An Internet-Based Migraine Headache Diary: Issues in Internet-Based Research

The effect of computer use on the occurrence of migraine

Background/Aim. Risk factors concerning computer use-related migraine onsets are still unknown. The aim of this study was to determine the prevalence of headaches in computer users as well as the effects of computer use and behavior on the prediction of migraine presence. Methods. A cross-sectional study included 1,500 subjects from the general population who were given a questionnaire to assess the presence and type of headache and questions regarding computer-assisted behavior. All examinees were divided into two groups: the first group consisted of respondents who had a headache, and the second group consisted of subjects without a headache. Results. A total of 67.9% of the subjects had a headache, of which 23.9% had a migraine. Results of multinomial regression analysis showed that significant predictors of the migraine group, compared to the group without headache, were gender (female) and family anamnesis positive for migraine, as well as spending more time on the computer, making shorter and infrequent breaks in which physical activities were less included. Furthermore, members of the migraine group, compared with the group with other types of headaches, were younger and had family anamnesis, rarely made pauses during computer use, and their pauses were shorter. Conclusion. Improper and excessive computer use could be considered a risk factor for migraine occurrence, particularly in young people who have positive family anamnesis for migraine.

Recruiting custodial grandmothers using Facebook

OBJECTIVES

Recruitment through Facebook is gaining favor as an approach for research, including clinical trials, because of the platform's ability to reach broad and diverse populations. As older adults increase their social media use, recruitment through Facebook has become a viable option. The purposes of this paper are to report the methodological process and lessons learned from recruiting custodial grandmothers (CGMs) for a cross-sectional study examining parenting self-efficacy and psychological well-being.

PARTICIPANTS

A total of 113 people consented and accessed the survey online, with 40 (35.4%) completing surveys. The final sample comprised 68 grandmothers, with 59% recruited via Facebook.

METHODS

Facebook recruitment for the online survey included creating a dedicated Facebook study page, accessing existing Facebook pages for custodial grandparents, and using paid advertising. Face-to-face recruitment strategies also were used with paper surveys.

RESULTS

We compared the characteristics of those completing online surveys versus paper surveys. CGMs completing the survey online were significantly younger and more likely to be Caucasian than those completing the paper survey.

CONCLUSIONS

Findings indicated online recruitment via Facebook is an advantageous method to reach CGMs. However, additional research is needed to determine if other online and social media platforms would be useful in recruiting this population.

Multinational descriptive analysis of the real-world burden of headache using the Migraine Buddy application

BACKGROUND AND PURPOSE

A large proportion of headache sufferers do not routinely seek medical care. App-based technologies permit the collection of real-world data over time and between countries that can help assess true burden of headache. This study used a mobile phone application to collect information on the real-world burden of self-diagnosed headache and to describe its impact on daily life in headache sufferers who do not routinely seek medical advice.

METHODS

This retrospective, non-interventional, cross-sectional study analysed self-reported data from users of the 'Migraine Buddy' app. The main objective was to describe self-reported characteristics of headache and migraine (triggers, duration, frequency), treatment patterns and impact on daily activity in headache sufferers from Australia, Brazil, France, Germany and Japan. Data including demographics, self-diagnosed episode type (headache/migraine), duration, potential triggers and impact on daily activity are reported. All analyses were exploratory and performed per country.

RESULTS

Self-reported data were collected from 60,474 users between August 2016 and August 2018. Approximately 90% of users were females; >60% were aged 24-45 years. Over one-third of users reported having two to five episodes of headache or migraine per month; impact included impaired concentration, being slower and missing work or social activities. Variations across countries were observed; within countries, episode characteristics were very similar for self-diagnosed headache versus migraine.

CONCLUSIONS

Headache tracking was used to describe the experience, impact and self-management approaches of migraine and headache sufferers in a real-world setting. Headache disorders present a range of important issues for patients that deserve more study and reinforce the need for better approaches to management.

Determining the Evolution of Headache Among Regular Users of a Daily Electronic Diary via a Smartphone App: Observational Study

Background

Smartphone-based apps represent a major development in health care management. Specifically in headache care, the use of electronic headache diaries via apps has become increasingly popular. In contrast to the soaring volume of available data, scientific use of these data resources is sparse.

