Influence of Patient Characteristics and Psychological Needs on Diabetes Mobile App Usability in Adults With Type 1 or Type 2 Diabetes: Crossover Randomized Trial.

BACKGROUND: More than 1100 diabetes mobile apps are available, but app usage by patients is low. App usability may be influenced by patient factors such as age, sex, and psychological needs. OBJECTIVE: Guided by Self-Determination Theory, the purposes of this study were to (1) assess the effect of patient characteristics on app usability, and (2) determine whether patient characteristics and psychological needs (competence, autonomy, and connectivity)-important for motivation in diabetes care-are associated with app usability. METHODS: Using a crossover randomized design, 92 adults with type 1 or 2 diabetes tested two Android apps (mySugr and OnTrack) for seven tasks including data entry, blood glucose (BG) reporting, and data sharing. We used multivariable linear regression models to examine associations between patient characteristics, psychological needs, user satisfaction, and user performance (task time, success, and accuracy). RESULTS: Participants had a mean age of 54 (range 19-74) years, and were predominantly white (62%, 57/92), female (59%, 54/92), with type 2 diabetes (70%, 64/92), and had education beyond high school (67%, 61/92). Participants rated an overall user satisfaction score of 62 (SD 18), which is considered marginally acceptable. The satisfaction mean score for each app was 55 (SD 18) for mySugr and 68 (SD 15) for OnTrack. The mean task completion time for all seven tasks was 7 minutes, with a mean task success of 82% and an accuracy rate of 68%. Higher user satisfaction was observed for patients with less education (P=.04) and those reporting more competence (P=.02), autonomy (P=.006), or connectivity with a health care provider (P=.03). User performance was associated with age, sex, education, diabetes duration, and autonomy. Older patients required more time (95% CI 1.1-3.2) and had less successful task completion (95% CI 3.5-14.3%). Men needed more time (P=.01) and more technical support than women (P=.04). High school education or less was associated with lower task success (P=.003). Diabetes duration of ≥10 years was associated with lower task accuracy (P=.02). Patients who desired greater autonomy and were interested in learning their patterns of BG and carbohydrates had greater task success (P=.049). CONCLUSIONS: Diabetes app usability was associated with psychological needs that are important for motivation. To enhance patient motivation to use diabetes apps for self-management, clinicians should address competence, autonomy, and connectivity by teaching BG pattern recognition and lifestyle planning, customizing BG targets, and reviewing home-monitored data via email. App usability could be improved for older male users and those with less education and greater diabetes duration by tailoring app training and providing ongoing technical support.

An updated protocol to detect invalid entries in an online survey of men who have sex with men (MSM): how do valid and invalid submissions compare?

Researchers use protocols to screen for suspicious survey submissions in online studies. We evaluated how well a de-duplication and cross-validation process detected invalid entries. Data were from the Sexually Explicit Media Study, an Internet-based HIV prevention survey of men who have sex with men. Using our protocol, 146 (11.6 %) of 1254 entries were identified as invalid. Most indicated changes to the screening questionnaire to gain entry (n = 109, 74.7 %), matched other submissions' payment profiles (n = 56, 41.8 %), or featured an IP address that was recorded previously (n = 43, 29.5 %). We found few demographic or behavioral differences between valid and invalid samples, however. Invalid submissions had lower odds of reporting HIV testing in the past year (OR 0.63), and higher odds of requesting no payment compared to check payments (OR 2.75). Thus, rates of HIV testing would have been underestimated if invalid submissions had not been removed, and payment may not be the only incentive for invalid participation.

Radiology diagnostic exchange agents: clinical term identification and validation.

Diagnostic radiology is one of the key areas of clinical diagnosis on which much of the health care system is built. Along with pathology, radiology has a unique role in providing diagnostic information for prognosis, treatment, and management of clinical conditions. This role is clinically challenging due to the problems of knowledge management associated with the free-text radiology reports which are currently the standard of practice for radiology care. In order to address this critical knowledge management problem, we have proposed a solution using the Radiology Diagnostics Exchange Agent, which is under development and will enhance clinical care management. Using a human computation approach, we have started to identify and validate clinically actionable terms on which an information management infrastructure can be developed with important implications for clinical care and research.

Reducing HIV risk behavior of men who have sex with men through persuasive computing: results of the Men's INTernet Study-II.

OBJECTIVE: The primary objective of this study was to develop and test a highly interactive Internet-based HIV prevention intervention for men who have sex with men (MSM). MSM remain the group at highest risk for HIV/AIDS in the United States and similar countries. As the Internet becomes popular for seeking sex, online interventions to reduce sexual risk are critical. Given previous studies, a secondary objective was to demonstrate that good retention is possible in online trials. DESIGN: A randomized controlled trial with 3-month, 6-month, 9-month, and 12-month follow-up design was employed. METHODS: In 2008, 650 participants were randomized to an online, interactive sexual risk reduction intervention or to a waitlist null control. RESULTS: Retention was 76-89% over 12 months. At 3-month follow-up, results showed a 16% reduction in reported unprotected anal intercourse risk among those in the treatment condition versus control [95% confidence interval (95% CI) of rate ratio: 0.70-1.01]. No meaningful differences were observed at 12-month follow-up. CONCLUSION: Internet-based, persuasive computing programs hold promise as an effective new approach to HIV prevention for MSM, at least in the short term. Further, online trials can be conducted with acceptable retention provided strong retention protocols are employed. Four directions for future research are identified.

