An Artificial Intelligence Chatbot for Young People's Sexual and Reproductive Health in India (SnehAI): Instrumental Case Study

Background

Leveraging artificial intelligence (AI)–driven apps for health education and promotion can help in the accomplishment of several United Nations sustainable development goals. SnehAI, developed by the Population Foundation of India, is the first Hinglish (Hindi + English) AI chatbot, deliberately designed for social and behavioral changes in India. It provides a private, nonjudgmental, and safe space to spur conversations about taboo topics (such as safe sex and family planning) and offers accurate, relatable, and trustworthy information and resources.

Objective

This study aims to use the Gibson theory of affordances to examine SnehAI and offer scholarly guidance on how AI chatbots can be used to educate adolescents and young adults, promote sexual and reproductive health, and advocate for the health entitlements of women and girls in India.

Methods

We adopted an instrumental case study approach that allowed us to explore SnehAI from the perspectives of technology design, program implementation, and user engagement. We also used a mix of qualitative insights and quantitative analytics data to triangulate our findings.

Results

SnehAI demonstrated strong evidence across fifteen functional affordances: accessibility, multimodality, nonlinearity, compellability, queriosity, editability, visibility, interactivity, customizability, trackability, scalability, glocalizability, inclusivity, connectivity, and actionability. SnehAI also effectively engaged its users, especially young men, with 8.2 million messages exchanged across a 5-month period. Almost half of the incoming user messages were texts of deeply personal questions and concerns about sexual and reproductive health, as well as allied topics. Overall, SnehAI successfully presented itself as a trusted friend and mentor; the curated content was both entertaining and educational, and the natural language processing system worked effectively to personalize the chatbot response and optimize user experience.

Conclusions

SnehAI represents an innovative, engaging, and educational intervention that enables vulnerable and hard-to-reach population groups to talk and learn about sensitive and important issues. SnehAI is a powerful testimonial of the vital potential that lies in AI technologies for social good.

Factors Affecting Physicians' Credibility on Twitter When Sharing Health Information: Online Experimental Study

Background

Largely absent from research on how users appraise the credibility of professionals as sources for the information they find on social media is work investigating factors shaping credibility within a specific profession, such as physicians.

Objective

We address debates about how physicians can show their credibility on social media depending on whether they employ a formal or casual appearance in their profile picture. Using prominence-interpretation theory, we posit that formal appearance will affect perceived credibility based on users' social context-specifically, whether they have a regular health care provider.

Methods

For this experiment, we recruited 205 social media users using Amazon Mechanical Turk. We asked participants if they had a regular health care provider and then randomly assigned them to read 1 of 3 Twitter posts that varied only in the profile picture of the physician offering health advice. Next, we tasked participants with assessing the credibility of the physician and their likelihood of engaging with the tweet and the physician on Twitter. We used path analysis to assess whether participants having a regular health care provider impacted how the profile picture affected their ratings of the physician's credibility and their likelihood to engage with the tweet and physician on Twitter.

Results

We found that the profile picture of a physician posting health advice in either formal or casual attire did not elicit significant differences in credibility, with ratings comparable to those having no profile image. Among participants assigned the formal appearance condition, those with a regular provider rated the physician higher on a credibility than those without, which led to stronger intentions to engage with the tweet and physician.

Conclusions

The findings add to existing research by showing how the social context of information seeking on social media shapes the credibility of a given professional. Practical implications for professionals engaging with the public on social media and combating false information include moving past debates about casual versus formal appearances and toward identifying ways to segment audiences based on factors like their backgrounds (eg, experiences with health care providers).

Development of Goal Management Training+ for Methamphetamine Use Disorder Through Collaborative Design

BACKGROUND

Methamphetamine use disorder (MUD) is associated with executive dysfunctions, which are linked with poorer treatment outcomes including earlier drop out and relapse. However, current treatments for MUD do not address executive functions. Goal Management Training (GMT) is an evidence-based cognitive remediation program for executive dysfunction, although required modifications to enhance its relevance and application within addiction treatment settings. This study aimed to (1) tailor GMT to the key cognitive deficits and typical treatment duration of MUD; (2) explore consumers' (people with MUD) engagement with the revised program; (3) implement a prototype of the program with consumers; and (4) present the manualized standard administration to clinical service providers.