Objective

In this analysis, we aimed to assess changes in headache and migraine frequency, headache and migraine intensity, and use of acute medication among people who showed daily use of the headache diary as implemented in the freely available basic version of the German commercial app, M-sense.

Methods

The basic version of M-sense comprises an electronic headache diary, documentation of lifestyle factors with a possible impact on headaches, and evaluation of headache patterns. This analysis included all M-sense users who had entered data into the app on a daily basis for at least 7 months.

Results

We analyzed data from 1545 users. Mean MHD decreased from 9.42 (SD 5.81) at baseline to 6.39 (SD 5.09) after 6 months (P<.001; 95% CI 2.80-3.25). MMD, AMD, and migraine intensity were also significantly reduced. Similar results were found in 985 users with episodic migraine and in 126 users with chronic migraine.

Conclusions

Among regular users of an electronic headache diary, headache and migraine frequency, in addition to other headache characteristics, improved over time. The use of an electronic headache diary may support standard headache care.

Air pollution, methane super-emitters, and oil and gas wells in Northern California: the relationship with migraine headache prevalence and exacerbation

BACKGROUND

Migraine-an episodic disorder characterized by severe headache that can lead to disability-affects over 1 billion people worldwide. Prior studies have found that short-term exposure to fine particulate matter (PM_2.5), nitrogen dioxide (NO₂), and ozone increases risk of migraine-related emergency department (ED) visits. Our objective was to characterize the association between long-term exposure to sources of harmful emissions and common air pollutants with both migraine headache and, among patients with migraine, headache severity.

METHODS

From the Sutter Health electronic health record database, we identified 89,575 prevalent migraine cases between 2014 and 2018 using a migraine probability algorithm (MPA) score and 270,564 frequency-matched controls. Sutter Health delivers care to 3.5 million patients annually in Northern California. Exposures included 2015 annual average block group-level PM_2.5 and NO₂ concentrations, inverse-distance weighted (IDW) methane emissions from 60 super-emitters located within 10 km of participant residence between 2016 and 2018, and IDW active oil and gas wells in 2015 within 10 km of each participant. We used logistic and negative binomial mixed models to evaluate the association between environmental exposures and (1) migraine case status; and (2) migraine severity (i.e., MPA score > 100, triptan prescriptions, neurology visits, urgent care migraine visits, and ED migraine visits per person-year). Models controlled for age, sex, race/ethnicity, Medicaid use, primary care visits, and block group-level population density and poverty.

RESULTS

In adjusted analyses, for each 5 ppb increase in NO₂, we observed 2% increased odds of migraine case status (95% CI: 1.00, 1.05) and for each 100,000 kg/hour increase in IDW methane emissions, the odds of case status also increased (OR = 1.04, 95% CI: 1.00, 1.08). We found no association between PM_2.5 or oil and gas wells and migraine case status. PM_2.5 was linearly associated with neurology visits, migraine-specific urgent care visits, and MPA score > 100, but not triptans or ED visits. NO₂ was associated with migraine-specific urgent care and ED visits, but not other severity measures. We observed limited or null associations between continuous measures of methane emissions and proximity to oil and gas wells and migraine severity.

CONCLUSIONS

Our findings illustrate the potential role of long-term exposure to multiple ambient air pollutants for prevalent migraine and migraine severity.

Strategies for the Planning and Handling of Missing Data in Nursing Research

BACKGROUND

Missing data are an inevitable reality in research. Nurse educators can promote proactive thinking about this topic to help avoid excessive missingness. The purpose of this article is to encourage nurses to view missing data as an accepted reality and to consider strategies for anticipating and minimizing missing data throughout the research process.

METHOD

The common causes of missing data and ways to minimize their occurrence are discussed, along with suggestions for adopting a statistical mindset about missing data. Rubin's framework for missingness as a random process, modern statistical methods for analyzing missing data, and recommendations for reporting also are discussed.

CONCLUSION

Nurse educators and researchers should understand all aspects of missing data, including the types, occurrence, causes, potential problems, and strategies for preventing, handling, and reporting missing data. By doing so, the occurrence of missing data can be lessened, thereby minimizing various problems that can result. [J Nurs Educ. 2020;59(5):249-255.].

