bluuebunny/crossref_metadata_2025 huggingface dataset:
THE PROJECT-BASED ASSESSMENT LEARNING MODEL THAT IMPACTS LEARNING ACHIEVEMENT AND NATIONALISM ATTITUDES
Authors: Widiana I Wayan , Tegeh I Made , Artanayasa I Wayan
Published: August 2021

Globalization gives a negative influence on children’s nationalism. This is exacerbated by the low students’ learning achievement in the social studies education (SSE), despite the fact that  one of the objectives of the SSE learning is to develop students’ potentials to be sensitive to social problems in the person, the society, the nation, and the state. This study is aimed at  describing the effectiveness of the project-based assessment learning model with national insight- oriented activities on the SSE learning achievement and nationalism attitudes of primary school students. The study is quasi-experimental research with a non-equivalent pre-test post test control group design. The research population consisted of all fourth-grade students totaling to 231 in number. Sampling was done by the random sampling technique, resulting in 46 students. Data were collected using test and non-test techniques. The test instrument was a multiple-choice test and the non-test instrument was a five-scale questionnaire. Both instruments were subjected to validity and reliability testing. The data analysis technique used the MANOVA statistic with the help of the SPSS computer software. The results showed that the significance level of the MANOVA test was .000 (< .0). This means that there are significant differences both partially and simultaneously in the SSE learning achievement and nationalism attitudes between students who learn by applying the project assessment learning model and students who learn ny applying the conventional learning model. In other words, there is a positive significant effect of learning using the project-based assessment learning model oriented on nationalism-insight activities towards the students’ SSE learning achievement and nationalism attitudes.
CARING ECONOMICS LEARNING TO DEVELOP CARING ATTITUDE AMONG HIGH SCHOOL STUDENTS
Authors: Wahyuni Daru , Djatmika Ery Tri , Widjaya Sri Umi Mintarti , Wahyono Hari
Published: August 2021

Even though economics learning in Senior High Schools has been able to increase students’ economic knowledge, their economic behavior is still far from being appropriate, whereas their concern for others, the environment, and even for themselves is lacking. The aims of this study were to apply caring economics learning (CEL) at senior high schools in Indonesia and to observe the internalization of caring economics attitude among the students through action research. It contained instructional package consisting of lesson plans, student worksheets, instructional materials, instructional media, and learning assessment in the form of situational judgment tests (SJTs). The CEL employed case method that was implemented in three learning activities. The data were obtained through observation, interviews, tests, and documentation. The study has revealed that the CEL was assessed by the observers as good and excellent. The success of caring attitude development on the students was reflected in the number of students showing caring attitudes, which increased from the first learning activity (52%) to the last one (95%). Based on the SJT-1, 55.56% of students achieved high scores and 44.44% had moderate scores. Based on the SJT-2, the number of students with high scores increased significantly (77.78%), while the number of students who had moderate scores decreased considerably (22.22%).
WHAT DO THEY LIKE AND DISLIKE FROM GAME-BASED ENTREPRENEURSHIP LEARNING? A QUALITATIVE STUDY
Authors: Ahsan Muhamad , Faletehan Aun Falestien
Published: August 2021

One of the ways to raise an entrepreneurial spirit through learning processes is the use of game simulation. Learning materials delivered using game simulation are expected to improve knowledge, understandings, and insights related to entrepreneurship. This study aimed to examine individual’s understanding of game-based entrepreneurship learning based on the expressions of like and dislike. Data of this study were collected by means of an open-ended questionnaire through a survey conducted for nine years (2011-2019). As many as 441 students participated in the entrepreneurship game called “Start and Improve Your Business (SIYB)” at a university in Indonesia. The collected data were analyzed qualitatively using NVivo 12plus. The results showed that participants liked the game because it could increase their entrepreneurial passions, skills, insights, and mindsets. However, what participants did not like about the game was related to its’ characteristics, the personal issues that it came out with, and the teamwork in the game. This study contributes to the development of a game-based entrepreneurship learning model by identifying participants' interests and discussing the strengths and weaknesses of the game implementation.
POSITIONING INDONESIAN ISLAMIC HIGHER-EDUCATION VIS-A-VIS GLOBALISATION: ORGANISATIONAL–RESILIENCE DYNAMICS
Authors: Kusumaputri Erika Setyanti , Muslimah Hanifah Latif , Ahmad Adib , Nurwardani Mayreyna
Published: August 2021