METHODS

We followed the Medical Research Council Complex Interventions Framework and employed an evidence- and person-based intervention development process. We used a four-phased approach and collaborated with neuropsychology experts, design researchers in healthcare, consumers with MUD, and clinical service providers. Each aim was addressed in a separate study phase; including content refinement and review with neuropsychology experts (phase 1), intervention design and collaboration with consumers (phase 2), prototype development and review with consumers (phase 3), and final program modifications and review with clinical stakeholders (phase 4).

RESULTS

Findings from phase 1 indicated support for targeting four cognitive processes (attention, impulse control, goal setting, and decision-making). Key feedback included the need to help habitualize cognitive strategies and to guide consumers in applying these strategies in emotionally salient situations. Findings from phases 2 and 3 indicated consumer support for the program strategies and materials but highlighted the need to further enhance the personal relevance of specific content and journal activities. Findings from phase 4 provided clinicians support for the revised program but indicated an opportunity to minimize unintended effects. We present the intervention materials for the final revised program, Goal Management Training⁺ (GMT⁺), in line with TIDieR guidelines.

CONCLUSIONS

GMT⁺ targets key cognitive processes and is sensitive to the clinical needs of people with MUD. Our intervention development process was important for informing the active ingredients and materials for GMT⁺, and indicated initial consumer and provider acceptability prior to conducting a clinical trial.

Estimating the impact of engagement with digital health interventions on patient outcomes in randomized trials

OBJECTIVE

Guidance is needed on studying engagement and treatment effects in digital health interventions, including levels required for benefit. We evaluated multiple analytic approaches for understanding the association between engagement and clinical outcomes.

MATERIALS AND METHODS

We defined engagement as intervention participants' response rate to interactive text messages, and considered moderation, standard regression, mediation, and a modified instrumental variable (IV) analysis to investigate the relationship between engagement and clinical outcomes. We applied each approach to two randomized controlled trials featuring text message content in the intervention: REACH (Rapid Encouragement/Education and Communications for Health), which targeted diabetes, and VERB (Vanderbilt Emergency Room Bundle), which targeted hypertension.

RESULTS

In REACH, the treatment effect on hemoglobin A1c was estimated to be -0.73% (95% CI: [-1.29, -0.21]; P = 0.008), and in VERB, the treatment effect on systolic blood pressure was estimated to be -10.1 mmHg (95% CI: [-17.7, -2.8]; P = 0.007). Only the IV analyses suggested an effect of engagement on outcomes; the difference in treatment effects between engagers and non-engagers was -0.29% to -0.51% in the REACH study and -1.08 to -3.25 mmHg in the VERB study.

DISCUSSION

Standard regression and mediation have less power than a modified IV analysis, but the IV approach requires specification of assumptions. This is the first review of the strengths and limitations of various approaches to evaluating the impact of engagement on outcomes.

CONCLUSIONS

Understanding the role of engagement in digital health interventions can help reveal when and how these interventions achieve desired outcomes.

On the Use of Large Interactive Displays to Support Collaborative Engagement and Visual Exploratory Tasks

Large interactive displays can provide suitable workspaces for learners to conduct collaborative learning tasks with visual information in co-located settings. In this research, we explored the use of these displays to support collaborative engagement and exploratory tasks with visual representations. Our investigation looked at the effect of four factors (number of virtual workspaces within the display, number of displays, position arrangement of the collaborators, and collaborative modes of interaction) on learners’ knowledge acquisition, engagement level, and task performance. To this end, a user study was conducted with 72 participants divided into 6 groups using an interactive tool developed to support the collaborative exploration of 3D visual structures. The results of this study showed that learners with one shared workspace and one single display can achieve better user performance and engagement levels. In addition, the back-to-back position with learners sharing their view and control of the workspaces was the most favorable. It also led to improved learning outcomes and engagement levels during the collaboration process.

Perceptions of Factors Influencing Engagement With Health and Well-being Apps in the United Kingdom: Qualitative Interview Study

BACKGROUND

Digital health devices, such as health and well-being smartphone apps, could offer an accessible and cost-effective way to deliver health and well-being interventions. A key component of the effectiveness of health and well-being apps is user engagement. However, engagement with health and well-being apps is typically poor. Previous studies have identified a list of factors that could influence engagement; however, most of these studies were conducted on a particular population or for an app targeting a particular behavior. An understanding of the factors that influence engagement with a wide range of health and well-being apps can inform the design and the development of more engaging apps in general.

OBJECTIVE

The aim of this study is to explore user experiences of and reasons for engaging and not engaging with a wide range of health and well-being apps.

