue for Publishing Interdisciplinary Research on the Development, Implementation, and Evaluation of Health Innovations and Emerging Technologies in the Field of Rehabilitation JO - JMIR Rehabil Assist Technol SP - e56348 VL - 11 KW - rehabilitation KW - assistive technologies KW - JMIR Rehabilitation and Assistive Technologies KW - digital KW - online UR - https://rehab.jmir.org/2024/1/e56348 UR - http://dx.doi.org/10.2196/56348 UR - http://www.ncbi.nlm.nih.gov/pubmed/38648632 ID - info:doi/10.2196/56348 ER - TY - JOUR AU - Movahed, Mehrnoosh AU - Rue, Ishana AU - Yoo, Yejong Paul AU - Sogomonian, Tamara AU - Majnemer, Annette AU - Shikako, Keiko PY - 2023/5/4 TI - Characteristics of Inclusive Web-Based Leisure Activities for Children With Disabilities: Qualitative Descriptive Study JO - JMIR Pediatr Parent SP - e38236 VL - 6 KW - children with disabilities KW - social inclusion KW - participation KW - accessibility KW - leisure KW - web-based activities KW - pandemic N2 - Background: The participation of children with disabilities in leisure activities is a key determinant of their physical and mental health. The COVID-19 pandemic has limited participation in leisure activities for all children, particularly those with disabilities. As a result, children with disabilities may be less active while feeling more isolated and stressed. Web-based communities and activities have become increasingly important. Understanding how web-based activities include or exclude children with disabilities can contribute to the development of inclusive communities that may support participation after the pandemic. Objective: This study aimed to identify factors that may facilitate or prevent the participation of children with disabilities in web-based leisure activities. Methods: We adopted a qualitative descriptive interpretative methodology and conducted interviews with 2 groups of participants: service providers offering inclusive web-based leisure activities and parents of children with disabilities who have engaged in web-based leisure activities during the COVID-19 pandemic. A semistructured interview format was created based on the Theoretical Domains Framework. The questions focused on the description of the web-based activities offered by the service provider (eg, age range, frequency, cost, target population, and type of activity offered) and any adaptations to make the web-based activity accessible to children and youth with disabilities, and their perceptions and beliefs about what supported or deterred participation in the activities. Results: A total of 17 participants described their experiences in participating in and creating web-based leisure programs and the factors preventing or facilitating children?s participation in web-based activities. Environment and context factors included accommodations, the format of activities and the web-based setting, stakeholder involvement, and materials and resources available. Activities that had flexible schedules, both recorded and live options for joining, and that provided clear instructions and information were perceived as more accessible. Beliefs involved the characteristics of the child and the family environment, as well as the characteristics of the organizations providing the activity. Activity facilitators who were familiar with the web-based environment and knew the specific characteristics of the child facilitated their participation. Engagement in community champions and respect for children?s individual preferences were perceived as positive. Access to technology, funding, and caregivers? ability to facilitate child engagement are crucial factors that must be considered when offering web-based programs. Conclusions: Web-based environments offer an accessible and safe option for leisure participation when public health conditions prevent children with disabilities from participating in in-person activities. However, to make web-based activities accessible to children with a variety of disabilities, there needs to be a clear plan toward universal web-based accessibility that accounts for individual needs and collective approaches to web-based leisure. Future work should consider developing and testing guidelines for web-based accessibility, equity, public policy, and programming considerations in offering these activities for all children. UR - https://pediatrics.jmir.org/2023/1/e38236 UR - http://dx.doi.org/10.2196/38236 UR - http://www.ncbi.nlm.nih.gov/pubmed/36668903 ID - info:doi/10.2196/38236 ER - TY - JOUR AU - McDonall, Jo AU - Redley, Bernice AU - Livingston, Patricia AU - Hutchinson, Ana AU - de Steiger, Richard AU - Botti, Mari PY - 2022/5/19 TI - A Nurse-Led Multimedia Intervention to Increase Patient Participation in Recovery After Knee Arthroplasty: Hybrid Type II Implementation Study JO - JMIR Hum Factors SP - e36959 VL - 9 IS - 2 KW - patient participation KW - multimedia KW - nurse-facilitated KW - knee arthroplasty KW - orthopedic surgery KW - acute care KW - nurse KW - participatory