Towards eHealth to support the health journey of headache patients: a scoping review

Objective

The aim of this study is to (1) review the digital health tools that have been used in headache studies, and (2) discuss the effectivity and reliability of these tools.

Background

Many headache patients travel a long and troublesome journey from first symptoms until a meaningful care plan. eHealth, mHealth, and digital therapeutic modalities have been advocated as the way forward to improve patient care.

Method

Online databases PubMed, Cinahl, and PsycINFO were searched using a predefined search query. A data extraction form was used to gather relevant data elements from the selected papers.

Results

A total of 39 studies were selected. The studies included 94,127 participants. The majority of studies focused on diaries (N = 27 out of 39). Digital (cognitive) behavioral therapy were also quite common (N = 7 out of 39). Other digital health tool categories were tele-consultations, telemonitoring and patient portals.

Conclusion

Many digital health tools for headache patients regarding diaries and behavioral/therapeutical treatment are described in scientific research with limited information on effectivity and reliability. Scientific knowledge with regard to other categories such as tele-consultations, patient portals, telemonitoring including medication adherence, online information resources, wearable, symptom checkers, digital peer support is still scarce or missing.

A multi-modal recruitment strategy using social media and internet-mediated methods to recruit a multidisciplinary, international sample of clinicians to an online research study

Background

Challenges exist in recruiting an international sample of clinicians and researchers to an online survey. Traditional recruitment methods remain relevant but issues such as narrow geographical reach, high cost and time intensity limit what can be achieved when aiming to recruit an international, multi-disciplinary sample. Internet-mediated and social media approaches to recruitment and engagement offer new, untested ways of capitalizing upon existing professional networks.

Objective

To develop, use and appraise a multi-modal recruitment strategy for an online, international survey regarding the management of shoulder pain.

Methods

Traditional recruitment methods were combined with internet-mediated recruitment methods to form a multi-modal recruitment strategy. An overview of the development of this three-month recruitment strategy is provided and the value and role of each strand of the recruitment strategy discussed.

Results

In response to the multi-modal recruitment strategy, data was received from 565 clinicians and researchers from 31 countries (64% UK). Complete data was received from 387 respondents with no demographic differences between respondents who completed, and those who started but did not complete the survey. Over 30% of responses were received within 1 week, 50% within 4 weeks and 81% within 8 weeks.

Conclusions

This study shows the acceptability and international, multidisciplinary reach of a low cost multi-modal recruitment strategy for an online survey of international clinicians and researchers. Incorporating the use of social media proved to be an effective, time and resource-efficient recruitment strategy for this online survey and appeared to enhance clinician engagement. A multimodal recruitment strategy is worthy of consideration for future online surveys of clinicians and researchers.

Which Factors Affect Daily Compliance With an Internet Headache Diary Among Youth With Migraine?

OBJECTIVE

To determine the specific factors that affect Internet headache diary compliance among youth with primary headaches.

MATERIALS AND METHODS

Patients aged 10 to 18 years completed a 90-day Internet-based headache diary with date-stamping and time-stamping features that allowed compliance monitoring. Eight potential predictors were assessed in a multilevel statistical model of headache diary compliance: age, sex, diary entries during the school year versus summer, entries on evenings preceding weekends (Friday or Saturday) versus evenings preceding weekdays (Sunday through Thursday), headache days versus nonheadache days, headache intensity ratings, use of an abortive headache medicine, and the first 2 weeks of diary use versus the latter 76 days.

RESULTS

Fifty-two patients generated 4680 diary entries; 3215 (68.7%) entries were compliant (completed via same-day diary entries). Compliance for each diary participant ranged from 39% to 97% (mean, 68.7%; median, 70%; SD=0.15%). Three specific factors were associated with diary compliance in the multilevel model. Compliance was better on days when an abortive headache medicine was used (P<0.001; odds ratio [OR], 33.7 [95% confidence interval [CI], 13.1-86.6]) and during the first 2 weeks of the diary period versus the remaining 76 days (P=0.05; OR, 1.3 [95% CI, 1.03-1.68]). Compliance was worse on evenings proceeding weekends versus evenings preceding weekdays (P<0.001; OR, 0.55 [95% CI, 0.46-0.66]). Patients who did not start the diary protocol (n=12) or did not complete the 90 days (n=14) were excluded from the analysis.