In the present era of globalisation, higher-education institutions are required to focus on innovation to deal with the various challenges. Considering what Islamic higher-education institutions in Indonesia, have achieved in recent times, they face an uphill struggle to compete at the global level. This study aimed at identifying and analysing the dynamics of resilience for globalisation in a state Islamic–University in Indonesia. The results of studies on the management of Islamic tertiary institutions, specifically on organizational resilience, are very difficult to find. This study used the qualitative analysis method of a case-study and comprised in-depth interviews with key people concerned with the management of the university, observation, and secondary data namely academic documents, photos, and information from the university’s official website. The findings showed the university’s continuous efforts to improve not only the academic community’s management skills, knowledge, and expertise but also the implementation of international-curriculum standardization and cooperation with overseas universities. These actions cannot be separated from obstacles faced by university from within and without particularly in terms of funding-related policies. The university’s program-based innovations which are yet to be carried out by other Islamic-universities in Indonesia indicate this institution’s initiative to break the obstacles.
COPING STRATEGIES AMONG KINDERGARTENERS IN THE GENDER PERSPECTIVE
Authors: Muthmainah Muthmainah , Purwanta Edi , Suwarjo Suwarjo , Md Nor Mariani Binti
Published: August 2021

Negative emotions remains common among some kindergarteners in general since it may impact their anxiety and stress. This study aimed to describe various elicitors for negative emotions among young children, their coping strategies, and the parents’ response to them in the gender perspective. The data were collected through questionnaires containing statements about coping strategies of their children developed using the Lazarus and Folkman theories and findings by Chalmers, Frydenberg, and Deans. The study involved 102 parents of children aged 4-6 years in Yogyakarta, Indonesia. The findings show that elicitors for negative emotions among boys are dominated by physical bullying by peers, while in girls, they are dominated by unfulfilled wishes. Meanwhile, coping uses among boys are dominated by assertive behavior, while in girls, they share their concerns with others. Regarding the response in dealing with children’s negative emotions, the parents give them a gadget, such as smartphone, for both boys and girls. The study implies that more educational parenting model is needed to educate parents in handling negative emotions through coping skills and indiscriminating behavior.
THE SCIENTIFIC LITERACY PERFORMANCE OF GIFTED YOUNG SCIENTIST CANDIDATES IN THE DIGITAL AGE
Authors: Fausan Muhammad Mifta , Susilo Herawati , Gofur Abdul , Sueb Sueb , Yusop Farrah Dina
Published: August 2021

Scientific Literacy (SL) is an important competency to deal with and keep up with the increasingly sophisticated technological developments. However, information about the SL of prospective gifted young scientists over 15 years old has not been widely revealed holistically. Therefore, this survey research aimed to investigate the SL performance of prospective gifted young scientists holistically and compare the SL performance based on the grade level. A total of 278 students from a public senior high school in Jombang Regency, East Java Province, Indonesia, participated in this research. They were asked to take the SL test with 18 essential question items. As a result, the participants still showed low SL performance (total success rate = 40). The one-way ANOVA test results indicated no significant difference in the participants' SL performance based on the grade level. Therefore, three recommendations were provided: teachers should use various learning models, SL should be an explicit focus in science and non-science classrooms, and schools need to be equipped with supporting facilities to accommodate student readiness to practice SL.
PARENTAL ENGAGEMENT ON CHILDREN CHARACTER EDUCATION: THE INFLUENCES OF POSITIVE PARENTING AND AGREEABLENESS MEDIATED BY RELIGIOSITY
Authors: Diana Raden Rachmy , Chirzin Muhammad , Bashori Khoiruddin , Suud Fitriah M , Khairunnisa Nadea Zulfa
Published: August 2021

Parents have an important role in introducing character education to children. Positive parenting and agreeableness are considered to have essential influences on parent engagement in children’s character education mediated by religiosity. This study aimed to examine the effects of positive parenting and agreeableness towards parental engagement in character education with religiosity as the mediator. Data were obtained using five instruments, namely the parental engagement scale, agreeableness scale, religiosity scale, Islamic knowledge test items, and the positive parenting scale. The population of this research was the parents of students of Muhammadiyah elementary schools located in the Special Region of Yogyakarta, Indonesia. By cluster random sampling technique, the study involved 210 parents. The collected data were analyzed using the SEM technique. The results of this study show that: (1) there was a significant relationship between positive parenting and agreeableness on parental engagement, (2) religiosity worked as a mediator of the relationship between positive parenting and agreeableness in parental engagement, and (3) religiosity worked better as the mediator of agreeableness than positive engagement. It was concluded that the correlation between agreeableness and parental engagement would not be formed without religiosity as a mediator.
FROM DISRUPTION TO MOBILIZATION: IRE TEACHERS’ PERSPECTIVES ON INDEPENDENT LEARNING POLICY
Authors: Thohir Muhammad , Maarif Samsul , Rosyid Junaedi , Huda Hisbullah , Ahmadi Ahmadi
Published: August 2021

