Identifying barriers and facilitators for using a smartwatch to monitor health among older adults.

Smartwatches are a type of wearable device that enable continuous monitoring of an individual's activities and critical health metrics. As the number of older adults age 65+ continues to grow in the U.S., so does their usage of smartwatches, making it necessary to understand the real-world uptake and use of these devices to monitor health. In this study, older adults with a relatively high level of education and digital skills were provided with a smartwatch equipped with a mobile application (ROAMM) that was worn for a median of 14 days. Usability surveys were distributed, and a qualitative analysis was performed about participants' experience using the smartwatch and ROAMM application. Constructs from the Technology Acceptance Model and Consolidated Framework for Implementation Research were incorporated into in-depth interviews, which were recorded and transcribed. Data were analyzed using the constant comparative method. Interviews among 30 older adults revealed the following main themes: 1) familiarization with the device and adoption and acceptance, 2) factors encouraging usage, such as a doctor's endorsement or the appeal of tracking one's health, and 3) barriers to usage, such as insufficient education and training and the desire for additional functionality. Overall, participants found the smartwatch easy to use and were likely to continue using the device in a long-term study. Data generated from smartwatches have the potential to engage individuals about their health and could inspire them to participate more actively during clinical encounters.

Tele-Oncology Use During the COVID-19 Pandemic: Patient Experiences and Communication Behaviors with Clinicians.

Background: Tele-oncology became a widely used tool during the COVID-19 pandemic, but there was limited understanding of how patient-clinician communication occurred using the technology. Our goal was to identify how communication transpired during tele-oncology consultations compared with in-person appointments. Methods: A convergent parallel mixed-method design was utilized for the web-based survey, and follow-up interviews were conducted with cancer patients from March to December 2020. Participants were recruited from the University of Florida Health Cancer Center and two national cancer organizations. During the survey, participants rated their clinician's patient-centered communication behaviors. Open-ended survey responses and interview data were combined and analyzed thematically using the constant comparative method. Results: A total of 158 participants completed the survey, and 33 completed an interview. Ages ranged from 19 to 88 years (mean = 64.2; standard deviation = 13.0); 53.2% identified as female and 44.9% as male. The majority of respondents (76%) considered communication in tele-oncology equal to in-person visits. Preferences for tele-oncology included the ability to get information from the clinician, with 13.5% rating tele-oncology as better than in-person appointments. Tele-oncology was considered worse than in-person appointments for eye contact (n = 21, 12.4%) and virtual waiting room times (n = 50, 29.4%). The following qualitative themes corresponded with several quantitative variables: (1) commensurate to in-person appointments, (2) uncertainty with the digital platform, (3) lack of a personal connection, and (4) enhanced patient experience. Conclusion: Patient-centered communication behaviors were mostly viewed as equally prevalent during tele-oncology and in-person appointments. Addressing the challenges of tele-oncology is necessary to improve the patient experience.

Understanding the Design of Fear Appeals by Applying the Extended Parallel Process Model: A Qualitative Analysis of COVID-19 Public Service Announcements.

PURPOSE: Identify how early COVID-19 public health messages incorporated in the tenets of the extended parallel process model (EPPM). SETTING: YouTube videos developed by governmental departments, medical institutions, news organizations, and non-profit organizations in the United States were aggregated. METHOD: This qualitative study conducted a keyword search to identify public service announcements (PSAs). The sample was further refined after searching PSAs that contained fear appeals. A thematic analysis was performed by using the constant comparative method. SAMPLE: A total of forty-three videos was included in the final analysis. RESULT: Two themes emerged regarding messages aimed at arousing the perceived severity of threat. These themes include emphasizing the consequences of being infected and utilizing personal narratives. Perceived susceptibility of threat was aroused by emphasizing that some groups have higher risks than others. Two themes emerged around arousing perceived response efficacy: (1) the authority of professionals; and (2) altruism and personal responsibility. One way was identified to arouse perceived self-efficacy, which is informing the protective measures. CONCLUSION: Multiple strategies were used in PSAs about COVID-19 to arouse fear during the early stages of the pandemic. The utilization of self-efficacy was oversimplified, by not providing details about the rationale for the recommended behavior.

