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Journal Description

JMIR Aging (JA, Founding Editor-in-chief: Jing Wang, Professor and Vice Dean for Research, Hugh Roy Cullen Professor, UT Health San Antonio School of Nursing, San Antonio, TX, USA) is a new sister journal of JMIR (the leading open-access journal in health informatics (Impact Factor 2017: 4.671), focusing on technologies, medical devices, apps, engineering, informatics applications and patient education for medicine and nursing, education, preventative interventions and clinical care / home care for elderly populations. In addition, aging-focused big data analytics using data from electronic health record systems, health insurance databases, federal reimbursement databases (e.g. U.S. Medicare and Medicaid), and other large databases are also welcome.  

As open access journal we are read by clinicians, nurses/allied health professionals, informal caregivers and patients alike and have (as all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies. We publish original research, viewpoints, and reviews (both literature reviews and medical device/technology/app reviews).

During a limited period of time, there are no fees to publish in this journal. Articles are carfully copyedited and XML-tagged, ready for submission in PubMed Central.

Be a founding author of this new journal and submit your paper today!


Recent Articles:

  • Source: Philips Lifeline; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Health Care Cost Analyses for Exploring Cost Savings Opportunities in Older Patients: Longitudinal Retrospective Study


    Background: Half of Medicare reimbursement goes toward caring for the top 5% of the most expensive patients. However, little is known about these patients prior to reaching the top or how their costs change annually. To address these gaps, we analyzed patient flow and associated health care cost trends over 5 years. Objective: To evaluate the cost of health care utilization in older patients by analyzing changes in their long-term expenditures. Methods: This was a retrospective, longitudinal, multicenter study to evaluate health care costs of 2643 older patients from 2011 to 2015. All patients had at least one episode of home health care during the study period and used a personal emergency response service (PERS) at home for any length of time during the observation period. We segmented all patients into top (5%), middle (6%-50%), and bottom (51%-100%) segments by their annual expenditures and built cost pyramids based thereon. The longitudinal health care expenditure trends of the complete study population and each segment were assessed by linear regression models. Patient flows throughout the segments of the cost acuity pyramids from year to year were modeled by Markov chains. Results: Total health care costs of the study population nearly doubled from US $17.7M in 2011 to US $33.0M in 2015 with an expected annual cost increase of US $3.6M (P=.003). This growth was primarily driven by a significantly higher cost increases in the middle segment (US $2.3M, P=.003). The expected annual cost increases in the top and bottom segments were US $1.2M (P=.008) and US $0.1M (P=.004), respectively. Patient and cost flow analyses showed that 18% of patients moved up the cost acuity pyramid yearly, and their costs increased by 672%. This was in contrast to 22% of patients that moved down with a cost decrease of 86%. The remaining 60% of patients stayed in the same segment from year to year, though their costs also increased by 18%. Conclusions: Although many health care organizations target intensive and costly interventions to their most expensive patients, this analysis unveiled potential cost savings opportunities by managing the patients in the lower cost segments that are at risk of moving up the cost acuity pyramid. To achieve this, data analytics integrating longitudinal data from electronic health records and home monitoring devices may help health care organizations optimize resources by enabling clinicians to proactively manage patients in their home or community environments beyond institutional settings and 30- and 60-day telehealth services.

  • Source: Marine Corps Air Station Iwakuni; Copyright: US Marine Corps (Aaron Henson); URL:; License: Public Domain (CC0).

    Association Between Advanced Care Management and Progression of Care Needs Level in Long-Term Care Recipients: Retrospective Cohort Study


    Background: Long-term care insurance systems in Japan started a special senior care program overseen by qualified care managers (also known as advanced care managers). However, the relationship between advanced care management and outcomes in long-term care recipients remains unknown. Objective: We aimed to compare the outcome of long-term care recipients using facilities with advanced care management and conventional care management, in terms of care needs level progression. Methods: We conducted a retrospective cohort study using the Survey of Long-Term Care Benefit Expenditures in Japan. We identified those aged ≥65 years who were newly designated a care need level of 3, and received long-term care services between April 2009 and March 2014 in Tokyo. We compared survival without progression of care needs level between the groups, with and without advanced care management, using the Kaplan-Meier method. Factors affecting the outcomes were determined using a multivariable logistic regression model fitted with a generalized estimating equation. Results: Of 45,330 eligible persons, 12,903 (28.46%) received long-term care based on advanced care management. The average duration of progression-free survival was 17.4 (SD 10.2) months. The proportions of five-year cumulative progression-free survival were 41.2% and 32.8% in those with and without advanced care management, respectively. The group with advanced care management had significantly lower care needs levels (odds ratio 0.77, 95% CI, 0.72-0.82, P<.001). Conclusions: Advanced care management was significantly associated with improved care needs levels.

