Web-based Studies Research Articles

Data Integrity Issues With Web-Based Studies: An Institutional Example of a Widespread Challenge.

This paper reports on the growing issues experienced when conducting web-based-based research. Nongenuine participants, repeat responders, and misrepresentation are common issues in health research posing significant challenges to data integrity. A summary of existing data on the topic and the different impacts on studies is presented. Seven case studies experienced by different teams within our institutions are then reported, primarily focused on mental health research. Finally, strategies to combat these challenges are presented, including protocol development, transparent recruitment practices, and continuous data monitoring. These strategies and challenges impact the entire research cycle and need to be considered prior to, during, and post data collection. With a lack of current clear guidelines on this topic, this report attempts to highlight considerations to be taken to minimize the impact of such challenges on researchers, studies, and wider research. Researchers conducting web-based research must put mitigating strategies in place, and reporting on mitigation efforts should be mandatory in grant applications and publications to uphold the credibility of web-based research.

Pharmacological mechanisms of Taohe Chengqi decoction in diabetic cardiovascular complications: A systematic review, network pharmacology and molecular docking

BackgroundDiabetic cardiovascular complications are the leading cause of diabetes-related deaths. These complications place an enormous and growing burden on global health systems and economies. The objective of this study was to conduct a systematic review on the therapeutic mechanisms of Taohe Chengqi Decoction (THCQD) in the treatment of diabetic cardiovascular complications. To predict the potential mechanisms of action of THCQD on diabetic cardiovascular complications using network pharmacology, and to validate these predictions through molecular docking analysis. MethodsTo collect relevant animal experiments, we searched a total of 6 databases. Eligibility for the study was determined based on inclusion and exclusion criteria. Data extraction was then performed on the literature. Methodological quality of animal studies was assessed using SYRCLE criteria. Based on network pharmacology, intersecting genes for THCQD and diabetic cardiovascular complications were obtained using Venny, PPI analysis and topology analysis of intersecting genes were performed; GO and KEGG were used for enrichment analysis and prediction of new targets of action. Molecular docking techniques were employed to model the interactions between drug components and target genes, thereby validating the results of network pharmacology predictions. ResultsA total of 16 studies were finally identified that fit the direction of this review. Included 6 studies of the myocardium, 1 study of the aortic arch, 5 studies of the femoral artery, 4 studies of the thoracic aorta. THCQD exhibited anti-inflammatory, anti-fibrotic and anti-atherosclerotic effects on cardiovascular complications in diabetic rats. Network pharmacology results showed that C0363 (Resveratrol), C0041 (Emodin), and C1114 (Baicalein) were the key components in the treatment of diabetic cardiovascular complications by THCQD. PPI results showed that INS, AKT1, TNF, ALB, IL6, IL1B as the genes that interact with the top 6. KEGG enrichment analysis identified the AGE-RAGE signaling pathway in diabetic complications as the most prominent pathway enriched by THCQD for diabetic cardiovascular complications genes. The results of molecular docking showed that the key active components demonstrated favorable interactions with their corresponding target genes. ConclusionIn conclusion, the results of both basic and web-based pharmacological studies support the beneficial effects of the natural herbal formulation THCQD on diabetic cardiovascular complications. This decoction has anti-inflammatory and antifibrotic properties and is effective in ameliorating diabetic cardiovascular disease. The network pharmacology results further support these ideas and identify the AGE-RAGE signaling pathway in diabetic complications as possibly the most relevant pathway for THCQD in the treatment of diabetic cardiovascular complications. The extent of the therapeutic potential of all-natural herbal components in the treatment of diabetic cardiovascular disease merits further investigation.

Evaluating the Safety of Assessing and Factors Associated With Suicidality and Self-Injury Within a Remote Online Assessment Among Sexual Minority Men in the United States

Research suggests that sexual minority individuals are at increased risk of suicide compared with the general population. As technology continues to develop in sophistication and accessibility, a growing number of research and therapeutic interventions utilize web-based assessments. To facilitate future research on assessing and responding to suicidal thoughts and behaviors, we describe the implementation of procedures for doing so in the context of a limited-interaction, remote cohort study. We describe factors associated with suicidal thoughts and behaviors among sexual minority men (SMM) that can guide risk/benefit assessments in future studies. Descriptive statistics were used to characterize the sample in terms of self-injury/suicidality. Bivariate χ2tests were conducted to explore differences in these indicators by age, race and ethnicity, sexual orientation, health insurance, region, education, and self-ranked socioeconomic status. Additionally, logistic regressions were used to examine associations between demographic characteristics, various psychosocial syndemic factors, and the four measures of self-injury/suicidality. In addition, we describe the experiences completing the suicidality follow-up protocol within the study. We conducted a nationwide study of 10,607 participants and found that 27.8% had a history of self-injury, 5.6% in the past year, 21.0% had attempted suicide, 18.2% experienced suicidal ideation, and 9.4% had thoughts of killing themselves. Logistic regressions revealed that depression, everyday discrimination based on sexual orientation, childhood sexual assault, and intimate partner violence were the strongest predictors of self-injury and suicidality. Study participants experienced high rates of self-injury and suicidality. Effective protocols can be developed to assess and respond to suicide risk in web-based SMM studies.