medicine KW - digital technology N2 - Background: Advances in digital technology and the use of multimedia platforms to deliver information provide clinicians with a unique opportunity to develop innovative ways to consistently provide high-quality, accessible, and evidence-based information to support patient participation. Introducing new technologies into everyday acute care clinical practice can be difficult. Objective: The aim of this paper was to provide a description of an implementation strategy and the subsequent evaluation undertaken to examine the contextual factors important to the successful adoption of new technology by nurses in the context of acute postoperative care. Methods: Implementation of the intervention and process evaluation was undertaken in 3 phases: phase 1, preimplementation stakeholder engagement and identification of barriers and enablers to implementation; phase 2, supported implementation of the intervention; and phase 3, evaluation of uptake, usability, and acceptability of the intervention in clinical practice. Results: The outcomes of the implementation of the multimedia intervention in the context of acute postoperative care were positive. Of the 104 patients in the intervention group, 103 (99%) received the intervention. All 103 patients completed the 8-item intervention questionnaire and 93.3% (97/103) were interviewed on day 3 to evaluate usability, uptake, and acceptability. Of these 97 patients, almost all (n=94, 91%) found the program easy to use and most (n=64, 62%) could view the MyStay Total Knee Replacement program as often as they wanted. The findings also suggest that the time to implement the program was minimal (5-10 minutes). Collaboration with nurses and patients before and during implementation to identify potential barriers to successful implementation of the intervention was essential to develop timely strategies to overcome these barriers. To ensure end-user engagement, careful consideration was given to nurses? views on who was responsible for facilitating this intervention. Conclusions: The findings provide evidence that the structured implementation of the multimedia intervention was robust and successful in terms of patient participant recruitment and application; however, it was difficult to assess the level of engagement by nurse clinicians with the program. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614000340639; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000340639 UR - https://humanfactors.jmir.org/2022/2/e36959 UR - http://dx.doi.org/10.2196/36959 UR - http://www.ncbi.nlm.nih.gov/pubmed/35588363 ID - info:doi/10.2196/36959 ER - TY - JOUR AU - Prescott, Mike AU - Routhier, François AU - Labbé, Delphine AU - Grandisson, Marie AU - Mahmood, Atiya AU - Morales, Ernesto AU - Best, L. Krista AU - Mostafavi, Abolfazl Mir AU - Borisoff, Jaimie AU - Gamache, Stéphanie AU - Sawatzky, Bonita AU - Miller, C. William AU - Bulk, Yvonne Laura AU - Robillard, M. Julie AU - Jenkins, Hailey-Thomas AU - Seetharaman, Kishore AU - Mortenson, Ben W. PY - 2022/3/31 TI - Providing Accessible Recreation Outdoors?User-Driven Research on Standards (PARCOURS): Protocol for a Multiphase Study JO - JMIR Res Protoc SP - e33611 VL - 11 IS - 3 KW - parks KW - accessibility KW - standards KW - user-oriented research N2 - Background: Canada?s national parks are world-renowned. However, despite recent attempts to improve access, many are not accessible to people with disabilities. With the advent of provincial and federal legislation, standards are being developed to assist with the design and management of parks. Objective: The overarching objective of this study is to inform accessibility standards for federal parks that meet the needs of all park visitors, regardless of ability. The specific objectives of this study are to identify park accessibility standards that exist internationally, identify the accessibility challenges that people with disabilities face in park environments, and prioritize and recommend accessibility standards for national parks. Methods: A 3-phase approach will be used to achieve the study objectives. In the first phase, a scoping review of the existing accessibility standards will be conducted. The second phase will include objective audits of trails and features in 6 parks, 3 in western Canada and 3 in eastern Canada, as well as mobile interviews with 24 diverse participants in each region regarding their experiences of and recommendations for improving the park?s accessibility. In the final phase, a Delphi participatory consensus development process will be used, based on the data gathered in the first 2 phases, to prioritize recommendations for standards. Results: We expect to find gaps in existing standards that do not account for the diverse range of accessibility requirements that people with disabilities have for visiting parks. We also expect to find that existing standards, on their own, may not be enough to ensure equitable access to all the experiences and amenities