Identifying the mechanisms of patient-centred communication in secure messages between clinicians and cancer patients.

Objective: Identify how patients and clinicians incorporate patient-centered communication (PCC) within secure messaging. Methods: A random sample of 199 secure messages from patient portal communication between patients and clinicians were collected and analyzed. Via manual annotation, the task of tagging target words/phrases in text, we identified five components of PCC: information giving, information seeking, emotional support, partnership, and shared decision-making. Textual analysis was also performed to understand the context of PCC expressions within messages. Results: Information-giving was the predominant (n = 346, 68.1%) PCC category used in secure messaging, more than double of the other four PCC codes, information-seeking (n = 82, 16.1%), emotional support (n = 52, 10.2%), shared decision making (n = 5, 1.0%), combined. The textual analysis revealed that clinicians informed patients about appointment reminders and new protocols while patients reminded clinicians about upcoming procedures and outcomes of test results conducted by other clinicians. Although less common, patients expressed statements of concern, uncertainty, and fear; enabling clinicians to provide support. Conclusion: Secure messaging is mainly used for exchanging information, but other aspects of PCC emerge using this channel of communication. Innovation: Meaningful discussions can occur via secure messaging, and clinicians should be mindful of incorporating PCC when communicating with patients through secure messaging.

Feasibility of a Smartwatch Platform to Assess Ecological Mobility: Real-Time Online Assessment and Mobility Monitor.

BACKGROUND: Early detection of mobility decline is critical to prevent subsequent reductions in quality of life, disability, and mortality. However, traditional approaches to mobility assessment are limited in their ability to capture daily fluctuations that align with sporadic health events. We aim to describe findings from a pilot study of our Real-time Online Assessment and Mobility Monitor (ROAMM) smartwatch application, which uniquely captures multiple streams of data in real time in ecological settings. METHODS: Data come from a sample of 31 participants (Mage = 74.7, 51.6% female) who used ROAMM for approximately 2 weeks. We describe the usability and feasibility of ROAMM, summarize prompt data using descriptive metrics, and compare prompt data with traditional survey-based questionnaires or other established measures. RESULTS: Participants were satisfied with ROAMM's function (87.1%) and ranked the usability as "above average." Most were highly engaged (average adjusted compliance = 70.7%) and the majority reported being "likely" to enroll in a 2-year study (77.4%). Some smartwatch features were correlated with their respective traditional measurements (eg, certain GPS-derived life-space mobility features (r = 0.50-0.51, p < .05) and ecologically measured pain (r = 0.72, p = .01), but others were not (eg, ecologically measured fatigue). CONCLUSIONS: ROAMM was usable, acceptable, and effective at measuring mobility and risk factors for mobility decline in our pilot sample. Additional work with a larger and more diverse sample is necessary to confirm associations between smartwatch-measured features and traditional measures. By monitoring multiple data streams simultaneously in ecological settings, this technology could uniquely contribute to the evolution of mobility measurement and risk factors for mobility loss.

Integrating patient-centeredness into online patient-clinician communication: a qualitative analysis of clinicians' secure messaging usage.

PURPOSE: Patient-centered communication (PCC) in cancer care is helpful to nurture the patient-clinician relationship and respond to patients' emotions. However, it is unknown how PCC is incorporated into electronic patient-clinician communication. METHODS: In-depth, semi-structured qualitative interviews with clinicians were conducted to understand how PCC was integrated into asynchronous communication between patients and clinicians; otherwise, known as secure messaging. The constant comparative method was used to develop a codebook and formulate themes. RESULTS: Twenty clinicians in medical and radiation oncology participated in audio-recorded interviews. Three main themes addressed how clinicians incorporate PCC within messages: (1) being mindful of the patient-clinician relationship, (2) encouraging participation and partnership, and (3) responding promptly suggests accessibility and approachability. Clinicians recommended that patients could craft more effective messages by being specific, expressing concern, needs, and directness, summarized by the acronym S.E.N.D. CONCLUSIONS: Clinicians value secure messaging to connect with patients and demonstrate their accessibility. They acknowledge that secure messaging can influence the patient-clinician relationship and make efforts to include considerate and supportive language. As secure messaging is increasingly relied upon for patient-clinician communication, patients' message quality must improve to assist clinicians in being able to provide prompt responses inclusive of PCC.