The policy on Independent Learning was established by the Indonesian government to promote teacher performance in midst of disruption in the educational aspect during this COVID-19 pandemic. However, teachers may not share the same perspective related to the policy. This study aims to examine Islamic Religious Education (IRE) teachers’ perspectives on Independent Learning policy. The research participants were IRE teachers who passed the 2019 In-service Teacher Profession Training Program at a State Islamic University in East Java, Indonesia. The mix-method research design with a qualitative-quantitative sequential exploratory analysis was used in this study. Qualitative data were obtained through telephone interviews, non-participant observations, and investigative documentary tracing, while quantitative data were obtained through a survey using online questionnaires. The collected data were analyzed using the descriptive qualitative phenomenological technique and descriptive statistics. The findings show that the increase in the use of mobile learning by IRE teachers is an implication of the disruption leading to the mobilization of the educational sector to approach the Independent Learning policy based on performances in three perspectives. First, the policy is considered a critique of traditional educational practices. Second, the policy serves as a space for independence with rules and regulations that are more open for students and schools. Third, the policy is an effort to free education from social and political pressures and restraints. This study provides a new understanding of the philosophical inter-connection in teachers’ perceptions to the practice of distant learning implementation based on informational technology.
Response Guidelines for Coronavirus Disease 2019 in Newborn Infants: A 2021 Update
Authors: Kim Do-Hyun
Published: August 2021

Since the first report of neonatal case on March 29, 2020, a small number of coronavirus disease 2019 (COVID-19) cases in newborn infants have been reported in Korea. The COVID-19 pandemic in Korea has urged the development of response guidelines for newborn infants born to mothers with suspected or confirmed COVID-19. These guidelines have been revised following further updates on COVID-19. The Korean Society of Pediatric Infectious Diseases and the Korean Society of Neonatology issued updated guidelines for COVID-19 in newborn infants on December 31, 2020. The present review introduces the management of newborn infants born to mothers with suspected or confirmed COVID-19, based on current updated guidelines for COVID-19. The management includes infection precautions for healthcare workers, neonatal resuscitation, neonatal isolation and medical care, breastfeeding, testing for COVID-19, and mother/baby contact.
The Study of Relationship among Infertility Stress, Gratitude, and Couple Relationship Changes of Women Undergoing Reproductive Treatments
Authors: Kim Miok , Park Jummi , Hong Ju-Eun , Ban Minkyung
Published: August 2021

Purpose: We aim to assess infertility stress, gratitude, and changes in couple relationship of the women under reproductive treatments and to identify the relationships between variables. Methods: The subjects were 212 infertile women receiving reproductive treatments. The data were collected by self-administered questionnaires from June to August in 2019. The questionnaire consisted of the questions about infertility stress, gratitude and changes in their couple relationships. Descriptive statistics, t-tests, 1-way analysis of variance, and correlation coefficient were analyzed using the SPSS 26.0 Windows program. Results: The level of Infertility stress, gratitude, and changes in couple relationship averaged 3.23±0.59 (range of 1 to 6), 4.85±1.06 (range of 1 to 6), 3.03±0.55 (range of 1 to 5), respectively. Infertility stress had a negative correlation with gratitude (r=-0.322, p<0.001) and changes in couple relationship (r= -0.371, p<0.001). Gratitude also had a negative correlation with changes in couple relationship (r=-0.370, p<0.001). Conclusion: The results revealed that infertility stress has a negative correlation with gratitude and changes in couple relationship. Thus, psychological interventions that can alleviate negative emotions should be provided.
A Structural Model for Breastfeeding Behavior of First-Time Mothers
Authors: Park Seol Hui , Ryu Seang
Published: August 2021