  • Blood pressure monitor. Source: Flickr; Copyright: Jason Cao; URL:; License: Creative Commons Attribution + ShareAlike (CC-BY-SA).

    Usability and Acceptability of a Home Blood Pressure Telemonitoring Device Among Community-Dwelling Senior Citizens With Hypertension: Qualitative Study


    Background: Hypertension is a major cause of cardiovascular disease in older individuals. To ensure that blood pressure (BP) levels are within the optimal range, accurate BP monitoring is required. Contemporary hypertension clinical practice guidelines strongly endorse the use of home BP measurement as a preferred method of BP monitoring for individuals with hypertension. The benefits of home BP monitoring may be optimized when measurements are telemonitored to care providers; however, this may be challenging for older individuals with less technological capabilities. Objective: The objective of this qualitative study was to examine the usability and acceptability of a home BP telemonitoring device among senior citizens. Methods: We conducted a qualitative descriptive study. Following a 1-week period of device use, individual, semistructured interviews were conducted. Interview audio recordings were anonymized, de-identified, and transcribed verbatim. We performed thematic analysis on interview transcripts. Results: Seven senior citizens participated in the usability testing of the home BP telemonitoring device. Participants comprised females (n=4) and males (n=3) with a mean age of 86 years (range, 70-95 years). Overall, eight main themes were identified from the interviews: (1) positive features of the device; (2) difficulties or problems with the device; (3) device was simple to use; (4) comments about wireless capability and components; (5) would recommend device to someone else; (6) would use device in future; (7) suggestions for improving the device; and (8) assistance to use device. Additional subthemes were also identified. Conclusions: Overall, the home BP telemonitoring device had very good usability and acceptability among community-dwelling senior citizens with hypertension. To enhance its long-term use, few improvements were noted that may mitigate some of the relatively minor challenges encountered by the target population.

  • Adult woman with diabetes visiting the DOC. Source: Shutterstock; Copyright: Natalie Board; URL:; License: Licensed by the authors.

    Understanding Why Older Adults With Type 2 Diabetes Join Diabetes Online Communities: Semantic Network Analyses


    Background: As individuals age, chronic health difficulties may disrupt physical and social well-being. Individuals can turn to online communities to interact with similar peers, which may help buffer negative effects resulting from health difficulties. Objective: This study investigated the reasons that older adults join a diabetes online community to better understand the specific resources that are being sought. Methods: We used semantic network analyses to categorize the reasons participants provided for joining a community during the sign-up process. Results: The most frequent reasons for joining were to seek information about their health condition, to help with self-management of health difficulties, for feelings of informational and social support, and for having a community with whom to share. Women were more likely to go online for sharing and companionship as well as for information and social support reasons, whereas men were more likely to go online for general information and self-management reasons. Conclusions: This study shows the reasons older adults seek to join a diabetes online community: for increased information and support regarding chronic health difficulties. Practitioners may want to consider ways to promote access to online communities among their older patients as a source of health information and a resource to provide a sense of community.

  • Source: iStock by Getty Images; Copyright: vgajic; URL:; License: Licensed by the authors.