Clinicians' Attitudes and Behaviors Towards Communicating Electronically with Patients: A Grounded Practical Theory Approach.

Secure messaging (SM), asynchronous communication between patients and clinicians, is an increasingly popular tool among patients to contact clinicians about their care. Despite patients' enthusiasm, clinicians have been hesitant to embrace the technology to communicate with patients. Using the theoretical and methodological framework of Grounded Practical Theory (GPT), we analyzed and interpreted clinicians' perceptions, attitudes, and approaches toward SM to communicate with patients. Twenty clinicians in medical oncology and radiation oncology participated in audio-recorded, semi-structured interviews. Findings revealed the problems with using SM, such as difficulty interpreting low-quality messages, the amount of time needed to devote to responding, and its potential to negatively affect the patient-clinician relationship. Techniques employed to manage such problems consisted of using different forms of communication and utilizing messaging to expedite workloads. The philosophical rationale of clinicians toward SM was that it can improve patient care and this form of communication is already embedded within existing patient care. Overall, this article clarifies how clinicians can re-conceptualize how they think about SM so that it becomes a productive, informative, and useful aspect of patient care.

Practicing Mindfulness through mHealth Applications: Emerging Adults' Health-Enhancing and Inhibiting Experiences.

Mindfulness-based interventions (MBIs) and practices (MBPs) can promote better health outcomes. Although MBIs and MBPs were developed to be delivered in-person, mobile health (mHealth) tools such as apps have made these more accessible. Mindfulness apps (MAs) are popular among emerging adults (EAs) who have the highest ownership of smartphones and who are also at risk for distress. While adverse effects have been observed with MBIs/MBPs, this has not been examined when mindfulness is practiced using apps. We interviewed EAs (n = 22) to capture their motivations for using these apps and identified health-inhibiting and enhancing experiences. Data were thematically analyzed using the constant comparative method. Motivations for app use included accessibility, convenience, and stress/health management. EAs described health-enhancing outcomes (reduced distress, improved physical symptoms, increased focus) and health-inhibiting outcomes (worsened distress, performance uncertainty, dependency development, worsened physical health). They provided suggestions for improving apps (e.g., feedback option). These findings illustrate benefits and risks that EAs may encounter when practicing mindfulness using apps, which can inform the best practices for app design.

Clinicians' Perceptions of the Benefits and Challenges of Teleoncology as Experienced Through the COVID-19 Pandemic: Qualitative Study.

BACKGROUND: COVID-19 thrust both patients and clinicians to use telemedicine in place of traditional in-person visits. Prepandemic, limited research had examined clinician-patient communication in telemedicine visits. The shift to telemedicine in oncology, or teleoncology, has placed attention on how the technology can be utilized to provide care for patients with cancer. OBJECTIVE: Our objective was to describe oncology clinicians' experiences with teleoncology and to uncover its benefits and challenges during the first 10 months of the COVID-19 pandemic. METHODS: In-depth, semistructured qualitative interviews were conducted with oncology clinicians. Using an inductive, thematic approach, the most prevalent themes were identified. RESULTS: In total, 21 interviews with oncology clinicians revealed the following themes: benefits of teleoncology, such as (1) reducing patients' travel time and expenses, (2) limiting COVID-19 exposure, and (3) enabling clinicians to "see" a patients' lifestyle and environment, and challenges, such as (1) technological connection difficulties, (2) inability to physically examine patients, and (3) patients' frustration related to clinicians being late to teleoncology appointments. CONCLUSIONS: Teleoncology has many benefits and is well suited for specific types of appointments. Challenges could be addressed through improved communication when scheduling appointments to make patients aware about what to expect. Ensuring patients have the proper technology to participate in teleoncology and an understanding about how it functions are necessary.

Secure Messaging and COVID-19: A Content Analysis of Patient-Clinician Communication During the Pandemic.