Purpose: This study aimed to develop a structural model to explain breastfeeding behavior of primipara based on information-motivation-behavioral skills. Variables were breastfeeding knowledge, breastfeeding motivation, breastfeeding self-efficacy, and parenting stress. Methods: Participants were first-time mothers who were breastfeeding infants from birth to 6 months. Data were collected from 5 pediatric hospitals and 1 public health center in Jeollanam-do from December 24, 2018 to February 28, 2019. A total of 285 questionnaires were included in the analysis. Data were analyzed using IBM SPSS Statistics ver. 20.0 and AMOS 20.0 programs. Results: Fitness statistics for the hypothetical model were appropriate (χ2=48.30 [degrees of freedom= 14, p<0.001], goodness of fit index=0.96, normed fit index=0.89, comparative fit index=0.92, standardized root mean square residual=0.06). Breastfeeding self-efficacy had the most direct and total impact on breastfeeding behaviors (β=0.38, p=0.01). Breastfeeding self-efficacy was directly and totally influenced by breastfeeding knowledge (β=-0.18, p=0.01), breastfeeding motivation (β=0.26, p=0.01). Parenting stress showed a direct effect on breastfeeding self-efficacy (β=-0.14, p=0.02) and breastfeeding behavior (β=0.20, p=0.01), confirming its modulating effect on both variables. Conclusion: Since breastfeeding self-efficacy was the most important variable for the breastfeeding behavior in first-time mothers, nursing interventions should be developed to promote breastfeeding selfefficacy including accurate breastfeeding information and enhanced breastfeeding motivation. Strategies that could relieve or adjust parenting stress should be considered since parenting stress had a causal relationship with breastfeeding self-efficacy and breastfeeding behavior.
Congenital Syphilis in Neonate: A Single Center Study for 10 Years
Authors: Lee Narae , Jeong Mun Hui , Jeong Seong Hee , Bae Mi-Hye , Han Young Mi , Park Kyung-Hee , Byun Shin-Yun
Published: August 2021

Purpose: Syphilis infections are becoming more prevalent in the Republic of Korea, and inadequately treated syphilis can lead to congenital syphilis (CS) in newborns. This study aimed to analyze the clinical manifestations of syphilis in mothers and newborns and to make suggestions to improve disease prognosis. Methods: This single-center study was performed between August 2009 and August 2019 and included 29 newborns with CS. We retrospectively evaluated the clinical features, rapid plasma reagin (RPR) card test, fluorescent treponemal antibody absorption test (FTA-ABS), morbidity, and treatment regimen of all the syphilis-affected mothers and their newborns. Results: At the time of delivery, mean maternal age was 29.0±6.1 years old, and newborn gestational age was 38.0 weeks. In cases when syphilis was confirmed during the second and third trimesters of pregnancy, the newborn with CS had morbidity (p=0.004). The mean RPR titer was related to morbidity (p= 0.036). Positive results of FTA-ABS IgM (p<0.001) and pleocytosis in the cerebrospinal fluid (CSF) (p= 0.020) also increase morbidity. The most common symptoms were desquamation and skin rash, followed by hepatomegaly, neurodevelopmental disability, and bone abnormalities. The highest number of CS cases per 1,000 live births in this hospital was in 2014. Conclusion: CS is a preventable and treatable disease if physicians detect symptoms and provide appropriate treatment through RPR examinations during every trimester. General practitioners should be widely trained on various aspects including early detection, formal treatment, and regular follow-up. Additionally, medical services should be provided for the entire childbearing population regardless of the socioeconomic status.
A Study on the Relationship between Fatigue, Psychosocial Stress, and Behavior that Reduces Endocrine Disrupting Chemicals Exposure in Infertile Males
Authors: Kim Sung Ju , Choi So Young
Published: August 2021

Purpose: This study aimed to identify the relationships between fatigue, psychosocial stress, and behavior of infertile males that reduces endocrine-disrupting chemical (EDC) exposure and to provide baseline data needed for nursing intervention. Methods: A total of 110 infertile males were recruited from a special fertility hospital in Gwangju city in Korea. The participants were administered a self-reported questionnaire. Results: The mean scores were as follows: for fatigue, 59.1 out of 133; for psychosocial stress, 20.3 out of 54; and for behavior that reduced EDC exposure, 52.6 out of 85. Fatigue and psychosocial stress had a positive correlation(r=0.68, p<0.001), behavior that reduces EDC exposure was negatively correlated with fatigue and psychosocial stress(r=-0.54, p<0.001; r=-0.61, p<0.001) Conclusion: Fatigue and stress were higher in infertile males. Our findings suggest that a nursing intervention program should focus on reducing fatigue and stress in infertile males and induce behaviors that decrease EDC exposure.
Clinical Practice Patterns of Hypertensive Disease in Pregnancy among Korean Obstetricians
Authors: Ahn Tae Gyu , Kim Yeon Hee , Kim Yun Sook , Shin Jae Eun , Oh Young-Lim , Lee Soon Ae , Lee Mina , Lee Gui Se Ra , Kim Suk Young , Kim Su-Mi , Hwang Jong Yun
Published: August 2021

