Telemedicine in monitoring pediatric LT patients before and during COVID-19 pandemic.

BACKGROUND: The delivery of healthcare services by telemedicine decreases costs of traveling for patients, is less time-consuming, and most importantly permits the connection between highly skilled specialists and patients. However, whether the use of telemedicine (text messaging) for LT patients was affected by the COVID-19 pandemic is unknown. METHODS: We collected data (following consent from patients and parents) from 57 patients (33 male/24 female) with a median age of 47 (IQR: 9-91) months, whom we followed up with text messaging between September 2019 and September 2020, spanning the 6 months prior to COVID-19 and during this period. RESULTS: In total, 723 text message mediated consultations occurred during this period, henceforth simply referred to as "messages." Three hundred and twenty-eight (45%) messages occurred during the 6 months up to the start of the pandemic. Following the COVID-19 outbreak, the number of messages increased to 395 (55%). The three most common reasons of messaging were post-liver-LT follow-up messages (n = 215/723, 29.7%), consultations for drug use (n = 157/723, 21.7%), and medication prescriptions (n = 113/723, 15.6%). Protocol biopsy discussions (n = 33/723, 4.6%) and fever (n = 27/723, 3.7%) were among others (vaccination, rash, diarrhea, cough, fatigue, acne). During the COVID-19 outbreak, only post-LT follow-up messages increased significantly to 132/395 (33%) from 83/328 (25%) (p-value: .02). CONCLUSIONS: We found that the pandemic resulted in an increase in the total number of text message mediated consultations and specifically for the use of post-LT follow-up. Messaging was effective for post-LT follow-ups and all patients were at least satisfied.

Acceptability of Texting 4 Relapse Prevention, Text Messaging-Based Relapse Prevention Program for People With Schizophrenia and Schizoaffective Disorder.

ABSTRACT: We report process outcomes of the pilot randomized controlled trial of Texting 4 Relapse Prevention (T4RP), a text messaging-based relapse prevention program for people with schizophrenia or schizoaffective disorder (SAD). Forty people were randomized to either the intervention or treatment as usual control group at a 2:1 ratio. Process indicators were collected at 6 months post enrollment.Over 90% of patients agreed or strongly agreed that the text messages were easy to understand, easy to answer, positive, and helped them feel supported. Patient acceptability was positively associated with recovery (ß = 0.29, p = <0.001) and patient-provider communication scores (ß = 1.04, p < 0.001), and negatively associated with symptoms of the disorder (ß = -0.27, p = 0.07). Acceptability was similar by diagnosis (ß, SAD diagnosis = 0.40, p = 0.90) and age (ß = 0.05, p = 0.67). Findings suggest that a text messaging intervention aimed at preventing relapse is feasible and perceived as beneficial in individuals with schizophrenia and SAD. Future research might include a targeted study of T4RP within the context of hospital discharge when people with schizophrenia/SAD are at highest risk of relapse.

Putting the social back into physical distancing: The role of digital connections in a pandemic crisis.

During the COVID-19 pandemic, physical distancing is necessary to reduce the spread of the coronavirus. To compensate for the lack of social encounters, people have been advised to connect with others via digital communication channels. Drawing on a psychological framework combined with assumptions from communication science, we therefore investigated whether technology-mediated communication can actually meet individuals' social needs to foster compliance with distancing measures and whether there are differences between distinct communication channels. Based on an online survey (N = 301) during the first national lockdown in Germany, we found that the impact of audio-visual communication is limited. Instead, the data showed that text-based communication indirectly fostered willingness to adhere to physical distancing through the pathway of increased feelings of social support and life satisfaction. Three follow-up surveys (N = 180) revealed that while feelings of social support increased, people's technology-based communication and willingness to adhere to distancing measures decreased. Our results challenge the assumption that audio-visual communication compensates for lack of physical contact more effectively than text-based communication. This study highlights the potential of text-based communication to increase feelings of social support, which may be particularly important during a pandemic.

Changes in Low Back Muscle Activity and Spine Kinematics in Response to Smartphone Use During Walking.