Background: Coronavirus disease 2019 (COVID-19) immediately impacted patient-clinician communication, particularly in the oncology setting. Relatedly, secure messaging (SM) usage greatly increased, yet it is unknown what was discussed and whether the technology was utilized to disseminate information. Aims: This study aimed at identifying the most frequently discussed topics using SM as well as at understanding how the communication process transpired during the early stages of the pandemic. Materials and Methods: A mixed-methods design was utilized, consisting of a content analysis of more than 4,200 secure messages, aggregated into 1,454 patient-clinician discussions. Data were collected from February 2020 to May 2020. Discussions were from various oncology departments and included physicians, physician assistants, and nurses. Based on the identified categories, a thematic analysis was conducted to understand the nuances occurring within discussions. Results: Out of the 1,454 discussions, 26% (n = 373) related to COVID-19. Of the COVID-19 discussion, the most frequently coded category was "changes, adjustments, and re-arranging care" (65%, n = 241), followed by "risk for COVID-19" (24%, n = 90), "precautions inside the hospital" (18%, n = 66), and "precautions outside the hospital" (14%, n = 52). Natural language processing techniques were used to confirm the validity of the results. Thematic analysis revealed that patients were proactive in rescheduling appointments, expressed anxiety about being immunocompromised, and clinicians were uncertain about providing recommendations related to COVID-19. Conclusions: The COVID-19 outbreak revealed the need for responsive and effective public health communication. The SM can disseminate information from trusted sources, clinicians, but can be better utilized to deliver tailored information for specific patient populations.

Vaping and Instagram: A Content Analysis of e-Cigarette Posts Using the Content Appealing to Youth (CAY) Index.

BACKGROUND: The promotion of flavors, perceptions of "coolness," and general curiosity are characteristics of electronic nicotine delivery systems (ENDS) that have appealed to young adults. However, little is known about the characteristics of popular social media posts related to ENDS on the social media network, Instagram. Methods: Content analysis was performed using the Content Appealing to Youth (CAY) index. Over 700 posts were collected from August 2019 - December 2019 by searching the Instagram hashtags, #vape and #vapelife. Frequencies and percentages were calculated for each of the six major categories and 35 sub-categories. Results: Nearly all of the images were color photographs and 84% featured an ENDS device (mod) as the focal point. The style of the device was often matte (75%) in only one or two main colors (55%). Warnings about age restrictions and nicotine were included in 28% of images, but commonly used promotional tactics, such as humor, presence of vapor puffs, and flavors were rarely utilized. Conclusions: Instagram posts featuring ENDS are visually appealing and like cigarette packaging, may have the capacity to influence perceptions about the product. Since it is culturally normative for appealing images to be shared on Instagram, greater attention should be placed on media literacy skills to educate young adults about ENDS viewed on social media.

The Causal Relationship Between Portal Usage and Self-Efficacious Health Information-Seeking Behaviors: Secondary Analysis of the Health Information National Trends Survey Data.

BACKGROUND: Patient portals have drawn much attention, as they are considered an important tool for health providers in facilitating patient engagement. However, little is known about whether the intensive use of patient portals contributes to improved management of patients' health in terms of their confidence in acquiring health information and exercising self-care. There is a lack of randomized trials with these outcomes measured both pre- and postadoption of patient portals. OBJECTIVE: The aim of this study was to examine the causal relationship between the usage of patient portals and patients' self-efficacy toward obtaining health information and performing self-care. METHODS: This study was a secondary data analysis that used data from a US national survey, the National Cancer Institute's Health Information National Trends Survey 5 Cycle 1. Patient portal usage frequency was used to define the treatment. Survey items measuring self-efficacy on a Likert-type scale were selected as the main outcomes, including patients' confidence in obtaining health information and performing self-care. To establish causality using survey data, we adopted the instrumental variables method. To determine the direction of the causal relationship in the presence of high-dimensional confounders, we further proposed a novel testing framework that employs conditional independence tests in a directed acyclic graph. The average causal effect was measured using the two-stage least squares regression method. RESULTS: We showed that frequently using patient portals improves patients' confidence in obtaining health information. The estimand of the weighted average causal effect was 0.14 (95% CI 0.06-0.23; P<.001). This means that when increasing the portal usage intensity, for instance, from 1-2 times to 3-5 times per year, the expected average increase in confidence level measured on a Likert-type scale would be 0.14. However, we could not conclusively determine the causal effect between patient portal usage and patients' confidence in exercising self-care. CONCLUSIONS: The results support the use of patient portals and encourage better support and education to patients. The proposed statistical method can be used to exploit the potential of national survey data for causal inference studies.