Predictors of Dropout Among Psychosomatic Rehabilitation Patients During the COVID-19 Pandemic: Secondary Analysis of a Longitudinal Study of Digital Training.

High dropout rates are a common problem reported in web-based studies. Understanding which risk factors interrelate with dropping out from the studies provides the option to prevent dropout by tailoring effective strategies. This study aims to contribute an understanding of the predictors of web-based study dropout among psychosomatic rehabilitation patients. We investigated whether sociodemographics, voluntary interventions, physical and mental health, digital use for health and rehabilitation, and COVID-19 pandemic-related variables determine study dropout. Patients (N=2155) recruited from 4 psychosomatic rehabilitation clinics in Germany filled in a web-based questionnaire at T1, which was before their rehabilitation stay. Approximately half of the patients (1082/2155, 50.21%) dropped out at T2, which was after the rehabilitation stay, before and during which 3 voluntary digital trainings were provided to them. According to the number of trainings that the patients participated in, they were categorized into a comparison group or 1 of 3 intervention groups. Chi-square tests were performed to examine the differences between dropout patients and retained patients in terms of sociodemographic variables and to compare the dropout rate differences between the comparison and intervention groups. Logistic regression analyses were used to assess what factors were related to study dropout. The comparison group had the highest dropout rate of 68.4% (173/253) compared with the intervention groups' dropout rates of 47.98% (749/1561), 50% (96/192), and 42.9% (64/149). Patients with a diagnosis of combined anxiety and depressive disorder had the highest dropout rate of 64% (47/74). Younger patients (those aged <50 y) and patients who were less educated were more likely to drop out of the study. Patients who used health-related apps and the internet less were more likely to drop out of the study. Patients who remained in their jobs and patients who were infected by COVID-19 were more likely to drop out of the study. This study investigated the predictors of dropout in web-based studies. Different factors such as patient sociodemographics, physical and mental health, digital use, COVID-19 pandemic correlates, and study design can correlate with the dropout rate. For web-based studies with a focus on mental health, it is suggested to consider these possible dropout predictors and take appropriate steps to help patients with a high risk of dropping out overcome difficulties in completing the study.

Identifying the Most Effective Recruitment Strategy Using Financial Reimbursements for a Web-Based Peer Network Study With Young People Aged 16-18 Years: Protocol for a Randomized Controlled Trial.

Peers are an important determinant of health and well-being during late adolescence; however, there is limited quantitative research examining peer influence. Previous peer network research with adolescents faced methodological limitations and difficulties recruiting young people. This study aims to determine whether a web-based peer network survey is effective at recruiting adolescent peer networks by comparing 2 strategies for reimbursement. This study will use a 2-group randomized trial design to test the effectiveness of reimbursements for peer referral in a web-based cross-sectional peer network survey. Young people aged 16-18 years recruited through Instagram, Snapchat, and a survey panel will be randomized to receive either scaled group reimbursement (the experimental group) or fixed individual reimbursement (the control group). All participants will receive a reimbursement of Aus $5 (US $3.70) for their own survey completion. In the experimental group (scaled group reimbursement), all participants within a peer network will receive an additional Aus $5 (US $3.70) voucher for each referred participant who completes the study, up to a maximum total value of Aus $30 (US $22.20) per participant. In the control group (fixed individual reimbursement), participants will only be reimbursed for their own survey completion. Participants' peer networks are assessed during the survey by asking about their close friends. A unique survey link will be generated to share with the participant's nominated friends for the recruitment of secondary participants. Outcomes are the proportion of a participant's peer network and the number of referred peers who complete the survey. The required sample size is 306 primary participants. Using a multilevel logistic regression model, we will assess the effect of the reimbursement intervention on the proportion of primary participants' close friends who complete the survey. The secondary aim is to determine participant characteristics that are associated with successfully recruiting close friends. Young people aged 16-18 years were involved in the development of the study design through focus groups and interviews (n=26). Participant recruitment commenced in 2022. A longitudinal web-based social network study could provide important data on how social networks and their influence change over time. This trial aims to determine whether scaled group reimbursement can increase the number of peers referred. The outcomes of this trial will improve the recruitment of young people to web-based network studies of sensitive health issues. DERR1-10.2196/44813.

