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ical stimulation by gamified interventions; however, the need for enjoyment of this type of challenging game must be addressed. ©Najmeh Khalili-Mahani, Atousa Assadi, Kate Li, Mahsa Mirgholami, Marie-Eve Rivard, Habib Benali, Kim Sawchuk, Bob De Schutter. Originally published in JMIR Mental Health (http//mental.jmir.org), 26.03.2020.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 Quehorter 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. ©Haomiao Jin, Shinyi Wu. Originally published in the Journal of Medical Internet Research (http//www.jmir.org), 26.03.2020.BACKGROUND Substance use by youth remains a significant public health concern. Social media provides the opportunity to discuss and display substance use-related beliefs and behaviors, suggesting that the act of posting drug-related content, or viewing posted content, may influence substance use in youth. This aligns with empirically supported theories, which posit that behavior is influenced by perceptions of normative behavior. Nevertheless, few studies have explored the content of posts by youth related to substance use. OBJECTIVE This study aimed to identify the beliefs and behaviors of youth related to substance use by characterizing the content of youths' drug-related tweets. Using a sequential explanatory mixed methods approach, we sampled drug-relevant tweets and qualitatively examined their content. METHODS We used natural language processing to determine the frequency of drug-related words in public tweets (from 2011 to 2015) among youth Twitter users geolocated to Pennsylvania. We limited our sampllizabeth Lazarus, Maramawit Abera, Sarah Huang, Lyle Ungar. Originally published in JMIR Public Health and Surveillance (http//publichealth.jmir.org), 26.03.2020.BACKGROUND Pediatric home hospitalization improves the quality of life of children and their families, involving them in their children's care, while favoring the work-life balance of the family. In this context, technology guarantees accessibility to assistance, which provides security to users. From the perspective of the health care system, this could lower the demand for hospital services and reduce hospitalization costs. OBJECTIVE This study aimed to assess families' degree of satisfaction and acceptability of pediatric telehomecare and explore the clinical characteristics of children benefiting from the program. METHODS A total of 95 children and their families participated in the home-hospitalization pilot program operated by Sant Joan de Déu Hospital in Barcelona, Spain. Families were visited once a day and patients were monitored using a kit consisting of a scale, a thermometer, a pulse oximeter, and a blood pressure monitor. Data on parental experience, satisfaction, safety, and preference for care ed and that the home-based telemonitoring system resulted in few adverse incidents. ©Francesc López Seguí, Astrid Batlle Boada, Juan José García García, Ana López Ulldemolins, Ane Achotegui del Arco, Cristina Adroher Mas, Francesc García Cuyàs. Originally published in JMIR Pediatrics and Parenting (http//pediatrics.jmir.org), 26.03.2020.BACKGROUND Web-based interventions have been shown to be effective for the treatment of depression. However, interventions are often complex and include a variety of elements, making it difficult to identify the most effective component(s). OBJECTIVE The aim of this pilot study was to shed light on mechanisms in the online treatment of depression by comparing a single-module, fully automated intervention for depression (internet-based behavioral activation [iBA]) to a nonoverlapping active control intervention and a nonactive control group. METHODS We assessed 104 people with at least mild depressive symptoms (Patient Health Questionnaire-9, >4) via the internet at baseline (t0) and 2 weeks (t1) and 4 weeks (t2) later. After the t0 assessment, participants were randomly allocated to one of three groups (1) iBA (n=37), (2) active control using a brief internet-based mindfulness intervention (iMBI, n=32), or (3) care as usual (CAU, n=35). The primary outcome was improvement in depressive symptoms, as measured urval. TRIAL REGISTRATION DKRS (#DRKS00011562). ©Lena Jelinek, Sönke Arlt, Steffen Moritz, Johanna Schröder, Stefan Westermann, Barbara Cludius. Originally published in the Journal of Medical Internet Research (http//www.jmir.org), 26.03.2020.BACKGROUND Hand hygiene is a crucial and cost-effective method to prevent health care-associated infections, and in 2009, the World Health Organization (WHO) issued guidelines to encourage and standardize hand hygiene procedures. However, a common challenge in health care settings is low adherence, leading to low handwashing quality. Recent advances in machine learning and wearable sensing have made it possible to accurately measure handwashing quality for the purposes of training, feedback, or accreditation. OBJECTIVE We measured the accuracy of a sensor armband (Myo