that parks have to offer. Development of subsequent guidelines and best practices may be necessary to address complex scenarios for which standards may not be the best approach to ensuring accessibility. Conclusions: The participatory and mixed methods approaches used in this study will provide rich insights for developing accessible park standards that consider the diverse needs of people with disabilities. The findings will also support the development or enhancement of park standards at all levels of government. International Registered Report Identifier (IRRID): DERR1-10.2196/33611 UR - https://www.researchprotocols.org/2022/3/e33611 UR - http://dx.doi.org/10.2196/33611 UR - http://www.ncbi.nlm.nih.gov/pubmed/35357324 ID - info:doi/10.2196/33611 ER - TY - JOUR AU - Chowdhary, Kuntal AU - Yu, Xie Daihua AU - Pramana, Gede AU - Mesoros, Matthew AU - Fairman, Andrea AU - Dicianno, Edward Brad AU - Parmanto, Bambang PY - 2022/2/24 TI - User-Centered Design to Enhance mHealth Systems for Individuals With Dexterity Impairments: Accessibility and Usability Study JO - JMIR Hum Factors SP - e23794 VL - 9 IS - 1 KW - cellular phone KW - mobile apps KW - telemedicine KW - adaptive mHealth KW - rehabilitation KW - self-care KW - spinal cord injury KW - spina bifida KW - chronic disease KW - persons with disability KW - accessibility KW - dexterity impairments KW - mobile phone N2 - Background: Mobile health systems have been shown to be useful in supporting self-management by promoting adherence to schedules and longitudinal health interventions, especially in people with disabilities. The Interactive Mobile Health and Rehabilitation (iMHere) system was developed to empower people with disabilities and those with chronic conditions with supports needed for self-management and independent living. Since the first iteration of the iMHere 1.0 app, several studies have evaluated the accessibility and usability of the system. Potential opportunities to improve and simplify the user interface were identified, and the iMHere modules were redesigned accordingly. Objective: In this study, we aim to evaluate the usability of the redesigned modules within the iMHere 1.0 app. Methods: We evaluated the original and redesigned iMHere modules?MyMeds and SkinCare. The Purdue Pegboard Test was administered to assess the participants? dexterity levels. Participants were then asked to perform a set of tasks using both the original and redesigned MyMeds and SkinCare modules to assess their efficiency and effectiveness. Usability was measured using the Telehealth Usability Questionnaire to evaluate 10 new accessibility features that were added to the redesigned app. Participants were also asked which version they preferred. Results: In total, 24 participants with disabilities and varying degrees of dexterity impairments completed the entire study protocol. Participants displayed improved efficiency and effectiveness when using the redesigned modules compared with the original modules. The participants also reported improved usability and preferred the redesigned modules. Conclusions: This study demonstrated that the iMHere system became more efficient, effective, and usable for individuals with dexterity impairments after redesigning it according to user-centered principles. UR - https://humanfactors.jmir.org/2022/1/e23794 UR - http://dx.doi.org/10.2196/23794 UR - http://www.ncbi.nlm.nih.gov/pubmed/35200144 ID - info:doi/10.2196/23794 ER - TY - JOUR AU - Kadakia, Shevali AU - Stratton, Catherine AU - Wu, Yinfei AU - Feliciano, Josemari AU - Tuakli-Wosornu, A. Yetsa PY - 2022/2/15 TI - The Accessibility of YouTube Fitness Videos for Individuals Who Are Disabled Before and During the COVID-19 Pandemic: Preliminary Application of a Text Analytics Approach JO - JMIR Form Res SP - e34176 VL - 6 IS - 2 KW - persons with disabilities KW - disability KW - exercise KW - physical activity KW - digital health KW - YouTube KW - accessibility KW - fitness KW - COVID-19 KW - text analysis KW - social media KW - video N2 - Background: People with disabilities face barriers to in-person physical activity (PA), including a lack of adaptive equipment and knowledgeable instructors. Given this and the increased need for digital resources due to widespread COVID-19 lockdowns, it is necessary to assess the accessibility of digital fitness resources for people with disabilities. To investigate whether YouTube fitness content creators have made videos accessible to people with disabilities would be informative about access to PA during COVID-19 and could also provide insight into the feasibility of individuals who are disabled relying on YouTube for PA in a post?COVID-19 world. Objective: This study aims to ascertain if disability-friendly PA videos on YouTube are accessible through searching general fitness terms and whether a change in the availability of accessible fitness resources for people with disabilities occurred on YouTube between before and during the COVID-19 pandemic on ?Hospital/Medical