STUDY DESIGN: Within-subject design of an experimental study. OBJECTIVE: The aim of this study was to determine the effects of smartphone use on the activity level of the lumbar erector spinae muscles and spine kinematics during walking. SUMMARY OF BACKGROUND DATA: Using a smartphone while walking makes the user hold the phone steady and look downward to interact with the phone. Walking with this non-natural posture of the head and the arms may alter the spine kinematics and increase the muscular load on the low back extensor muscles. METHODS: Twenty healthy young individuals participated in the laboratory experiment. Each participant walked on a treadmill in five different conditions: normal walking without using a phone, conducting one-handed browsing while walking, two-handed texting while walking, walking with one arm bound, and walking with both arms bound. Spine kinematics variables and the myoelectric activity levels of the lumbar erector spinae muscles were quantified and compared between the five walking conditions. RESULTS: Participants walked with significantly (P < 0.05) more thoracic kyphosis and lumbar lordosis when using a phone compared to when walking without using the phone. The median level of muscle activity was also 16.5% (browsing) to 31.8% (texting) greater for the two smartphone use conditions than for the normal walking condition, and the differences were significant (P < .05). Between the normal walking and the two bound arm walking conditions, no significant difference in the muscle activity was found. CONCLUSION: Study results show that the concurrent use of a smartphone while walking could pose a larger muscular load to the lumbar erector spinae muscles than that of normal walking. Habitual use of a smartphone while walking could be a risk factor for low back musculoskeletal problems.Level of Evidence: N/A.

Association Between Text Neck and Neck Pain in Adults.

STUDY DESIGN: Observational cross-sectional study. OBJECTIVE: The aim of this study was to investigate the association between text neck and neck pain (NP) in adults. SUMMARY OF BACKGROUND DATA: It has been hypothesized that the inappropriate neck posture adopted when texting and reading on a smartphone, called text neck, is related to the increased prevalence of NP. METHODS: The sample was composed of 582 volunteers aged between 18 and 65 years. Sociodemographics, anthropometrics, lifestyle, psychosocial, NP, and smartphone use-related questions were assessed by a self-reported questionnaire. Text neck was assessed by measuring the cervical flexion angle of the participants standing and sitting while typing a text on their smartphones, using the Cervical Range of Motion (CROM) device. RESULTS: Multiple logistic regression analysis and linear regression analysis showed the cervical flexion angle of the standing participant using a smartphone did not associate with the prevalence of NP (odds ratio [OR] = 1.00; 95% confidence interval [CI]: 0.98-1.02; P = 0.66), NP frequency (OR = 1.01; 95% CI: 1.00-1.03; P = 0.056), or maximum NP intensity (beta coefficient = -5.195 × 10-5; 95% CI: -0.02 to 0.02; P = 0.99). Also, the cervical flexion angle of the sitting participant using the smartphone did not associate with NP (OR = 0.99; 95% CI: 0.98-1.01; P = 0.93), NP frequency (OR = 1.01; 95% CI: 0.99-1.02; P = 0.13), or maximum NP intensity (beta coefficient = 0.002; 95% CI: -0.002 to 0.02; P = 0.71). CONCLUSION: Text neck was not associated with prevalence of NP, NP frequency, or maximum NP intensity in adults.Level of Evidence: 4.

Clinical outcomes from the texting for relapse prevention (T4RP) in schizophrenia and schizoaffective disorder study.

This 6 month randomized control trial investigated whether a novel text-messaging program impacted targeted clinical outcomes in patients with schizophrenia and schizoaffective disorder (SAD). Forty patients were enrolled and completed baseline, 3-month and 6-month assessments. The intervention group received daily symptom check-in text messages, plus, a medication reminder or, inspirational quote text. The control group had treatment as usual. At 6 months the Positive and Negative Syndrome Scale mean positive score was significantly lower and injectable medication compliance was significantly higher in the intervention group. Recovery scores were significantly higher at 3 months. Results suggest that this program may benefit individuals with schizophrenia/SAD who use text messaging. Further investigation in a larger sample appears warranted.

Tailoring a mobile health text-messaging intervention to promote antiretroviral therapy adherence among African Americans: A qualitative study.