Web-based psychoacoustics: Hearing screening, infrastructure, and validation

Anonymous web-based experiments are increasingly used in many domains of behavioral research. However, online studies of auditory perception, especially of psychoacoustic phenomena pertaining to low-level sensory processing, are challenging because of limited available control of the acoustics, and the inability to perform audiometry to confirm normal-hearing status of participants. Here, we outline our approach to mitigate these challenges and validate our procedures by comparing web-based measurements to lab-based data on a range of classic psychoacoustic tasks. Individual tasks were created using jsPsych, an open-source JavaScript front-end library. Dynamic sequences of psychoacoustic tasks were implemented using Django, an open-source library for web applications, and combined with consent pages, questionnaires, and debriefing pages. Subjects were recruited via Prolific, a subject recruitment platform for web-based studies. Guided by a meta-analysis of lab-based data, we developed and validated a screening procedure to select participants for (putative) normal-hearing status based on their responses in a suprathreshold task and a survey. Headphone use was standardized by supplementing procedures from prior literature with a binaural hearing task. Individuals meeting all criteria were re-invited to complete a range of classic psychoacoustic tasks. For the re-invited participants, absolute thresholds were in excellent agreement with lab-based data for fundamental frequency discrimination, gap detection, and sensitivity to interaural time delay and level difference. Furthermore, word identification scores, consonant confusion patterns, and co-modulation masking release effect also matched lab-based studies. Our results suggest that web-based psychoacoustics is a viable complement to lab-based research. Source code for our infrastructure is provided.

The Development and Deployment of an Online Exam System: A Web Application

The rapid advancements in computer technology and the internet’s acceptance in every aspect of our lives, particularly in recent years, have made students and instructors vital in the teaching and learning sector. Web-based studies have also brought about advances in the education area, and numerous applications have become widespread in this field. In this paper, we suggested an online test multiple-choice question assessment system for students called the Online Exam System (OES). This system may be used by any university, college, or institution that has a computerized education system. The OES can be used by teachers to administer quizzes. The system will calculate the participant’s performance based on his response, and the following question will be created based on the participant’s performance. After the examination, the system will display the results and offer feedback based on the participant’s request. Administrative control over the entire system is available. A teacher has authority over the question bank and is responsible for creating test schedules. Therefore, the project will be very helpful for the beginner and mid-level programming learners. And also, will give a proper guideline to the students who are willing to learn programming and introduce the users with competitive programming and problem-solving skills.

Feeling present matters: effects of social presence on live-streaming workout courses’ purchase intention

PurposeThis paper aims to test the effects of social presence (SP) and other related factors, including trust, self-construal and brand familiarity, in affecting consumers’ purchase intention of live-streaming workout courses.Design/methodology/approachThree between-subjects, Web-based experimental studies were conducted. There were separately 108, 208 and 284 valid questionnaires collected in the three studies. Moderation and mediation analyses were performed to test the research hypotheses.FindingsUsers’ sense of SP when watching live-streaming courses positively affects their willingness to purchase courses, and users’ sense of trust plays a mediating role in the influence of users’ SP on their purchase intention. In addition, when users belong to dependent self-construal rather than independent self-construal, their trust in live-streaming courses plays a stronger mediating role in the influence of users’ SP on their purchase intentions. What is more, when users have high brand familiarity rather than low brand familiarity, their trust in online live-streaming plays a stronger mediating role in the influence of users’ SP on their purchase intentions.Originality/valueThis research delineates the effects of SP on the consumption of live-streaming courses, thus further adding to the understanding of the role of real-time interaction in determining consumer behavior. It also highlights the roles of self-construal and brand familiarity as mediating influences on the relationship between SP and consumer trust.

Extended Family Outreach in Hereditary Cancer Using Web-Based Genealogy, Direct-to-Consumer Ancestry Genetics, and Social Media: Mixed Methods Process Evaluation of the ConnectMyVariant Intervention

