TY - JOUR AU - Ouellet, Steven AU - Naye, Florian AU - Supper, Wilfried AU - Cachinho, Chloé AU - Gagnon, Marie-Pierre AU - LeBlanc, Annie AU - Laferrière, Marie-Claude AU - Décary, Simon AU - Sasseville, Maxime PY - 2025/7/18 TI - Digital Health Portals for Individuals Living With or Beyond Cancer: Patient-Driven Scoping Review JO - JMIR Cancer SP - e72862 VL - 11 KW - cancer KW - oncology KW - patient portal KW - electronic health records KW - online access KW - patient records KW - social determinants of health KW - scoping review KW - Preferred Reporting Items for Systematic Reviews and Meta-Analyses N2 - Background: Digital health portals are online platforms allowing individuals to access their personal information and communicate with health care providers. While digital health portals have been associated with improved health outcomes and more streamlined health care processes, their impact on individuals living with or beyond cancer remains underexplored. Objective: This scoping review aimed to (1) identify the portal functionalities reported in studies involving individuals living with or beyond cancer, as well as the outcomes assessed, and (2) explore the diversity of participant characteristics and potential factors associated with portal use. Methods: We conducted a scoping review in accordance with the JBI methodology (formerly the Joanna Briggs Institute) and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. We included primary research studies published between 2014 and 2024 that involved participants living with or beyond cancer, had access to personal health information, and assessed at least one outcome related to health or the health care system. We searched the Embase, Web of Science, MEDLINE (Ovid), and CINAHL Plus with Full Text databases. Five reviewers independently screened all titles, abstracts, and full texts in duplicate using Covidence. We extracted data on study design, participant characteristics, portal functionalities, outcomes assessed, and PROGRESS-Plus (place of residence; race, ethnicity, culture, or language; occupation; gender or sex; religion; education; socioeconomic status; and social capital?Plus) equity factors. Results: We included 44 studies; most were conducted in the United States (n=30, 68%) and used quantitative (n=23, 52%), mixed methods (n=11, 25%), or qualitative (n=10, 23%) designs. The most common portal features were access to test results (28/44, 64%) and secure messaging (30/44, 68%). Frequently reported services included appointment-related functions (19/44, 43%), educational resources (13/44, 30%), and prescription management features (11/44, 25%). Behavioral and technology-related outcomes were the most frequently assessed (37/44, 84%), followed by system-level (19/44, 43%), psychosocial (16/44, 36%), and clinical outcomes (5/44, 11%). Overall, 43% (19/44) of the studies addressed PROGRESS-Plus factors. Age was the most frequently reported (13/19, 68%), followed by socioeconomic status (10/19, 53%), race or ethnicity (7/19, 37%), and gender or sex (7/19, 37%). Social capital (2/19, 11%), occupation (1/19, 5%), and disability (1/19, 5%) were rarely considered, and religion was not reported in any study. Conclusions: While digital health portals enhance patient engagement, their clinical impact and equity implications remain insufficiently evaluated. We found disparities in functionalities, outcomes, and PROGRESS-Plus representation. To promote equitable benefits, future studies should adopt inclusive designs and evaluation strategies that address diverse outcomes and integrate social determinants of health. UR - https://cancer.jmir.org/2025/1/e72862 UR - http://dx.doi.org/10.2196/72862 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/72862 ER - TY - JOUR AU - Fei-Zhang, J. David AU - Lawrence, Sherron Amelia AU - Chelius, C. Daniel AU - Sheyn, M. Anthony AU - Rastatter, C. Jeffrey PY - 2025/7/15 TI - The Impact of Digital Inequities on Nasal and Paranasal-Sinus Cancer Disparities in the United States: A Cohort Study JO - JMIR Cancer SP - e52627 VL - 11 KW - paranasal sinus diseases KW - nasopharyngeal carcinoma KW - statistics KW - digital inequities KW - cancer disparities KW - technology KW - morality KW - treatment KW - care access KW - United States KW - cohort study KW - sinus cancer KW - sociodemographic KW - online access KW - equity KW - digital divide KW - public health N2 - Background: In the modern era, the use of technology can substantially impact care access. Despite the extent of its influence on several chronic medical conditions related to the heart, lungs, and others, the relationship between one?s access to digital resources and oncologic conditions has been seldom investigated in select pathologies among gastrointestinal and head-neck regions. However, studies on the influence of this ?digital inequity? on other cancers pertaining to nasal and paranasal sinus cancer (NPSC) have yet to be performed. This remains in stark contrast to the extent of large data approaches assessing the impact of traditional social determinants/drivers of health (SDoH), such as factors related to one?s socioeconomic status, minoritized race or ethnicity, and housing-transportation status, on prognostic and treatment outcomes. Objective: This study aims to use the Digital Inequity Index (DII), a novel, comprehensive tool that quantifies digital resource access on an area- or community-based level, to assess the relationship between inequities in digital accessibility with NPSC disparities in prognosis and care in the United States. Methods: Patients with NPSC from 2008 to 2017 in the Surveillance, Epidemiology, and End Results Program were assessed for significant regression trends in the long-term follow-up period and treatment receipt across NPSCs with increasing overall digital inequity, as measured by DII. DII was based on 17 census-tract level variables derived from the summarized values overlapping that same time period from the US Census/American Community Survey and Federal Communications Commission Annual Broadband Report. Variables were categorized as infrastructure-access (ie, electronic device ownership, internet provider availability, and income-broadband subscription ratio) or sociodemographic (education, income, age, and disability), ranked, and then averaged into a composite score to encompass direct and indirect factors related to digital inequity. Results: Across 8012 adult patients with NPSC, males (n=5416, 67.6%) and White race (n=4293, 53.6%) were the most represented demographics. With increasing digital inequity, as measured by increasing total DII scores, significant decreases in the length of long-term follow-up were observed with nasopharyngeal (P<.01) and maxillary sinus cancers (P=.02), with decreases as high as 19% (35.2 to 28.5 months, nasopharynx). Electronic device and service availability inequities showcased higher-magnitude contributions to observed associated regression trends, while the income-broadband ratio contributed less. Significantly decreased odds of receiving indicated surgery (lowest odds ratio 0.87, 95% CI 0.80-0.95, maxillary) and radiation (lowest odds ratio 0.78, 95% CI 0.63-0.95, ethmoid) for several NPSCs were also observed. Conclusions: Digital inequities are associated with detrimental NPSC care and surveillance trends in the United States, even when accounting for traditional SDoH factors. These results prompt the need to include digital factors into the discussion of contextualizing SDoH-based analyses of cancer care disparities, as well as the specific factors from which prospective implementations and initiatives can invest limited public health resources to alleviate the most pertinent drivers of disparities. UR - https://cancer.jmir.org/2025/1/e52627 UR - http://dx.doi.org/10.2196/52627 ID - info:doi/10.2196/52627 ER - TY - JOUR AU - Qu, Jiajia PY - 2025/7/10 TI - Factors Affecting Patients? Use of Telehealth Services: Cross-Sectional Survey Study JO - J Med Internet Res SP - e63295 VL - 27 KW - HINTS dataset KW - telehealth utilization KW - confidence in health information seeking KW - patient-centered communication KW - health literacy KW - trust KW - social determinants of health KW - health self-efficacy KW - structural equation modeling N2 - Background: The increased integration of telehealth services into health care systems, especially during the COVID-19 pandemic, transformed patient-provider interactions. Despite numerous benefits that promote health equity and resource allocation, patients? acceptance and use of telehealth have declined post pandemic. To enhance health care delivery and patient satisfaction, we study the factors of this decline from the perspective of patient characteristics that influence the adoption and use of telehealth services. Objective: This study examines the direct impact of patient trust, social determinants of health, and health self-efficacy on telehealth usage, the indirect effect of confidence in health information seeking, patient-centered communication, and health literacy barriers on telehealth usage through trust. Methods: This paper uses secondary data from cycle 6 of the Health Information National Trends Survey, a nationally representative dataset collected by the National Cancer Institute. This dataset used a mixed-mode experimental design, with data collected between March and November 2022. The survey included 2 experimental conditions: concurrent (web and paper surveys offered simultaneously) and sequential (web survey offered first, followed by paper). A total of 6252 respondents participated, with a household response rate of 28.1% (6252/22,471). Respondents were randomly assigned to 1 of 3 web-based survey groups to address data quality issues such as speeding and straight lining. We use structural equation modeling to test our research questions, evaluating both direct and indirect pathways influencing telehealth usage. Common method bias is addressed through Harman?s single-factor test, and robustness checks ensure the validity and reliability of our results. Results: Out of 5554 participants who had at least 1 doctor visit within the past 12 months, 44.89% used telehealth services in the past year. Trust has an inverted U-shaped relationship with confidence in health information seeking (?=?.031; P=.002); we find trust positively influenced by patient-centered communication (?=.156; P<.001) and negatively affected by health literacy barriers (?=?.063; P<.001). Trust enhances telehealth usage (?=.025; P<.001), with social determinants of health exerting a positive impact (?=.105; P<.001) and health self-efficacy having a negative impact (?=?.019; P=.007). Conclusions: This study finds that trust, social determinants of health, and health self-efficacy directly impact telehealth usage. Additionally, telehealth usage is indirectly influenced by patient characteristics, such as confidence in health information seeking and health literacy barriers, as well as by a patient-centered communication environment. The findings emphasize the need for targeted interventions to improve patient health literacy and engagement, thereby promoting the telehealth services usage. UR - https://www.jmir.org/2025/1/e63295 UR - http://dx.doi.org/10.2196/63295 ID - info:doi/10.2196/63295 ER - TY - JOUR AU - Hayer, Rupinder AU - Tang, Joyce AU - Bisschops, Julia AU - Schneider, W. Gregory AU - Kirley, Kate AU - Khan, Tamkeen AU - Rieger, Erin AU - Walford, Eric AU - Anderson, Irsk AU - Press, Valerie AU - Williams, Brent PY - 2025/6/5 TI - Implementing the H&P 360 in Three Medical Institutions: Usability Study JO - JMIR Med Educ SP - e66221 VL - 11 KW - history and physical KW - medical education KW - social drivers KW - social determinants of health N2 - Background: The traditional history and physical (H&P) provides the basis for physicians? data gathering, problem formulation, and care planning, yet it can miss relevant behavioral or social risk factors. The American Medical Association?s ?H&P 360,? a modified H&P, has been shown to foster information gathering and patient rapport in inpatient settings and objective structured clinical examinations. It prompts students to explore 7 domains, as appropriate to the clinical context: biomedical problems, psychosocial problems, patients? priorities and goals, behavioral history, relationships, living environment and resources, and functional status. Objective: This study aims to examine the perceived usability of the H&P 360 outside standardized patient settings. Methods: The H&P 360 was implemented in various clinical settings across 3 institutions. Of the 207 student participants, 18 were preclerkship, 126 were clerkship, and 63 were postclerkship; 3-8 months after implementation, we administered a student survey consisting of 14 Likert-type items (1=strongly disagree to 5=strongly agree) and 3 free-text response items to assess usability. Results: Of the 207 students, 61 responded to the survey (response rate was 29.5%). Among all students, mean ratings on the 3 usability survey items ranged from 4.03 to 4.24. The 5 items assessing the impact on patient care had mean ratings ranging from 3.88 to 4.24. The mean ratings for the 2 student learning items were 4.10 and 4.16. Students? open-ended comments were generally positive, expressing a perceived value in obtaining a more complete contextual picture of patients? conditions and supporting the usability of the H&P 360. Survey response patterns varied across institutions and learner levels. Conclusions: Our findings suggest that using the H&P 360 may enhance information gathering critical for chronic disease management, particularly regarding social drivers of health. As a potential new standard, the H&P 360 may have clinical usability for identifying and addressing health inequities. Future work should assess its effects on patient care and outcomes. UR - https://mededu.jmir.org/2025/1/e66221 UR - http://dx.doi.org/10.2196/66221 UR - http://www.ncbi.nlm.nih.gov/pubmed/40471655 ID - info:doi/10.2196/66221 ER - TY - JOUR AU - Ponting, Carolyn AU - Baer, J. Rebecca AU - Blackman, Kacie AU - Blebu, Bridgette AU - Felder, N. Jennifer AU - Oltman, Scott AU - Tabb, M. Karen AU - Jelliffe Pawlowski, Laura PY - 2025/5/30 TI - Transforming Health and Reducing Perinatal Anxiety Through Virtual Engagement: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e70627 VL - 14 KW - cognitive behavioral therapy KW - telemedicine KW - perinatal care KW - anxiety KW - ethnic and racial minorities N2 - Background: Prenatal anxiety affects between 20% and 30% of pregnant people and is associated with adverse prenatal health conditions, birth outcomes, and postpartum mental health challenges. Individuals from racial and ethnic minority groups, sexual and gender minority groups, and those with low income are all at heightened risk for prenatal anxiety due to disproportionate exposure to adverse social determinants of health. Digital cognitive behavioral therapy (dCBT) has been shown to reliably reduce anxiety in mostly White and middle- to higher-income