African Americans are disproportionately affected by HIV and socio-structural barriers that impact antiretroviral (ART) adherence. Two-way text-messaging interventions have shown promise in supporting adherence in US studies of mostly White people living with HIV (PLWH). However, culturally-appropriate tailoring is necessary to maximize intervention effectiveness among other racial/ethnic groups. Thus, to refine an existing text-messaging intervention, we examined barriers and facilitators to ART adherence among African Americans and perspectives on features to integrate into the extant intervention. Three focus groups, two with African American PLWH (n = 5 and n = 7) and one with providers of care (n = 11) were conducted; transcripts of audio-recordings were thematically analyzed. Adherence supports operated at individual, interpersonal, and structural/environmental levels (e.g., using reminders and pill organizers, wanting to protect partners from HIV, and positive interactions with providers). Adherence barriers also operated at multiple ecological levels (e.g., poor mental health, fear of disclosure of HIV status, and unstable housing). Participant-suggested features for refinement included: i) matching content to participants' comfort with receiving messages referencing HIV or medication-taking, ii) culturally-tailoring content for African Americans, iii) tracking adherence, and iv) encouraging adherence interactions between patients and providers. Feedback from both patients and providers is foundational to designing effective ART interventions among African American PLWH.

Usability and acceptability of a two-way texting intervention for post-operative follow-up for voluntary medical male circumcision in Zimbabwe.

BACKGROUND: Voluntary medical male circumcision (MC) is safe and effective. Nevertheless, MC programs require multiple post-operative visits. In Zimbabwe, a randomized control trial (RCT) found that post-operative two-way texting (2wT) between clients and MC providers instead of in-person reviews reduced provider workload and safeguarded patient safety. A critical component of the RCT assessed usability and acceptability of 2wT among providers and clients. These findings inform scale-up of the 2wT approach to post-operative follow-up. METHODS: The RCT assigned 362 adult MC clients with cell phones into 2wT; these men responded to 13 automated daily texts supported by interactive texting or in-person follow-up, when needed. A subset of 100 texting clients filled a self-administered usability survey on day 14. 2wT acceptability was ascertained via 2wT response rates. Among 2wT providers, eight key informant interviews focused on 2wT acceptability and usability. Influences of wage and age on response rates and client-reported potential AEs were explored using linear and logistic regression models, respectively. RESULTS: Clients felt confident, comfortable, satisfied, and well-supported with 2wT-based follow-up; few noted texting challenges or concerns about healing. Clients felt 2wT saved them time and money. Response rates (92%) suggested 2wT acceptability. Both clients and providers felt 2wT was highly usable. Providers noted 2wT saved them time, empowered clients to engage in their healing, and closed gaps in MC service quality. For scale, providers reinforced good post-operative counseling on AEs and texting instructions. Wage and age did not influence text response rates or potential AE texts. CONCLUSION: Results strongly suggest that 2wT is highly usable and acceptable for providers and patients. Men with concerns solicited provider guidance and reassurance offered via text. Providers noted that men engaged proactively in their healing. 2wT between providers and patients should be expanded for MC and considered for other short-term care contexts. The trial is registered on ClinicalTrials.gov, trial NCT03119337, and was activated on April 18, 2017. https://clinicaltrials.gov/ct2/show/NCT03119337.

Text message reminders for improving sun protection habits: A systematic review.

BACKGROUND: Excessive exposure to ultraviolet radiation increases the risk of skin cancer and other conditions. SMS text reminders may be a useful tool to improve sun protection habits due to its massive reach, low cost, and accessibility. OBJECTIVE: To perform a systematic review of randomized controlled trials (RCTs) that evaluated the effects of SMS text reminders in promoting sun protection habits. METHODS: We performed a systematic search in PubMed, Central Cochrane Library, and Scopus; following the PRISMA recommendations to perform systematic reviews. We included RCTs published up to December 2018, which evaluated the benefits and harms of SMS text reminders to improve sun protection habits. Random-effects meta-analyses were performed whenever possible. The certainty of the evidence was assessed for RCTs estimates using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The study protocol was registered in PROSPERO (CRD42018091661). RESULTS: Five RCTs were included in this review. When pooled, the studies found no effect of SMS text reminders in "sunburn anytime during follow-up" (two studies, risk ratio: 0.93; 95% confidence interval: 0.83-1.05). Contradictory results were obtained for sunscreen use (three RCTs) and sun protection habits (two RCTs), however, they could not be meta-analyzed because outcomes were measured differently across studies. The certainty of the evidence was very low for these three outcomes according to GRADE methodology. CONCLUSIONS: RCTs that assessed effects of SMS text reminders did not find a significant benefit on objective outcomes, such as having a sunburn, sunscreen use and composite score of sun protection habits. Since certainty of the evidence was very low, future high-quality studies are needed to reach a conclusion regarding the balance of desirable and undesirable outcomes. PROTOCOL REGISTRATION NUMBER: PROSPERO (CRD42018091661).