DISCUSSION

Specific factors predict Internet-based headache diary compliance. Further research about the factors related to diary compliance and the optimization of diary-based data collection is warranted.

Simple Tools to Facilitate Project Management of a Nursing Research Project

Highly organized project management facilitates rigorous study implementation. Research involves gathering large amounts of information that can be overwhelming when organizational strategies are not used. We describe a variety of project management and organizational tools used in different studies that may be particularly useful for novice researchers. The studies were a multisite study of caregivers of stroke survivors, an Internet-based diary study of women with migraines, and a pilot study testing a sleep intervention in mothers of low-birth-weight infants. Project management tools were used to facilitate enrollment, data collection, and access to results. The tools included protocol and eligibility checklists, event calendars, screening and enrollment logs, instrument scoring tables, and data summary sheets. These tools created efficiency, promoted a positive image, minimized errors, and provided researchers with a sense of control. For the studies described, there were no protocol violations, there were minimal missing data, and the integrity of data collection was maintained.

Analysis of Trigger Factors in Episodic Migraineurs Using a Smartphone Headache Diary Applications

Background

Various stimuli can trigger migraines in susceptible individuals. We examined migraine trigger factors by using a smartphone headache diary application.

Method

Episodic migraineurs who agreed to participate in our study downloaded smartphone headache diary application, which was designed to capture the details regarding headache trigger factors and characteristics for 3 months. The participants were asked to access the smartphone headache diary application daily and to confirm the presence of a headache and input the types of trigger factors.

Results

Sixty-two participants kept diary entries until the end of the study. The diary data for 4,579 days were analyzed. In this data set, 1,099 headache days (336 migraines, 763 non-migraine headaches) were recorded; of these, 772 headache events had with trigger factors, and 327 events did not have trigger factors. The common trigger factors that were present on headache days included stress, fatigue, sleep deprivation, hormonal changes, and weather changes. The likelihood of a headache trigger was 57.7% for stress, 55.1% for sleep deprivation, 48.5% for fatigue, and 46.5% for any trigger. The headaches with trigger factors were associated with greater pain intensity (p<0.001), headache-related disability (p<0.001), abortive medication use (p = 0.02), and the proportion of migraine (p < 0.001), relative to those without trigger factors. Traveling (odd ratios [OR]: 6.4), hormonal changes (OR: 3.5), noise (OR: 2.8), alcohol (OR: 2.5), overeating (OR: 2.4), and stress (OR:1.8) were significantly associated with migraines compared to non-migraine headaches. The headaches that were associated with hormonal changes or noise were more often migraines, regardless of the preventive medication. The headaches due to stress, overeating, alcohol, and traveling were more often migraines without preventive medication, but it was not evident with preventive medication.

Conclusion

Smartphone headache diary application is an effective tool to assess migraine trigger factors. The headaches with trigger factors had greater severity or migraine features. The type of triggers and the presence of preventive medication influenced the headache characteristics; hence, an investigation of trigger factors would be helpful in understanding migraine occurrences.

Clinical impact of migraine for the management of glaucoma patients

Migraine is a common and debilitating primary headache disorder that affects 10-15% of the general population, particularly people of working age. Migraine is relevant to providers of clinical eye-care because migraine attacks are associated with a range of visual sensory symptoms, and because of growing evidence that the results of standard tests of visual function necessary for the diagnosis and monitoring of glaucoma (visual fields, electrophysiology, ocular imaging) can be abnormal due to migraine. These abnormalities are measureable in-between migraine events (the interictal period), despite patients being asymptomatic and otherwise healthy. This picture is further complicated by epidemiological data that suggests an increased prevalence of migraine in patients with glaucoma, particularly in patients with normal tension glaucoma. We discuss how migraine, as a co-morbidity, can confound the results and interpretation of clinical tests that form part of contemporary glaucoma evaluation, and provide practical evidence-based recommendations for the clinical testing and management of patients with migraine who attend eye-care settings.