    Diabetes Online Community User Perceptions of Successful Aging With Diabetes: Analysis of a #DSMA Tweet Chat


    Background: According to the American Diabetes Association, there are approximately 30.3 million Americans with diabetes, and the incidence is growing by nearly 1.5 million cases per year. These individuals are at particularly high risk of developing secondary comorbid conditions related to diabetes and aging. Nearly 45% of individuals aged 65 to 75 years use social media, and this number is steadily growing. The use of social media provides the opportunity to assess the perceptions and needs of this population. Objective: The purpose of this study was to examine stakeholder perceptions of successful aging with diabetes. Methods: This study presents a retrospective analysis of a tweet chat focused on aging with diabetes. Tweets were collected using Symplur Signals data analytics software (Symplur LLC) and analyzed for content analysis, sentiment, and participant demographics. Two authors reviewed discussion posts for accuracy of analysis. Results: A total of 59 individuals participated in this tweet chat generating 494 tweets and nearly 2 million impressions. Most (36/59, 63%) tweet chat participants were people living with diabetes; 25% (14/59) were caregivers and advocates. Seven countries were represented in the conversation. A majority (352/494, 71.3%) of the tweets indicated positive sentiment related to aging with diabetes. Five major themes emerged from the qualitative analysis: (1) personal decline now and in the future, (2) limited access to treatment, (3) inability to provide self-care, (4) health care provider capacity to support aging with diabetes, and (5) life-long online peer health support to facilitate diabetes management. Conclusions: Individuals with diabetes are living longer and want to be supported with specialized care and access to technology that will allow them to successfully age. Aging- and diabetes-related changes may complicate diabetes management into old age. People with diabetes desire options including aging in place; therefore, special training for care partners and health care providers who care for older adults is needed.

  • The McMaster Optimal Aging Portal web resource rating. Source: Image created by the Authors; Copyright: The McMaster Optimal Aging Portal; URL:; License: Licensed by JMIR.

    A Tool That Assesses the Evidence, Transparency, and Usability of Online Health Information: Development and Reliability Assessment


    Background: The internet is commonly used by older adults to obtain health information and this trend has markedly increased in the past decade. However, studies illustrate that much of the available online health information is not informed by good quality evidence, developed in a transparent way, or easy to use. Furthermore, studies highlight that the general public lacks the skills necessary to distinguish between online products that are credible and trustworthy and those that are not. A number of tools have been developed to assess the evidence, transparency, and usability of online health information; however, many have not been assessed for reliability or ease of use. Objective: The first objective of this study was to determine if a tool assessing the evidence, transparency, and usability of online health information exists that is easy and quick to use and has good reliability. No such tool was identified, so the second objective was to develop such a tool and assess it for reliability when used to assess online health information on topics of relevant to optimal aging. Methods: An electronic database search was conducted between 2002 and 2012 to identify published papers describing tools that assessed the evidence, transparency, and usability of online health information. Papers were retained if the tool described was assessed for reliability, assessed the quality of evidence used to create online health information, and was quick and easy to use. When no one tool met expectations, a new instrument was developed and tested for reliability. Reliability between two raters was assessed using the intraclass correlation coefficient (ICC) for each item at two time points. SPSS Statistics 22 software was used for statistical analyses and a one-way random effects model was used to report the results. The overall ICC was assessed for the instrument as a whole in July 2015. The threshold for retaining items was ICC>0.60 (ie, “good” reliability). Results: All tools identified that evaluated online health information were either too complex, took a long time to complete, had poor reliability, or had not undergone reliability assessment. A new instrument was developed and assessed for reliability in April 2014. Three items had an ICC<0.60 (ie, “good” reliability). One of these items was removed (“minimal scrolling”) and two were retained but reworded for clarity. Four new items were added that assessed the level of research evidence that informed the online health information and the tool was retested in July 2015. The total ICC score showed excellent agreement with both single measures (ICC=0.988; CI 0.982–0.992) and average measures (ICC=0.994; CI 0.991–0.996). Conclusions: The results of this study suggest that this new tool is reliable for assessing the evidence, transparency, and usability of online health information that is relevant to optimal aging.