samples, but its efficacy in low-income and marginalized pregnant people is understudied. Objective: We propose a randomized controlled trial of a dCBT (Daylight app, Big Health, Ltd) in a sample of low-income pregnant people oversampled for racial, ethnic, sexual, and gender minority identity. Methods: Participants (N=132) will be randomized to the intervention or waitlist control group using a 1:1 allocation ratio. The intervention will be a self-guided application that uses an online therapist to teach and encourage the practice of 4 key cognitive behavioral therapy skills (eg, identifying catastrophic thinking and increasing physical relaxation) that can reduce anxiety. The primary outcome will be generalized anxiety symptoms; secondary outcomes will include depressive symptoms, stress, pregnancy-specific anxiety, and insomnia symptoms. Focus groups with a subset of participants will provide qualitative data about the acceptability of dCBT. Results: Recruitment began in June 2024. Data will be analyzed using linear mixed models, which will be fit with treatment condition (dCBT and waitlist control group) as the between-group factor, time (baseline, 3, 6, and 10 weeks post randomization) as a within-group factor, and a group-by-time interaction. Linear mixed models produce unbiased parameter estimates in situations where there are different numbers of observations per record and will accommodate intent-to-treat and sensitivity analyses. Conclusions: This clinical trial will evaluate the efficacy and acceptability of a self-guided dCBT for prenatal anxiety among low-income and marginalized pregnant people, a group that continues to experience substantial barriers to accessing in-person evidence-based psychotherapy. Trial Registration: ClinicalTrials.gov NCT06404450; https://clinicaltrials.gov/study/NCT06404450 International Registered Report Identifier (IRRID): DERR1-10.2196/70627 UR - https://www.researchprotocols.org/2025/1/e70627 UR - http://dx.doi.org/10.2196/70627 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/70627 ER - TY - JOUR AU - Kusi-Mensah, Iyeyinka AU - Taksal, Aarati AU - Akinyemi, Joshua AU - Owoade, Oluwatomisin AU - OlaOlorun, M. Funmilola AU - Adeniyi, F. Ade AU - Egbokhare, Olayinka AU - Taiwo, Olusade AU - Adeoye, Oluwabukola AU - Tamambang, Rita AU - Afolayan, Adeola AU - Ononye, Chuka AU - Akinpelu, Adebukola Olafunmilayo AU - Iyer, N. Srividya AU - Omigbodun, Olayinka PY - 2025/5/30 TI - Understanding the Gendered Impact of COVID-19 on Young Self-Employed Nigerian Women and Coproducing Interventions That Foster Better Systems and Well-Being: Protocol for a Multimethods Study JO - JMIR Res Protoc SP - e69577 VL - 14 KW - COVID-19 pandemic KW - low- and middle-income countries KW - self-employed women KW - resilience KW - well-being KW - coproduction KW - Nigeria N2 - Background: The COVID-19 pandemic has had disproportionate economic and health impacts on self-employed workers in Nigeria, particularly self-employed women and youth. Though uniquely different, the COVID-19 pandemic shares similarities with events such as childbirth, family, and health emergencies. Self-employed young women lack adequate support structures to cope with disruptive life events, which have negative consequences for their well-being. This is concerning, as 86% of women in the Nigerian labor force are self-employed. Objective: The project?s first objective is to conduct a gendered situational analysis to address the question of how the COVID-19 pandemic and other life events affect the paid and unpaid work and the physical, mental, and social well-being of self-employed young women in Nigeria; their strategies for coping with such events; and how their experiences compare with those of self-employed young men. Informed by this analysis, the second objective is to coproduce and pilot-test a gender-transformative intervention that integrates social protection and promotes well-being. Methods: This multimethod project has 3 components. The first is a situational analysis of the impact of the pandemic and other significant life events on the work and well-being of self-employed young women vis-à-vis self-employed young men. This involves qualitative interviews with approximately 60 self-employed young women and men and a digital storytelling initiative to represent some of these stories in video format. Secondary data analysis of the Nigerian General Household Survey and the COVID-19 Longitudinal Phone Survey will be conducted. Furthermore, a scoping review of the impact of significant life events, including the COVID-19 pandemic, on self-employed workers in low- and middle-income countries will be conducted. The second component is the coproduction of interventions involving qualitative interviews with self-employed young women, members of their support network, and policy makers to find out their views on how to support self-employed women. It also entails an analysis of policies relevant to self-employed women in Nigeria and theory of change workshops to create a map for achieving the long-term goal of improving their resilience. Furthermore, a systematic review of interventions to improve the job quality and well-being of self-employed workers will be conducted. The third component is a pilot of the coproduced interventions in a quasi-experimental study involving 300 participants to assess feasibility, acceptability, cost, and potential effectiveness. Results: This project was funded in October 2022. Data collection for the project commenced in May 2023 and will end in November 2025. Data collection for the situational analysis and coproduction of intervention phases have been completed while the pilot of intervention packages is underway. Conclusions: This project will advance knowledge of the impact of the COVID-19 pandemic and other significant disruptive life events on the work and well-being of self-employed young Nigerian women and provide coproduced solutions to mitigate their effects. International Registered Report Identifier (IRRID): DERR1-10.2196/69577 UR - https://www.researchprotocols.org/2025/1/e69577 UR - http://dx.doi.org/10.2196/69577 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/69577 ER - TY - JOUR AU - Tran, H. Yvette AU - Park, Seho AU - Coven, L. Scott AU - Mendonca, A. Eneida PY - 2025/5/2 TI - Area-Level Indices and Health Care Use in a Pediatric Brain and Central Nervous System Tumor Cohort: Observational Study JO - JMIR Public Health Surveill SP - e66834 VL - 11 KW - child opportunity KW - neighborhood deprivation KW - area deprivation KW - social vulnerability KW - health care use KW - social determinants of health KW - pediatrics KW - health disparities N2 - Background: While survival among pediatric patients with cancer has advanced, disparities persist. Public health tools such as the Area Deprivation Index, the Child Opportunity Index (COI), and the Social Vulnerability Index (SVI) are potential proxies for social determinants of health and could help researchers, public health practitioners, and clinicians identify neighborhoods or populations most likely to experience adverse outcomes. However, evidence regarding their relationship with health care use, especially in the pediatric population with cancer, remains mixed. Objective: We sought to evaluate the relationship between emergency department (ED) visits and hospitalizations with these area-level indices in our study population. Methods: We conducted a cross-sectional study of pediatric patients with brain and central nervous system tumors in a single Midwestern state who were diagnosed between 2010 and 2020. We fitted zero-inflated Poisson models for counts of ED and inpatient visits to determine if any of these use measures were associated with our 3 area-level indices. Finally, we mapped index quintiles onto neighborhoods to visualize and compare how each index differentially ranks neighborhoods. Results: Our study cohort consisted of 524 patients; 78.6% (n=412) of them had no recorded ED visit, and 39.7% (n=208) had no record of hospitalization. Moderate (coefficient=0.306; P=.01) and high (coefficient=0.315; P=.01) deprivation were associated with more ED visits. Both low child opportunity (coefficient=0.497; P<.001) and very high child opportunity (coefficient=0.328; P=.01) were associated with more ED visits. All quintiles of SVI were associated with ED visits, but the relationship was not dose-dependent. Low and very high deprivation were associated with hospitalizations, but COI and SVI were not. Additionally, by overlaying index quintiles onto census tracts and census block groups, we showed that most patients who had an ED visit lived in disadvantaged neighborhoods based on Area Deprivation Index rankings, but not necessarily COI or SVI rankings. Conclusions: Although indices provide useful context about the environment in which our patient population resides in, we found little evidence that neighborhood conditions as measured by these indices consistently or reliably relate to health care use. UR - https://publichealth.jmir.org/2025/1/e66834 UR - http://dx.doi.org/10.2196/66834 ID - info:doi/10.2196/66834 ER - TY - JOUR AU - Zhang, Kehe AU - Taylor, M. Madison AU - Hunyadi, Jocelyn AU - Doan, Q. Hung AU - Adamson, S. Adewole AU - Miller, Paige AU - Nelson, C. Kelly AU - Bauer, Cici PY - 2025/5/2 TI - Examining Demographic, Geographic, and Temporal Patterns of Melanoma Incidence in Texas From 2000 to 2018: Retrospective Study JO - JMIR Cancer SP - e67902 VL - 11 KW - melanoma incidence KW - melanoma screening KW - geographic disparity KW - geospatial analysis KW - joinpoint regression KW - demographic variation KW - temporal trend analysis KW - stage at diagnosis N2 - Background: Melanoma currently ranks as the fifth leading cancer diagnosis and is projected to become the second most common cancer in the United States by 2040. Melanoma detected at earlier stages may be treated with less-risky and less-costly therapeutic options. Objective: This study aims to analyze temporal and spatial trends in melanoma incidence by stage at diagnosis (overall, early, and late) in Texas from 2000 to 2018, focusing on demographic and geographic variations to identify high-risk populations and regions for targeted prevention efforts. Methods: We used melanoma incidence data from all 254 Texas counties from the Texas Cancer Registry (TCR) from 2000 to 2018, aggregated by county and year. Among these, 250 counties reported melanoma cases during the period. Counties with no cases reported in a certain year were treated as having no cases. Melanoma cases were classified by SEER Summary Stage and stratified by the following four key covariates: age, sex, race and ethnicity, and stage at diagnosis. Incidence rates (IRs) were calculated per 100,000 population, and temporal trends were analyzed using joinpoint regression to determine average annual percentage changes (AAPCs) with 95% CIs for the whole time period (2000?2018), the most recent 10-year period (2009?2018), and the most recent 5-year period (2014?2018). Heat map visualizations were developed to assess temporal trends by patient age, year of diagnosis, stage at diagnosis, sex, and race and ethnicity. Spatial cluster analysis was conducted using Getis-Ord Gi* statistics to identify county-level geographic clusters of high and low melanoma incidence by stage at diagnosis. Results: A total of 82,462 melanoma cases were recorded, of which 74.7% (n=61,588) were early stage, 11.3% (n=9,352) were late stage, and 14% (n=11,522) were of unknown stage. Most cases were identified as males and non-Hispanic White individuals. Melanoma IRs increased from 2000 to 2018, particularly among older adults (60+ years; AAPC range 1.20%-1.84%; all P values were <.001), males (AAPC 1.59%; P<.001), and non-Hispanic White individuals (AAPC of 3.24% for early stage and 2.38% for late stage; P<.001 for early stage and P = .03 for late state). Early-stage diagnoses increased while the rates of late-stage diagnoses remained stable for the overall population. The spatial analysis showed that urban areas had higher early-stage incidence rates (P=.06), whereas rural areas showed higher late-stage incidence rates (P=.05), indicating possible geographic-based differences in access to dermatologic care. Conclusions: Melanoma incidence in Texas increased over the study time period, with the most-at-risk populations being non-Hispanic White individuals, males, and individuals aged 50 years and older. The stable rates of late-stage melanoma among racial and ethnic minority populations and rural populations highlight potential differences in access to diagnostic care. Future prevention efforts may benefit from increasing access to dermatologic care in areas with higher rates of late-stage melanoma at diagnosis. UR - https://cancer.jmir.org/2025/1/e67902 UR - http://dx.doi.org/10.2196/67902 ID - info:doi/10.2196/67902 ER - TY - JOUR AU - Stanimirovic, Aleksandra AU - Francis, Troy AU - Meerai, Sonia AU - Mathew, Suja AU - Ibrahim, Sarah AU - Bowen, M. James AU - PIkula, Aleksandra AU - Rac, Valeria PY - 2025/4/30 TI - Diabetic Retinopathy Screening Among at Risk Populations: Protocol for Distributional Cost-Effectiveness Analysis JO - JMIR Res Protoc SP - e60488 VL - 14 KW - diabetic retinopathy KW - equity of care KW - distributional cost-effectiveness analysis KW - health equity KW - health care disparities KW - intersectionality KW - telehealth KW - telemedicine KW - retinopathy screening N2 - Background: Diabetic retinopathy (DR) remains the primary vision complication of diabetes and the leading cause of blindness among adults, with up to 30% prevalence among low-income populations. Tele-retina is a cost-effective screening alternative to vision loss prevention, yet there is an adverse association between screening and income. Intersectionality theory notes that barriers to achieving health equity result from the intersection of personal and social characteristics. Experiences at this intersection are influenced by interpersonal and structural systems of oppression. Studies have found that tele-retina is the preferred strategy over standard of care screening for at-risk populations. No study has assessed the economic equity impact of DR screening using a theoretical foundation. Objective: This study aims to address shortcomings related to the utilization of intersectionality theory in the economic evaluation of DR screening. We propose conducting a distributional cost-effectiveness analysis (DCEA) of the tele-retina program. Methods: The study will be undertaken using a deductive theoretical drive sequential multimethod approach, consisting of two studies: (1) a modified Delphi study and (2) DCEA. The Delphi panel (patient partners, field experts, and decision makers; N=35-50) will select the social constructs (eg, age, gender) for at-risk populations and potential trade-offs between health maximization and equity. The research will be guided by a social theory framework (intersectionality theory) to understand the impact of social constructs on economic outcomes. Social