Purpose: The purpose of this study was to investigate the clinical practice patterns of Korean obstetricians and gynecologists the diagnosis and management of hypertensive disease in pregnant women. Methods: From April 2015 to October 2015, questionnaire was distributed via email to obstetricians who were members of the Society for Maternal and Fetal Medicine. The survey consisted of 37 questions in 6 categories. Responses to the questions on the management of hypertensive disorders of pregnancy, from diagnosis to treatment, were evaluated. Results: A total of 93 obstetricians and gynecologists responded to the survey. High blood pressure was allocated the highest priority as an index mainly used when deciding to hospitalize patients with hypertensive disease during pregnancy, followed by pregnancy symptoms, proteinuria, and blood test results. Calcium channel blocker (CCB) for oral administration and hydralazine for injection were preferred as antihypertensive drugs mainly used to control severe hypertension. Regarding the delivery method for hypertensive disease during pregnancy, in cases of preeclampsia, 63% of the respondents chose the delivery method according to the cervical status, and in cases of hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome and eclampsia, which increased in severity, 52% and 31% responded that the delivery method was determined according to the cervical status, respectively. In cases of mild preeclampsia, the 70% of respondents preferred 37–38 weeks of gestation for the delivery time. Regarding the use of aspirin in patient with hypertension during pregnancy, 52% of the respondents occasionally administered aspirin, and in patients with a history of hypertensive disease during pregnancy, only 43% were administered prophylactic aspirin. Conclusion: Domestic obstetricians regarded blood pressure as the most meaningful factor when treating women with hypertension during pregnancy and considered blood pressure control as important. The preferred antihypertensive agents were oral CCB and hydralazine injections, and the choice of delivery method was determined according to the condition of the cervix and severity of the disease. Even in women with high risk factors for preeclampsia, prophylactic aspirin was administered in as low as 50%, of patients, possibly may due to the absence of domestic guidelines for aspirin use during pregnancy. Korean guidelines for prophylactic aspirin administration during pregnancy is needed based on additional research on the efficacy of aspirin for domestic women in the future.
Short-Term and Long-Term Renal Outcomes in Patients With Obesity After Minimally Invasive Versus Open Partial Nephrectomy for the Treatment of Renal Cancer: Retrospective Study
Authors: Flippo Brittany , Stone Bradley , Stahr Shelbie , Khalil Mahmoud , Davis Rodney , Kamel Mohamed , Singh Manisha
Published: August 2021

Background

Obesity is significantly associated with renal cell carcinoma. Surgery is the preferred treatment for demarcated lesions of renal cell carcinoma; however, obesity increases the complexity of surgical outcomes. Minimally invasive surgical techniques are preferred over open partial nephrectomy (OPN), but controversy remains regarding the most efficacious technique in patients with obesity.

Objective

This study aims to determine whether minimally invasive partial nephrectomy (MIPN) or OPN better preserves renal function and investigate short- and long-term renal outcomes in patients with obesity undergoing a partial nephrectomy.

Methods

We conducted a retrospective chart review of 242 adult patients aged ≥18 years who underwent MIPN or OPN between January 1, 2005, and December 31, 2016, at the University of Arkansas for Medical Sciences. Using creatinine as a measure of kidney function, patients’ preoperative levels were compared with their postoperative levels in 2-time frames: short (3-6 months postsurgery) or long (>6 months). The primary outcome was the change in creatinine values from preoperative to >6 months postoperatively in patients with obesity. Secondary outcomes included the change in creatinine values from preoperative to 3 to 6 months postoperatively in patients with obesity who underwent MIPN versus OPN. We also analyzed the creatinine values of nonobese patients (BMI <30) who underwent partial nephrectomy using the same time frames. Unconditional logistic regression was used to estimate crude and multivariable-adjusted odds ratios (ORs) and 95% CI to observe associations between surgery type and changes in creatinine values from while stratifying for obesity.

Results

A total of 140 patients were included in the study, of whom 75 were obese and 65 were nonobese. At >6 months after MIPN (n=20), the odds of patients with obesity having a decrease or no change in creatinine values was 1.24 times higher than those who had OPN (n=13; OR 1.24, 95% CI 0.299-6.729; P=.80). At 3 to 6 months after MIPN (n=27), the odds were 0.62 times lower than those after OPN (n=17; OR 0.62, 95% CI 0.140-2.753; P=.56). In the nonobese group, at 3 to 6 months after undergoing minimally invasive surgery (n=18), the odds of having a decrease or no change in creatinine values was 4.86 times higher than those who had open surgery (n=21; OR 4.86, 95% CI 1.085-21.809; P=.04). At more than 6 months after MIPN (n=14), the odds were 4.13 times higher than those after OPN (n=11; OR 4.13, 95% CI 0.579-29.485; P=.16).