HIV sexual risk behavior by men who use the Internet to seek sex with men: results of the Men's INTernet Sex Study-II (MINTS-II).

This study sought to identify the magnitude of HIV risk in a diverse sample of Men who use the Internet to seek Sex with Men (MISM), and test if specific subpopulations are at sufficiently increased risk to warrant tailored interventions. A sample of 2,716 American MISM, stratified by race/ethnicity, completed an Internet survey of online and offline sex seeking behavior during the last 3 months. Across most demographics, a minority of MISM reported unprotected anal intercourse with male partners (UAIMP). Across all demographics, risk of UAIMP substantially increased with partners met online. Other predictors of increased online partner risk include being 30-39 years old, having children, not living in the Northeast, and low income. HIV-positive men and African Americans reported increased online and offline partner risk. To address higher risk of UAIMP, online HIV interventions should prioritize the needs of MISM, especially HIV-positive men, with content focused on online-mediated liaisons.

HIV risk and the internet: results of the Men's INTernet Sex (MINTS) Study.

This study assessed the feasibility of online recruitment of high-risk Latino men who have sex with men (MSM) for HIV prevention survey research and investigated the relationship between Internet use and unsafe sex. Participants (N = 1,026) were Internet-using Latino MSM living in the U.S. recruited using online banner advertisements. Respondents completed a cross-sectional, online survey in English or Spanish. Sample characteristics reflected national statistics within 5%. Nearly all (99%) reported having used the Internet to seek sex with another man. Two-thirds of respondents reported having unprotected anal sex with > or =1 man in the last year, 57% of these with multiple partners. Participants reported engaging in anal sex and unprotected anal sex with nearly twice as many men first met online versus offline, but risk proportions did not differ. Internet-based HIV prevention research is possible even with geographically-dispersed minority populations. Efficiency appears the primary risk associated with meeting partners online.

The Challenges of Ensuring Participant Consent in Internet-based Sex Studies: A Case Study of the Men's INTernet Sex (MINTS-I and II) Studies.

This study documents our experience in designing, testing, and refining human subjects' consent protocol in 3 of the first NIH-funded online studies of HIV/STI sexual risk behavior in the USA. We considered 4 challenges primary: a) designing recruitment and enrollment procedures to ensure adequate attention to subject considerations; b) obtaining and documenting subjects' consent; c) establishing investigator credibility through investigator-participant interactions; d) enhancing confidentiality during all aspects of the study. Human consent in online studies appears more relative, continuous, inherent, tenuous, and diverse than in offline studies. Reasons for declining consent appear related to pragmatic concerns not human subjects' risks. Reordering the consent process, and short, chunked, stepwise, tailored consent procedures may enhance communicating information and documenting consent.

Conducting Internet-based HIV/STD prevention survey research: considerations in design and evaluation.

The aim of this paper is to advance rigorous Internet-based HIV/STD Prevention quantitative research by providing guidance to fellow researchers, faculty supervising graduates, human subjects' committees, and review groups about some of the most common and challenging questions about Internet-based HIV prevention quantitative research. The authors represent several research groups who have gained experience conducting some of the first Internet-based HIV/STD prevention quantitative surveys in the US and elsewhere. Sixteen questions specific to Internet-based HIV prevention survey research are identified. To aid rigorous development and review of applications, these questions are organized around six common criteria used in federal review groups in the US: significance, innovation, approach (broken down further by research design, formative development, procedures, sampling considerations, and data collection); investigator, environment and human subjects' issues. Strategies promoting minority participant recruitment, minimizing attrition, validating participants, and compensating participants are discussed. Throughout, the implications on budget and realistic timetabling are identified.

Characteristics of latino men who have sex with men on the internet who complete and drop out of an internet-based sexual behavior survey.

To identify biases and threats to validity of Internet survey data collection on HIV-related risk behaviors, we studied 1,546 Latino men who have sex with men on the Internet recruited through banner impressions on a leading national gay Internet site. The study could be completed in English or Spanish. Of those commencing, 33.6% dropped out before completing the 450-field questionnaire. None of the linguistic variables (level of use of Spanish or English) predicted dropout. However, dropouts were more likely to identify as Puerto Rican or Black, to reject the $20 compensation or offer it to a charity, to not have met men for sex on the Internet, to identify as bisexual or heterosexual, and to use Web sites or personal ads for contact and to use the Internet less at home than those who completed the study. Men in seroconcordant monogamous relationships and those who had not met a man for sex on the Internet were also more likely to drop out. These data suggest that there are no linguistic and few demographic and Internet use variables that are associated with dropout. Issues of compensation and respondent characteristics that make it likely that there will be a large number of inapplicable data fields in the questionnaire appear to be significant predictors of dropout. Although there were many data missing, the dropouts did not appear to be at greater HIV-associated risk than the completers. The fact that there appear to be few systematic demographic or Internet use biases in dropouts suggests that the completers do not represent a seriously skewed sample of those Latinos who commence the Internet survey.