constructs that are selected by the Delphi panel will be integrated into the validated tele-retina cost-effectiveness analysis model, which will serve as a case study for DCEA. Results: We have submitted the research ethics board application to the University Health Network Research Ethics Board and are expecting to begin recruitment for the Delphi study in Spring 2025. We anticipate beginning work on the model in the summer of 2025 and completing it by early 2026. Conclusions: The Delphi study will provide an understanding of which social factors are deemed necessary by the stakeholders for guiding the inequity in care access. Study results will offer information related to the net health benefit of the intervention and the health equity impact of the tele-retina program, hence providing a more comprehensive valuation of the tele-retina program, which is informative to policy makers and governments whose goal is to mitigate the drivers of health inequities. We anticipate that each of these drivers will raise important questions regarding the implications for decision-making that may have not yet been addressed by Canadian health technology assessment bodies, such as the Canada Drug Agency. This is the first Canadian study to (1) have social constructs for DCEA selected by the Delphi panel, (2) mainstream how health equity framework and social constructs are used in economic assessment, (3) improve DR screening programs by using health equity lens, and (4) scale and adopt ?de-novo? integration of social constructs in economic models for program evaluation. International Registered Report Identifier (IRRID): PRR1-10.2196/60488 UR - https://www.researchprotocols.org/2025/1/e60488 UR - http://dx.doi.org/10.2196/60488 UR - http://www.ncbi.nlm.nih.gov/pubmed/40305086 ID - info:doi/10.2196/60488 ER - TY - JOUR AU - Gicquelais, E. Rachel AU - Conway, Caitlin AU - Vjorn, Olivia AU - Genz, Andrew AU - Kirk, Gregory AU - Westergaard, Ryan PY - 2025/3/26 TI - Mobile Health Tool to Capture Social Determinants of Health and Their Impact on HIV Treatment Outcomes Among People Who Use Drugs: Pilot Feasibility Study JO - JMIR Form Res SP - e59953 VL - 9 KW - HIV KW - drug use KW - social determinants of health KW - mobile health KW - mHealth KW - smartphone N2 - Background: Active substance use, food or housing insecurity, and criminal legal system involvement can disrupt HIV care for people living with HIV and opioid use disorder (OUD). These social determinants of health are not routinely captured in clinical settings. Objective: We evaluated whether real-time reports of social and behavioral factors using a smartphone app could predict viral nonsuppression and missed care visits to inform future mobile health interventions. Methods: We enrolled 59 participants from the AIDS Linked to the Intravenous Experience (ALIVE) Study in Baltimore, Maryland, into a 12-month substudy between February 2017 and October 2018. Participants were eligible if they had OUD and had either a measured HIV RNA ?1000 copies/mL or a ?1-month lapse in antiretroviral therapy in the preceding 2 years. Participants received a smartphone and reported HIV medication adherence, drug use or injection, and several disruptive life events, including not having a place to sleep at night, skipping a meal due to lack of income, being stopped by police, being arrested, or experiencing violence on a weekly basis, through a survey on a mobile health app. We described weekly survey completion and investigated which factors were associated with viral nonsuppression (HIV RNA ?200 copies/mL) or a missed care visit using logistic regression with generalized estimating equations adjusted for age, gender, smartphone comfort, and drug use. Results: Participants were predominantly male (36/59, 61%), Black (53/59, 90%), and had a median of 53 years old. At baseline, 16% (6/38) were virally unsuppressed. Participants completed an average of 23.3 (SD 16.3) total surveys and reported missing a dose of antiretroviral therapy, using or injecting drugs, or experiencing any disruptive life events on an average of 13.1 (SD 9.8) weekly surveys over 1 year. Reporting use of any drugs (adjusted odds ratio [aOR] 2.3, 95% CI 1.4?3.7), injecting drugs (aOR 2.3, 95% CI 1.3?3.9), and noncompletion of all surveys (aOR 1.6, 95% CI 1.1?2.2) were associated with missing a scheduled care visit over the subsequent 30 days. Missing ?2 antiretroviral medication doses within 1 week was associated with HIV viral nonsuppression (aOR 3.7, 95% CI: 1.2?11.1) in the subsequent 30 days. Conclusions: Mobile health apps can capture risk factors that predict viral nonsuppression and missed care visits among people living with HIV who have OUD. Using mobile health tools to detect sociobehavioral factors that occur prior to treatment disengagement may facilitate early intervention by health care teams. UR - https://formative.jmir.org/2025/1/e59953 UR - http://dx.doi.org/10.2196/59953 ID - info:doi/10.2196/59953 ER - TY - JOUR AU - Whittemore, Robin AU - Jeon, Sangchoon AU - Akyirem, Samuel AU - Chen, C. Helen N. AU - Lipson, Joanna AU - Minchala, Maritza AU - Wagner, Julie PY - 2025/3/25 TI - Multilevel Intervention to Increase Patient Portal Use in Adults With Type 2 Diabetes Who Access Health Care at Community Health Centers: Single Arm, Pre-Post Pilot Study JO - JMIR Form Res SP - e67293 VL - 9 KW - patient portal KW - mobile phone KW - diabetes KW - community health center KW - adults KW - diabetic KW - DM KW - diabetes mellitus KW - Type 2 diabetes KW - T2D KW - community health centers KW - CHCs KW - pilot study KW - feasibility KW - self-management KW - glycemic control KW - patient portals KW - social determinants of health KW - primary outcome KW - digital health KW - digital health literacy KW - health technology KW - health technologies KW - psychosocial KW - efficacy N2 - Background: Diabetes self-management education and support (DSMS) delivered via patient portals significantly improves glycemic control. Yet, disparities in patient portal use persist. Community health centers (CHCs) deliver care to anyone who needs it, regardless of income or insurance status. Objective: This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of a multilevel intervention to increase access and use of portals (MAP) among people with type 2 diabetes (T2D) receiving health care at CHCs. Methods: A within-subjects, pre-post design was used. Adults with T2D who were portal naive were recruited from 2 CHCs. After informed consent, participants met with a community health worker for referrals for social determinants of health, provision of a tablet with cell service, and individualized training on use of the tablet and portal. Next, a nurse met individually with participants to develop a DSMS plan and then communicated with patients via the portal at least twice weekly during the first 3 months and weekly for the latter 3 months. Data were collected at baseline, 3 months and 6 months. The primary outcome was patient activation and engagement with the portal. Secondary outcomes included technology attitudes, digital health literacy, health-related outcomes and psychosocial function. Results: In total, 26 patients were eligible, 23 received the intervention, and one was lost to follow up. The sample was predominately Latino or Hispanic (17/22, 77%) and reported low income (19/22, 86%< US $40,000/year), low education (13/22, 59% 85%) were limited to geocoding or basic mapping without implementing advanced spatial statistical analysis, leaving only 49 studies that met the eligibility criteria. These studies used diverse spatial methods, with a predominant focus on clustering techniques, while spatiotemporal analysis (frequentist and Bayesian) and modeling were less common. A noteworthy surge (n=42, 86%) in publications was observed after 2017. The publications investigated a variety of adult and pediatric clinical areas, including infectious disease, endocrinology, and cardiology, using phenotypes defined over a range of data domains such as demographics, diagnoses, and visits. The primary health outcomes investigated were asthma, hypertension, and diabetes. Notably, patient phenotypes involving genomics, imaging, and notes were limited. Conclusions: This review underscores the growing interest in spatial analysis of EHR-derived data and highlights knowledge gaps in clinical health, phenotype domains, and spatial methodologies. We suggest that future research should focus on addressing these gaps and harnessing spatial analysis to enhance individual patient contexts and clinical decision support. UR - https://medinform.jmir.org/2024/1/e56343 UR - http://dx.doi.org/10.2196/56343 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56343 ER - TY - JOUR AU - Wakeman, Michael AU - Tesfaye, Lydia AU - Gregory, Tim AU - Leahy, Erin AU - Kendrick, Brandon AU - El-Toukhy, Sherine PY - 2024/10/11 TI - Perceptions of the Use of Mobile Technologies for Smoking Cessation: Focus Group Study With Individuals of Low Socioeconomic Status Who Smoke JO - JMIR Form Res SP - e58221 VL - 8 KW - smoking cessation KW - social determinants of health KW - mhealth KW - apps KW - qualitative research KW - young adults N2 - Background: The use of mobile technologies to deliver behavioral health interventions, including smoking cessation support, has grown. Users? perceptions are important determinants of the adoption and use of new technologies. However, little is known about users? perceptions of mobile technologies as smoking cessation aids, particularly among disadvantaged individuals who smoke. Objective: This study aimed to examine the acceptance of mobile technologies for smoking cessation among young adults with low socioeconomic status who smoke. Methods: In total, 38 current cigarette smokers, 18 to 29 years old, who wanted to quit and did not have a 4-year college degree nor were enrolled in a 4-year college, participated in 12 semistructured digital focus groups. The moderation guide was guided by the Unified Theory of Acceptance and Use of Technology. Discussions were audio recorded, transcribed verbatim, and coded for the Unified Theory of Acceptance and Use of Technology constructs (ie, effort expectancy, facilitating conditions, performance expectancy, and social influence), sentiment (ie, negative, neutral, and positive), and purpose of using mobile technologies (ie, lifestyle and health management and smoking cessation) following a deductive thematic analysis approach. Results: Participants had positive experiences using mobile technologies for lifestyle and health management, primarily for fitness and dietary purposes. Salient themes were facilitating conditions of use (44/80, 55%), with prior experiences and costs subthemes, followed by perceived usefulness of mobile technologies in helping users attain health goals (22/80, 27.50%), which were generally positive. Ease of use (11/80, 13.75%) and social influences (3/80, 3.75%) were minimally discussed. Conversely, participants had limited awareness of smoking cessation uses of mobile technologies, which was the primary barrier under facilitating conditions discussed (33/51, 64.70%). Participants expressed skepticism about the usefulness of mobile technologies in helping them quit smoking (14/51, 27.45%). Effort expectancy was not discussed, given participants? limited prior use. Social influences on mobile technology use for smoking cessation were minimally discussed (4/51, 7.84%). Conclusions: The use of mobile technologies for smoking cessation was unknown to young adults with low socioeconomic status who smoke. To reduce cigarette smoking and associated health disparities, increasing awareness and use of evidence-based mobile-based smoking cessation interventions are needed. Smoking cessation interventions should incorporate features perceived as useful and easy to use to capitalize on positive user experiences and the acceptability of mobile technologies for lifestyle and health management. UR - https://formative.jmir.org/2024/1/e58221 UR - http://dx.doi.org/10.2196/58221 UR - http://www.ncbi.nlm.nih.gov/pubmed/39392684 ID - info:doi/10.2196/58221 ER - TY - JOUR AU - Hichborn, Emily AU - Turner, Avery AU - Moore, Sarah AU - Gauthier, Phoebe AU - Bell, Kathleen AU - Montgomery, LaTrice AU - Boggis, Jesse AU - Lambert-Harris, Chantal AU - Saunders, Elizabeth AU - Dallery, Jesse AU - McLeman, Bethany AU - Marsch, Lisa PY - 2024/10/10 TI - Technology-Based Interventions in Tobacco Use Treatment Among People Who Identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native: Scoping Review JO - J Med Internet Res SP - e50748 VL - 26 KW - health disparities KW - underrepresented KW - social determinants of health KW - tobacco use KW - technology-based interventions KW - scoping review KW - mobile phone N2 - Background: Although tobacco use has significantly declined in the general population, traditional tobacco use treatment uptake and success rates remain disproportionately low among people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native. Technology-based interventions (TBIs) for tobacco use are promising alternatives to traditional tobacco use treatments. Objective: This scoping review aims to investigate the extent to which the use of digital TBIs in tobacco use treatment research promotes health equity among people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native. Methods: This scoping review identifies US-based studies (between January 2000 and March 2021) that enlist TBIs for tobacco use treatment and include people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native at ?50% of the sample when combined; features studies that are also race and ethnicity conscious; and highlights health equity?promoting insights from included studies. Results: In 85% (22/26) of the studies, the largest proportion of the sample was African American/Black, most participants had low socioeconomic status, and recruitment was most commonly from medical settings. In total, 58% (15/26) of the studies were race and ethnicity conscious, and 67% (10/15) of these studies sought to partner with potential end users. An array of TBIs were represented; however, SMS text messaging was most prevalent. Most TBIs were combined with other evidence-based intervention components (eg, nicotine replacement therapy). Approximately one-third of the studies (8/26, 31%) required participants to have their own device or internet access. The majority were underpowered to detect substantial differences. Conclusions: The modest number of studies, particularly for persons who identify as Hispanic/Latina/o and American Indian/Alaska Native, demonstrates the limited application of TBIs for tobacco use and that additional research is needed to determine the extent to which TBIs for tobacco use promote health equity among these populations. International Registered Report Identifier (IRRID): RR2-10.2196/34508 UR - https://www.jmir.org/2024/1/e50748 UR - http://dx.doi.org/10.2196/50748 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50748 ER - TY - JOUR AU - Zhou, Weipeng AU - Youngbloom, Amy AU - Ren, Xinyang AU - Saelens, E. Brian AU - Mooney, D. Sean AU - Mooney, J. Stephen PY - 2024/10/4 TI - The Automatic Context Measurement Tool (ACMT) to Compile Participant-Specific Built and Social Environment Measures for Health Research: Development and Usability Study JO - JMIR Form Res SP - e56510 VL - 8 KW - built environment KW - social environment KW - geocoding KW - GIS KW - geographic information systems KW - ACMT KW - automatic context measurement tool KW - linkage KW - privacy N2 - Background: The environment shapes health behaviors and outcomes. Studies exploring this influence have been limited to research groups with the geographic information systems expertise required to develop built and social environment measures (eg, groups that include a researcher with geographic information system expertise). Objective: The goal of this study was to develop an open-source, user-friendly, and privacy-preserving tool for conveniently linking built, social, and natural environmental variables to study participant addresses. Methods: We built the automatic context measurement tool (ACMT). The ACMT comprises two components: (1) a geocoder, which identifies a latitude and longitude given an address (currently limited to the United States), and (2) a context measure assembler, which computes measures from publicly available data sources linked to a latitude and longitude. ACMT users access both of these components using an RStudio/RShiny-based web interface that is hosted within a Docker container, which runs on a local computer and keeps user data stored in local to protect sensitive data. We illustrate ACMT with 2 use cases: one comparing population density patterns within several major US cities, and one identifying correlates of cannabis licensure status in Washington State. Results: In the population density analysis, we created a line plot showing the population density (x-axis) in relation to distance from the center of the city (y-axis, using city hall location as a proxy) for Seattle, Los Angeles, Chicago, New York City, Nashville, Houston, and Boston with the distances being 1000, 2000, 3000, 4000, and 5000 m. We found the population density tended to decrease as distance from city hall increased except for Nashville and Houston, 2 cities that are notably more sprawling than the others. New York City had a significantly higher population density than the others. We also observed that Los Angeles and Seattle had similarly low population densities within up to 2500 m of City Hall. In the cannabis licensure status analysis, we gathered neighborhood measures such as age, sex, commute time, and education. We found the strongest predictive characteristic of cannabis license approval to be the count of female children aged 5 to 9 years and the proportion of females aged 62 to 64 years who were not in the labor force. However, after accounting for Bonferroni error correction, none of the measures were significantly associated with cannabis retail license approval status. Conclusions: The ACMT can be used to compile environmental measures to study the influence of environmental context on population health. The portable and flexible nature of ACMT makes it optimal for neighborhood study research seeking to attribute environmental data to specific locations within the United States. UR - https://formative.jmir.org/2024/1/e56510 UR - http://dx.doi.org/10.2196/56510 UR - http://www.ncbi.nlm.nih.gov/pubmed/39365663 ID - info:doi/10.2196/56510 ER - TY - JOUR AU - Pappadis, R. Monique AU - Talley, G. Kelli AU - Garcia, Patricia AU - Aguirre, R. Caitlin AU - Onwudebe, K. Chinedu AU - Smith, Michelle AU - Lequerica, H. Anthony PY - 2024/10/3 TI - Racial and Ethnic Differences in Traumatic Brain Injury Outcomes From 2009 to 2023: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e58763 VL - 13 KW - traumatic brain injury KW - TBI KW - health disparities KW - racial and ethnic differences KW - injury outcomes KW - outcomes assessment KW - social determinants of health KW - neurorehabilitation KW - evidence-based interventions N2 - Background: In 2009, Gary and colleagues reviewed prior research examining racial and ethnic differences in outcomes after traumatic brain injury (TBI). Over the past 15 years, advances in research and changes in the demographic composition of the United States warrant a comprehensive understanding of racial and ethnic disparities after TBI. Objective: A systematic review will be conducted to examine racial and ethnic differences in TBI outcomes from 2009 to 2023. Methods: Preliminary searches and study screening processes will identify relevant English-language articles published from January 2009 to December 2023 using the CINAHL, Gale OneFile, PsycINFO (Ovid), and PubMed electronic databases. Relevant articles will include quantitative or mixed method approaches, involve individuals with TBI or their caregivers, and compare 2 or more groups by race or ethnicity on post-TBI outcomes. Quality will be assessed using the Newcastle-Ottawa Scale. This systematic review protocol was developed following PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. Results will be summarized, and a subgroup analysis may be conducted based on demographics (eg, age, gender, or sex). Results: We have already identified abstracts using the search strategy for all 4 of the included electronic databases. We recently updated the search and will begin abstract screening of the additional abstracts identified from the last search completed in January 2024. This systematic review is anticipated to be completed by fall 2024, and its findings will be disseminated to the scientific community, persons with TBI, caregivers, and the lay audience. Conclusions: This systematic review will advance our understanding regarding outcome disparities among minoritized individuals with TBI, examine progress over the past 15 years in minimizing barriers encountered by these racial and ethnic groups, and provide professionals with a roadmap illustrating existing gaps in rehabilitation care, making way for further development and implementation of evidence-based interventions to improve health equity in TBI outcomes. Trial Registration: PROSPERO CRD42023394529; https://tinyurl.com/53mtcz9b International Registered Report Identifier (IRRID): PRR1-10.2196/58763 UR - https://www.researchprotocols.org/2024/1/e58763 UR - http://dx.doi.org/10.2196/58763 UR - http://www.ncbi.nlm.nih.gov/pubmed/39361416 ID - info:doi/10.2196/58763 ER - TY - JOUR AU - Doueiri, Nadeem Zakaria AU - Bajra, Rika AU - Srinivasan, Malathi AU - Schillinger, Erika AU - Cuan, Nancy PY - 2024/10/1 TI - Bridging the Telehealth Digital Divide With Collegiate Navigators: Mixed Methods Evaluation Study of a Service-Learning Health Disparities Course JO - JMIR Med Educ SP - e57077 VL - 10 KW - service learning KW - medical education KW - access to care KW - telehealth KW - telemedicine KW - health disparities KW - social determinants of health KW - digital literacy KW - vulnerable populations KW - community engagement KW - value-added medical education KW - digital health KW - digital divide KW - health equity KW - collegiate navigator KW - experimental KW - education KW - student KW - qualitative analysis KW - technology KW - mobile phone N2 - Background: Limited digital literacy is a barrier for vulnerable patients accessing health care. Objective: The Stanford Technology Access Resource Team (START), a service-learning course created to bridge the telehealth digital divide, trained undergraduate and graduate students to provide hands-on patient support to improve access to electronic medical records (EMRs) and video visits while learning about social determinants of health. Methods: START students reached out to 1185 patients (n=711, 60% from primary care clinics of a large academic medical center and n=474, 40% from a federally qualified health center). Registries consisted of patients without an EMR account (at primary care clinics) or patients with a scheduled telehealth visit (at a federally qualified health center). Patient outcomes were evaluated by successful EMR enrollments and video visit setups. Student outcomes were assessed by reflections coded for thematic content. Results: Over 6 academic quarters, 57 students reached out to 1185 registry patients. Of the 229 patients contacted, 141 desired technical support. START students successfully established EMR accounts and set up video visits for 78.7% (111/141) of patients. After program completion, we reached out to 13.5% (19/141) of patients to collect perspectives on program utility. The majority (18/19, 94.7%) reported that START students were helpful, and 73.7% (14/19) reported that they had successfully connected with their health care provider in a digital visit. Inability to establish access included a lack of Wi-Fi or device access, the absence of an interpreter, and a disability that precluded the use of video visits. Qualitative analysis of student reflections showed an impact on future career goals and improved awareness of health disparities of technology access. Conclusions: Of the patients who desired telehealth access, START improved access for 78.7% (111/141) of patients. Students found that START broadened their understanding of health disparities and social determinants of health and influenced their future career goals. UR - https://mededu.jmir.org/2024/1/e57077 UR - http://dx.doi.org/10.2196/57077 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57077 ER - TY - JOUR AU - Hoadley, Ariel AU - Fleisher, Linda AU - Kenny, Cassidy AU - Kelly, JA Patrick AU - Ma, Xinrui AU - Wu, Jingwei AU - Guerra, Carmen AU - Leader, E. Amy AU - Alhajji, Mohammed AU - D?Avanzo, Paul AU - Landau, Zoe AU - Bass, Bauerle Sarah PY - 2024/9/30 TI - Exploring Racial Disparities in Awareness and Perceptions of Oncology Clinical Trials: Cross-Sectional Analysis of Baseline Data From the mychoice Study JO - JMIR Cancer SP - e56048 VL - 10 KW - oncology clinical trial KW - cancer KW - decision-making KW - racial disparity KW - medical mistrust N2 - Background: Black/African American adults are underrepresented in oncology clinical trials in the United States, despite efforts at narrowing this disparity. Objective: This study aims to explore differences in how Black/African American oncology patients perceive clinical trials to improve support for the clinical trial participation decision-making process. Methods: As part of a larger randomized controlled trial, a total of 244 adult oncology patients receiving active treatment or follow-up care completed a cross-sectional baseline survey on sociodemographic characteristics, clinical trial knowledge, health literacy, perceptions of cancer clinical trials, patient activation, patient advocacy, health care self-efficacy, decisional conflict, and clinical trial intentions. Self-reported race was dichotomized into Black/African American and non?Black/African American. As appropriate, 2-tailed t tests and chi-square tests of independence were used to examine differences between groups. Results: Black/African American participants had lower clinical trial knowledge (P=.006), lower health literacy (P<.001), and more medical mistrust (all P values <.05) than non?Black/African American participants. While intentions to participate in a clinical trial, if offered, did not vary between Black/African American and non?Black/African American participants, Black/African American participants indicated lower awareness of clinical trials, fewer benefits of clinical trials, and more uncertainty around clinical trial decision-making (all P values <.05). There were no differences for other variables. Conclusions: Despite no significant differences in intent to participate in a clinical trial if offered and high overall trust in individual health care providers among both groups, beliefs persist about barriers to and benefits of clinical trial participation among Black/African American patients. Findings highlight specific ways that education and resources about clinical trials could be tailored to better suit the informational and decision-making needs and preferences of Black/African American oncology patients. UR - https://cancer.jmir.org/2024/1/e56048 UR - http://dx.doi.org/10.2196/56048 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56048 ER - TY - JOUR AU - Johar, Hamimatunnisa AU - Ang, Way Chiew AU - Ismail, Roshidi AU - Kassim, Zaid AU - Su, Tin Tin PY - 2024/9/26 TI - Changes in 10-Year Predicted Cardiovascular Disease Risk for a Multiethnic Semirural Population in South East Asia: Prospective Study JO - JMIR Public Health Surveill SP - e55261 VL - 10 KW - cardiovascular risk trajectory KW - Framingham risk score KW - population-based study KW - low- and middle-income countries N2 - Background: Cardiovascular disease (CVD) risk factors tend to cluster and interact multiplicatively and have been incorporated into risk equations such as the Framingham risk score, which can reasonably predict CVD over short- and long-term periods. Beyond risk factor levels at a single time point, recent evidence demonstrated that risk trajectories are differentially related to CVD risk. However, factors associated with suboptimal control or unstable CVD risk trajectories are not yet established. Objective: This study aims to examine factors associated with CVD risk trajectories in a semirural, multiethnic community-dwelling population. Methods: Data on demographic, socioeconomic, lifestyle, mental health, and cardiovascular factors were measured at baseline (2013) and during follow-up (2018) of the South East Asia Community Observatory cohort. The 10-year CVD risk change transition was computed. The trajectory patterns identified were improved; remained unchanged in low, moderate, or high CVD risk clusters; and worsened CVD risk trajectories. Multivariable regression analyses were used to examine the association between risk factors and changes in Framingham risk score and predicted CVD risk trajectory patterns with adjustments for concurrent risk factors. Results: Of the 6599 multiethnic community-dwelling individuals (n=3954, 59.92% female participants and n=2645, 40.08% male participants; mean age 55.3, SD 10.6 years), CVD risk increased over time in 33.37% (n=2202) of the sample population, while 24.38% (n=1609 remained in the high-risk trajectory pattern, which was reflected by the increased prevalence of all major CVD risk factors over the 5-year follow-up. Meanwhile, sex-specific prevalence data indicate that 21.44% (n=567) of male and 41.35% (n=1635) of female participants experienced an increase in CVD risk. However, a stark sex difference was observed in those remaining in the high CVD risk cluster, with 45.1% (n=1193) male participants and 10.52% (n=416) female participants. Regarding specific CVD risk factors, male participants exhibited a higher percentage increase in the prevalence of hypertension, antihypertensive medication use, smoking, and obesity, while female participants showed a higher prevalence of diabetes. Further regression