Predictors of valid engagement with a video streaming web study among asian american and non-Hispanic white college students

The study purpose was to determine the predictors of watching most of a Web-based streaming video and whether data characteristics differed for those watching most or only part of the video. A convenience sample of 650 students (349 Asian Americans and 301 non-Hispanic whites) was recruited from a public university in the United States. Study participants were asked to view a 27-minute suicide awareness streaming video and to complete online questionnaires. Early data monitoring showed many, but not all, watched most of the video. We added software controls to facilitate video completion and defined times for a video completion group (≥26 minutes) and video noncompletion (<26 minutes) group. Compared with the video noncompletion group, the video completion group included more females, undergraduates, and Asian Americans, and had higher individualistic orientation and more correct manipulation check answers. The video noncompletion group skipped items in a purposeful manner, showed less interest in the video, and spent less time completing questionnaires. The findings suggest that implementing software controls, evaluating missing data patterns, documenting the amount of time spent completing questionnaires, and effective manipulation check questions are essential to control potential bias in Web-based research involving college students.

A comparison between prospective Internet-based and paper diary recordings of headache among adolescents in the general population

AIM

The aim of this article was to develop and apply an Internet-based headache diary (i-diary) for adolescents and compare it with a paper-diary (p-diary) regarding adherence, user acceptability and recorded headache activity.

METHODS

In a cross-sectional school-based study, a representative sample of 488 adolescents aged 12-18 years were randomly allocated by cluster sampling to record for three weeks in i-diaries or p-diaries their headache intensity, disability, and use of acute medication.

RESULTS

A significantly (p = 0.008) higher proportion of adolescents in the i-diary group used the diary at least once during the 21-day period (86% vs 76% for the p-diary). However, the p-diary group completed a significantly (p < 0.001) higher number of diary days (20.8 vs 15.0 days for the i-diary). The response rate for the i-diary-group was largely evenly distributed over the study period; conversely, approximately two-thirds of the adolescents using the p-diary responded on all 21 days, whereas one-fourth did not respond at all. The two diary types were rated as equal in easiness to remember (p = 0.25), but the i-diaries were more bothersome to use (p = 0.029).

CONCLUSION

Although p-diary users completed a higher proportion of diary days, i-diaries provided more reliable and credible estimates of headache parameters because of better real-time assessment.

Testing the Feasibility and Psychometric Properties of a Mobile Diary (myWHI) in Adolescents and Young Adults With Headaches

BACKGROUND

Headaches are prevalent among teens and young adults. Self-monitoring is essential for managing headaches and can be accomplished with the help of electronic headache diaries. An increasing number of electronic headache diaries exist, yet the absence of quality standards compromises their use for research and clinical purposes.

OBJECTIVE

Our goal was to develop and test the usability, feasibility, and psychometric properties of an electronic diary iPhone application for self-monitoring by adolescents and young adults with headaches.

METHODS

We used an iterative participatory design to develop and test our electronic headache diary. Participants aged 14-28 years old with recurrent headaches were recruited internationally. Screening and consent were conducted online. Following completion of an online pre-questionnaire, participants downloaded the diary to use in their natural environment for 14 days. An online post-questionnaire was completed following testing. The diary's usability and feasibility were tested first and determined to be complete when improvements to the diary did not result in a statistically significant impact on indicators of feasibility and adherence. Interviews were conducted with participants of usability and feasibility testing. The psychometric properties of the diary were then tested, and a case study analysis of one participant was completed.

RESULTS

Three cycles to test the usability and feasibility were conducted. Each cycle included 11-19 unique participants ranging in age from 16 to 28 years. Following the testing period for each cycle, 15% to 25% of participants took part in the post-cycle interview. Participants perceived the final version of the diary as useful, easy to learn, and efficient to use. Psychometric properties were then tested with a sample of 65 participants (6 aged 14-17 years old; 59 aged 18-28 years old). All items in the diary had substantial between- and within-subjects variability (percent of variance for the two participant groups ranged from 20.64 to 75.60 and 23.74 to 79.21, respectively). Moreover, the Migraine Disability Assessment (MIDAS) included in the diary had adequate between-subjects reliability (R1F=0.66, RKF=0.98), but low within-subjects reliability (RC=0.51). Critical elements of the diary demonstrated adequate convergent and concurrent validity, particularly in the older age group (18-28 years). The validity of some critical elements of the diary could not be explored in the younger age group due to the small subgroup size. The case study provides an example of the potential utility of the diary.