METHODS

A sample of adults in the United Kingdom (N=17) interested in using a health or well-being app participated in a semistructured interview to explore experiences of engaging and not engaging with these apps. Participants were recruited via social media platforms. Data were analyzed with the framework approach, informed by the Capability, Opportunity, Motivation-Behaviour (COM-B) model and the Theoretical Domains Framework, which are 2 widely used frameworks that incorporate a comprehensive set of behavioral influences.

RESULTS

Factors that influence the capability of participants included available user guidance, statistical and health information, reduced cognitive load, well-designed reminders, self-monitoring features, features that help establish a routine, features that offer a safety net, and stepping-stone app characteristics. Tailoring, peer support, and embedded professional support were identified as important factors that enhance user opportunities for engagement with health and well-being apps. Feedback, rewards, encouragement, goal setting, action planning, self-confidence, and commitment were judged to be the motivation factors that affect engagement with health and well-being apps.

CONCLUSIONS

Multiple factors were identified across all components of the COM-B model that may be valuable for the development of more engaging health and well-being apps. Engagement appears to be influenced primarily by features that provide user guidance, promote minimal cognitive load, support self-monitoring (capability), provide embedded social support (opportunity), and provide goal setting with action planning (motivation). This research provides recommendations for policy makers, industry, health care providers, and app developers for increasing effective engagement.

Integration of Web Analytics Into Graduate Medical Education: Usability Study

Background

Web analytics is the measurement, collection, analysis, and reporting of website and web application usage data. While common in the e-commerce arena, web analytics is underutilized in graduate medical education (GME).

Objective

The University of Arkansas for Medical Sciences Department of Surgery website was revamped with input from in-house surgeons in August 2017. This study investigated the use of web analytics to gauge the impact of our department’s website redesign project.

Methods

Google Analytics software was used to measure website performance before and after implementation of the new website. Eight-month matched periods were compared. Factors tracked included total users, new users, total sessions, sessions per user, pages per session, average session duration, total page views, and bounce rate (the percentage of visitors who visit a site and then leave [ie, bounce] without continuing to another page on the same site).

Results

Analysis using a nonpaired Student t test demonstrated a statistically significant increase for total page views (before vs after: 33,065 vs 81,852; P<.001) and decrease for bounce rate (before vs after: 50.70% vs 0.23%; P<.001). Total users, new users, total sessions, sessions per user, and pages per session showed improvement. The average session duration was unchanged. Subgroup analysis showed that after the main page, the next 3 most frequently visited pages were related to GME programs in our department.

Conclusions

Web analytics is a practical measure of a website’s efficacy. Our data suggest that a modern website significantly improves user engagement. An up-to-date website is essential for contemporary GME recruitment, will likely enhance engagement of residency applicants with GME programs, and warrants further investigation.

Engagement in Digital Mental Health Interventions: Can Monetary Incentives Help?

Digital mental health interventions (DMHI) are scalable and cost-effective strategies for increasing access to mental health care; however, dropout rates associated with digital interventions are high, particularly for open-access digital interventions. While some studies have focused on predictors of dropout from digital mental health programs, few studies have focused on engagement features that might improve engagement. In this perspective article, we discuss whether monetary incentives (MI) are one avenue to increasing user engagement in DMHI. We begin by reviewing the literature on the effects of MI for behavior change in health domains (e.g., dietary behaviors, substance use, and medication adherence). Then, drawing on a pilot study we conducted to test the effects of different levels of MI on usage and improvement in subjective well-being among users of a DMHI (Happify), we discuss the potential applications of MI for DMHI, the potential drawbacks of financial incentives in this context, and open questions for future research.

Engagement with consumer smartwatches for tracking symptoms of individuals living with multiple long-term conditions (multimorbidity): A longitudinal observational study

Introduction

People living with multiple long-term conditions (multimorbidity) (MLTC-M) experience an accumulating combination of different symptoms. It has been suggested that these symptoms can be tracked longitudinally using consumer technology, such as smartphones and wearable devices.

Aim

The aim of this study was to investigate longitudinal user engagement with a smartwatch application, collecting survey questions and active tasks over 90 days, in people living with MLTC-M.

Methods

‘Watch Your Steps’ was a prospective observational study, administering multiple questions and active tasks over 90 days. Adults with more than one clinician-diagnosed long-term conditions were loaned Fossil® Sport smartwatches, pre-loaded with the study app. Around 20 questions were prompted per day.

Daily completion rates were calculated to describe engagement patterns over time, and to explore how these varied by patient characteristics and question type.