armband) in detecting the steps and duration of the WHO procedures for handwashing and handrubbing. METHODS We recruited 20 participants (10 females; mean age 26.5 years, SD 3.3). In a semistructured environment, we collected armband data (acceleration, gyroscope, orientation, and surface electromyography data) and video data from each participant during 15 handrub and 15 handwash sessions. We evaluated the detection accuracy for different armbaing a single armband worn in the upper arm but can substantially improve by placing the armband on the forearm or by using two armbands. ©Chaofan Wang, Zhanna Sarsenbayeva, Xiuge Chen, Tilman Dingler, Jorge Goncalves, Vassilis Kostakos. Originally published in JMIR mHealth and uHealth (http//mhealth.jmir.org), 26.03.2020.BACKGROUND Patient narratives are illustrative, individual accounts of patients' experiences with certain health conditions. Web-based patient narratives have become widely available on the internet and in social media, as part of electronically available patient decision aids or Web-based databases. In recent years, the role of patient narratives as a source of information, insight, and support for both health care users and providers has increasingly been emphasized. Although the potential impact of patient stories has high immediate plausibility, it is of interest to know if this impact can be captured in quantitative studies. OBJECTIVE This review aimed to evaluate whether research-generated Web-based patient narratives have quantifiable risks or benefits for (potential) patients, relatives, or health care professionals. METHODS We searched the following databases from August 2017 to March 2019 Medical Literature Analysis and Retrieval System Online, PsycInfo, Sociological Abstracts, Web of Science, and Ereported effects are rather small or were identified under specific experimental conditions. CONCLUSIONS Patient narratives seem to be a promising means to support users in improving their understanding of certain health conditions and possibly to provide emotional support and have an impact on behavioral changes. There is limited evidence for beneficial effects on some outcomes. SGI-1027 order However, narratives are characterized by considerable heterogeneity and the investigated outcomes are hardly comparable with each other, which makes the overall judgment difficult. As there are numerous possible measures and purposes of narratives, quantifying the impact of Web-based patient narratives remains a challenge. Future research is needed to define the optimal standards for quantitative approaches to narrative-based interventions. ©Daniel Drewniak, Andrea Glässel, Martina Hodel, Nikola Biller-Andorno. Originally published in the Journal of Medical Internet Research (http//www.jmir.org), 26.03.2020.BACKGROUND Insurance organizations are essential stakeholders in health care ecosystems. For addressing future health care needs, insurance companies require access to health data to deliver preventative and proactive digital health services to customers. However, extant research is limited in examining the conditions that incentivize health data sharing. OBJECTIVE This study aimed to (1) identify the expectations of insurance customers when sharing health data, (2) determine the perceived intrinsic value of health data, and (3) explore the conditions that aid in incentivizing health data sharing in the relationship between an insurance organization and its customer. METHODS A Web-based survey was distributed to randomly selected customers from a Finnish insurance organization through email. A single open-text answer was used for a qualitative data analysis through inductive coding, followed by a thematic analysis. Furthermore, the 4 constructs of commitment, power, reciprocity, and trust from the social exchndra Grundstrom, Olli Korhonen, Karin Väyrynen, Minna Isomursu. Originally published in JMIR Medical Informatics (http//medinform.jmir.org), 26.03.2020.BACKGROUND AND OBJECTIVE Research on the factors contributing to multiple sclerosis (MS) related fatigue are far from conclusive. Some studies put forward that clinical aspects of the disease give rise to this symptom whilst others emphasize the effects of psychological factors on its etiology. This study investigated the relationship between clinical aspects of MS and personality with MS fatigue. METHOD A total of 201 participants with MS of which 48 (23.9%) males and 153 (76.1%) females took part in this online study. Questionnaires were populated measuring clinical features of the disease (disease duration, type of MS, Expanded Disability Status Scale - EDSS), personality traits, and MS-related fatigue. Data was analyzed by hierarchical regression analyses. RESULTS Personality traits accounted for a greater variance in MS fatigue (R² = .482, p  less then  .01) than clinical aspects of the disease, these results were conclusive after controlling for the sociodemographic variables and depression. Temperament explained in total 10.