Institutions,? ?Individual(s),? and ?Other(s)? channels. Secondary aims are to investigate if different categories of YouTube channels produce more accessible fitness content and highlight any disparities in disability-friendly PA content on YouTube. Methods: A cross-sectional text analysis of exercise-related YouTube videos was conducted. The authors used Python (version 3.0) to access the YouTube database via its data application programming interface. Terms pertaining to PA that were searched on YouTube were at-home exercise, exercise at home, exercise no equipment, home exercise, home-based exercise, no equipment workout, and workout no equipment. Various elements (eg, view count and content generation) of the videos published between January 1 and June 30, 2019 (n=700), were compared to the elements of videos published between January 1 and June 30, 2020 (n=700). To capture a broad idea of disability-friendly videos on YouTube, videos were labeled ?accessible? if they were found in the first 100 video results and if their title, description, or tags contained the following terms: para, paralympic, adaptive, adapted, disabled, disability, differently abled, disability-friendly, wheelchair accessible, and inclusive. Each video and channel were categorized as ?Hospitals/Medical Institutions,? ?Individuals,? or ?Other(s).? Results: The analysis revealed a statistically significant increase in viewership of fitness content on YouTube (P=.001) and in fitness content generated by Hospitals/Medical Institutions (P=.004). Accessible terms applicable to people with disabilities had minimal appearances in 2019 (21 videos) and 2020 (19 videos). None of the top viewed fitness videos that populated on YouTube from 2019 or 2020 were accessible. Conclusions: The proportion of accessible disability-friendly videos remains diminutive relative to the prevalence of disability in the general population, revealing that disability-friendly videos are seldom findable on YouTube. Thus, the need for disability-friendly fitness content to be easily searched and found remains urgent if access to digital fitness resources is to improve. UR - https://formative.jmir.org/2022/2/e34176 UR - http://dx.doi.org/10.2196/34176 UR - http://www.ncbi.nlm.nih.gov/pubmed/35044305 ID - info:doi/10.2196/34176 ER - TY - JOUR AU - Hijab, Fadi Mohamad Hassan AU - Al-Thani, Dena AU - Banire, Bilikis PY - 2021/12/7 TI - A Multimodal Messaging App (MAAN) for Adults With Autism Spectrum Disorder: Mixed Methods Evaluation Study JO - JMIR Form Res SP - e33123 VL - 5 IS - 12 KW - autism KW - assistive technology KW - mobile app KW - social and communication skills N2 - Background: Individuals with autism spectrum disorder (ASD) often exhibit difficulties in social and communication skills. For more than 30 years, specialists, parents, and caregivers have used techniques, such as applied behavioral analysis, augmentative and alternative communication, and the picture exchange communication system to support the social and communication skills of people with ASD. Even though there are many techniques devised to enhance communication, these techniques are not considered in existing social media apps for people with ASD. Objective: This study aimed to investigate the effect of adding accessibility features, such as text-to-speech (TTS), speech-to-text (STT), and communication symbols (CS), to a messaging app (MAAN). We hypothesized that these accessibility features can enhance the social and communication skills of adults with ASD. We also hypothesized that usage of this app can reduce social loneliness in adults with ASD. Methods: Semistructured interviews were conducted with 5 experts working in fields related to ASD to help design the app. Seven adults with ASD participated in the study for a period of 10 to 16 weeks. Data logs of participants? interactions with the app were collected. Additionally, 6 participants? parents and 1 caregiver were asked to complete a short version of the Social and Emotional Loneliness Scale for Adults (SELSA-S) questionnaire to compare pre-post study results. The Mobile Application Rating Scale: user version questionnaire was also used to evaluate the app?s usability. Following the study, interviews were conducted with participants to discuss their experiences with the app. Results: The SELSA-S questionnaire results showed no change in the family subscale; however, the social loneliness subscale showed a difference between prestudy and poststudy. The Wilcoxon signed-rank test indicated that poststudy SELSA-S results were statistically significantly higher than prestudy results (z=?2.047; P=.04). Point-biserial correlation indicated that the SELSA-S rate of change was strongly related to usage of the TTS feature (r=0.708; P=.04) and CS feature (r=?0.917; P=.002), and moderately related to usage of the STT feature (r=0.428; P=.17). Lastly, we adopted grounded theory to analyze the interview data, and the following 5 categories emerged: app support, feature relevance, user