Cascade screening, defined as helping at-risk relatives get targeted genetic testing of familial variants for dominant hereditary cancer syndromes, is a proven component of cancer prevention; however, its uptake is low. We developed and conducted a pilot study of the ConnectMyVariant intervention, in which participants received support to contact at-risk relatives that extended beyond first-degree relatives and encourage relatives to obtain genetic testing and connect with others having the same variant through email and social media. The support that participants received included listening to participants' needs, assisting with documentary genealogy to find common ancestors, facilitating direct-to-consumer DNA testing and interpretation, and assisting with database searches. We aimed to assess intervention feasibility, motivations for participating, and engagement among ConnectMyVariant participants and their families. We used a mixed methods design including both quantitative and qualitative evaluation methods. First, we considered intervention feasibility by characterizing recruitment and retention using multiple recruitment mechanisms, including web-based advertising, dissemination of invitations with positive test results, provider recruitment, snowball sampling, and recruitment through web-based social networks and research studies. Second, we characterized participants' motivations, concerns, and engagement through project documentation of participant engagement in outreach activities and qualitative analysis of participant communications. We used an inductive qualitative data analysis approach to analyze emails, free-text notes, and other communications generated with participants as part of the ConnectMyVariant intervention. We identified 84 prospective participants using different recruitment mechanisms; 57 participants were ultimately enrolled in the study for varying lengths of time. With respect to motivations for engaging in the intervention, participants were most interested in activities relating to genealogy and communication with others who had their specific variants. Although there was a desire to find others with the same variant and prevent cancer, more participants expressed an interest in learning about their genealogy and family health history, with prevention in relatives considered a natural side effect of outreach. Concerns about participation included whether relatives would be open to communication, how to go about it, and whether others with a specific variant would be motivated to help find common ancestors. We observed that ConnectMyVariant participants engaged in 6 primary activities to identify and communicate with at-risk relatives: sharing family history, family member testing, direct-to-consumer genealogy genetic testing analysis, contacting (distant) relatives, documentary genealogy, and expanding variant groups or outreach. Participants who connected with others who had the same variant were more likely to engage with several extended family outreach activities. This study demonstrated that there is an interest in extended family outreach as a mechanism to improve cascade screening for hereditary cancer prevention. Additional research to systematically evaluate the outcomes of such outreach may be challenging but is warranted.

Examining Visual Attention to Tobacco Marketing Materials Among Young Adult Smokers: Protocol for a Remote Webcam-Based Eye-Tracking Experiment.

Eye tracking provides an objective way to measure attention, which can advance researchers' and policy makers' understanding of tobacco marketing influences. The development of remote webcam-based eye-tracking technology, integrated with web-based crowdsourcing studies, may be a cost-effective and time-efficient alternative to laboratory-based eye-tracking methods. However, research is needed to evaluate the utility of remote eye-tracking methods. This study aimed to detail the process of designing a remote webcam-based eye-tracking experiment and provide data on associations between participant characteristics and the outcomes of experiment completion. A total of 2023 young adult (aged 18-34 years) cigarette smokers in the United States were recruited to complete a web-based survey that included a 90-second remote eye-tracking experiment that examined attention to e-cigarette marketing materials. Primary outcome measures assessed the completion of the remote eye-tracking experiment-specifically, experiment initiated versus not initiated, experiment completed versus not completed, and usable versus nonusable eye-tracking data generated. Multivariable logistic regressions examined the associations between outcome measures and participants' sociodemographic backgrounds, tobacco use history, and electronic devices (mobile vs desktop) used during the experiment. Study recruitment began on April 14, 2022, and ended on May 3, 2022. Of the 2023 survey participants, 1887 (93.28%) initiated the experiment, and 777 (38.41%) completed the experiment. Of the 777 participants who completed the experiment, 381 (49%) generated usable data. Results from the full regression models show that non-Hispanic Black participants (adjusted odds ratio [AOR] 0.64, 95% CI 0.45-0.91) were less likely to complete the eye-tracking experiment than non-Hispanic White participants. In addition, female (vs male) participants (AOR 1.46, 95% CI 1.01-2.11), those currently using (vs not using) e-cigarettes (AOR 2.08, 95% CI 1.13-3.82), and those who used mobile (vs desktop) devices (AOR 5.10, 95% CI 3.05-8.52) were more likely to generate usable eye-tracking data. Young adult participants were willing to try remote eye-tracking technology, and nearly half of those who completed the experiment generated usable eye-tracking data (381/777, 49%). Thus, we believe that the use of remote eye-tracking tools, integrated with crowdsourcing recruitment, can be a useful approach for the tobacco regulatory science research community to collect high-quality, large-scale eye-tracking data in a timely fashion and thereby address research questions related to the ever-evolving tobacco marketing landscape. It would be useful to investigate techniques to enhance completion rates and data usability. RR1-10.2196/43512.

Lessons Learned From the Implementation of a Pilot Study on Self-collected Specimen Return by Sexual Minority Men (Project Caboodle!): Qualitative Exploration.