CONCLUSIONS

Our electronic headache diary was shown to be a usable and feasible self-monitoring tool when used by adolescents and young adults with headaches for 14 days. This study provides preliminary support of its psychometric properties. Our diary has the potential for helping users to better understand their headaches and, consequently, to change behaviors to improve self-management of their headaches. Its effectiveness as a component of an intervention will be the focus of future research.

Response of sensitive behaviors to frequent measurement

We study the influence of frequent survey measurement on behavior. Widespread access to the Internet has made important breakthroughs in frequent measurement possible-potentially revolutionizing social science measurement of processes that change quickly over time. One key concern about using such frequent measurement is that it may influence the behavior being studied. We investigate this possibility using both a population-based experiment with random assignment to participation in a weekly journal for twelve months (versus no journal) and a large-scale, population-based, journal-keeping study with weekly measurement for 30 months. Results reveal few of the measured behaviors are correlated with assignment to frequent measurement. Theoretical reasoning regarding the likely behavioral response to frequent measurement correctly predicts domains most vulnerable to this possibility. Overall, however, we found little evidence of behavioral response to frequent measurement.

Methodological issues in studying trigger factors and premonitory features of migraine

OBJECTIVE

In this review, we focus on migraine as a chronic disorder with episodic attacks (CDEA). We aim to review methodological approaches to studying trigger factors and premonitory features that often precede a migraine attack.

BACKGROUND

Migraine attacks are sometimes initiated by trigger factors, exposures which increase the probability of an attack. They are heralded by premonitory features, symptoms which warn of an impending attack.

DESIGN/METHODS

We review candidate predictors of migraine attack and discuss the methodological issues and approaches to studying attack prediction and suggest that electronic diaries may be the method of choice.

CONCLUSION

Establishing the relationship between antecedent events and headaches is a formidable challenge. Successfully addressing this challenge should provide insights into disease mechanisms and lead to new strategies for treatment. In the second paper in this series, we review the available literature on trigger factors and premonitory features.

Treatment adherence in patients with headache: a systematic review

OBJECTIVE

To review and critically evaluate the extant research literature pertaining to adherence in youth and adults with headache and to provide recommendations for future research.

BACKGROUND

This article provides the first systematic review of pediatric headache adherence and updates a previous review of treatment adherence in adults with headache.

DESIGN

Systematic review of empirical literature.

METHODS

A literature search with no date restriction was conducted using PubMed and PsycINFO electronic databases and bibliographies of relevant articles.

RESULTS

Adherence rates in adults with headache range considerably from 25% to 94% across treatment, assessment method, and definition of adherence utilized. Methods to assess adherence included retrospective prescription claims data, paper or electronic diaries, follow-up appointment attendance, written and verbal self-report of general adherence, verbal self-report of adherence over a specific amount of time via in person interview or telephone, validated adherence measures, adherence questionnaires without validation, and counselor ratings of homework. Each methodology and assessment tool demonstrated strengths and weaknesses. No studies have systematically examined medication adherence in children with headache, and the few available studies examining adherence to behavioral treatment have documented adherence rates ranging from 52% to 86%.

CONCLUSIONS

Adherence research in adults with headache is growing, but studies demonstrate a number of methodological shortcomings. Adherence research in children with headache, and adherence intervention research in both adults and children, is scant. Future research should use objective measures of adherence, consider over-the-counter medications and medication overuse, examine demographic, psychological, and behavioral correlates of adherence, assess adherence to botulinum toxin type A, and examine the efficacy of adherence interventions in individuals with headache.

Monitoring childhood asthma: web-based diaries and the asthma control test

BACKGROUND

Data from asthma diaries are frequently used as an end point in asthma studies; however, data on the validity of Web-based diaries are scarce.

OBJECTIVES

First, we examined the validity of a Web-based diary in assessing asthma control. Second, we determined the cutoff points for well-controlled asthma of the Childhood Asthma Control Test (C-ACT) and the Asthma Control Test (ACT), and calculated the minimal important difference for both tests.

METHODS

Children with asthma, ages 4-18 years (n = 228) completed a 4-week Web-based diary, C-ACT, ACT, and an asthma-related quality-of-life questionnaire at baseline and after 1-year follow-up.