analyses identified that Malay compared to Chinese (P<.001) and Indian (P=.04) ethnicity, nonmarried status (P<.001), full-time employment (P<.001), and depressive symptoms (P=.04) were all significantly associated with increased CVD risk scores. In addition, lower educational levels and frequently having meals from outside were significantly associated to higher odds of both worsening and remaining in high CVD risk trajectories. Conclusions: Sociodemographics and mental health were found to be differently associated with CVD risk trajectories, warranting future research to disentangle the role of psychosocial disparities in CVD. Our findings carry public health implications, suggesting that the rise in major risk factors along with psychosocial disparities could potentially elevate CVD risk among individuals in underserved settings. More prevention efforts that continuously monitor CVD risk and consider changes in risk factors among vulnerable populations should be emphasized. UR - https://publichealth.jmir.org/2024/1/e55261 UR - http://dx.doi.org/10.2196/55261 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55261 ER - TY - JOUR AU - Dasa, Osama AU - Bai, Chen AU - Sajdeya, Ruba AU - Kimmel, E. Stephen AU - Pepine, J. Carl AU - Gurka J, J. Matthew AU - Laubenbacher, Reinhard AU - Pearson, A. Thomas AU - Mardini, T. Mamoun PY - 2024/9/26 TI - Identifying Potential Factors Associated With Racial Disparities in COVID-19 Outcomes: Retrospective Cohort Study Using Machine Learning on Real-World Data JO - JMIR Public Health Surveill SP - e54421 VL - 10 KW - health disparities KW - racial disparities KW - COVID-19 outcomes KW - social determinants of health KW - area deprivation index KW - health outcomes KW - machine learning KW - real-world data KW - COVID-19 KW - SARS-CoV-2 KW - socioeconomic status N2 - Background: Racial disparities in COVID-19 incidence and outcomes have been widely reported. Non-Hispanic Black patients endured worse outcomes disproportionately compared with non-Hispanic White patients, but the epidemiological basis for these observations was complex and multifaceted. Objective: This study aimed to elucidate the potential reasons behind the worse outcomes of COVID-19 experienced by non-Hispanic Black patients compared with non-Hispanic White patients and how these variables interact using an explainable machine learning approach. Methods: In this retrospective cohort study, we examined 28,943 laboratory-confirmed COVID-19 cases from the OneFlorida Research Consortium?s data trust of health care recipients in Florida through April 28, 2021. We assessed the prevalence of pre-existing comorbid conditions, geo-socioeconomic factors, and health outcomes in the structured electronic health records of COVID-19 cases. The primary outcome was a composite of hospitalization, intensive care unit admission, and mortality at index admission. We developed and validated a machine learning model using Extreme Gradient Boosting to evaluate predictors of worse outcomes of COVID-19 and rank them by importance. Results: Compared to non-Hispanic White patients, non-Hispanic Blacks patients were younger, more likely to be uninsured, had a higher prevalence of emergency department and inpatient visits, and were in regions with higher area deprivation index rankings and pollutant concentrations. Non-Hispanic Black patients had the highest burden of comorbidities and rates of the primary outcome. Age was a key predictor in all models, ranking highest in non-Hispanic White patients. However, for non-Hispanic Black patients, congestive heart failure was a primary predictor. Other variables, such as food environment measures and air pollution indicators, also ranked high. By consolidating comorbidities into the Elixhauser Comorbidity Index, this became the top predictor, providing a comprehensive risk measure. Conclusions: The study reveals that individual and geo-socioeconomic factors significantly influence the outcomes of COVID-19. It also highlights varying risk profiles among different racial groups. While these findings suggest potential disparities, further causal inference and statistical testing are needed to fully substantiate these observations. Recognizing these relationships is vital for creating effective, tailored interventions that reduce disparities and enhance health outcomes across all racial and socioeconomic groups. UR - https://publichealth.jmir.org/2024/1/e54421 UR - http://dx.doi.org/10.2196/54421 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54421 ER - TY - JOUR AU - Lee, Seung-Yup AU - Hayes, W. Leslie AU - Ozaydin, Bunyamin AU - Howard, Steven AU - Garretson, M. Alison AU - Bradley, M. Heather AU - Land, M. Andrew AU - DeLaney, W. Erin AU - Pritchett, O. Amy AU - Furr, L. Amanda AU - Allgood, Ashleigh AU - Wyatt, C. Matthew AU - Hall, G. Allyson AU - Banaszak-Holl, C. Jane PY - 2024/9/25 TI - Integrating Social Determinants of Health in Machine Learning?Driven Decision Support for Diabetes Case Management: Protocol for a Sequential Mixed Methods Study JO - JMIR Res Protoc SP - e56049 VL - 13 KW - diabetes KW - case management KW - case manager KW - social work KW - case mix KW - social determinants of health KW - clinical decision support KW - decision support KW - predictive analytics KW - disparities KW - health disparities KW - data warehouse KW - tertiary care KW - health care system KW - chronic disease management N2 - Background: The use of both clinical factors and social determinants of health (SDoH) in referral decision-making for case management may improve optimal use of resources and reduce outcome disparities among patients with diabetes. Objective: This study proposes the development of a data-driven decision-support system incorporating interactions between clinical factors and SDoH into an algorithm for prioritizing who receives case management services. The paper presents a design for prediction validation and preimplementation assessment that uses a mixed methods approach to guide the implementation of the system. Methods: Our study setting is a large, tertiary care academic medical center in the Deep South of the United States, where SDoH contribute to disparities in diabetes-specific hospitalizations and emergency department (ED) visits. This project will develop an interpretable artificial intelligence model for a population with diabetes using SDoH and clinical data to identify which posthospitalization cases have a higher likelihood of subsequent ED use. The electronic health record data collected for the study include demographics, SDoH, comorbidities, hospitalization-related factors, laboratory test results, and medication use to predict posthospitalization ED visits. Subsequently, a mixed methods approach will be used to validate prediction outcomes and develop an implementation strategy from insights into patient outcomes from case managers, clinicians, and quality and patient safety experts. Results: As of December 2023, we had abstracted data on 174,871 inpatient encounters between January 2018 and September 2023, involving 89,355 unique inpatients meeting inclusion criteria. Both clinical and SDoH data items were included for these patient encounters. In total, 85% of the inpatient visits (N=148,640) will be used for training (learning from the data) and the remaining 26,231 inpatient visits will be used for mixed-methods validation (testing). Conclusions: By integrating a critical suite of SDoH with clinical data related to diabetes, the proposed data-driven risk stratification model can enable individualized risk estimation and inform health professionals (eg, case managers) about the risk of patients? upcoming ED use. The prediction outcome could potentially automate case management referrals, helping to better prioritize services. By taking a mixed methods approach, we aim to align the model with the hospital?s specific quality and patient safety considerations for the quality of patient care and the optimization of case management resource allocation. International Registered Report Identifier (IRRID): DERR1-10.2196/56049 UR - https://www.researchprotocols.org/2024/1/e56049 UR - http://dx.doi.org/10.2196/56049 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56049 ER - TY - JOUR AU - Sharma, Divya AU - Yadav, Jyoti AU - Gupta, Madhu AU - Halder, Pritam AU - Rajan, K. Abin AU - Kiran, Tanvi PY - 2024/9/24 TI - Socioeconomic Moderators of the Association Between Delayed Breastfeeding Initiation and Place of Delivery: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e57254 VL - 10 KW - breastfeeding KW - institutional deliveries KW - delayed initiation KW - moderation analysis KW - Indian mothers KW - socio-economic KW - cross-sectional study KW - infant KW - infancy KW - infant feeding KW - human milk KW - breastfeeding initiation KW - mother KW - women KW - India KW - healthcare services KW - awareness KW - pregnancy KW - public health N2 - Background: Breastfeeding is a crucial and irreplaceable method of feeding infants. Despite the well-established advantages of early breastfeeding initiation, its progress remains constrained. Over half of Indian mothers witness delayed breastfeeding initiation. Various factors have been implicated to influence breastfeeding initiation, with institutional deliveries emerging as a crucial factor among them. Objective: We tested the hypothesized association between institutional delivery and initiation delays and identified how various socioeconomic variables moderate (weaken, strengthen, or reverse) the association between breastfeeding initiation delays and place of delivery. Methods: This cross-sectional study analyses data of 106,569 breastfeeding mothers from the NFHS-5 (National Family Health Survey, 2019-21). Missing data were managed by using a complete case analysis approach. The outcome variable was the timing of breastfeeding initiation for the most recent child, with the place of delivery being the explanatory variable. Socioeconomic factors including age, education level, marital status, place of residence, and wealth index were considered moderating variables. Logistic regression?based moderation analysis explored how these variables influence the relationship between breastfeeding initiation delays and place of delivery. Separate binary logistic regression models analyzed the effect of each moderating variable. Statistical analysis was conducted using IBM SPSS Statistics 26. Results: The highest occurrence of delayed breastfeeding initiation was observed among mothers aged ?36 years (58.3%), lacking formal education (60.9%), belonging to lower wealth groups (58.1%), residing in rural areas (57.4%), and having home births (64.1%). Results confirmed the primary hypothesis that institutional delivery significantly and negatively affects delayed breastfeeding initiation (odds ratio [OR] 0.705, 95% CI 0.676-0.735, P<.001). Age as a moderating variable significantly affected this association (adjusted OR [aOR] 0.757, 95% CI 0.696-1.307, P=.02 for the 15-25 age group). Notably, education level (aOR 0.616, 95% CI 0.429-1.930, P=.005 for no education and aOR 0.510, 95% CI 0.429-1.772, P=.04 for primary education) and poor wealth index (aOR 0.672, 95% CI 0.528-1.432, P=.004) as moderating factors significantly strengthened the negative effect of institutional delivery on delayed initiation. Poor mothers and those without education or a lower level of education (primary) when delivering the child at the health institution further reduced the chances of witnessing delayed initiation. Conclusions: Institutional delivery significantly lowers the likelihood of delayed breastfeeding initiation, and this negative effect is significantly strengthened when uneducated women or lesser-educated women and those with lower wealth deliver their children at the institutional facilities, underscoring the significance of these moderating factors. Developing strategies targeting these socioeconomic moderating factors is crucial. Tailored awareness programs crafted to address the needs of uneducated mothers from economically disadvantaged backgrounds can enhance coverage. Outreach initiatives aimed at promoting health care service use during pregnancy and delivery, as well as raising awareness about breastfeeding practices, are warranted for the adoption and implementation of early breastfeeding initiation. UR - https://publichealth.jmir.org/2024/1/e57254 UR - http://dx.doi.org/10.2196/57254 UR - http://www.ncbi.nlm.nih.gov/pubmed/39316434 ID - info:doi/10.2196/57254 ER - TY - JOUR AU - Lawrence, Katharine AU - Levine, L. Defne PY - 2024/8/29 TI - The Digital Determinants of Health: A Guide for Competency Development in Digital Care Delivery for Health Professions Trainees JO - JMIR Med Educ SP - e54173 VL - 10 KW - digital health KW - digital determinants of health KW - digital health competencies KW - medical education curriculum KW - competency development KW - digital health education KW - training competencies KW - digital health skills KW - digital care delivery KW - health professions training UR - https://mededu.jmir.org/2024/1/e54173 UR - http://dx.doi.org/10.2196/54173 ID - info:doi/10.2196/54173 ER - TY - JOUR AU - Harrigan, P. Sean AU - Velásquez García, A. Héctor AU - Abdia, Younathan AU - Wilton, James AU - Prystajecky, Natalie AU - Tyson, John AU - Fjell, Chris AU - Hoang, Linda AU - Kwong, C. Jeffrey AU - Mishra, Sharmistha AU - Wang, Linwei AU - Sander, Beate AU - Janjua, Z. Naveed AU - Sbihi, Hind PY - 2024/8/27 TI - The Clinical Severity of COVID-19 Variants of Concern: Retrospective Population-Based Analysis JO - JMIR Public Health Surveill SP - e45513 VL - 10 KW - COVID-19 KW - SARS-CoV-2 KW - severity KW - whole genome sequencing KW - WGS KW - social determinants of health KW - SDOHs KW - vaccination KW - variants of concern KW - VOCs KW - Alpha KW - Gamma KW - Delta KW - Omicron N2 - Background: SARS-CoV-2 variants of concern (VOCs) emerged and rapidly replaced the original strain worldwide. The increased transmissibility of these new variants led to increases in infections, hospitalizations, and mortality. However, there is a scarcity of retrospective investigations examining the severity of all the main VOCs in presence of key public health measures and within various social determinants of health (SDOHs). Objective: This study aims to provide a retrospective assessment of the clinical severity of COVID-19 VOCs in the context of heterogenous SDOHs and vaccination rollout. Methods: We used a population-based retrospective cohort design with data from the British Columbia COVID-19 Cohort, a linked provincial surveillance platform. To assess the relative severity (hospitalizations, intensive care unit [ICU] admissions, and deaths) of Gamma, Delta, and Omicron infections during 2021 relative to Alpha, we used inverse probability treatment weighted Cox proportional hazard modeling. We also conducted a subanalysis among unvaccinated individuals, as assessed severity differed across VOCs and SDOHs. Results: We included 91,964 individuals infected with a SARS-CoV-2 VOC (Alpha: n=20,487, 