  • Source: MyTools4Care /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    A Web-Based Intervention to Help Caregivers of Older Adults With Dementia and Multiple Chronic Conditions: Qualitative Study


    Background: Caregivers (ie, family members and friends) play a vital role in the ongoing care and well-being of community-living older persons with Alzheimer disease and related dementia in combination with multiple chronic conditions. However, they often do so to the detriment of their own physical, mental, and emotional health. Caregivers often experience multiple challenges in their caregiving roles and responsibilities. Recent evidence suggests that Web-based interventions have the potential to support caregivers by decreasing caregiver stress and burden. However, we know little about how Web-based supports help caregivers. Objective: The objectives of this paper were to describe (1) how the use of a self-administered, psychosocial, supportive, Web-based Transition Toolkit, My Tools 4 Care (MT4C), designed by atmist, Edmonton, Alberta, Canada, helped caregivers of older adults with Alzheimer disease and related dementia and multiple chronic conditions; (2) which features of MT4C caregivers found most and least beneficial; and (3) what changes would they would recommend making to MT4C. Methods: This study was part of a larger multisite mixed-methods pragmatic randomized controlled trial. The qualitative portion of the study and the focus of this paper used a qualitative descriptive design. Data collectors conducted semistructured, open-ended, telephone interviews with study participants who were randomly allocated to use MT4C for 3 months. All interviews were audio-taped and ranged from 20 to 40 min. Interviews were conducted at 1 and 3 months following a baseline interview. Qualitative content analysis was used to analyze collected data. Results: Fifty-six caregivers from Alberta and Ontario, Canada, participated in either one or both of the follow-up interviews (89 interviews in total). Caregivers explained that using MT4C (1) encouraged reflection; (2) encouraged sharing of caregiving experiences; (3) provided a source of information and education; (4) provided affirmation; and for some participants (5) did not help. Caregivers also described features of MT4C that they found most and least beneficial and changes they would recommend making to MT4C. Conclusions: Study results indicate that a self-administered psychosocial supportive Web-based resource helps caregivers of community-dwelling older adults with Alzheimer disease and related dementia and multiple chronic conditions with their complex caregiving roles and responsibilities. The use of MT4C also helped caregivers in identifying supports for caring, caring for self, and planning for future caregiving roles and responsibilities. Caregivers shared important recommendations for future development of Web-based supports.

  • Source: Freepik; Copyright: pressfoto; URL:; License: Public Domain (CC0).

    Coproduction of a Theory-Based Digital Resource for Unpaid Carers (The Care Companion): Mixed-Methods Study


    Background: Family and other unpaid carers are crucial to supporting the growing population of older people that are living outside residential care with frailty and comorbidities. The burden associated with caring affects carers’ well-being, thus limiting the sustainability of such care. There is a need for accessible, flexible, and responsive interventions that promote carers’ coping and resilience, and hence support maintenance of the health, well-being, and independence of the cared-for person. Objective: This study aimed to coproduce a digital program for carers to promote resilience and coping through supporting effective use of information and other Web-based resources. Its overlapping stages comprised the following: understanding the ways in which Web-based interventions may address challenges faced by carers, identifying target behaviors for the intervention, identifying intervention components, and developing the intervention prototype. Methods: The study was informed by person-based theories of coproduction and involved substantial patient and public involvement. It drew on the Behavior Change Wheel framework to support a systematic focus on behavioral issues relevant to caring. It comprised scoping literature reviews, interviews, and focus groups with carers and organizational stakeholders, and an agile, lean approach to information technology development. Qualitative data were analyzed using a thematic approach. Results: Four behavioral challenges were identified: burden of care, lack of knowledge, self-efficacy, and lack of time. Local health and social care services for carers were only being accessed by a minority of carers. Carers appreciated the potential value of Web-based resources but described difficulty identifying reliable information at times of need. Key aspects of behavior change relevant to addressing these challenges were education (increasing knowledge and understanding), enablement (increasing means and reducing barriers for undertaking caring roles), and persuasion (changing beliefs and encouraging action toward active use of the intervention). In collaboration with carers, this was used to define requirements for the program. A resources library was created to link to websites, Web-based guidance, videos, and other material that addressed condition-specific and generic information. Each resource was classified according to a taxonomy itemizing over 30 different subcategories of need under the headings Care Needs (of the cared-for person), General Information and Advice, and Sustaining the Carer. In addition, features such as a journal and mood monitor were incorporated to address other enablement challenges. The need for proactive, personalized prompts emerged; the program regularly prompts the carer to revisit and update their profile, which, together with their previous use of the intervention, drives notifications about resources and actions that may be of value. Conclusions: The person-based approach allowed an in-depth understanding of the biopsychosocial context of caring to inform the production of an engaging, relevant, applicable, and feasible Web-based intervention. User acceptance and feasibility testing is currently underway.