RESULTS

The completion rate of the Web-based diaries was 89%. The diary scores correlated strongly with C-ACT and ACT scores (r = -0.73, P < .01; r = -0.64, P < .01, respectively) and the changes in diary scores correlated well with changes in C-ACT and ACT scores. The best cutoff points for well-controlled asthma were C-ACT ≥ 22 and ACT ≥ 23. The minimal important differences were 1.9 (95% CI, 1.3-2.5) for ACT and 1.6 (95% CI, 1.1-2.1) for C-ACT, and -0.7 points/d (95% CI, -1.1 to -0.4) for the Web-based diary.

CONCLUSIONS

Our Web-based diary was valid for recording asthma symptoms. Cutoff points of ≥22 (C-ACT) and ≥23 (ACT) define well-controlled asthma. We recommend a 2 C-ACT and ACT points difference as minimally important.

A qualitative review of the psychometric properties and feasibility of electronic headache diaries for children and adults: where we are and where we need to go

BACKGROUND

While paper headache pain diaries have been used to determine the effectiveness of headache treatments in clinical trials, recent advances in information and communication technologies have resulted in the burgeoning use of electronic diaries (e-diaries) for headache pain.

OBJECTIVE

To qualitatively review headache e-diaries, assess their measurement properties, examine measurement components and compare these components with recommended reporting guidelines.

METHODS

The databases Medline, the Cumulative Index to Nursing and Allied Health Literature, Embase, PsychInfo, the Education Resources Information Centre and ISI Web of Science were searched for self-report headache e-diaries for children and adults. A total of 21 publications that involved e-diaries were found; five articles reported on the development of an e-diary and 16 used an e-diary as an outcome measure in randomized controlled trials or observational studies. The diary measures' components, features and psychometric properties, as well as the quality of evidence of their psychometric properties, were evaluated.

RESULTS

Five headache e-diaries met the a priori criteria and were included in the final analysis. None of these e-diaries had well-developed evidence of reliability and validity. Three e-diaries showed evidence of feasibility. E-diaries with ad hoc measures developed by the study investigators were most common, with little to no supportive evidence of reliability and⁄or validity. Compliance with the reporting guidelines was variable, with only one-half of the e-diaries measuring the recommended primary outcome of headache frequency.

CONCLUSIONS

Specific recommendations regarding the development (including essential components) and testing of headache e-diaries are discussed. Further research is needed to strengthen the measurement of headache pain in clinical trials using headache e-diaries.

Challenges and solutions for using informatics in research

Computer technology provides innovations for research but not without concomitant challenges. Herein, we present our experiences with technology challenges and solutions across 16 nursing research studies. Issues included intervention integrity, software updates and compatibility, web accessibility and implementation, hardware and equipment, computer literacy of participants, and programming. Our researchers found solutions related to best practices for computer-screen design and usability testing, especially as they relate to the target populations' computer literacy levels and use patterns; changes in software; availability and limitations of operating systems and web browsers; resources for on-site technology help for participants; and creative facilitators to access participants and implement study procedures. Researchers may find this information helpful as they consider successful ways to integrate informatics in the design and implementation of future studies with technology that maximizes research productivity.

Interactive web-based breastfeeding monitoring: feasibility, usability, and acceptability

BACKGROUND

Strategies that promote higher exclusive breastfeeding rate and duration are highly recommended. To date, no study has tested the feasibility of Web-based monitoring among breastfeeding mothers.

GOALS

To develop an interactive Web-based breastfeeding monitoring system (LACTOR) and examine its feasibility, usability, and acceptability among breastfeeding mothers.

METHODS

A prospective, descriptive, mixed-methods study was conducted. Mothers who met the study inclusion criteria were recruited from mother infant units in 2 Midwestern hospitals in the United States. Mothers were asked to enter their breastfeeding data daily through the system for 30 days and then submit an online exit survey. This survey consisted of a system usability scale and mothers' perceptions form. Twenty-six mother/infant dyads completed the study.

RESULTS

The Feasibility of LACTOR was established by mothers' compliance in entering their breastfeeding data. The mean was 8.87 (SD = 1.21) daily entries, and the range was 6-13 times per day. Usability scale total mean score was 3.35 (SD = 0.33; scale range 0-4). Ninety-two percent of the mothers thought that they did not need to learn many skills before they started to use LACTOR and did not need any technical support. Mothers reported that the monitoring was beneficial and gave them the chance to track their infants' feeding patterns and detect any problems early.