Results

Fifty three people with MLTC-M took part in the study. Around half were male ( = 26; 49%) and the majority had a white ethnic background (n = 45; 85%). About a third of participants engaged with the smartwatch app nearly every day. The overall completion rate of symptom questions was 45% inter-quartile range (IQR 23–67%) across all study participants. Older patients and those with greater MLTC-M were more engaged, although engagement was not significantly different between genders.

Conclusion

It was feasible for people living with MLTC-M to report multiple symptoms per day over 3 months. User engagement appeared as good as other mobile health studies that recruited people with single health conditions, despite the higher daily data entry burden.

Responsible innovation in health and health system sustainability: Insights from health innovators' views and practices

Although healthcare managers make increasingly difficult decisions about health innovations, the way they may interact with innovators to foster health system sustainability remains underexplored. Drawing on the Responsible Innovation in Health (RIH) framework, this paper analyses interviews (n=37) with Canadian and Brazilian innovators to identify: how they operationalize inclusive design processes; what influences the responsiveness of their innovation to system-level challenges; and how they consider the level and intensity of care required by their innovation. Our qualitative findings indicate that innovators seek to: 1) engage stakeholders at an early ideation stage through context-specific methods combining both formal and informal strategies; 2) address specific system-level benefits but often struggle with the positioning of their solution within the health system; and 3) mitigate staff shortages in specialized care, increase general practitioners’ capacity or patients and informal caregivers’ autonomy. These findings provide empirical insights on how healthcare managers can promote and organize collaborative processes that harness innovation towards more sustainable health systems. By adopting a RIH-oriented managerial role, they can set in place more inclusive design processes, articulate key system-level challenges, and help innovators adjust the level and intensity of care required by their innovation.

Characteristics of and User Engagement With Antivaping Posts on Instagram: Observational Study

BACKGROUND

Although government agencies acknowledge that messages about the adverse health effects of e-cigarette use should be promoted on social media, effectively delivering those health messages is challenging. Instagram is one of the most popular social media platforms among US youth and young adults, and it has been used to educate the public about the potential harm of vaping through antivaping posts.

OBJECTIVE

We aim to analyze the characteristics of and user engagement with antivaping posts on Instagram to inform future message development and information delivery.

METHODS

A total of 11,322 Instagram posts were collected from November 18, 2019, to January 2, 2020, by using antivaping hashtags including #novape, #novaping, #stopvaping, #dontvape, #antivaping, #quitvaping, #antivape, #stopjuuling, #dontvapeonthepizza, and #escapethevape. Among those posts, 1025 posts were randomly selected and 500 antivaping posts were further identified by hand coding. The image type, image content, and account type of antivaping posts were hand coded, the text information in the caption was explored by topic modeling, and the user engagement of each category was compared.

RESULTS

Analyses found that antivaping images of the educational/warning type were the most common (253/500; 50.6%). The average likes of the educational/warning type (15 likes/post) were significantly lower than the catchphrase image type (these emphasized a slogan such as "athletesdontvape" in the image; 32.5 likes/post; P<.001). The majority of the antivaping posts contained the image content element text (n=332, 66.4%), followed by the image content element people/person (n=110, 22%). The images containing people/person elements (32.8 likes/post) had more likes than the images containing other elements (13.8-21.1 likes/post). The captions of the antivaping Instagram posts covered topics including "lung health," "teen vaping," "stop vaping," and "vaping death cases." Among the 500 antivaping Instagram posts, while most posts were from the antivaping community (n=177, 35.4%) and personal account types (n=182, 36.4%), the antivaping community account type had the highest average number of posts (1.69 posts/account). However, there was no difference in the number of likes among different account types.

CONCLUSIONS

Multiple features of antivaping Instagram posts may be related to user engagement and perception. This study identified the critical elements associated with high user engagement, which could be used to design antivaping posts to deliver health-related information more efficiently.

Evaluating a Strengths-Based mHealth Tool (MyStrengths): Explorative Feasibility Trial

BACKGROUND

As the number of people living with chronic illnesses increases, providing wide-reaching and easy-to-use support tools is becoming increasingly important. Supporting people in this group to recognize and use more of their personal strengths has the potential to improve their quality of life. With this in mind, we have developed the MyStrengths app prototype, a gamefully designed app aimed at aiding users in both identifying their strengths and using these strengths more actively in their daily life.

OBJECTIVE

The goal of this study was to evaluate the user-reported feasibility and usefulness of the MyStrengths app. The study additionally aimed to explore whether the use of MyStrengths could be associated with selected psychosocial outcomes.