Self-collection of specimens at home and their return by mail might help reduce some of the barriers to HIV and bacterial sexually transmitted infection (STI) screening encountered by gay, bisexual, and other men who have sex with men (GBMSM). To evaluate the benefits and challenges of bringing this approach to scale, researchers are increasingly requesting GBMSM to return self-collected specimens as part of web-based sexual health studies. Testing self-collected hair samples for preexposure prophylaxis drug levels may also be a viable option to identify GBMSM who face adherence difficulties and offer them support. Project Caboodle! sought to evaluate the acceptability and feasibility of self-collecting at home and returning by mail 5 specimens (a finger-stick blood sample, a pharyngeal swab, a rectal swab, a urine specimen, and a hair sample) among 100 sexually active GBMSM in the United States aged between 18 and 34 years. In this manuscript, we aimed to describe the key lessons learned from our study's implementation and to present recommendations offered by participants to maximize the rates of self-collected specimen return. Following the specimen self-collection phase, a subset of 25 participants (11 who returned all 5 specimens, 4 who returned between 1 and 4 specimens, and 10 who did not return any specimens) was selected for in-depth interviews conducted via a videoconferencing platform. During the session, a semistructured interview guide was used to discuss the factors influencing decisions regarding returning self-collected specimens for laboratory processing. The transcripts were analyzed using template analysis. University branding of web-based and physical materials instilled a sense of trust in participants and increased their confidence in the test results. Shipping the specimen self-collection box in plain unmarked packaging promoted discretion during transit and on its receipt. Using different colored bags with matching color-coded instructions to self-collect each type of specimen minimized the potential for confusion. Participants recommended including prerecorded instructional videos to supplement the written instructions, providing information on the importance of triple-site bacterial STI testing, and adding a reminder of the types of testing that would and would not be conducted on hair samples. Participants also suggested tailoring the specimen self-collection box to include only the tests that they might be interested in completing at that time, adding real-time videoconferencing to the beginning of the study to introduce the research team, and sending personalized reminders following the delivery of the specimen self-collection box. Our results offer valuable insights into aspects that facilitated participant engagement in self-collected specimen return, as well as areas for potential improvement to maximize return rates. Our findings can help guide the design of future large-scale studies and public health programs for home-based HIV, bacterial STI, and preexposure prophylaxis adherence testing. RR2-10.2196/13647.

The Vaping and Patterns of e-Cigarette Use Research Study: Protocol for a Web-Based Cohort Study.

In total, 3.2% of American adults report using e-cigarettes every day or some days. The Vaping and Patterns of E-cigarette Use Research (VAPER) Study is a web-based longitudinal survey designed to observe patterns in device and liquid use that suggest the benefits and unintended consequences of potential e-cigarette regulations. The heterogeneity of the e-cigarette devices and liquids on the market, the customizability of the devices and liquids, and the lack of standardized reporting requirements result in unique measurement challenges. Furthermore, bots and survey takers who submit falsified responses are threats to data integrity that require mitigation strategies. This paper aims to describe the protocols for 3 waves of the VAPER Study and discuss recruitment and data processing experiences and lessons learned, including the benefits and limitations of bot- and fraudulent survey taker-related strategies. American adults (aged ≥21 years) who use e-cigarettes ≥5 days per week are recruited from up to 404 Craigslist catchment areas covering all 50 states. The questionnaire measures and skip logic are designed to accommodate marketplace heterogeneity and user customization (eg, different skip logic pathways for different device types and customizations). To reduce reliance on self-report data, we also require participants to submit a photo of their device. All data are collected using REDCap (Research Electronic Data Capture; Vanderbilt University). Incentives are US $10 Amazon gift codes delivered by mail to new participants and electronically to returning participants. Those lost to follow-up are replaced. Several strategies are applied to maximize the odds that participants who receive incentives are not bots and are likely to possess an e-cigarette (eg, required identity check and photo of a device). In total, 3 waves of data were collected between 2020 and 2021 (wave 1: n=1209; wave 2: n=1218; wave 3: n=1254). Retention from waves 1 to 2 was 51.94% (628/1209), and 37.55% (454/1209) of the wave 1 sample completed all 3 waves. These data were mostly generalizable to daily e-cigarette users in the United States, and poststratification weights were generated for future analyses. Our data offer a detailed examination of users' device features and specifications, liquid characteristics, and key behaviors, which can provide more insights into the benefits and unintended consequences of potential regulations. Relative to existing e-cigarette cohort studies, this study methodology has some advantages, including efficient recruitment of a lower-prevalence population and collection of detailed data relevant to tobacco regulatory science (eg, device wattage). The web-based nature of the study requires several bot- and fraudulent survey taker-related risk-mitigation strategies, which can be time-intensive. When these risks are addressed, web-based cohort studies can be successful. We will continue to explore methods for maximizing recruitment efficiency, data quality, and participant retention in subsequent waves. DERR1-10.2196/38732.

Pilot-testing a Multiplayer HIV and Sexually Transmitted Infection Prevention Video Game Intervention for Black Adolescent Girls: Protocol for a Randomized Controlled Trial.