Coronavirus Disease 2019 Pandemic: Health System and Community Response to a Text Message (Text4Hope) Program Supporting Mental Health in Alberta.

In an effort to support the mental health of Albertans during the coronavirus disease 2019 (COVID-19) pandemic, Alberta Health Services launched a supportive text message (Text4Mood) program on March 23, 2020. The program was simultaneously approved for funding by the 6 regional health foundations and launched within 1 week of conception. Residents of Alberta can subscribe to the program by texting "COVID19HOPE" to a sort code number. Each subscriber receives free daily supportive text messages, for 3 months, crafted by a team of clinical psychologists, psychiatrists, mental health therapist, and mental health service users. Within 1 week of the launch of Text4Hope, 32 805 subscribers had signed up to the program, and there have been expressions of interests from other jurisdictions to implement a similar program to support the mental health of those in quarantine, isolation, or lockdown.

Text Messaging as a Screening Tool for Depression and Related Conditions in Underserved, Predominantly Minority Safety Net Primary Care Patients: Validity Study.

BACKGROUND: SMS text messaging is an inexpensive, private, and scalable technology-mediated assessment mode that can alleviate many barriers faced by the safety net population to receive depression screening. Some existing studies suggest that technology-mediated assessment encourages self-disclosure of sensitive health information such as depressive symptoms while other studies show the opposite effect. OBJECTIVE: This study aimed to evaluate the validity of using SMS text messaging to screen depression and related conditions, including anxiety and functional disability, in a low-income, culturally diverse safety net primary care population. METHODS: This study used a randomized design with 4 study groups that permuted the order of SMS text messaging and the gold standard interview (INTW) assessment. The participants for this study were recruited from the participants of the prior Diabetes-Depression Care-management Adoption Trial (DCAT). Depression was screened by using the 2-item and 8-item Patient Health Questionnaire (PHQ-2 and PHQ-8, respectively). Anxiety was screened by using the 2-item Generalized Anxiety Disorder scale (GAD-2), and functional disability was assessed by using the Sheehan Disability Scale (SDS). Participants chose to take up the assessment in English or Spanish. Internal consistency and test-retest reliability were evaluated by using Cronbach alpha and intraclass correlation coefficient (ICC), respectively. Concordance was evaluated by using an ICC, a kappa statistic, an area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity. A regression analysis was conducted to examine the association between the participant characteristics and the differences in the scores between the SMS text messaging and INTW assessment modes. RESULTS: Overall, 206 participants (average age 57.1 [SD 9.18] years; females: 119/206, 57.8%) were enrolled. All measurements except the SMS text messaging-assessed PHQ-2 showed Cronbach alpha values ≥.70, indicating acceptable to good internal consistency. All measurements except the INTW-assessed SDS had ICC values ≥0.75, indicating good to excellent test-retest reliability. For concordance, the PHQ-8 had an ICC of 0.73 and AUROC of 0.93, indicating good concordance. The kappa statistic, sensitivity, and specificity for major depression (PHQ-8 ≥8) were 0.43, 0.60, and 0.86, respectively. The concordance of the shorter PHQ-2, GAD-2, and SDS scales was poor to fair. The regression analysis revealed that a higher level of personal depression stigma was associated with reporting higher SMS text messaging-assessed PHQ-8 and GAD-2 scores than the INTW-assessed scores. The analysis also determined that the differences in the scores were associated with marital status and personality traits. CONCLUSIONS: Depression screening conducted using the longer PHQ-8 scale via SMS text messaging demonstrated good internal consistency, test-retest reliability, and concordance with the gold standard INTW assessment mode. However, care must be taken when deploying shorter scales via SMS text messaging. Further regression analysis supported that a technology-mediated assessment, such as SMS text messaging, may create a private space with less pressure from the personal depression stigma and therefore encourage self-disclosure of depressive symptoms. TRIAL REGISTRATION: ClinicalTrials.gov NCT01781013; https://clinicaltrials.gov/ct2/show/NCT01781013. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/12392.

Preliminary Efficacy of a Cognitive Behavioral Therapy Text Messaging Intervention Targeting Alcohol Use and Antiretroviral Therapy Adherence: A Randomized Clinical Trial.