METHODS

A 31-day explorative feasibility trial with a pretest-posttest design and an optional end of study interview was conducted. Data collection included system-use log data, demographic information, pre- and post-psychosocial measures (ie, strengths use, self-efficacy, health-related quality of life, depression), user experience measures (ie, usability, engagement, flow), and interview data.

RESULTS

In total, 34 people with at least 1 chronic condition were enrolled in the study, with 26 participants (mean age 48 years, range 29-62 years; 1 male) completing the trial. Among these individuals, 18 were also interviewed posttrial. Participants used the MyStrengths app an average of 6 days during the trial period, with 54% (14/26) using the app over a period of at least 19 days. In total, 8738 unique app actions were registered. Of the psychosocial outcome measures, only 1 subscale, general health in the RAND 36-Item Health Survey, yielded significant pre- and posttest changes. Posttrial interviews showed that the number of participants who considered the MyStrengths app to be useful, somewhat useful, or not useful was evenly distributed across 3 groups. However, every participant did voice support for the strengths approach. All participants were able to identify a multitude of personal strengths using the MyStrengths app. Most participants that reported it to be useful had little or no previous experience with the personal strengths approach. A multitude of users welcomed the gameful design choices, particularly the rolling die feature, suggesting strengths exercises, activities that use a specific strength, were well received.

CONCLUSIONS

Although the reported usefulness and feedback from use varied, most participants were favorable to the strengths-focused approach to care and support. Consequently, low-threshold and wide-reaching mobile health tools that use a strengths-focused approach, such as MyStrengths, hold the potential to support people living with chronic illness in performing self-management and achieving mastery of their life.

Cancer Communication and User Engagement on Chinese Social Media: Content Analysis and Topic Modeling Study

Background

Cancer ranks among the most serious public health challenges worldwide. In China—the world’s most populous country—about one-quarter of the population consists of people with cancer. Social media has become an important platform that the Chinese public uses to express opinions.

Objective

We investigated cancer-related discussions on the Chinese social media platform Weibo (Sina Corporation) to identify cancer topics that generate the highest levels of user engagement.

Methods

We conducted topic modeling and regression analyses to analyze and visualize cancer-related messages on Weibo and to examine the relationships between different cancer topics and user engagement (ie, the number of retweets, comments, and likes).

Results

Our results revealed that cancer communication on Weibo has generally focused on the following six topics: social support, cancer treatment, cancer prevention, women’s cancers, smoking and skin cancer, and other topics. Discussions about social support and cancer treatment attracted the highest number of users and received the greatest numbers of retweets, comments, and likes.

Conclusions

Our investigation of cancer-related communication on Weibo provides valuable insights into public concerns about cancer and can help guide the development of health campaigns in social media.

A Systematic Multidisciplinary Process for User Engagement and Sensor Evaluation: Development of a Digital Toolkit for Assessment of Movement in Children With Cerebral Palsy

Objectives: To describe and critique a systematic multidisciplinary approach to user engagement, and selection and evaluation of sensor technologies for development of a sensor-based Digital Toolkit for assessment of movement in children with cerebral palsy (CP). Methods: A sequential process was employed comprising three steps: Step 1: define user requirements, by identifying domains of interest; Step 2: map domains of interest to potential sensor technologies; and Step 3: evaluate and select appropriate sensors to be incorporated into the Digital Toolkit. The process employed a combination of principles from frameworks based in either healthcare or technology design. Results: A broad range of domains were ranked as important by clinicians, patients and families, and industry users. These directly informed the device selection and evaluation process that resulted in three sensor-based technologies being agreed for inclusion in the Digital Toolkit, for use in a future research study. Conclusion: This report demonstrates a systematic approach to user engagement and device selection and evaluation during the development of a sensor-based solution to a healthcare problem. It also provides a narrative on the benefits of employing a multidisciplinary approach throughout the process. This work uses previous frameworks for evaluating sensor technologies and expands on the methods used for user engagement.

Mobile vs. Non-Mobile Live-Streaming: A Comparative Analysis of Users Engagement and Interruption Using Big Data from a Large CDN Perspective

Video streaming on the Internet is constantly changing and growing. New devices and new video delivery mechanisms generate huge gaps in the understanding of how video application works. From exploratory research of one among the largest streaming services in Brazil, this work presents a comparison between mobile and non-mobile users, in large-scale lives. This work focuses on metrics such as engagement, interruption, churn, and payload. This work also presents a report-overview of mobile-users, considering the operating system, geolocation, network access, interruption, and engagement. These results might offer potential information for streaming improvement, in addition to serving as a historical mark.