Black adolescent girls aged between 14 and 19 years are more likely than White girls to be diagnosed with a sexually transmitted infection (STI). As STI diagnosis is associated with an increase in the risk for HIV acquisition, an early intervention specifically tailored to Black adolescent girls is warranted. A web-based video game intervention has the potential to reach this demographic. Because studies of social and behavioral determinants of disease demonstrate the protective role of peer group structures on individual outcomes, a multiplayer game can facilitate opportunities to exchange and evaluate information, learn social norms, develop behavioral skills, and allow peers to influence attitudes and behavior. No prior research has examined the feasibility of a web-based multiplayer game intervention for this population. This study describes the protocol for a randomized controlled trial (RCT) pilot-testing the feasibility, acceptability, and limited efficacy of a multiplayer game-based intervention for increasing HIV and STI testing and condom use in Black adolescent girls. We enrolled 79 Black adolescent girls aged 14 to 19 years residing in the United States into a 2-arm parallel RCT. The intervention is a theory-based, community-informed, multiplayer game that can be played with peers on the web using videoconferencing software. The goal of the game is to empower Black adolescent girls to make healthy decisions regarding dating, relationships, and sex, thus reducing HIV and STI infection. Control condition participants received a list of resources after playing a time and attention control game. All study procedures were conducted via the internet. We conveniently sampled Black adolescent girls using web-based advertisements. Study assessments occurred at enrollment, 1 week, 1 month, and 4 months after enrollment. The primary outcome of this study is increased HIV and STI testing by Black adolescent girls. Secondary outcomes include increased condom use, self-efficacy to use condoms, positive attitudes toward condom use, intentions, harm perceptions, HIV and STI and pre-exposure prophylaxis knowledge, positive sexual norms, sexual communication with partners, and reduced incidence of sexual risk behaviors associated with HIV and STI transmission. Secondary outcomes also included assessment of intervention feasibility and acceptability. From February to April 2022, a total of 79 Black adolescent girls were enrolled, with 40 (51%) having been randomized into the intervention condition and 39 (49%) into the control condition. At baseline, participant ages ranged from 14 to 19 (mean 16.4, SD 1.23) years. Web-accessible game interventions overcome common impediments of face-to-face interventions presenting a unique opportunity to reach Black adolescent girls and improve their sexual health and self-efficacy. Trial data will provide information about the limited efficacy of the intervention and inform future web-based studies and a larger RCT aimed at improving the sexual health of Black adolescent girls. ClinicalTrials.gov NCT04108988; https://clinicaltrials.gov/ct2/show/NCT04108988. DERR1-10.2196/43666.

Young Adults' Perceptions of 2 Publicly Available Digital Resources for Self-injury: Qualitative Study of a Peer Support App and Web-Based Factsheets.

Digital resources have the potential to bridge the gaps in mental health services for young people who self-injure. Most research on digital resources for this population has involved observational studies of content in web-based communities or formative studies focused on the design and early evaluation of new interventions. Far less research has sought to understand young people's experiences with publicly available digital resources or to identify specific components of these resources that are perceived to be of value in their recovery. This study aimed to understand young people's experiences with 2 publicly available digital resources for self-injury-a peer support app and web-based factsheets-and to disentangle potential explanatory mechanisms associated with perceived benefits and harms. Participants were 96 individuals (aged 16-25 years) with nonsuicidal self-injury behavior in the past month, who recently completed a pilot randomized controlled trial designed to assess the efficacy of a peer support app as compared with web-based factsheets to reduce self-injury behavior. The trial showed that participants using the peer support app reported less self-injury behavior relative to those receiving the web-based factsheets over 8 weeks. In this study, we used a conventional approach to content analysis of responses to 2 open-ended questions delivered at the end of the trial with the aims of exploring participants' overall experiences with these resources and identifying the qualities of these resources that were perceived to be beneficial to or harmful for participants' recovery. Overall, participants were more likely to report benefits than harms. Participants who used the peer support app reported more harms than those who received the web-based factsheets. In the open coding phase, clear benefits were also derived from repeated weekly surveys about self-injury. Key benefits across digital resources included enhanced self-knowledge, reduction in self-injury activity, increased outreach or informal conversations, improved attitudes toward therapy, improved mood, and feeling supported and less alone. Key challenges included worsened or unchanged self-injury activity, diminished mood, and increased barriers to outreach. The most prominent benefit derived from the web-based factsheets and weekly surveys was improved self-understanding. However, the way this manifested differed, with factsheets providing insight on why participants engage in self-injury and the function it serves them and surveys making the frequency and severity of participants' behaviors more apparent. The benefits perceived from using the peer support app were general improvements in mood and feeling less alone. Findings contribute a nuanced understanding of young people's experiences with these digital resources and have implications for the optimization of existing platforms and the design of novel resources to support individuals who self-injure.

A novel research method to measure the usage of web-based information

This research method contributes to the literature by measuring commensurably ‘the usage of information for (or web traffic on) web-based research studies’. The introduced method deepens the understanding the functionality of online media by focusing on specific web metrics to make the usage of this type of media efficient for disclosure function. The inputs of new method are originally based on publicly available data, and it can be applied through 3 consecutive steps. Accordingly, this method is applicable to assess stakeholders’ engagement for any web-based research study. In sum, this method presents:•The inputs of the method are publicly available data.•This method is applicable for variety web-based research studies regardless of the applied methodological approach (e.g., qualitative, quantitative).