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  • “I ain’t ready to die”: Mobile Technology For Healthy Aging Among Older HIV-Positive Black Men Who Have Sex with Men

    Date Submitted: Jul 31, 2018

    Open Peer Review Period: Aug 3, 2018 - Sep 28, 2018

    Background: People living with HIV are living longer in the U.S as a result of antiretroviral therapy. Black men who have sex with men (MSM) are disproportionally affected by HIV and have low rates of...

    Background: People living with HIV are living longer in the U.S as a result of antiretroviral therapy. Black men who have sex with men (MSM) are disproportionally affected by HIV and have low rates of engagement in HIV care and treatment. Mobile technology holds tremendous promise as an intervention platform, but little is known regarding its use among older Black MSM with HIV. Objective: The present study explored mobile technology use and narratives of aging with HIV among older Black MSM in order to inform mHealth interventions Methods: A total of 12 Black MSM living with HIV age 50 or older completed in-person, semi-structured interviews exploring issues of aging, HIV care engagement, and mobile technology use. Interviews were audiotaped, transcribed, and analyzed using qualitative analysis. Results: Almost all men appreciated having survived the AIDS epidemic, but expressed discomfort and ambivalence toward aging. Men described various levels of engagement in HIV care and treatment; challenges included social isolation and need for support that was not focused on HIV. Almost all described using mobile technology to engage in healthcare, while some referenced important barriers and challenges to technology use. Conclusions: Findings highlighted a high level of interest toward a mobile technology-based intervention targeting older Black men, but also identified barriers and challenges to using mobile technology for healthcare engagement. Mobile technology is well-incorporated into older Black MSM’s lives, and shows potential as an intervention platform for addressing aging issues to enhance engagement in HIV care and treatment. Clinical Trial: N/A

  • Ambient Assisted Living as Support for Aging in Place: A Quantitative Users’ Acceptance Study on Ultrasonic Whistles

    Date Submitted: Aug 3, 2018

    Open Peer Review Period: Aug 3, 2018 - Sep 28, 2018

    Background: Given the fact of an aging society, new supply measures and living concepts are needed, especially as health impairments along with care dependency increase with age. As many elderly peop...

    Background: Given the fact of an aging society, new supply measures and living concepts are needed, especially as health impairments along with care dependency increase with age. As many elderly people wish to stay at home for as long as possible, ambient assisted living (AAL) represents a support for aging in place. Objective: AAL combines medical and care technology within living environments and is therefore a promising approach to cope with demographic change in terms of fast-growing care needs and fewer skilled workers. Ultrasonic whistles represent one innovative technical possibility for such supportive housing solutions. Central fields of application are home automation, emergency service, and positioning. As AAL technologies affect sensitive areas of life, it is of great interest under which conditions they are accepted or rejected taking individual user requirements into account. Methods: In this study, we examined the acceptance of ultrasonic whistles in home care by function and room using an online questionnaire. Besides an evaluation of the overall usefulness, we focused on the intention to use ultrasonic whistles, n = 270 participants assessed home automation, emergency service, and positioning as specific functions of ultrasonic whistles. Further, bathroom, bedroom, and living room were evaluated as specific usage locations (rooms). With regard to the user’s perspective, the focus was set on age and attitudes towards aging of care receivers. Results: The study revealed a significant influence of function (F(1.967,529.167) = 60.444; P < .001), room (F(1.731,465.739) = 41.388; P < .001), and the interaction of function and room (F(3.051,831.303) = 8.701; P < .001) on the acceptance of ultrasonic whistles: the use of emergency services within the bathroom represented the most accepted alternative, whereas positioning within the living room received the comparably lowest evaluations. While user diversity played overall a minor role for acceptance, the assessment of single applications differed among user groups, particularly with regard to age differences (F(20,500) = 1.988; P = .007 < .01) in the evaluation of specific installation options, such as automated doors. Conclusions: The study revealed profound insights into the user-centered assessment of ultrasonic whistles in home care and discovered function and room as influencing acceptance parameters. Concerning user characteristics, age and attitude towards aging partly affected these evaluations forming the basis for and showing the importance of further investigations in this context. Clinical Trial: Does not apply

  • Digital media recruitment for falls prevention among older Chinese-Americans

    Date Submitted: Aug 1, 2018

    Open Peer Review Period: Aug 3, 2018 - Sep 28, 2018

    Background: Research in falls prevention programs have increased in recent years in response to the aging demographics of the United States. Yet, few research and outreach programs have focused on eth...