User engagement in the development of a home-based virtual multidisciplinary stroke care clinic for stroke survivors and caregivers: a qualitative descriptive study

PURPOSE

To understand the user expectations and the facilitators and barriers of using a virtual multidisciplinary stroke care clinic ("virtual clinic").

METHODS

A qualitative descriptive study involving two rounds of face-to-face semi-structured interviews per participant was conducted. We purposively recruited ten participants in Hong Kong who were receiving traditional stroke rehabilitation. The first interview was conducted to explore participants' expectations. The second interview was conducted after a 4-week trial of the virtual clinic. Both interviews were analysed using thematic analysis. The findings were translated from Cantonese into English.

RESULTS

Before using the virtual clinic, the participants perceived a need for (i) information communication technology guidance and support, (ii) familiar hardware and applications, and (iii) services to meet psychosocial needs. Facilitators identified by the participants included (i) feeling safe and supported, (ii) willingness to learn, adapt to, and use the new service, and (iii) ease of use with a flexible schedule. Issues relating to (i) internet connectivity, (ii) hardware, and (iii) interface and design were perceived barriers to the use of the clinic.

CONCLUSION

This study provides findings of users' expectations of using telehealth services. Their perspectives on facilitators and barriers may increase the adoption of the newly developed telehealth service.Implications for rehabilitationTo implement telehealth as part of post-stroke care, it is important to ensure that stroke survivors and caregivers have the necessary information and communication technology support and infrastructure to engage in two-way interactions.Stroke survivors and caregivers may be inclined to use telehealth services due to ease of use, having flexibility in scheduling consultation sessions, do not need to travel to the clinic, useful online content, and remote blood pressure monitoring.Addressing the barriers of using telehealth services (e.g., hardware issues, internet connectivity issues, and user interface to facilitate the reading of information on the website) can improve the usability and acceptance to ensure the successful adoption of telehealth as part of post-stroke recovery.

Does Dynamic Tailoring of A Narrative-Driven Exergame Result in Higher User Engagement among Adolescents? Results from A Cluster-Randomized Controlled Trial

Physical activity interventions for youth are direly needed given low adherence to physical activity guidelines, but many interventions suffer from low user engagement. Exergames that require bodily movement while played may provide an engaging form of physical activity intervention but are not perceived as engaging to all. This study aimed to evaluate whether dynamic tailoring in a narrative-driven mobile exergame for adolescents played in leisure settings, can create higher user engagement compared to a non-tailored exergame. A cluster-randomized controlled trial assessed differences in user engagement between a dynamically tailored (based on an accelerometer sensor integrated in a T-shirt) and non-tailored condition. In total, 94 participants (M age = 14.61 ± 1.93; 35% female) participated and were assigned to one of the two conditions. User engagement was measured via a survey and game metric data. User engagement was low in both conditions. Narrative sensation was higher in the dynamically tailored condition, but the non-tailored condition showed longer play-time. User suggestions to create a more appealing game included simple and more colorful graphics, avoiding technical problems, more variety and shorter missions and multiplayer options. Less cumbersome or more attractive sensing options than the smart T-shirt may offer a more engaging solution, to be tested in future research.

Exploratory Analysis of Electronic Cigarette-Related Videos on YouTube: Observational Study

BACKGROUND

Electronic cigarette (e-cigarette) use has become more popular than cigarette smoking, especially among youth. Social media platforms, including YouTube, are a popular means of sharing information about e-cigarette use (vaping).

OBJECTIVE

This study aimed to characterize the content and user engagement of e-cigarette-related YouTube videos.

METHODS

The top 400 YouTube search videos related to e-cigarettes were collected in January 2020. Among them, 340 valid videos were classified into provaping, vaping-warning, and neutral categories by hand coding. Additionally, the content of e-cigarette videos and their user engagement (including average views and likes) were analyzed and compared.

RESULTS

While provaping videos were dominant among e-cigarette-related YouTube videos from 2007 to 2017, vaping-warning videos started to emerge in 2013 and became dominant between 2018 and 2019. Compared to vaping-warning videos, provaping videos had higher average daily views (1077 vs 822) but lower average daily likes (12 vs 15). Among 161 provaping videos, videos on user demonstration (n=100, 62.11%) were dominant, and videos on comparison with smoking had the highest user engagement (2522 average daily views and 28 average daily likes). Conversely, among 141 vaping-warning videos, videos on potential health risks were the most popular topic (n=57, 40.42%) with the highest user engagement (1609 average daily views and 33 average daily likes).