Twenty-first Century Bedside Manner: Exploring Patient-Centered Communication in Secure Messaging with Cancer Patients.

Patient-centered communication (PCC) is integral to providing high-quality health care and is recommended to be incorporated during face-to-face consultations. Electronic communication, such as the use of secure messaging (SM) within patient portals, is a popular form of patient-provider communication, but preliminary studies have shown that PCC is rarely utilized by providers in SM. As a consequence, the patient-provider relationship can be negatively affected, especially for cancer patients who have greater electronic health information needs than the general population. Therefore, our objective was to determine the importance of SM to cancer patients and to identify which attributes of PCC are preferred to be incorporated into secure messages. Five focus groups were conducted, comprised of patients with a current or previous cancer diagnosis (three all-female; two all-male). Participants recalled their own experiences and reviewed simulated messages. Three main topics emerged from the thematic analysis: (1) the normalization of SM, (2) SM quality can affect perceptions of care, and (3) patients need guidance. Overall, participants valued the ability to communicate with their care team using SM and indicated that electronic communication may have the potential to have just as big of an impact on a patient's care than in-person communication.

Fatalistic Cancer Beliefs Across Generations and Geographic Classifications: Examining the Role of Health Information Seeking Challenges and Confidence.

Information seeking is an active health behavior that influences cancer fatalism; however, people commonly experience challenges in accessing high-quality and actionable health information that is personally relevant. This is especially common among older and rural adults who have a high cancer risk. The purpose of this study was to examine the theoretical assumption that enhancing perceived confidence to overcome health information seeking challenges will alleviate cancer fatalism. In 2017, 895 adults from a large southeastern medical university's cancer catchment area participated in a random digit dial survey. Participants were Millennials (18-35; 19%), Generation X (36-51; 23%), Baby Boomers (52-70; 40%), and Silent Generation (71-95; 16.9%) who had equal representation across metro (78.9%) and nonmetro (21.1%) counties. Younger generations (Millennials and Generation X) held stronger fatalistic cancer beliefs ("It seems like everything causes cancer," "When I think about cancer, I automatically think about death") than older generations. Most participants believed that precautionary efforts exist to reduce their chances of getting cancer, which was strongest among individuals residing in metro counties. In controlling for generation and geographic residence, individuals who experienced challenges in the process of accessing health information had stronger fatalistic beliefs about cancer prevention; however, this relationship was most pronounced among individuals with confidence to ultimately obtain information that they needed. This study contributes to evidence for health information equity in combatting fatalistic cancer beliefs. Findings have important implications for the optimized dissemination of culturally adapted cancer education and skill-based training to efficiently access and evaluate relevant cancer education.

Improving secure messaging: A framework for support, partnership & information-giving communicating electronically (SPICE).

BACKGROUND: Patient-centered communication benefits patients and is widely endorsed. However, it is primarily associated with face-to-face contexts, although patients are increasingly using electronic platforms, such as secure messaging in patient portals, to communicate with providers. PURPOSE: Given the popularity of secure messaging and its ability to impact the patient-provider relationship, this study aimed to determine which attributes of patient-centered communication are most desired by cancer patients using secure messaging. METHODS: A 26 balanced incomplete block design discrete choice experiment was conducted using the best-worst scaling technique. Respondents were asked to select their most and least preferred attributes of two simulated patient-provider exchanges within each of eight choice sets. RESULTS: 210 respondents indicated that either level of partnership (high and low) and either level of information-giving (high and low) were most preferred, while response times greater than 24 hours and low levels of support were least favored. CONCLUSIONS: Similar to face-to-face communication, patients value aspects of patient-centered communication in the secure messaging setting and desire them to be included in provider replies. PRACTICE IMPLICATIONS: Patient-centered communication is important to patients using secure messaging. Providers should incorporate SPICE (Support, Partnership, and Information-giving while Communicating Electronically).

A Simulated Graphical Interface for Integrating Patient-Generated Health Data From Smartwatches With Electronic Health Records: Usability Study.