interface design, overall feedback, and recommendations. Conclusions: This study discusses the potential for improving the communication skills of adults with ASD through special features in mobile messaging apps. The developed app aims to support the inclusion and independent life of adults with ASD. The study results showed the importance of using TTS, STT, and CS features to enhance social and communication skills, as well as reduce social loneliness in adults with ASD. UR - https://formative.jmir.org/2021/12/e33123 UR - http://dx.doi.org/10.2196/33123 UR - http://www.ncbi.nlm.nih.gov/pubmed/34878998 ID - info:doi/10.2196/33123 ER - TY - JOUR AU - Levati, Sara AU - Mellacqua, Zefiro AU - Caiata-Zufferey, Maria AU - Soldini, Emiliano AU - Albanese, Emiliano AU - Alippi, Maddalena AU - Bolla, Emilio AU - Colombo, Ada Raffaella AU - Cordasco, Severino AU - Kawohl, Wolfram AU - Larghi, Giuseppina AU - Lisi, Angela AU - Lucchini, Mario AU - Rossa, Simona AU - Traber, Rafael AU - Crivelli, Luca PY - 2021/11/9 TI - Home Treatment for Acute Mental Health Care: Protocol for the Financial Outputs, Risks, Efficacy, Satisfaction Index and Gatekeeping of Home Treatment (FORESIGHT) Study JO - JMIR Res Protoc SP - e28191 VL - 10 IS - 11 KW - acute mental healthcare KW - home treatment KW - crisis resolution KW - home visits KW - mental health KW - home care KW - crisis KW - home KW - community-based KW - mental health services KW - economic KW - risk KW - risks KW - efficacy KW - public health KW - accessibility N2 - Background: Crisis Resolution and Home Treatment (CRHT) teams represent a community-based mental health service offering a valid alternative to hospitalization. CRHT teams have been widely implemented in various mental health systems worldwide, and their goal is to provide care for people with severe acute mental disorders who would be considered for admission to acute psychiatric wards. The evaluation of several home-treatment experiences shows promising results; however, it remains unclear which specific elements and characteristics of CRHT are more effective and acceptable. Objective: This study aims to assess the acceptability, effectiveness, and cost-effectiveness of a new CRHT intervention in Ticino, Southern Switzerland. Methods: This study includes an interventional, nonrandomized, quasi-experimental study combined with a qualitative study and an economic evaluation to be conducted over a 48-month period. The quasi-experimental evaluation involves two groups: patients in the northern area of the region who were offered the CRHT service (ie, intervention group) and patients in the southern area of the region who received care as usual (ie, control group). Individual interviews will be conducted with patients receiving the home treatment intervention and their family members. CRHT members will also be asked to participate in a focus group. The economic evaluation will include a cost-effectiveness analysis. Results: The project is funded by the Swiss National Science Foundation as part of the National Research Program NRP74 for a period of 48 months starting from January 2017. As of October 2021, data for the nonrandomized, quasi-experimental study and the qualitative study have been collected, and the results are expected to be published by the end of the year. Data are currently being collected for the economic evaluation. Conclusions: Compared to other Swiss CRHT experiences, the CRHT intervention in Ticino represents a unique case, as the introduction of the service is backed by the closing of one of its acute wards. The proposed study will address several areas where there are evidence gaps or contradictory findings relating to the home treatment of acute mental crisis. Findings from this study will allow local services to improve their effectiveness in a challenging domain of public health and contribute to improving access to more effective care for people with severe mental disorders. Trial Registration: ISRCTN registry ISRCTN38472626; https://www.isrctn.com/ISRCTN38472626 International Registered Report Identifier (IRRID): DERR1-10.2196/28191 UR - https://www.researchprotocols.org/2021/11/e28191 UR - http://dx.doi.org/10.2196/28191 UR - http://www.ncbi.nlm.nih.gov/pubmed/34751660 ID - info:doi/10.2196/28191 ER - TY - JOUR AU - Champlin, Sara AU - Cuculick, Jessica AU - Hauser, C. Peter AU - Wyse, Kelley AU - McKee, M. Michael PY - 2021/9/7 TI - Using Gaze Tracking as a Research Tool in the Deaf Health Literacy and Access to Health Information Project: Protocol for a Multisite Mixed Methods Study and Preliminary Results JO - JMIR Res Protoc SP - e26708 VL - 10 IS - 9 KW - gaze tracking KW - deaf KW - disabilities KW - accessibility KW - online health information KW - health information seeking KW - mobile phone N2 - Background: Previous studies have identified the internet as a major source of health information. Reliable and accessible sources of web-based health information are critical for cultivating patient-centered care. However, the