22.28%; Gamma: n=15,223, 16.55%; Delta: n=49,161, 53.46%; and Omicron: n=7093, 7.71%). Delta was associated with the most severe disease in terms of hospitalization, ICU admissions, and deaths (hospitalization: adjusted hazard ratio [aHR] 2.00, 95% CI 1.92-2.08; ICU: aHR 2.05, 95% CI 1.91-2.20; death: aHR 3.70, 95% CI 3.23-4.25 relative to Alpha), followed generally by Gamma and then Omicron and Alpha. The relative severity by VOC remained similar in the unvaccinated individual subanalysis, although the proportion of individuals infected with Delta and Omicron who were hospitalized was 2 times higher in those unvaccinated than in those fully vaccinated. Regarding SDOHs, the proportion of hospitalized individuals was higher in areas with lower income across all VOCs, whereas among Alpha and Gamma infections, 2 VOCs that cocirculated, differential distributions of hospitalizations were found among racially minoritized groups. Conclusions: Our study provides robust severity estimates for all VOCs during the COVID-19 pandemic in British Columbia, Canada. Relative to Alpha, we found Delta to be the most severe, followed by Gamma and Omicron. This study highlights the importance of targeted testing and sequencing to ensure timely detection and accurate estimation of severity in emerging variants. It further sheds light on the importance of vaccination coverage and SDOHs in the context of pandemic preparedness to support the prioritization of allocation for resource-constrained or minoritized groups. UR - https://publichealth.jmir.org/2024/1/e45513 UR - http://dx.doi.org/10.2196/45513 UR - http://www.ncbi.nlm.nih.gov/pubmed/39190434 ID - info:doi/10.2196/45513 ER - TY - JOUR AU - Arueyingho, Oritsetimeyin AU - Aprioku, Sydney Jonah AU - Marshall, Paul AU - O'Kane, Ann Aisling PY - 2024/8/21 TI - Insights Into Sociodemographic Influences on Type 2 Diabetes Care and Opportunities for Digital Health Promotion in Port Harcourt, Nigeria: Quantitative Study JO - JMIR Diabetes SP - e56756 VL - 9 KW - type 2 diabetes KW - digital health KW - t2d in nigeria KW - technologies for diabetes KW - pharmaceutical care for t2d N2 - Background: A significant percentage of the Nigerian population has type 2 diabetes (T2D), and a notable portion of these patients also live with comorbidities. Despite its increasing prevalence in Nigeria due to factors such as poor eating and exercise habits, there are insufficient reliable data on its incidence in major cities such as Port Harcourt, as well as on the influence of sociodemographic factors on current self-care and collaborative T2D care approaches using technology. This, coupled with a significant lack of context-specific digital health interventions for T2D care, is our major motivation for the study. Objective: This study aims to (1) explore the sociodemographic profile of people with T2D and understand how it directly influences their care; (2) generate an accurate understanding of collaborative care practices, with a focus on nuances in the contextual provision of T2D care; and (3) identify opportunities for improving the adoption of digital health technologies based on the current understanding of technology use and T2D care. Methods: We designed questionnaires aligned with the study?s objectives to obtain quantitative data, using both WhatsApp (Meta Platforms, Inc) and in-person interactions. A social media campaign aimed at reaching a hard-to-reach audience facilitated questionnaire delivery via WhatsApp, also allowing us to explore its feasibility as a data collection tool. In parallel, we distributed surveys in person. We collected 110 responses in total: 83 (75.5%) from in-person distributions and 27 (24.5%) from the WhatsApp approach. Data analysis was conducted using descriptive and inferential statistical methods on SPSS Premium (version 29; IBM Corp) and JASP (version 0.16.4; University of Amsterdam) software. This dual approach ensured comprehensive data collection and analysis for our study. Results: Results were categorized into 3 groups to address our research objectives. We found that men with T2D were significantly older (mean 61 y), had higher household incomes, and generally held higher academic degrees compared to women (P=.03). No statistically significant relationship was found between gender and the frequency of hospital visits (P=.60) or pharmacy visits (P=.48), and cultural differences did not influence disease incidence. Regarding management approaches, 75.5% (83/110) relied on prescribed medications; 60% (66/110) on dietary modifications; and 35.5% (39/110) and 20% (22/110) on traditional medicines and spirituality, respectively. Most participants (82/110, 74.5%) were unfamiliar with diabetes care technologies, and 89.2% (98/110) of those using technology were only familiar with glucometers. Finally, participants preferred seeking health information in person (96/110, 87.3%) over digital means. Conclusions: By identifying the influence of sociodemographic factors on diabetes care and health or information seeking behaviors, we were able to identify context-specific opportunities for enhancing the adoption of digital health technologies. UR - https://diabetes.jmir.org/2024/1/e56756 UR - http://dx.doi.org/10.2196/56756 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56756 ER - TY - JOUR AU - Vazquez, Elias Christian AU - Mauldin, L. Rebecca AU - Mitchell, N. Denise AU - Ohri, Faheem PY - 2024/8/14 TI - Sociodemographic Factors Associated With Using eHealth for Information Seeking in the United States: Cross-Sectional Population-Based Study With 3 Time Points Using Health Information National Trends Survey Data JO - J Med Internet Res SP - e54745 VL - 26 KW - health information seeking KW - eHealth use KW - disparities KW - sex KW - age KW - education KW - mobile phone N2 - Background: Despite the potential benefits of using eHealth, sociodemographic disparities exist in eHealth use, which threatens to further widen health equity gaps. The literature has consistently shown age and education to be associated with eHealth use, while the findings for racial and ethnic disparities are mixed. However, previous disparities may have narrowed as health care interactions shifted to web-based modalities for everyone because of the COVID-19 pandemic. Objective: This study aims to provide an updated examination of sociodemographic disparities that contribute to the health equity gap related to using eHealth for information seeking using 3 time points. Methods: Data for this study came from the nationally representative 2018 (n=3504), 2020 (n=3865), and 2022 (n=6252) time points of the Health Information National Trends Survey. Logistic regression was used to regress the use of eHealth for information seeking on race and ethnicity, sex, age, education, income, health status, and year of survey. Given the consistent association of age with the dependent variable, analyses were stratified by age cohort (millennials, Generation X, baby boomers, and silent generation) to compare individuals of similar age. Results: For millennials, being female, attaining some college or a college degree, and reporting an annual income of US $50,000-$74,999 or >US $75,000 were associated with the use of eHealth for information seeking. For Generation X, being female, having attained some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, better self-reported health, and completing the survey in 2022 (vs 2018; odds ratio [OR] 1.80, 95% CI 1.11-2.91) were associated with the use of eHealth for information seeking. For baby boomers, being female, being older, attaining a high school degree, attaining some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, and completing the survey in 2020 (OR 1.56, 95% CI 1.15-2.12) and 2022 (OR 4.04, 95% CI 2.77-5.87) were associated with the use of eHealth for information seeking. Among the silent generation, being older, attaining some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, and completing the survey in 2022 (OR 5.76, 95% CI 3.05-10.89) were associated with the use of eHealth for information seeking. Conclusions: Baby boomers may have made the most gains in using eHealth for information seeking over time. The race and ethnicity findings, or lack thereof, may indicate a reduction in racial and ethnic disparities. Disparities based on sex, education, and income remained consistent across all age groups. This aligns with health disparities literature focused on individuals with lower socioeconomic status, and more recently on men who are less likely to seek health care compared to women. UR - https://www.jmir.org/2024/1/e54745 UR - http://dx.doi.org/10.2196/54745 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54745 ER - TY - JOUR AU - Bather, R. Jemar AU - Kaphingst, A. Kimberly AU - Goodman, S. Melody PY - 2024/8/8 TI - Racial Composition of Social Environments Over the Life Course Using the Pictorial Racial Composition Measure: Development and Validation Study JO - JMIR Public Health Surveill SP - e55461 VL - 10 KW - racial residential segregation KW - racial composition KW - health equity KW - social environment KW - place KW - neighborhood composition KW - health inequities KW - social determinants of health N2 - Background: Studies investigating the impact of racial segregation on health have reported mixed findings and tended to focus on the racial composition of neighborhoods. These studies use varying racial composition measures, such as census data or investigator-adapted questions, which are currently limited to assessing one dimension of neighborhood racial composition. Objective: This study aims to develop and validate a novel racial segregation measure, the Pictorial Racial Composition Measure (PRCM). Methods: The PRCM is a 10-item questionnaire of pictures representing social environments across adolescence and adulthood: neighborhoods and blocks (adolescent and current), schools and classrooms (junior high and high school), workplace, and place of worship. Cognitive interviews (n=13) and surveys (N=549) were administered to medically underserved patients at a primary care clinic at the Barnes-Jewish Hospital. Development of the PRCM occurred across pilot and main phases. For each social environment and survey phase (pilot and main), we computed positive versus negative pairwise comparisons: mostly Black versus all other categories, half Black versus all other categories, and mostly White versus all other categories. We calculated the following validity metrics for each pairwise comparison: sensitivity, specificity, correct classification rate, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, false positive rate, and false negative rate. Results: For each social environment, the mostly Black and mostly White dichotomizations generated better validity metrics relative to the half Black dichotomization. Across all 10 social environments in the pilot and main phases, mostly Black and mostly White dichotomizations exhibited a moderate-to-high sensitivity, specificity, correct classification rate, positive predictive value, and negative predictive value. The positive likelihood ratio values were >1, and the negative likelihood ratio values were close to 0. The false positive and negative rates were low to moderate. Conclusions: These findings support that using either the mostly Black versus other categories or the mostly White versus other categories dichotomizations may provide accurate and reliable measures of racial composition across the 10 social environments. The PRCM can serve as a uniform measure across disciplines, capture multiple social environments over the life course, and be administered during one study visit. The PRCM also provides an added window into understanding how structural racism has impacted minoritized communities and may inform equitable intervention and prevention efforts to improve lives. UR - https://publichealth.jmir.org/2024/1/e55461 UR - http://dx.doi.org/10.2196/55461 UR - http://www.ncbi.nlm.nih.gov/pubmed/39115929 ID - info:doi/10.2196/55461 ER - TY - JOUR AU - Bhawra, Jasmin AU - Elsahli, Nadine AU - Patel, Jamin PY - 2024/7/23 TI - Applying Digital Technology to Understand Human Experiences of Climate Change Impacts on Food Security and Mental Health: Scoping Review JO - JMIR Public Health Surveill SP - e54064 VL - 10 KW - climate change KW - digital health KW - ecoanxiety KW - environmental hazards KW - food security KW - mental health KW - scoping review KW - smartphone apps KW - digital apps KW - mobile health KW - mobile phone N2 - Background: The global impact of climate change ranges from intense heatwaves to extreme weather events that endanger entire ecosystems and people?s way of life. Adverse climate change events place undue stress on food and health systems, with consequences for human food security and mental health status. Ubiquitous digital devices, such as smartphones, have the potential to manage existing and emerging climate-related crises, given their ability to enable rapid response, instant communication, and knowledge sharing. Objective: This scoping review aimed to identify digital apps being used to capture or address climate change impacts on food security and mental health to inform the development of a digital citizen science initiative. Methods: A scoping review was conducted using 3 peer-reviewed databases (PubMed, IEEE Xplore, and Web of Science) and manual gray literature searches of relevant organizational (ie, governmental and nonprofit) websites to identify articles and reports published between January 2012 and July 2023. Three separate searches were conducted in each database to identify digital apps focused on climate change and (1) food security, (2) mental health, and (3) food security and mental health. Two reviewers conducted initial screening, with a third reviewer resolving any discrepancies. Articles focused on climate change impacts on wildlife or agriculture (ie, not human food security) were excluded. Full-text screening was conducted for shortlisted articles, and a final data abstraction table was generated, summarizing key app features, contextual factors, and participant involvement. Results: From the 656 records screened, 14 digital apps met the inclusion criteria. The food security apps (n=7, 50%) aimed to capture traditional knowledge to preserve food systems, conduct food security assessments, and aid users in decreasing food insecurity risk. The mental health apps (n=7, 50%) assessed climate change?related stress and provided users with coping strategies following adverse weather events. No digital apps examined the intersection of climate change, food security, and mental health. Key app features included user-to-user communication (n=5, 36%), knowledge databases (n=5, 36%), data collection and analysis (n=3, 21%), gamification (n=1, 7%), and educational resources (n=2, 14%) to address climate change impacts on food security or mental health. In total, 3 approaches to participant involvement were used across studies, including contributory (n=1, 7%), collaborative (n=1, 7%), and cocreative (n=1, 