Conclusions

We observed a nonstatistically significant preservation of renal function in patients with obesity who underwent OPN at 3 to 6 months postoperatively. Conversely, after 6 months, the same was true for MIPN, indicating the long-term benefit of MIPN. In the nonobese group, MIPN was favored over OPN.
Comparing a Multimedia Digital Informed Consent Tool With Traditional Paper-Based Methods: Randomized Controlled Trial
Authors: Abujarad Fuad , Peduzzi Peter , Mun Sophia , Carlson Kristina , Edwards Chelsea , Dziura James , Brandt Cynthia , Alfano Sandra , Chupp Geoffrey
Published: August 2021

Background

The traditional informed consent (IC) process rarely emphasizes research participants’ comprehension of medical information, leaving them vulnerable to unknown risks and consequences associated with procedures or studies.

Objective

This paper explores how we evaluated the feasibility of a digital health tool called Virtual Multimedia Interactive Informed Consent (VIC) for advancing the IC process and compared the results with traditional paper-based methods of IC.

Methods

Using digital health and web-based coaching, we developed the VIC tool that uses multimedia and other digital features to improve the current IC process. The tool was developed on the basis of the user-centered design process and Mayer’s cognitive theory of multimedia learning. This study is a randomized controlled trial that compares the feasibility of VIC with standard paper consent to understand the impact of interactive digital consent. Participants were recruited from the Winchester Chest Clinic at Yale New Haven Hospital in New Haven, Connecticut, and healthy individuals were recruited from the community using fliers. In this coordinator-assisted trial, participants were randomized to complete the IC process using VIC on the iPad or with traditional paper consent. The study was conducted at the Winchester Chest Clinic, and the outcomes were self-assessed through coordinator-administered questionnaires.

Results

A total of 50 participants were recruited in the study (VIC, n=25; paper, n=25). The participants in both groups had high comprehension. VIC participants reported higher satisfaction, higher perceived ease of use, higher ability to complete the consent independently, and shorter perceived time to complete the consent process.

Conclusions

The use of dynamic, interactive audiovisual elements in VIC may improve participants’ satisfaction and facilitate the IC process. We believe that using VIC in an ongoing, real-world study rather than a hypothetical study improved the reliability of our findings, which demonstrates VIC’s potential to improve research participants’ comprehension and the overall process of IC.

Trial Registration

ClinicalTrials.gov NCT02537886; https://clinicaltrials.gov/ct2/show/NCT02537886
Investigation of the Effects of an Online Support Group for Mental Health Problems on Stigma and Help-Seeking Among Japanese Adults: Cross-sectional Study
Authors: Kobori Osamu , Yoshinaga Naoki
Published: August 2021

Background

Online support groups vary widely in both goals and structures owing to the rapid development of social networking services. Several studies have shown the potential effectiveness of online support groups, such as reducing psychological distress (eg, depression) among individuals with mental health problems. However, online support groups often do not aim at effectiveness regarding distress relief–related outcomes.

Objective

This study aims to examine whether the use frequency of online support group platform functions (U2plus) is associated with lower stigma and higher consumer activation.

Methods

A total of 350 U2plus users participated in a web-based survey. They were asked what therapy they had received in the past and how often they logged on to it, used each of its functions, and completed the following questionnaires: the Patient Health Questionnaire-9, the Devaluation-Discrimination Scale, and the General Help-Seeking Questionnaire.

Results

Regarding the therapy received, 88% (308/350) of participants had taken medication for mental health problems, and 66.6% (233/350) had received psychotherapy or mental health counseling. Regarding use frequency, 21.7% (74/341) of the participants signed in to U2plus and used its functions more than once a week. The use frequency of U2plus functions was not correlated with perceived stigma, but the use frequency of some functions was weakly correlated with help-seeking intentions from formal sources (eg, doctors and psychologists). However, multiple regression analyses revealed that the use frequency of those functions did not uniquely predict help-seeking intentions.

Conclusions

It was suggested that online support groups may serve as an alternative treatment option for those who are already undergoing pharmacological treatment and are willing to seek help from whatever source they deem helpful.
Web-Based Information Seeking Behaviors of Low-Literacy Hispanic Survivors of Breast Cancer: Observational Pilot Study
Authors: Iacobelli Francisco , Dragon Ginger , Mazur Giselle , Guitelman Judith
Published: August 2021

Background

Internet searching is a useful tool for seeking health information and one that can benefit low-literacy populations. However, low-literacy Hispanic survivors of breast cancer do not normally search for health information on the web. For them, the process of searching can be frustrating, as frequent mistakes while typing can result in misleading search results lists. Searches using voice (dictation) are preferred by this population; however, even if an appropriate result list is displayed, low-literacy Hispanic women may be challenged in their ability to fully understand any individual article from that list because of the complexity of the writing.