accessibility and use of web-based health information remains largely unknown for deaf individuals. We used gaze-tracking technology to understand the navigation and use of web-based health information by deaf adults who communicate with sign language and by hearing adults. Objective: This paper discusses our protocol for implementing gaze-tracking technology in a study that included both deaf and hearing participants. We report the preliminary results and lessons learned from the implementation of the protocol. Methods: We conducted gaze-tracking sessions with 450 deaf signers and 450 hearing participants as a part of a larger, multisite mixed methods research study. Then, we conducted qualitative elicitation interviews with a subsample of 21 deaf and 13 hearing participants, who engaged in a search task and reviewed their gaze recordings. To our knowledge, no study has implemented a similar research protocol to better understand the experiences of deaf adults. As such, we also examined research staff notes and observations from team meetings regarding the conduct of gaze-tracking data to delineate lessons learned and best practices for research protocols in this area. Results: Findings from the implementation of this study protocol highlight the use of gaze technology with deaf participants. We developed additional protocol steps to minimize gaze disruption from either lipreading or communicating in sign language. For example, research assistants were often unable to maintain eye contact with participants while signing because of the need to simultaneously point at the computer monitor to provide instructions related to gaze study components, such as the calibration process. In addition to developing ways to effectively provide instructions in American Sign Language, a practice exercise was included in the gaze tracker session to familiarize participants with the computer and technology. The use of the playback feature permitted a deeper dialogue between researchers and participants, which we found vital for understanding the experiences of deaf participants. Conclusions: On the basis of our experience using the study protocol through a large research project, incorporating gaze-tracking technology offers beneficial avenues for better understanding how individuals interact with health information. Gaze tracking can determine the type and placement of visual content that attracts attention from the viewers of diverse backgrounds, including deaf individuals. The lessons learned through this study will help future researchers in determining ideal study designs, such as suitable protocols and participant characteristics (eg, deaf signers), while including gaze trackers in their projects. This approach explored how different ways of presenting health information can affect or enable visual learners to engage and use health information effectively. International Registered Report Identifier (IRRID): RR1-10.2196/26708 UR - https://www.researchprotocols.org/2021/9/e26708 UR - http://dx.doi.org/10.2196/26708 UR - http://www.ncbi.nlm.nih.gov/pubmed/34491211 ID - info:doi/10.2196/26708 ER - TY - JOUR AU - Ratnanather, Tilak J. AU - Bhattacharya, Rohit AU - Heston, B. Margo AU - Song, Joanne AU - Fernandez, R. Lindsey AU - Lim, Seo Hong AU - Lee, Seung-Wook AU - Tam, Edric AU - Yoo, Sungho AU - Bae, Seung-Ho AU - Lam, Inez AU - Jeon, Won Hyoung AU - Chang, A. Son AU - Koo, Ja-Won PY - 2021/3/15 TI - An mHealth App (Speech Banana) for Auditory Training: App Design and Development Study JO - JMIR Mhealth Uhealth SP - e20890 VL - 9 IS - 3 KW - speech therapy KW - mobile phone KW - computers, handheld KW - cochlear implants KW - hearing aids N2 - Background: With the growing adult population using electronic hearing devices such as cochlear implants or hearing aids, there is an increasing worldwide need for auditory training (AT) to promote optimal device use. However, financial resources and scheduling conflicts make clinical AT infeasible. Objective: To address this gap between need and accessibility, we primarily aimed to develop a mobile health (mHealth) app called Speech Banana for AT. The app would be substantially more affordable and portable than clinical AT; would deliver a validated training model that is reflective of modern techniques; and would track users? progress in speech comprehension, providing greater continuity between periodic in-person visits. To improve international availability, our secondary aim was to implement the English language training model into Korean as a proof of concept for worldwide usability. Methods: A problem- and objective-centered Design Science Research Methodology approach was adopted to develop the Speech Banana app. A review of previous literature and computer-based learning programs outlined current AT gaps, whereas interviews with speech pathologists and users clarified the features that were addressed in the app. Past and present users were invited to evaluate the app via community forums and the System Usability