7%) approaches, to ensure the relevance and use of digital apps. Conclusions: Most digital apps identified provided a service to citizens to either prevent adverse climate change?related health impacts or manage these effects following an acute event or a natural disaster. The capacity of ubiquitous digital tools to enable near real-time communication, the involvement of various stakeholder groups, and their ability to share relevant educational resources in a timely manner are important for developing tailored climate change adaptation and mitigation strategies across jurisdictions. UR - https://publichealth.jmir.org/2024/1/e54064 UR - http://dx.doi.org/10.2196/54064 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54064 ER - TY - JOUR AU - Hatef, Elham AU - Richards, Thomas AU - Topel, Kristin AU - Hail, Sofia AU - Kitchen, Christopher AU - Shaw, Katherine AU - Zhang, Talan AU - Lasser, C. Elyse AU - Weiner, P. Jonathan PY - 2024/7/23 TI - Piloting a Clinical Decision Support Tool to Identify Patients With Social Needs and Provide Navigation Services and Referral to Community-Based Organizations: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e57316 VL - 13 KW - social needs KW - social determinants of health KW - clinical decision support tool KW - electronic health records KW - randomized controlled trial N2 - Background: Social needs and social determinants of health (SDOH) significantly outrank medical care when considering the impact on a person?s length and quality of life, resulting in poor health outcomes and worsening life expectancy. Integrating social needs and SDOH data along with clinical risk information within operational clinical decision support (CDS) systems built into electronic health records (EHRs) is an effective approach to addressing health-related social needs. To achieve this goal, applied research is needed to develop EHR-integrated CDS tools and closed-loop referral systems and implement and test them in the digital and clinical workflows at health care systems and collaborating community-based organizations (CBOs). Objective: This study aims to describe the protocol for a mixed methods study including a randomized controlled trial and a qualitative phase assessing the feasibility, acceptability, and effectiveness of an EHR-integrated digital platform to identify patients with social needs and provide navigation services and closed-loop referrals to CBOs to address their social needs. Methods: The randomized controlled trial will enroll and randomize adult patients living in socioeconomically challenged neighborhoods in Baltimore City receiving care at a single academic health care institution in the 3-month intervention (using the digital platform) or the 3-month control (standard-of-care assessment and addressing of social needs) arms (n=295 per arm). To evaluate the feasibility and acceptability of the digital platform and its impact on the clinical and digital workflow and patient care, we will conduct focus groups with the care teams in the health care system (eg, clinical providers, social workers, and care managers) and collaborating CBOs. The outcomes will be the acceptability, feasibility, and effectiveness of the CDS tool and closed-loop referral system. Results: This clinical trial opened to enrollment in June 2023 and will be completed in March 2025. Initial results are expected to be published in spring 2025. We will report feasibility outcome measures as weekly use rates of the digital platform. The acceptability outcome measure will be the provider?s and patient?s responses to the truthfulness of a statement indicating a willingness to use the platform in the future. Effectiveness will be measured by tracking a 3-month change in identified social needs and provided navigation services as well as clinical outcomes such as hospitalization and emergency department visits. Conclusions: The results of this investigation are expected to contribute to our understanding of the use of digital interventions and the implementation of such interventions in digital and clinical workflows to enhance the health care system and CBO ability related to social needs assessment and intervention. These results may inform the construction of a future multi-institutional trial designed to test the effectiveness of this intervention across different health care systems and care settings. Trial Registration: ClinicalTrials.gov NCT05574699; https://clinicaltrials.gov/study/NCT05574699 International Registered Report Identifier (IRRID): DERR1-10.2196/57316 UR - https://www.researchprotocols.org/2024/1/e57316 UR - http://dx.doi.org/10.2196/57316 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57316 ER - TY - JOUR AU - Lee, JinWook AU - Park, JuWon AU - Kim, Nayeon AU - Nari, Fatima AU - Bae, Seowoo AU - Lee, Ji Hyeon AU - Lee, Mingyu AU - Jun, Kwan Jae AU - Choi, Son Kui AU - Suh, Mina PY - 2024/7/22 TI - Socioeconomic Disparities in Six Common Cancer Survival Rates in South Korea: Population-Wide Retrospective Cohort Study JO - JMIR Public Health Surveill SP - e55011 VL - 10 KW - cancer survival KW - income level KW - socioeconomic status KW - deprivation index KW - inequality KW - nationwide analysis KW - cancer KW - South Korea KW - public health N2 - Background: In South Korea, the cancer incidence rate has increased by 56.5% from 2001 to 2021. Nevertheless, the 5-year cancer survival rate from 2017 to 2021 increased by 17.9% compared with that from 2001 to 2005. Cancer survival rates tend to decline with lower socioeconomic status, and variations exist in the survival rates among different cancer types. Analyzing socioeconomic patterns in the survival of patients with cancer can help identify high-risk groups and ensure that they benefit from interventions. Objective: The aim of this study was to analyze differences in survival rates among patients diagnosed with six types of cancer?stomach, colorectal, liver, breast, cervical, and lung cancers?based on socioeconomic status using Korean nationwide data. Methods: This study used the Korea Central Cancer Registry database linked to the National Health Information Database to follow up with patients diagnosed with cancer between 2014 and 2018 until December 31, 2021. Kaplan-Meier curves stratified by income status were generated, and log-rank tests were conducted for each cancer type to assess statistical significance. Hazard ratios with 95% CIs for any cause of overall survival were calculated using Cox proportional hazards regression models with the time since diagnosis. Results: The survival rates for the six different types of cancer were as follows: stomach cancer, 69.6% (96,404/138,462); colorectal cancer, 66.6% (83,406/125,156); liver cancer, 33.7% (23,860/70,712); lung cancer, 30.4% (33,203/109,116); breast cancer, 91.5% (90,730/99,159); and cervical cancer, 78% (12,930/16,580). When comparing the medical aid group to the highest income group, the hazard ratios were 1.72 (95% CI 1.66?1.79) for stomach cancer, 1.60 (95% CI 1.54?1.56) for colorectal cancer, 1.51 (95% CI 1.45?1.56) for liver cancer, 1.56 (95% CI 1.51?1.59) for lung cancer, 2.19 (95% CI 2.01?2.38) for breast cancer, and 1.65 (95% CI 1.46?1.87) for cervical cancer. A higher deprivation index and advanced diagnostic stage were associated with an increased risk of mortality. Conclusions: Socioeconomic status significantly mediates disparities in cancer survival in several cancer types. This effect is particularly pronounced in less fatal cancers such as breast cancer. Therefore, considering the type of cancer and socioeconomic factors, social and medical interventions such as early cancer detection and appropriate treatment are necessary for vulnerable populations. UR - https://publichealth.jmir.org/2024/1/e55011 UR - http://dx.doi.org/10.2196/55011 ID - info:doi/10.2196/55011 ER - TY - JOUR AU - Acharya, Harshdeep AU - Sykes, J. Kevin AU - Neira, Mirás Ton AU - Scott, Angela AU - Pacheco, M. Christina AU - Sanner, Matthew AU - Ablah, Elizabeth AU - Oyowe, Kevin AU - Ellerbeck, F. Edward AU - Greiner, Allen K. AU - Corriveau, A. Erin AU - Finocchario-Kessler, Sarah PY - 2024/4/1 TI - A Novel Electronic Record System for Documentation and Efficient Workflow for Community Health Workers: Development and Usability Study JO - JMIR Form Res SP - e52920 VL - 8 KW - public health KW - database KW - community health worker KW - social determinants of health KW - health worker KW - health workers KW - CHW KW - CHWs KW - community-based KW - data collection KW - functionality KW - develop KW - development KW - EHR KW - EHRs KW - EMR KW - EMRs KW - dashboard KW - dashboards KW - health record KW - health records KW - documentation KW - medical record KW - medical records KW - equity KW - inequity KW - inequities N2 - Background: The COVID-19 pandemic added to the decades of evidence that public health institutions are routinely stretched beyond their capacity. Community health workers (CHWs) can be a crucial extension of public health resources to address health inequities, but systems to document CHW efforts are often fragmented and prone to unneeded redundancy, errors, and inefficiency. Objective: We sought to develop a more efficient data collection system for recording the wide range of community-based efforts performed by CHWs. Methods: The Communities Organizing to Promote Equity (COPE) project is an initiative to address health disparities across Kansas, in part, through the deployment of CHWs. Our team iteratively designed and refined the features of a novel data collection system for CHWs. Pilot tests with CHWs occurred over several months to ensure that the functionality supported their daily use. Following implementation of the database, procedures were set to sustain the collection of feedback from CHWs, community partners, and organizations with similar systems to continually modify the database to meet the needs of users. A continuous quality improvement process was conducted monthly to evaluate CHW performance; feedback was exchanged at team and individual levels regarding the continuous quality improvement results and opportunities for improvement. Further, a 15-item feedback survey was distributed to all 33 COPE CHWs and supervisors for assessing the feasibility of database features, accessibility, and overall satisfaction. Results: At launch, the database had 60 active users in 20 counties. Documented client interactions begin with needs assessments (modified versions of the Arizona Self-sufficiency Matrix and PRAPARE [Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences]) and continue with the longitudinal tracking of progress toward goals. A user-specific automated alerts-based dashboard displays clients needing follow-up and upcoming events. The database contains over 55,000 documented encounters across more than 5079 clients. Available resources from over 2500 community organizations have been documented. Survey data indicated that 84% (27/32) of the respondents considered the overall navigation of the database as very easy. The majority of the respondents indicated they were overall very satisfied (14/32, 44%) or satisfied (15/32, 48%) with the database. Open-ended responses indicated the database features, documentation of community organizations and visual confirmation of consent form and data storage on a Health Insurance Portability and Accountability Act?compliant record system, improved client engagement, enrollment processes, and identification of resources. Conclusions: Our database extends beyond conventional electronic medical records and provides flexibility for ever-changing needs. The COPE database provides real-world data on CHW accomplishments, thereby improving the uniformity of data collection to enhance monitoring and evaluation. This database can serve as a model for community-based documentation systems and be adapted for use in other community settings. UR - https://formative.jmir.org/2024/1/e52920 UR - http://dx.doi.org/10.2196/52920 UR - http://www.ncbi.nlm.nih.gov/pubmed/38557671 ID - info:doi/10.2196/52920 ER - TY - JOUR AU - Shim, Young Sun AU - Lee, Hyeonkyeong PY - 2023/12/1 TI - Sex and Age Differences in the Association Between Social Determinants of Health and Cardiovascular Health According to Household Income Among Mongolian Adults: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e44569 VL - 9 KW - social determinants of health KW - cardiovascular health KW - education KW - household income KW - health insurance KW - association KW - risk factors KW - cardiovascular KW - cardiovascular disease KW - cross-sectional study N2 - Background: Although social determinants of health (SDH) are an underlying cause of poor cardiovascular health (CVH), there is insufficient evidence for the association between SDH and CVH, which varies by sex and age among Mongolian adults. Objective: We aimed to explore whether education, household income, and health insurance were associated with CVH according to sex and age among Mongolian adults. Methods: The final sample included data on 5691 participants (male: n=2521. 