CONCLUSIONS

This study demonstrated the feasibility of LACTOR, and it was user-friendly and acceptable among mothers. Further studies to test its effect on breastfeeding outcomes are needed.

Characteristics and consumption patterns of Australian organic consumers

BACKGROUND

Increasingly, Australians are choosing to consume organically produced food, but only a small percentage consume organic food exclusively, and there is little information in the scientific literature that describes their actual level of intake. In order to provide a more meaningful description of Australian organic consumers the 'Organic Consumption Survey' and 'Organic Food Intake Survey' were conducted online in 2010. The aims were to provide information about the characteristics of regular organic consumers and quantify levels of organic consumption.

RESULTS

The majority of participants (n = 318) were female (80.3%), 25-55 years old (80.3%), living in urban areas (61.2%), born in Australia (68.9%) and were in a healthy weight range (55.5%). Organic fruit and vegetables had the highest uptake by organic consumers and meat products the lowest. The majority of participants consumed at least 65% organic food in their diet, including 35% certified organic food.

CONCLUSION

A better understanding of organic consumers may help to serve the long-term interests of the organic industry and other stakeholders of food marketing. Clearer definitions of organic consumers may also inform research evaluating the purported health benefits of organic foods.

An electronic diary on a palm device for headache monitoring: a preliminary experience

Patients suffering from headache are usually asked to use charts to allow monitoring of their disease. These diaries, providing they are regularly filled in, become crucial in the diagnosis and management of headache disorders because they provide further information on attack frequency and temporal pattern, drug intake, trigger factors, and short-/long-term responses to treatment. Electronic tools could facilitate diary monitoring and thus the management of headaches. Medication overuse headache (MOH) is a chronic and disabling condition that can be treated by withdrawing the overused drug(s) and adopting specific approaches that focus on the development of a close doctor–patient relationship in the post-withdrawal phase. Although the headache diary is, in this context, an essential tool for the constant, reliable monitoring of these patients to prevent relapses, very little is known about the applicability of electronic diaries in MOH patients. The purpose of this study was to evaluate the acceptability of and patient compliance with an electronic headache diary (palm device) as compared with a traditional diary chart in a group of headache inpatients with MOH. A palm diary device, developed in accordance with the ICHD-II criteria, was given to 85 MOH inpatients during the detoxification phase. On the first day of hospitalization, the patients were instructed in the use of the diary and were then required to fill it in daily for the following 7 days. Data on the patients’ opinions on the electronic diary and the instructions given, its screen and layout, as well as its convenience and ease of use, in comparison with the traditional paper version, were collected using a numerical rating scale. A total of 504 days with headache were recorded in both the electronic and the traditional headache diaries simultaneously. The level of patient compliance was good. The patients appreciated the electronic headache diary, deeming it easy to understand and to use (fill in); most of the patients rated the palm device handier than the traditional paper version.

Computer access and Internet use by urban and suburban emergency department customers

BACKGROUND

Patients are increasingly using the Internet (43% in 2000 vs. 70% in 2006) to obtain health information, but is there a difference in the ability of urban and suburban emergency department (ED) customers to access the Internet?

STUDY OBJECTIVE

To assess computer and Internet resources available to and used by people waiting to be seen in an urban ED and a suburban ED.

METHODS

Individuals waiting in the ED were asked survey questions covering demographics, type of insurance, access to a primary care provider, reason for their ED visit, computer access, and ability to access the Internet for health-related matters.

RESULTS

There were 304 individuals who participated, 185 in the urban ED and 119 in the suburban ED. Urban subjects were more likely than suburban to be women, black, have low household income, and were less likely to have insurance. The groups were similar in regard to average age, education, and having a primary care physician. Suburban respondents were more likely to own a computer, but the majority in both groups had access to computers and the Internet. Their frequency of accessing the Internet was similar, as were their reasons for using it. Individuals from the urban ED were less willing to schedule appointments via the Internet but more willing to contact their health care provider via e-mail. The groups were equally willing to use the Internet to fill prescriptions and view laboratory results.

CONCLUSION

Urban and suburban ED customers had similar access to the Internet. Both groups were willing to use the Internet to access personal health information.