Scale. Results: Speech Banana has been implemented in English and Korean languages for iPad and web use. The app comprises 38 lessons, which include analytic exercises pairing visual and auditory stimuli, and synthetic quizzes presenting auditory stimuli only. During quizzes, users type the sentence heard, and the app provides visual feedback on performance. Users may select a male or female speaker and the volume of background noise, allowing for training with a range of frequencies and signal-to-noise ratios. There were more than 3200 downloads of the English iPad app and almost 100 downloads of the Korean app; more than 100 users registered for the web apps. The English app received a System Usability Scale rating of ?good? from 6 users, and the Korean app received a rating of ?OK? from 16 users. Conclusions: Speech Banana offers AT accessibility with a validated curriculum, allowing users to develop speech comprehension skills with the aid of a mobile device. This mHealth app holds potential as a supplement to clinical AT, particularly in this era of global telemedicine. UR - https://mhealth.jmir.org/2021/3/e20890 UR - http://dx.doi.org/10.2196/20890 UR - http://www.ncbi.nlm.nih.gov/pubmed/33720025 ID - info:doi/10.2196/20890 ER - TY - JOUR AU - Yeong, Lee Jian AU - Thomas, Peter AU - Buller, James AU - Moosajee, Mariya PY - 2021/1/20 TI - A Newly Developed Web-Based Resource on Genetic Eye Disorders for Users With Visual Impairment (Gene.Vision): Usability Study JO - J Med Internet Res SP - e19151 VL - 23 IS - 1 KW - internet access KW - blindness KW - eye disease KW - genetic diseases KW - usability testing KW - qualitative research KW - internet-based intervention KW - consumer health information KW - mobile phone N2 - Background: Despite the introduction of the Web Content Accessibility Guidelines and legislations, many websites remain poorly accessible to users with disability, especially those with visual impairment, as the internet has become a more visually complex environment. With increasing reliance on the internet and almost 2 million people in the United Kingdom being affected by vision loss, it is important that they are not overlooked when developing web-based materials. A significant proportion of those affected have irreversible vision loss due to rare genetic eye disorders, and many of them use the internet as a primary source of information for their conditions. However, access to high-quality web-based health information with an inclusive design remains a challenge for many. We have developed a new web-based resource for genetic eye disorders called Gene.Vision that aims to provide a holistic guide for patients, relatives, and health care professionals. Objective: Through a usability testing session of our website prototype, this study aims to identify key web-based accessibility features for internet users with vision impairment and to explore whether the contents provided in Gene.Vision are relevant and comprehensible. Methods: A face-to-face testing session with 8 participants (5 patients, 2 family members, and 1 member of the public) and 8 facilitators was conducted on a prototype website. Remote testing was performed with another patient due to COVID-19 restrictions. Home page design, navigation, content layout and quality, language, and readability were explored through direct observation and task completion using the think-aloud method. A patient focus group was organized to elicit further feedback. Qualitative data were gathered and analyzed to identify core themes through open and axial coding. Results: All participants had good computer literacy; 6 patients with visual impairment used visual aid software including iOS VoiceOver and Speak Screen, iOS Classic Invert, ZoomText 2020, Job Access With Speech, and Nonvisual Desktop Access. The features identified by the participants that will enhance accessibility and usability for users with visual impairment were a consistent website layout, a structured information hierarchy with a clear description of links, good chromatic and luminance contrast, a simple home page with predictable and easy navigation, adaptability to various assistive software, and readable and relevant content. They reported that dynamic content (such as carousels) and large empty spaces reduced accessibility. Information on research, support available, practical advice, and links to charities were incentives for repeated website visits. Conclusions: We demonstrated the importance of developing a website with a user-based approach. Through end user testing, we identified several key web-based accessibility features for people with visual impairment. Target end users should always be involved early and throughout the design process to ensure their needs are met. Many of these steps can be implemented easily and will aid in search engine optimization. UR - http://www.jmir.org/2021/1/e19151/ UR - http://dx.doi.org/10.2196/19151 UR - http://www.ncbi.nlm.nih.gov/pubmed/33470932 ID - info:doi/10.2196/19151 ER -