CONCLUSIONS

YouTube was dominated by provaping videos, with the majority of videos on user demonstrations before 2018. The vaping-warning videos became dominant between 2018 and 2019, with videos on potential health risks being the most popular topic. This study provides updated surveillance on e-cigarette-related YouTube videos and some important guidance on associated social media regulations.

Exploring the Effect of Social Support and Empathy on User Engagement in Online Mental Health Communities

It is known that social support and empathy are beneficial for mental health. As a result of the widespread development of social media, online social support and empathy could also influence user behaviors during the development of online communities. However, few studies have examined these effects from the perspective of online mental health communities. These communities appear to be a crucial source for mental health related support, but the spread of online empathy in these communities is not well-understood. This study focused on 22 mental health related subreddits, and matched and compared users (1) who received social support with those who did not receive social support, and users (2) who received more empathic social support with those who received less empathic social support. The results showed that social support and empathy are "contagious". That is, users who received social support at their first post would be more likely to post again and provide support for others; in addition, users who received more empathic support would subsequently express a higher level of empathy to others in the future. Our findings indicate the potential chain reaction of social support and empathy in online mental health communities. Our study also provides insights into how online mental health communities might better assist people to deliver social support that can help others to deal with mental problems.

Comparing Two Commercially Available Diabetes Apps to Explore Challenges in User Engagement: Randomized Controlled Feasibility Study

BACKGROUND

Diabetes apps represent a promising addition to face-to-face self-management interventions, which can be time and resource intensive. However, few randomized controlled trials have evaluated the efficacy of diabetes apps, in particular as a stand-alone intervention without additional clinical support.

OBJECTIVE

We used a feasibility randomized trial design to investigate differences in user engagement between 2 commercially available apps (free versions of Glucose Buddy and mySugr) over 2 weeks in adults with type 2 diabetes. Feasibility was assessed based on recruitment uptake, adherence to the diabetes apps, and follow-up rates. We also hypothesized that the diabetes app mySugr would demonstrate higher user engagement at follow-up due to its use of gamification. We also predicted higher user engagement would be associated with improved self-care behaviors and illness beliefs.

METHODS

Adults with type 2 diabetes attending outpatient diabetes clinics in Auckland were recruited and randomized (1:1 without blinding) to use either the Glucose Buddy or mySugr diabetes apps. User engagement, self-care behaviors, and illness beliefs were measured 2 weeks after baseline. Spearman rank correlations, Mann-Whitney tests, and Wilcoxon signed-rank tests were used to explore associations between the outcome measures and to investigate possible changes between and within groups. Six participants were interviewed to further explore acceptability and usability.

RESULTS

In total, 58 participants (29 per group) completed the 2-week follow-up, of whom only 38 reported using the apps (Glucose Buddy: n=20; mySugr: n=18). Both groups reported low engagement (Glucose Buddy: median 4 days; mySugr: median 6.5 days; P=.06; use for both groups: median 10 minutes). No changes were observed in self-care or illness beliefs in either group. Out of the self-care behaviors, only blood glucose testing was significantly associated with minutes of app use (P=.02). The interviews suggested that although both apps were deemed acceptable, they were generally viewed as time-consuming and too complicated to use.

CONCLUSIONS

Low engagement with both Glucose Buddy and mySugr reflect the challenges associated with engaging users with diabetes apps. Due to low engagement and loss to follow-up, the changes in outcome measures should be interpreted with caution. The results highlight the need for more clinical support as well as involvement from end users and behavior change specialists in order to incorporate evidence-based behavior change techniques to motivate and provide value to users.

TRIAL REGISTRATION

Australia New Zealand Clinical Trials Registry ACTRN12618000424202; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374671.

The STAGE Platform: User Engagement of Older People Through Co-Design and Extended Access to Streamed Cultural Events

This paper illustrates the aim, concept and scope of the STAGE project as a complementary way of exploiting leisure. This is achieved through accessing cultural events for the benefit of older users in addition to the standard direct participation. Older users could not always avail such events within reach, due to several reasons - mobility and family problem, lacking infrastructure and transportation, affordability. Accessing cultural events via streaming is not an alternative or substitute of direct participation, but it is an additional way of attending that extends the audience, the range of selectable events - also internationally - and the participation options through time. Platform development was carried out with a significant and supportive user engagement of older people through the co-design methodology.