Objective

This observational study aims to explore and describe web-based search behaviors of Hispanic survivors of breast cancer by themselves and with their caregivers, as well as to describe the challenges they face when processing health information on the web.

Methods

We recruited 7 Hispanic female survivors of breast cancer. They had the option to bring a caregiver. Of the 7 women, 3 (43%) did, totaling 10 women. We administered the Health LiTT health literacy test, a demographic survey, and a breast cancer knowledge assessment. Next, we trained the participants to search on the web with either a keyboard or via voice. Then, they had to find information about 3 guided queries and 1 free-form query related to breast cancer. Participants were allowed to search in English or in Spanish. We video and audio recorded the computer activity of all participants and analyzed it.

Results

We found web articles to be written for a grade level of 11.33 in English and 7.15 in Spanish. We also found that most participants preferred searching using voice but struggled with this modality. Pausing while searching via voice resulted in incomplete search queries, as it confused the search engine. At other times, background noises were detected and included in the search. We also found that participants formulated overly general queries to broaden the results list hoping to find more specific information. In addition, several participants considered their queries satisfied based on information from the snippets on the result lists alone. Finally, participants who spent more time reviewing articles scored higher on the health literacy test.

Conclusions

Despite the problems of searching using speech, we found a preference for this modality, which suggests a need to avoid potential errors that could appear in written queries. We also found the use of general questions to increase the chances of answers to more specific concerns. Understanding search behaviors and information evaluation strategies for low-literacy Hispanic women survivors of breast cancer is fundamental to designing useful search interfaces that yield relevant and reliable information on the web.
Understanding University Students’ Experiences, Perceptions, and Attitudes Toward Peers Displaying Mental Health–Related Problems on Social Networking Sites: Online Survey and Interview Study
Authors: Kim Taewan , Hong Hwajung
Published: August 2021

Background

College students’ mental health is at an all-time low. Students are increasingly disclosing their vulnerable, stigmatizing experiences on online social networking sites (SNSs). Peer support facilitated by SNSs can play a crucial role for the students in coping with mental health–related problems. Thus, it is imperative to understand how university students form perceptions, attitudes, and behaviors toward their peers who are dealing with mental health problems.

Objective

This study aimed to provide a better understanding of how college students recognize, perceive, and react to signs of mental health problems in their peers on SNSs. Our ultimate goal in this study was to inform the design of SNSs that can facilitate online peer support.

Methods

We conducted surveys with 226 students as well as semistructured interviews with 20 students at six universities in South Korea.

Results

Of the 226 survey respondents, 150 (66.4%) reported that they recognized signs of a mental health problem on their friends’ SNS posts. However, a considerable number of respondents (62/150, 41.3%) were reluctant to offer support, even when they had identified friends who were at risk; this reluctance was due to a lack of knowledge or confidence and their desire to maintain a distance from at-risk peers to save their identity from stigmatization and to avoid emotional contagion online.

Conclusions

Drawing on these results, we provide implications that could explain the construction of students’ perceptions regarding their peers’ mental health problems. We also provide design proposals for SNSs to serve as platforms that facilitate just-in-time and adaptive support exchanges among peers while mitigating stigma-related concerns.
Dropout From an Internet-Delivered Cognitive Behavioral Therapy Intervention for Adults With Depression and Anxiety: Qualitative Study
Authors: Lawler Kate , Earley Caroline , Timulak Ladislav , Enrique Angel , Richards Derek
Published: August 2021

Background

Treatment dropout continues to be reported from internet-delivered cognitive behavioral therapy (iCBT) interventions, and lower completion rates are generally associated with lower treatment effect sizes. However, evidence is emerging to suggest that completion of a predefined number of modules is not always necessary for clinical benefit or consideration of the needs of each individual patient.

Objective

The aim of this study is to perform a qualitative analysis of patients’ experiences with an iCBT intervention in a routine care setting to achieve a deeper insight into the phenomenon of dropout.

Methods

A total of 15 purposively sampled participants (female: 8/15, 53%) from a larger parent randomized controlled trial were interviewed via telephone using a semistructured interview schedule that was developed based on the existing literature and research on dropout in iCBT. Data were analyzed using a descriptive-interpretive approach.

Results

The experience of treatment leading to dropout can be understood in terms of 10 domains: relationship to technology, motivation to start, background knowledge and attitudes toward iCBT, perceived change in motivation, usage of the program, changes due to the intervention, engagement with content, experience interacting with the supporter, experience of web-based communication, and termination of the supported period.