TRIAL REGISTRATION: This trial was registered with ClinicalTrials.gov, NCT02603471.

WhatsApp and other messaging apps in medicine: opportunities and risks.

WhatsApp is a popular messaging application frequently used by physicians and healthcare organizations that can improve the continuity of care and facilitate effective health services provision, especially in acute settings. However WhatsApp does not comply with the rules of the European GDPR and the US HIPA Act. So it is inappropriate to share clinical information via WhatsApp.For this reason alternatives to Whatsapp are considered. In particular, the features that must have secure messaging apps to be in compliance with GDPR and HIPAA and to protect patient data will be discussed. The aim is to encourage healthcare organizations and physicians to abandon WhatsApp and to adopt one of the many secure messaging apps now available, some of them at no cost.

Research and Implementation Lessons Learned From a Youth-Targeted Digital Health Randomized Controlled Trial (the ARMADILLO Study).

BACKGROUND: Evidence is lacking on the efficacy of sexual and reproductive health (SRH) communication interventions for youth (aged 15-24 years), especially from low- and middle-income countries. Therefore, the World Health Organization initiated the Adolescent/Youth Reproductive Mobile Access and Delivery Initiative for Love and Life Outcomes (ARMADILLO) program, a free, menu-based, on-demand text message (SMS, short message service) platform providing validated SRH content developed in collaboration with young people. A randomized controlled trial (RCT) assessing the effect of the ARMADILLO intervention on SRH-related outcomes was implemented in Kwale County, Kenya. OBJECTIVE: This paper describes the implementation challenges related to the RCT, observed during enrollment and the intervention period, and their implications for digital health researchers and program implementers. METHODS: This was an open, three-armed RCT. Following completion of a baseline survey, participants were randomized into the ARMADILLO intervention (arm 1), a once-a-week contact SMS text message (arm 2), or usual care (arm 3, no intervention). The intervention period lasted seven weeks, after which participants completed an endline survey. RESULTS: Two study team decisions had significant implications for the success of the trial's enrollment and intervention implementation: a hands-off participant recruitment process and a design flaw in an initial language selection menu. As a result, three weeks after recruitment began, 660 participants had been randomized; however, 107 (53%) participants in arm 1 and 136 (62%) in arm 2 were "stuck" at the language menu. The research team called 231 of these nonengaging participants and successfully reached 136 to learn reasons for nonengagement. Thirty-two phone numbers were found to be either not linked to our participants (a wrong number) or not in their primary possession (a shared phone). Among eligible participants, 30 participants indicated that they had assumed the introductory message was a scam or spam. Twenty-seven participants were confused by some aspect of the system. Eleven were apathetic about engaging. Twenty-four nonengagers experienced some sort of technical issue. All participants eventually started their seven-week study period. CONCLUSIONS: The ARMADILLO study's implementation challenges provide several lessons related to both researching and implementing client-side digital health interventions, including (1) have meticulous phone data collection protocols to reduce wrong numbers, (2) train participants on the digital intervention in efficacy assessments, and (3) recognize that client-side digital health interventions have analog discontinuation challenges. Implementation lessons were (1) determine whether an intervention requires phone ownership or phone access, (2) digital health campaigns need to establish a credible presence in a busy digital space, and (3) interest in a service can be sporadic or fleeting. CLINICAL TRIAL: International Standard Randomized Controlled Trial Number (ISRCTN): 85156148; http://www.isrctn. com/ISRCTN85156148.

Common themes and emerging trends for the use of technology to support mental health and psychosocial well-being in limited resource settings: A review of the literature.

There are significant disparities in access to mental health care. With the burgeoning of technologies for health, digital tools have been leveraged within mental health and psychosocial support programming (eMental health). A review of the literature was conducted to understand and identify how eMental health has been used in resource-limited settings in general. PubMed, Ovid Medline and Web of Science were searched. Six-hundred and thirty full-text articles were identified and assessed for eligibility; of those, 67 articles met the inclusion criteria and were analyzed. The most common mental health use cases were for depression (n = 25) and general mental health and well-being (n = 21). Roughly one-third used a website or Internet-enabled intervention (n = 23) and nearly one-third used an SMS intervention (n = 22). Technology was applied to enhance service delivery (n = 32), behavior change communication (n = 26) and data collection (n = 8), and specifically dealt with adherence (n = 7), ecological momentary assessments (n = 7), well-being promotion (n = 5), education (n = 8), telemedicine (n = 28), machine learning (n = 5) and games (n = 2). Emerging trends identified wearables, predictive analytics, robots and virtual reality as promising areas. eMental health interventions that leverage low-tech tools can introduce, strengthen and expand mental health and psychosocial support services and can be a starting point for future, advanced tools.