Quality and Adoption of COVID-19 Tracing Apps and Recommendations for Development: Systematic Interdisciplinary Review of European Apps

BACKGROUND

Simulation study results suggest that COVID-19 contact tracing apps have the potential to achieve pandemic control. Concordantly, high app adoption rates were a stipulated prerequisite for success. Early studies on potential adoption were encouraging. Several factors predicting adoption rates were investigated, especially pertaining to user characteristics. Since then, several countries have released COVID-19 contact tracing apps.

OBJECTIVE

This study's primary aim is to investigate the quality characteristics of national European COVID-19 contact tracing apps, thereby shifting attention from user to app characteristics. The secondary aim is to investigate associations between app quality and adoption. Finally, app features contributing to higher app quality were identified.

METHODS

Eligible COVID-19 contact tracing apps were those released by national health authorities of European Union member states, former member states, and countries of the European Free Trade Association, all countries with comparable legal standards concerning personal data protection and app use voluntariness. The Mobile App Rating Scale was used to assess app quality. An interdisciplinary team, consisting of two health and two human-computer interaction scientists, independently conducted Mobile App Rating Scale ratings. To investigate associations between app quality and adoption rates and infection rates, Bayesian linear regression analyses were conducted.

RESULTS

We discovered 21 national COVID-19 contact tracing apps, all demonstrating high quality overall and high-level functionality, aesthetics, and information quality. However, the average app adoption rate of 22.9% (SD 12.5%) was below the level recommended by simulation studies. Lower levels of engagement-oriented app design were detected, with substantial variations between apps. By regression analyses, the best-case adoption rate was calculated by assuming apps achieve the highest ratings. The mean best-case adoption rates for engagement and overall app quality were 39.5% and 43.6%, respectively. Higher adoption rates were associated with lower cumulative infection rates. Overall, we identified 5 feature categories (symptom assessment and monitoring, regularly updated information, individualization, tracing, and communication) and 14 individual features that contributed to higher app quality. These 14 features were a symptom checker, a symptom diary, statistics on COVID-19, app use, public health instructions and restrictions, information of burden on health care system, assigning personal data, regional updates, control over tracing activity, contact diary, venue check-in, chats, helplines, and app-sharing capacity.

CONCLUSIONS

European national health authorities have generally released high quality COVID-19 contact tracing apps, with regard to functionality, aesthetics, and information quality. However, the app's engagement-oriented design generally was of lower quality, even though regression analyses results identify engagement as a promising optimization target to increase adoption rates. Associations between higher app adoption and lower infection rates are consistent with simulation study results, albeit acknowledging that app use might be part of a broader set of protective attitudes and behaviors for self and others. Various features were identified that could guide further engagement-enhancing app development.

Behavior Change Techniques in Popular Mobile Apps for Smoking Cessation in France: Content Analysis

Background

The mobile app market differs from country to country, and to date, no previous review of the content quality of smoking cessation apps has been conducted in France.

Objective

This study aimed to examine the general quality of the most popular smoking cessation apps in France and also determine the degree to which apps adhere to established behavioral and cognitive techniques (BCTs) proven effective in clinical practice.

Methods

A systematic research of smoking cessation apps was conducted in both the Google Play Store and Apple Store in the French market. The general quality of popular apps was rated with the Mobile App Rating Scale (MARS), and the therapeutic quality was assessed with the ratio of adherence of the behavior change technique taxonomy for smoking cessation treatment.

Results

A total of 14 mobile apps met all the inclusion criteria of the content analysis. The interrater reliability varied from “substantial” (0.79) to “almost perfect” (0.9) for the two measures. The mean MARS score was 3.5 out of 5 (median 3.6, IQR 0.6 [3.2-3.8]). The findings suggest that popular apps focus primarily on the functionality dimension of the MARS scale (4.2/5). The mean number of BCTs was 22, with a large difference between apps (minimum 4, maximum 38). At least half of the apps addressed motivation (8.8/14, 63%) and advised on using behavioral skills in order to quit smoking or stay a nonsmoker (8.7/14, 62%). However, only a handful of apps gathered important information (5.9/14, 42%) in order to deliver proper advice regarding the use of approved medication or the implementation of behavioral techniques (4.3/14, 31%). The mean MARS score was positively correlated with the price (r=0.70, P=.007) and the number of BCTs used (r=0.67, P=.01). User rating was not correlated with any quality scale (P=.67).

Conclusions

The content quality of popular smoking cessation apps in France varied by app type and price. Most popular apps propose in general good quality content but lack implementation of evidence-based BCTs associated with effectiveness on smoking cessation treatment. Further research is needed to evaluate the improvement in the content quality of smoking cessation apps in France.