Urinary concentrations of non-persistent endocrine disrupting chemicals and fecundability in a preconception cohort study

Background and aim: Non-persistent endocrine-disrupting chemicals (EDCs) are found in consumer products including personal care products, plastics, and cleaning supplies. EDCs can affect hormonal pathways involved in reproduction. We examined prospectively the association between urinary concentrations of select non-persistent EDCs and fecundability, the per cycle probability of conception. Methods: We used data from PRESTO and Snart Foraeldre.dk, web-based preconception cohort studies that recruited female participants who were aged 21-45 years, residents of North America or Denmark, and trying to conceive without fertility treatment (2013-2019). Participants completed a baseline questionnaire and follow-up questionnaires every 8 weeks for up to 12 months. A subset of 207 participants residing in Boston, Massachusetts (n=119), Detroit, Michigan (n=18), or Aalborg, Denmark (n=70) provided urine samples during in-person clinic visits. We measured concentrations of 7 phenols, 4 parabens, triclocarban, 15 phthalate metabolites and 2 phthalate alternative metabolites using on-line solid-phase extraction-high-performance liquid chromatography-isotope dilution-tandem mass spectrometry. We used proportional probabilities models to estimate fecundability ratios (FR) and 95% confidence intervals (CI), adjusting for potential confounders. Results: Concentrations of some non-persistent EDCs were associated with reduced fecundability. The adjusted FR for the highest vs. lowest quartile of benzophenone-3 was 0.53 (95% CI: 0.28-0.99), with evidence of a monotonic association. Bisphenol S and 2,5’-dichlorophenol, and ethyl paraben concentrations were also associated with reduced fecundability. Among phthalate metabolites, mono-ethyl phthalate (highest vs. lowest quartile: FR=0.71, 95% CI: 0.45-1.12), monocarboxyoctyl phthalate (highest vs. lowest quartile: FR=0.71, 95% CI: 0.44-1.14), and the non-phthalate plasticizer cyclohexane-1,2-dicarboxylic acid monohydroxy isononyl ester (&amp;#x2265;0.6 µg/g creatinine vs. &amp;#x3c;limit of detection: FR=0.59, 95% CI: 0.37-0.95) were associated with reduced fecundability. Conclusions: Biomarkers of some non-persistent EDCs were associated with reduced fecundability. Future analysis of additional urine specimens in these cohorts will enable examination of chemical mixtures on fecundability. Key words: endocrine-disrupting chemicals, fecundability, fertility, phenols, phthalates

Feasibility, Usability, and Implementation Context of an Internet-Based Pain Education and Exercise Program for Chronic Musculoskeletal Pain: Pilot Trial of the ReabilitaDOR Program.

BackgroundInternet-based self-management programs and telerehabilitation initiatives have increased and have been extensively used for delivering health care in many areas. These programs overcome common barriers that patients face with traditional face-to-face health care, such as travel expenditures, lack of time, and high demand on the public health system. During the COVID-19 pandemic, this mode of web-based health care delivery had become more popular. However, there is still a lack of studies testing this mode of delivery in low- and middle-income countries. To gain a better understanding of the context, feasibility, and factors involved in the implementation of a web-based program, pilot and implementation studies are necessary. These studies can better inform whether a strategy is feasible, acceptable, and adequate for its purposes and for optimizing resource allocation.ObjectiveThis study aims to evaluate the feasibility, usability, and implementation context of a self-management internet-based program based on exercises and pain education (ReabilitaDOR) in people with chronic musculoskeletal pain and to compare this program with a program using only a web-based self-management booklet.MethodsThe study design was a parallel pilot study of a prospectively registered, assessor-blinded, 2-arm randomized controlled trial with economic evaluation. This study was performed using waiting lists of physiotherapy and rehabilitation centers and advertisements on social media networks. The participants were 65 patients with chronic musculoskeletal pain aged between 18 and 60 years. The effects of an 8-week telerehabilitation program based on exercises and pain education (intervention group) were compared with those of a program based only on a web-based self-management booklet (control group). The main outcome measures were implementation outcomes of patients’ perceptions of acceptability, appropriateness, feasibility, and usability of the program and the societal costs and feasibility of the main trial at 8-week posttreatment follow-up. Adverse events were also analyzed.ResultsIn total, 56 participants were analyzed at the 8-week follow-up. The intervention group showed responses with a mean of 4.5 (SD 0.6) points for acceptability, 4.5 (SD 0.5) points for appropriateness, and 4.5 (SD 0.6) points for feasibility measured on a 1 to 5 scale. All patients in the intervention group showed satisfactory responses to the system usability outcome. There is satisfactory evidence for the feasibility of the main trial. For costs related to the interventions, health care, patients, and loss of productivity at 8 weeks, we found a total expenditure of US $278.30 per patient in the intervention group and US $141.52 per patient in the control group. No adverse events were reported during the intervention period.ConclusionsWe found that the ReabilitaDOR program is feasible, appropriate, and acceptable from the users’ implementation perspective. This system was considered usable by all the participants, and the main trial seemed feasible. Cost data were viable to be collected, and the program is likely to be safe.Trial RegistrationClinicalTrials.gov NCT04274439; https://clinicaltrials.gov/ct2/show/NCT04274439

Memory advantage for untrustworthy faces: Replication across lab- and web-based studies.