Developing Texting for Relapse Prevention: A Scalable mHealth Program for People With Schizophrenia and Schizoaffective Disorder.

Symptom relapse in people with schizophrenia and schizoaffective disorder is common and has a negative impact on the course of illness. Here, we describe the development of Texting for Relapse Prevention, a scalable, cost-effective text messaging relapse prevention program that queries patients' "early warning signs" daily. Results of development focus groups and content advisory teams with 25 patients and 19 providers suggest that patients were enthusiastic about the program and thought that receiving daily messages about their symptoms would help them feel supported. Providers also were positive about the idea but worried that the program might interfere with patient-provider communication if patients thought that the messages were coming from providers. Patients found the content positive and actionable. The program was improved to address this feedback. This iterative development process that included multiple stakeholders ensured that the program is feasible and acceptable to both patients and providers.

Video Game-Induced Theta Rhythm.

Smartphones and other personal electronic devices present novel cortical processing tasks with potential for identification of novel EEG waveforms. A 17-year-old patient with epilepsy manifested as recurrent myoclonic seizures, absence seizures, and a single generalized tonic-clonic seizure was hospitalized to undergo video-EEG monitoring for seizure quantification and classification of the epilepsy syndrome. During the monitoring session, a frontocentral predominant 5 to 6 Hz theta rhythm was identified only when the patient was actively texting or playing a video game on his smartphone. Previously, patients with focal epilepsy have been found to have a frontocentral theta rhythm on EEG while texting on mobile devices. We report similar EEG findings in a patient with genetic generalized epilepsy during smartphone gaming to expand the population and triggers for this theta waveform. Given the young age and type of epilepsy, we suggest that the waveform represents the EEG manifestation of the attention-visuomotor pathway that is stimulus independent.

Adolescent Sexting Involvement Over 4 Years and Associations With Sexual Activity.

PURPOSE: To investigate how demographic factors, dating, and sexual behaviors are related to both initial and changing rates of sexting over time, we examined sexting involvement among ethnically diverse adolescents over a 4-year period. METHODS: A total of 1,042 participants from seven public high schools throughout southeast Texas (Dating it Safe study) were asked yearly about sexting involvement, as well as sexual and dating behaviors. RESULTS: Using latent growth curve modeling, results revealed that males and white participants had greater initial involvement in sexting compared with females and Hispanic and other ethnicities, respectively. In addition, we found that sexting significantly increased over the 4-year period. Finally, participants who had sex and who had more dating partners at each wave were significantly more likely to be involved in sexting than their counterparts, even after controlling for their initial sexting involvement. CONCLUSIONS: Involvement in sexting increases steadily from adolescence into emerging adulthood. The present study extends prior research by identifying a longitudinal association between sexting and sexual activity.

Effects of self- and partner's online disclosure on relationship intimacy and satisfaction.

Most research on the effects of disclosure on close relationships have been done using offline disclosure. However, disclosure done online has disparate features and thus its effects on relationships may also differ. In five studies and using primes emulating Facebook timelines and messages, we compared the effects of disclosure depth on intimacy and satisfaction in online vs. offline contexts, in romantic vs. friend relationships, and with differing content (self- vs. partner-focused). After demonstrating consistent differences, we examined one mechanism that accounted for the differential effects of online vs. offline disclosure in romantic relationships: perceived inclusivity of the recipients. Results revealed that greater disclosure was associated with higher relational intimacy and satisfaction when done offline (Studies 1 and 4), and lower intimacy and satisfaction when done online (Studies 1-4), in both the discloser (Study 1) and his or her partner (Studies 2-4). The negative association between online disclosure and intimacy was present in romantic relationships, but not in friendships (Study 1). Importantly, this effect only appeared when perceived inclusivity of recipients was high (Study 4). Focusing the online disclosure content on the partner/relationship dissipated its negative effects (Study 5). Together, these studies extend further knowledge on how the effects of disclosure are contextualized, and suggest that disclosure done publicly online may be detrimental to romantic relationships.