44.3% and female: n=3170, 55.7%) aged 18-69 years from the 2019 World Health Organization STEPwise approach to noncommunicable disease risk-factor surveillance. CVH was measured using a modified version of Life?s Simple 7 with 4 health behaviors (cigarette smoking, BMI, physical activity, and a healthy diet) and 3 biological factors (blood pressure, fasting glucose, and total cholesterol blood levels) and classified into poor, intermediate, and ideal levels as recommended by the American Heart Association. Multinomial logistic regression analyses examined the associations between SDH and CVH by monthly equivalized household income after adjusting for age, sex, work status, area, history of myocardial infarction or stroke, use of aspirin, and use of statin. Subgroup analyses were conducted to examine the associations between SDH and CVH based on sex and age, considering monthly equivalized household income as a key variable. Results: Using the ideal level of CVH as a reference, among those with the lowest household income, having less than 12 years of education, and not having health insurance were associated with poor CVH (education level: odds ratio [OR] 2.42, 95% CI 1.30-4.51; P=.006; health insurance: OR 2.17, 95% CI 1.13-4.18; P=.02). These associations were more profound among female individuals (education level: OR 2.99, 95% CI 1.35-6.63; P=.007; health insurance: OR 2.54, 95% CI 1.09-5.90; P=.03) and those aged 18-44 years (education level: OR 3.22, 95% CI 1.54-6.72; P=.002; health insurance: OR 2.03, 95% CI 0.98-4.18; P=.06). Conclusions: Participants in the lowest household income group with lower educational levels and without health insurance were more likely to have poor CVH, and these results were more pronounced in female individuals and young adults. These findings suggest the need to develop strategies for CVH equity in Mongolian female individuals and young adults that consider income levels, education levels, and health insurance. UR - https://publichealth.jmir.org/2023/1/e44569 UR - http://dx.doi.org/10.2196/44569 UR - http://www.ncbi.nlm.nih.gov/pubmed/38039072 ID - info:doi/10.2196/44569 ER - TY - JOUR AU - Candela, Ernesto AU - Goizueta, Carolina AU - Sandon, Leonardo AU - Muñoz-Antoli, Carla AU - Periago, Victoria Maria PY - 2023/11/7 TI - The Relationship Between Soil-Transmitted Helminth Infections and Environmental Factors in Puerto Iguazú, Argentina: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e41568 VL - 9 KW - soil-transmitted helminths KW - hookworm KW - prevalence KW - intensity: distribution: Iguazú KW - Argentina N2 - Background: Soil-transmitted helminths (STHs) are widely distributed throughout the world. Various factors, including the environment, socioeconomic characteristics, and access to water and sanitation, play an important role in the spread and persistence of these parasites within communities. They, in turn, affect the growth and development of members of the community, especially children. Studies in the northern provinces of Argentina have shown variable prevalence of STHs, but the factors associated with their presence have not been completely elucidated. Objective: This cross-sectional study aimed to identify the socioeconomic and environmental factors related to STH infection in indigenous villages located in Puerto Iguazú (Misiones), Argentina. Methods: Between 2018 and 2019, stool samples were collected from individuals ?1 year residing in 3 villages: Mini-Marangatú, Yriapú, and Fortín Mbororé. Standard parasitological methods were used to determine STH prevalence. Standardized questionnaires were used to assess participants? habits, customs, and household characteristics, and environmental data were obtained through satellite imagery. Multilinear regression with Akaike information criterion stepwise variables was used to explore relevant associations. Results: A total of 342 individuals from the 3 villages participated in this study. The prevalence of STHs varied across villages: 89.6% (43/48), in Mini-Marangatú, 80.8% (101/125) in Yriapú, and 68.5% (115/169) in Fortín Mbororé. Notably, there was a significant difference in hookworm infection among the villages (P=.02). The analysis highlighted the significant influence of specific environmental factors on STH presence and spatial distribution, particularly in relation to hookworm infection. Vegetation patterns represented by the Vegetation Heterogeneity Index, created ad hoc for this study, emerged as a critical factor, with 2 significant predictors related to it (P=.002 and P=.004) alongside impervious surface density with a significant predictor (P<.001). The multilinear regression model yielded a high F test score (F108=4.75, P<.001), indicating a strong fit (R2=0.5465). Furthermore, socioeconomic factors, including walking barefoot in houses with dirt floors and overcrowding, were significantly correlated with hookworm infection intensity (P<.001 and P=.001, respectively). We also used the multilinear regression model to calculate hookworm infection intensity (F110=21.15, P<.001; R2=0.4971). Conclusions: Our study underscores the complexity of STH transmission, as villages with similar living conditions and environmental characteristics displayed varied STH prevalence and spatial distribution. Specific environmental factors, such as vegetation pattern and impervious surface density, played major roles in STH presence, demonstrating the crucial relationship between environmental factors and hookworm infection distribution. Moreover, our findings emphasize the significant influence of socioeconomic factors on hookworm infection intensity. By gaining insights into this complex interplay, our research contributes to a better understanding of STH transmission characteristics, thereby informing targeted public health interventions for effective control. UR - https://publichealth.jmir.org/2023/1/e41568 UR - http://dx.doi.org/10.2196/41568 UR - http://www.ncbi.nlm.nih.gov/pubmed/37934580 ID - info:doi/10.2196/41568 ER - TY - JOUR AU - Anil Kumar Vaidhyam, Sneha AU - Huang, Kuo-Ting PY - 2023/11/7 TI - Social Determinants of Health and Patients? Technology Acceptance of Telehealth During the COVID-19 Pandemic: Pilot Survey JO - JMIR Hum Factors SP - e47982 VL - 10 KW - social determinants of health KW - telehealth KW - COVID-19 KW - technology adoption N2 - Background: Telehealth has been widely adopted by patients during the COVID-19 pandemic. Many social determinants of health influence the adoption. Objective: This pilot study aimed to understand the social determinants of patients? adoption of telehealth in the context of the pandemic. Methods: A survey methodology was used to capture data from 215 participants using Amazon Mechanical Turk. The study was guided by the technology acceptance model and the social determinants of health framework. The questionnaire included technology acceptance model variables (eg, perceived usefulness [PU] and perceived ease of use [PEOU]), social determinants (eg, access to health care, socioeconomic status, education, and health literacy), and demographic information (eg, age, sex, race, and ethnicity). A series of ordinary least squares regressions were conducted to analyze the data using SPSS Statistics (IBM Corp). Results: The results showed that social determinant factors?safe neighborhood and built environment (P=.01) and economic stability (P=.05)?are predictors of the PEOU of telehealth adoption at a statistically significant or marginally statistically significant level. Furthermore, a moderated mediation model (PROCESS model 85) was used to analyze the effects of COVID-19 on the neighborhood, built environment, and economic stability. PEOU and PU significantly positively affected users? intention to use technology for both variables. Conclusions: This study draws attention to 2 research frameworks that address unequal access to health technologies. It also adds empirical evidence to telehealth research on the adoption of patient technology. Finally, regarding practical implications, this study will provide government agencies, health care organizations, and health care companies with a better perspective of patients? digital health use. This will further guide them in designing better technology by considering factors such as social determinants of health. UR - https://humanfactors.jmir.org/2023/1/e47982 UR - http://dx.doi.org/10.2196/47982 UR - http://www.ncbi.nlm.nih.gov/pubmed/37934556 ID - info:doi/10.2196/47982 ER - TY - JOUR AU - Schoch-Spana, Monica AU - Brunson, K. Emily AU - Gwon, Howard AU - Regenberg, Alan AU - Toner, S. Eric AU - Daugherty-Biddison, L. Elizabeth PY - 2020/3/30 TI - Influence of Community and Culture in the Ethical Allocation of Scarce Medical Resources in a Pandemic Situation: Deliberative Democracy Study JO - J Participat Med SP - e18272 VL - 12 IS - 1 KW - pandemic KW - COVID19 KW - influenza KW - disaster KW - preparedness KW - scarce resources KW - culture KW - ethics N2 - Background: Stark gaps exist between projected health needs in a pandemic situation and the current capacity of health care and medical countermeasure systems. Existing pandemic ethics discussions have advocated to engage the public in scarcity dilemmas and attend the local contexts and cultural perspectives that shape responses to a global health threat. This public engagement study thus considers the role of community and culture in the ethical apportionment of scarce health resources, specifically ventilators, during an influenza pandemic. It builds upon a previous exploration of the values and preferences of Maryland residents regarding how a finite supply of mechanical ventilators ought to be allocated during a severe global outbreak of influenza. An important finding of this earlier research was that local history and place within the state engendered different ways of thinking about scarcity. Objective: Given the intrastate variation in the themes expressed by Maryland participants, the project team sought to examine interstate differences by implementing the same protocol elsewhere to answer the following questions. Does variation in ethical frames of reference exist within different regions of the United States? What practical implications does evidence of sameness and difference possess for pandemic planners and policymakers at local and national levels? Methods: Research using the same deliberative democracy process from the Maryland study was conducted in Central Texas in March 2018 among 30 diverse participants, half of whom identified as Hispanic or Latino. Deliberative democracy provides a moderated process through which community members can learn facts about a public policy matter from experts and explore their own and others? views. Results: Participants proposed that by evenly distributing supplies of ventilators and applying clear eligibility criteria consistently, health authorities could enable fair allocation of scarce lifesaving equipment. The strong identification, attachment, and obligation of persons toward their nuclear and extended families emerged as a distinctive regional and ethnic core value that has practical implications for the substance, administration, and communication of allocation frameworks. Conclusions: Maryland and Central Texas residents expressed a common, overriding concern about the fairness of allocation decisions. Central Texas deliberants, however, more readily expounded upon family as a central consideration. In Central Texas, family is a principal, culturally inflected lens through which life and death matters are often viewed. Conveners of other pandemic-related public engagement exercises in the United States have advocated the benefits of transparency and inclusivity in developing an ethical allocation framework; this study demonstrates cultural competence as a further advantage. UR - http://jopm.jmir.org/2020/1/e18272/ UR - http://dx.doi.org/10.2196/18272 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/18272 ER - TY - JOUR AU - Kobayashi, Rei AU - Ishizaki, Masato PY - 2020/3/19 TI - Relationship Between Health Literacy and Social Support and the Quality of Life in Patients With Cancer: Questionnaire Study JO - J Participat Med SP - e17163 VL - 12 IS - 1 KW - health literacy KW - social support KW - quality of life KW - neoplasms KW - health communication N2 - Background: Low health literacy is associated with factors such as not taking medication as prescribed as well as poor health status and increased hospitalization and mortality risk, and has been identified as a risk factor for decreased physical function in older individuals. Health literacy is becoming an increasingly important issue because of the increased number of people affected by cancer who must make complicated treatment decisions. Health literacy has been shown to be positively associated with quality of life (QOL), and social support has been identified as important for addressing health-related problems and reducing the relative risk of mortality in patients with cancer. However, few studies have examined the relationship between health literacy, social support, age, and QOL. Objective: The aim of this study is to examine the effects of health literacy, social support, and age on the QOL of patients with cancer. Methods: An anonymous, self-administered online questionnaire was conducted from March 28 to 30, 2017, in Japan on patients with lung, stomach, or colon cancer that were voluntarily registered with an internet survey company. The survey covered basic attributes, health literacy, social support, and QOL. The European Health Literacy Survey Questionnaire, a comprehensive measure of health literacy instrument, was used to measure health literacy; the Japanese version of the Social Support Scale was used to measure social support; and the Japanese version of the Functional Assessment of Cancer Therapy-General (7-item version) assessment tool was used to measure QOL. Results: A total of 735 survey invitations were randomly sent to patients with lung, stomach, or colorectal cancer, and responses were obtained from 619 (82.2% response rate). Significant effects on the QOL in patients with lung, stomach, or colon cancer were observed for health literacy, social support, and age, and for the interactions of health literacy and social support and of social support and age. Health literacy, social support, and the interaction between these variables also showed a significant effect on the QOL in patients 50 years or older, but not on those younger than 50 years. Conclusions: The results of this study revealed that higher health literacy, social support, and age were associated with the QOL in patients with cancer. In addition, the relationship with QOL was stronger for social support than for health literacy. These findings suggest the importance of health literacy and social support and indicate that social support has a greater effect on QOL than does health literacy, while the QOL in patients with cancer aged younger than 50 years was lower than that of those 50 years or older. Therefore, elucidating the needs of these patients and strengthening social support based on those needs may improve their QOL. UR - http://jopm.jmir.org/2020/1/e17163/ UR - http://dx.doi.org/10.2196/17163 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/17163 ER - TY - JOUR AU - Berkowitz, L. Rachel AU - Phillip, Nimeka AU - Berry, Lyn AU - Yen, H. Irene PY - 2018/01/22 TI - Patient Experiences in a Linguistically Diverse Safety Net Primary Care Setting: Qualitative Study JO - J Participat Med SP - e4 VL - 10 IS - 1 KW - safety-net providers KW - urban health services KW - primary health care KW - patient-centered care KW - qualitative research KW - quality of health care KW - communication barriers N2 - Background: The patient-centered medical home model intends to improve patient experience and primary care quality. Within an urban safety net setting in Northern California, United States, these desired outcomes are complicated by both the diversity of the patient community and the care continuity implications of a residency program. Objective: The objective of our study was to understand the patient experience beyond standardized satisfaction measures. Methods: We conducted a qualitative study, interviewing 19 patients from the clinic (English-, Spanish-, or Mien-speaking patients). Results: Some themes, such as the desire to feel confident in their doctor, emerged across language groups, pointing to institutional challenges. Other themes, such as distrust in care being provided, were tied distinctly to speaking a language different from one?s provider. Still other themes, such as a sense of powerlessness, were related to cultural differences and to speaking a language (Mien) not spoken by staff. Conclusions: Findings illuminate the need to understand cultural behaviors and interactional styles in a diverse patient population to create a high-quality medical home. UR - http://jopm.jmir.org/2018/1/e4/ UR - http://dx.doi.org/10.2196/jopm.9229 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/jopm.9229 ER -