BACKGROUND: Wearable technology, such as smartwatches, can capture valuable patient-generated data and help inform patient care. Electronic health records provide logical and practical platforms for including such data, but it is necessary to evaluate the way the data are presented and visualized. OBJECTIVE: The aim of this study is to evaluate a graphical interface that displays patients' health data from smartwatches, mimicking the integration within the environment of electronic health records. METHODS: A total of 12 health care professionals evaluated a simulated interface using a usability scale questionnaire, testing the clarity of the interface, colors, usefulness of information, navigation, and readability of text. RESULTS: The interface was positively received, with 14 out of the 16 questions generating a score of 5 or greater among at least 75% of participants (9/12). On an 8-point Likert scale, the highest rated features of the interface were quick turnaround times (mean score 7.1), readability of the text (mean score 6.8), and use of terminology/abbreviations (mean score 6.75). CONCLUSIONS: Collaborating with health care professionals to develop and refine a graphical interface for visualizing patients' health data from smartwatches revealed that the key elements of the interface were acceptable. The implementation of such data from smartwatches and other mobile devices within electronic health records should consider the opinions of key stakeholders as the development of this platform progresses.

Secondary care provider attitudes towards patient generated health data from smartwatches.

Wearable devices, like smartwatches, are increasingly used for tracking physical activity, community mobility, and monitoring symptoms. Data generated from smartwatches (PGHD_SW) is a form of patient-generated health data, which can benefit providers by supplying frequent temporal information about patients. The goal of this study was to understand providers' perceptions towards PGHD_SW adoption and its integration with electronic medical records. In-depth, semi-structured qualitative interviews were conducted with 12 providers from internal medicine, family medicine, geriatric medicine, nursing, surgery, rehabilitation, and anesthesiology. Diffusion of Innovations was used as a framework to develop questions and guide data analysis. The constant comparative method was utilized to formulate salient themes from the interviews. Four main themes emerged: (1) PGHD_SW is perceived as a relative advantage; (2) data are viewed as compatible with current practices; (3) barriers to overcome to effectively use PGHD_SW; (4) assessments from viewing sample data. Overall, PGHD_SW was valued because it enabled access to information about patients that were traditionally unattainable. It also can initiate discussions between patients and providers. Providers consider PGHD_SW important, but data preferences varied by specialty. The successful adoption of PGHD_SW will depend on tailoring data, frequencies of reports, and visualization preferences to correspond with the demands of providers.

A content analysis of the promotional strategies employed by e-cigarette brands on Twitter.

Cigarette smoking in the U.S. is declining, but e-cigarette (e-cig) use is rapidly expanding. E-cig brands utilize social media for promotion and have the autonomy to disseminate messages that encourage the use of their products. The current study categorized the most frequent strategies among popular e-cig brands on Twitter. A content analysis of over 1800 tweets was performed based on Philip Morris brand personality characteristics. Most tweets emphasized e-cigs' economic value (24.2%) and normalized their use by portraying e-cigs as "cool" (23.1%). E-cig brands are employing similar strategies as tobacco companies and easily connecting to young adults through social media.

Patient access to clinical notes in oncology: A mixed method analysis of oncologists' attitudes and linguistic characteristics towards notes.

BACKGROUND: Providers have expressed concern about patient access to clinical notes. There is the possibility that providers may linguistically censor notes knowing that patients have access. PURPOSE: Qualitative interviews and a pre- and post- linguistic analysis of the implementation of OpenNotes was performed to determine whether oncologists changed the content and style of their notes. METHODS: Mixed methods were utilized, including 13 semi-structured interviews with oncologists and random effects modeling of over 500 clinical notes. The Linguistic Inquiry and Word Count program was used to evaluate notes for emotions, thinking styles, and social concerns. RESULTS: No significant differences from pre- and post-implementation of OpenNotes was found. Thematic analysis revealed that oncologists were concerned that changing their notes would negatively impact multidisciplinary communication. However, oncologists acknowledged that notes could be more patient-friendly and may stimulate patient-provider communication. CONCLUSIONS: Although oncologists were aware that patients could have access, they felt strongly about not changing the content of notes. A comparison between pre- and post-implementation confirmed this view and found that notes did not change. PRACTICE IMPLICATIONS: Patient access to oncologist's notes may serve as an opportunity to reinforce important aspects of the consultation.