    Background: Research in falls prevention programs have increased in recent years in response to the aging demographics of the United States. Yet, few research and outreach programs have focused on ethnic minorities due to increased cost, language barriers and cultural differences. Digital media platforms may be a cost-effective avenue to initiate falls prevention programs for the minority populations. Objective: To determine if Facebook advertisements are a practical recruitment method for health education to the Chinese-speaking population. Methods: This was an observational, cross-sectional study. A video on fall education was uploaded onto YouTube, and an advertisement campaign was initiated on Facebook that was linked to the video. The target population was older adults greater than 45 years old who use Facebook and were presented with the advertisement (N=1,039). Metrics such as number of unique individuals reached, the number of views of the advertisement, the number of clicks, user gender, age and traffic sources to the advertisement were recorded. Data was analyzed with descriptive statistics. Results: Our Facebook advertisement had 1,087 views (1,039 unique viewers). There were 121 link clicks with a click-through rate of 11.13%. The cost per link click was approximately $0.06 USD. There were 936 (91.40%) female viewers and 88 (8.59%) male viewers. In the 45-54 age group, the ad reached 50 people, with 1 link click (2.00%). In the 55- 64 age group, the ad reached 572 people, with 57 link clicks (9.97%). In the 65 and above age group, the ad reached 417 people, with 63 link clicks (15.11%). Conclusions: Facebook was able to directly target the advertisement to the desired older ethnic population at low cost. Engagement was highest among females and among those who were 65 years or older. Hence, Facebook can serve as an alternative platform for dissemination of health information to geriatrics patients in addition to print-based and face-to-face communication. Clinical Trial: none

  • Home-Based Video Telemedicine for Dementia Management

    Date Submitted: Jul 17, 2018

    Open Peer Review Period: Jul 20, 2018 - Sep 14, 2018

    Background: Individuals with dementia exhibit high rates of behavioral problems and medical comorbidities which may challenge attending doctors’ visits. Video telemedicine may benefit people with d...

    Background: Individuals with dementia exhibit high rates of behavioral problems and medical comorbidities which may challenge attending doctors’ visits. Video telemedicine may benefit people with dementia and their caregivers who often experience burden. However, data on video telemedicine into the homes of this cohort is lacking. The New England Geriatric Research Education and Clinical Center (GRECC) was the first facility in the United States to offer dementia management visits directly into patients’ homes using clinical video-conferencing telemedicine, known as Home Clinical Video Telehealth (Home-CVT). We analyzed reasons for enrolling in Home-CVT and visit satisfaction, comparing video telemedicine to in-person visits. Objective: To assess reasons for enrolling or not enrolling in Home-CVT and to compare acceptability of Home-CVT to in-person dementia management visits. Methods: Post-visit experience questionnaires were mailed to caregivers following in-person and Home-CVT dementia management visits. Additionally, we tracked reasons for declining or joining Home-CVT. Results: The primary reason for joining Home-CVT was convenience related to reduced travel and less disruption of daily routines. Lack of a home computer was the main reason for not enrolling. Families who chose Home-CVT reported equivalent visit satisfaction with in-person visits, with the added benefit of reduced need for transportation with Home-CVT. Conclusions: Home-CVT is an acceptable alternative visit format. Given recent policy changes regarding reimbursement for home video telemedicine, Home-CVT offers a promising dementia service delivery model, especially for rural patients and others for whom travel to a specialty clinic is burdensome.

  • Analyzing Twitter as a Platform for Alzheimer’s Dementia Awareness

    Date Submitted: Jul 10, 2018

    Open Peer Review Period: Jul 15, 2018 - Sep 9, 2018

    Background: Dementia is a prevalent disorder among adults and often causes negative stigmatization to the individual and his/her family. Social media websites provide a place to raise awareness for de...