The Covid-19 pandemic imposed new constraints on empirical research and forced researchers to transfer from traditional laboratory research to the online environment. This study tested the validity of a web-based episodic memory paradigm by comparing participants’ memory performance for trustworthy and untrustworthy facial stimuli in a supervised laboratory setting and an unsupervised web setting. Consistent with previous results, we observed enhanced episodic memory for untrustworthy compared to trustworthy faces. Most importantly, this memory bias was comparable in the online and the laboratory experiment, suggesting that web-based procedures are a promising tool for memory research.

Replacing vertical actions by mouse movements: a web-suited paradigm for investigating vertical spatial associations

The number of web-based studies in experimental psychology has been growing tremendously throughout the last few years. However, a straightforward web-based implementation does not exist for all types of experimental paradigms. In the current paper, we focus on how vertical response movements—which play a crucial role in spatial cognition and language research—can be translated into a web-based setup. Specifically, we introduce a web-suited counterpart of the vertical Stroop task (e.g., Fox & Shor, in Bull Psychon Soc 7:187–189, 1976; Lachmair et al., in Psychon Bull Rev 18:1180–1188, 2011; Thornton et al., in J Exp Psychol Hum Percept Perform 39:964–973, 2013). We employed nouns referring to entities typically located in lower or upper vertical space (e.g., “worm” and “bird”, respectively) in Experiments 1 and 2, and emotional valence words associated with a crouched or an upward bodily posture (e.g., “sadness” and “excitement”, respectively) in Experiment 3. Depending on the font color, our participants used their mouse to drag the words to the lower or upper screen location. Across all experiments, we consistently observed congruency effects analogous to those obtained with the lab paradigm using actual vertical arm movements. Consequently, we conclude that our web-suited paradigm establishes a reliable approach to examining vertical spatial associations.

Quantifying the Quality of Web-Based Health Information on Student Health Center Websites Using a Software Tool: Design and Development Study.

BackgroundThe internet has become a major source of health information, especially for adolescents and young adults. Unfortunately, inaccurate, incomplete, or outdated health information is widespread on the web. Often adolescents and young adults turn to authoritative websites such as the student health center (SHC) website of the university they attend to obtain reliable health information. Although most on-campus SHC clinics comply with the American College Health Association standards, their websites are not subject to any standards or code of conduct. In the absence of quality standards or guidelines, monitoring and compliance processes do not exist for SHC websites. Thus, there is no oversight of the health information published on SHC websites by any central governing body.ObjectiveThe aim of this study is to develop, describe, and validate an open-source software that can effectively and efficiently assess the quality of health information on SHC websites in the United States.MethodsOur cross-functional team designed and developed an open-source software, QMOHI (Quantitative Measures of Online Health Information), that assesses information quality for a specified health topic from all SHC websites belonging to a predetermined list of universities. The tool was designed to compute 8 different quality metrics that quantify various aspects of information quality based on the retrieved text. We conducted and reported results from 3 experiments that assessed the QMOHI tool in terms of its scalability, generalizability in health topics, and robustness to changes in universities’ website structure.ResultsEmpirical evaluation has shown the QMOHI tool to be highly scalable and substantially more efficient than manually assessing web-based information quality. The tool’s runtime was dominated by network-related tasks (98%), whereas the metric computations take <2 seconds. QMOHI demonstrated topical versatility, evaluating SHC website information quality for four disparate and broad health topics (COVID, cancer, long-acting reversible contraceptives, and condoms) and two narrowly focused topics (hormonal intrauterine device and copper intrauterine device). The tool exhibited robustness, correctly measuring information quality despite changes in SHC website structure. QMOHI can support longitudinal studies by being robust to such website changes.ConclusionsQMOHI allows public health researchers and practitioners to conduct large-scale studies of SHC websites that were previously too time- and cost-intensive. The capability to generalize broadly or focus narrowly allows a wide range of applications of QMOHI, allowing researchers to study both mainstream and underexplored health topics. QMOHI’s ability to robustly analyze SHC websites periodically promotes longitudinal investigations and allows QMOHI to be used as a monitoring tool. QMOHI serves as a launching pad for our future work that aims to develop a broadly applicable public health tool for web-based health information studies with potential applications far beyond SHC websites.