    Background: Dementia is a prevalent disorder among adults and often causes negative stigmatization to the individual and his/her family. Social media websites provide a place to raise awareness for dementia and have allowed researchers to explore health-related data on social platforms. Objective: This study examined the content and location of tweets containing the keyword “dementia” to better understand the reasons why individuals discuss dementia on the social media website Twitter. This approach examined location, Twitter user category, and tweet content subcategory to examine large publicly available datasets. Methods: A total of 400 tweets were collected using the Twitter Search Application Programming Interface (API) with the keyword “dementia”, circulated between January and February of 2018. Twitter users were categorized into four categories: general public, healthcare field, advocacy organization, and public broadcasting. Tweets posted by “general public” users were further subcategorized into five categories: mental health advocate, affected persons, stigmatization, marketing, and other. Placement into the categories were done through thematically analysis. Results: 400 Tweets were tweeted by 359 different screen names from 28 different countries. The top countries were the United States and the United Kingdom while the top states were California and Texas. The majority of Twitter users were categorized in the general public category (71%). The content analysis of Tweets from the general public category reveal stigmatization (41%) and mental health advocate (37%) themes. For tweets from California and Texas, California had more stigmatization tweets while Texas had more mental health advocate tweets. Conclusions: The themes from the content of the tweets highlight the mixture of the political climate along with the supportive network present on Twitter. The ability to use Twitter to combat stigma and raise awareness of mental health indicates the benefits that can potentially be facilitated via the platform but negative stigmatizing tweets may interfere with the effectiveness of this social support for the aging population affected with dementia.

  • The development and validation of video narratives for aging patients with the risk of recurrent stroke.

    Date Submitted: Jul 10, 2018

    Open Peer Review Period: Jul 15, 2018 - Sep 9, 2018

    Background: The debilitating effects of recurrent stroke among aging patients have urged researchers to explore medication adherence among these patients. Video narratives built upon Health Belief Mod...

    Background: The debilitating effects of recurrent stroke among aging patients have urged researchers to explore medication adherence among these patients. Video narratives built upon Health Belief Model (HBM) constructs have displayed potential impact on medication adherence adding a plus-point to patient education efforts. However, its effect on medication understanding and use self-efficacy have not been tested. Objective: The researchers believed that culturally sensitive video narratives which catered specific niche would reveal a personalized impact on medication adherence. This study aimed to develop and validate video narratives for this purpose. Methods: This study adapted Delphi method to develop a consensus on the video scripts contents of learning outcomes and HBM questions. The panel of experts consisted of eight members representing a mix of experiences in stroke in Malaysia. The Delphi method involved three rounds of discussion. Once consensus was achieved, the researchers drafted the initial scripts in English which were then back-translated to the Malay language. Ten bilingual patients within inclusion criteria screened the scripts for comprehension. Subsequently, an actual doctor and patient narrated the scripts while they were filmed; to add the realism of the narratives. Then, the video narratives underwent a few cycles of editing after some feedback on video engagement by the bilingual patients. Few statistical analysis were applied to confirm the validity of the video narratives. Results: Initially, the researchers proposed eight learning outcomes and nine HBM questions for the video scripts content. However, following Delphi rounds 1 to 3, few statements were omitted and rephrased. Complete agreement (>80%) arrived for five learning outcomes and five HBM questions. Kendall's coefficient of concordance, W; was above 0.7 which indicated a firm agreement, and SD values within a range of below 1.5 confirmed satisfactory content and construct validity of learning outcomes and HBM questions. Also, the video engagement scores were above average which indicated that the video narratives had a good link with perceived realism. Conclusions: The Delphi method was proven to be helpful in conducting discussion systematically and providing precise contents for the development of video narratives. Whereas, the video engagement scale had helped to create realistic video styles and emotions which the researchers believed could positively impact medication understanding and use self-efficacy among patients with stroke. A feasibility and acceptability study in an actual stroke care center is warranted. Clinical Trial: Approvals have been obtained from the Malaysian Medical Research and Ethics Committee – MREC (NMRR ID-15-851-24737) and the Monash University Human Research Ethics Committee - MUHREC (ID 9640), whereas MyStrokeStory trial was registered with the Australian New Zealand Clinical Trials Registry- ANZCTR (ACTRN12618000174280) with Universal Trial Number (UTN) U1111-1201-3955.