Conclusions

Patients who drop out of treatment can be distinguished in terms of their change in motivation: those who felt ready to leave treatment early and those who had negative reasons for dropping out. These 2 groups of participants have different treatment experiences, revealing the potential attributes and nonattributes of dropout. The reported between-group differences should be examined further to consider those attributes that are strongly descriptive of the experience and regarded less important than those that have become loosely affiliated.
Voice Assistant Reminders and the Latency of Scheduled Medication Use in Older Adults With Pain: Descriptive Feasibility Study
Authors: Shade Marcia , Rector Kyle , Kupzyk Kevin
Published: August 2021

Background

Pain is difficult to manage in older adults. It has been recommended that pain management in older adults should include both nonpharmacologic and pharmacologic strategies. Unfortunately, nonadherence to pain medication is more prevalent than nonadherence to any other chronic disease treatment. Technology-based reminders have some benefit for medication adherence, but adherence behavior outcomes have mostly been verified by self-reports.

Objective

We aimed to describe objective medication adherence and the latency of medication use after a voice assistant reminder prompted participants to take pain medications for chronic pain.

Methods

A total of 15 older adults created a voice assistant reminder for taking scheduled pain medications. A subsample of 5 participants were randomly selected to participate in a feasibility study, in which a medication event monitoring system for pain medications was used to validate medication adherence as a health outcome. Data on the subsample’s self-assessed pain intensity, pain interference, concerns and necessity beliefs about pain medications, self-confidence in managing pain, and medication implementation adherence were analyzed.

Results

In the 5 participants who used the medication event monitoring system, the overall latency between voice assistant reminder deployment and the medication event (ie, medication bottle cap opening) was 55 minutes. The absolute latency (before or after the reminder) varied among the participants. The shortest average time taken to open the cap after the reminder was 17 minutes, and the longest was 4.5 hours. Of the 168 voice assistant reminders for scheduled pain medications, 25 (14.6%) resulted in the opening of MEMS caps within 5 minutes of the reminder, and 107 (63.7%) resulted in the opening of MEMS caps within 30 minutes of the reminder.

Conclusions

Voice assistant reminders may help cue patients to take scheduled medications, but the timing of medication use may vary. The timing of medication use may influence treatment effectiveness. Tracking the absolute latency time of medication use may be a helpful method for assessing medication adherence. Medication event monitoring may provide additional insight into medication implementation adherence during the implementation of mobile health interventions.
Understanding the Social Determinants of Mental Health of Undergraduate Students in Bangladesh: Interview Study
Authors: Bhattacharjee Ananya , Haque S M Taiabul , Hady Md Abdul , Alam S M Raihanul , Rabbi Mashfiqui , Kabir Muhammad Ashad , Ahmed Syed Ishtiaque
Published: August 2021

Background

The undergraduate student population has been actively studied in digital mental health research. However, the existing literature primarily focuses on students from high-income nations, and undergraduates from limited-income nations remain understudied.

Objective

This study aims to identify the broader social determinants of mental health among undergraduate students in Bangladesh, a limited-income nation in South Asia; study the manifestation of these determinants in their day-to-day lives; and explore the feasibility of self-monitoring tools in helping them identify the specific factors or relationships that affect their mental health.

Methods

We conducted a 21-day study with 38 undergraduate students from 7 universities in Bangladesh. We conducted 2 semistructured interviews: one prestudy and one poststudy. During the 21-day study, participants used an Android app to self-report and self-monitor their mood after each phone conversation. The app prompted participants to report their mood after each phone conversation and provided graphs and charts so that the participants could independently review their mood and conversation patterns.

Results

Our results show that academics, family, job and economic condition, romantic relationship, and religion are the major social determinants of mental health among undergraduate students in Bangladesh. Our app helped the participants pinpoint the specific issues related to these factors, as the participants could review the pattern of their moods and emotions from past conversation history. Although our app does not provide any explicit recommendation, the participants took certain steps on their own to improve their mental health (eg, reduced the frequency of communication with certain persons).

Conclusions

Although some of the factors (eg, academics) were reported in previous studies conducted in the Global North, this paper sheds light on some new issues (eg, extended family problems and religion) that are specific to the context of the Global South. Overall, the findings from this study would provide better insights for researchers to design better solutions to help the younger population from this part of the world.
Toward an Extended Definition of Major Depressive Disorder Symptomatology: Digital Assessment and Cross-validation Study
Authors: Martin-Key Nayra A , Mirea Dan-Mircea , Olmert Tony , Cooper Jason , Han Sung Yeon Sarah , Barton-Owen Giles , Farrag Lynn , Bell Emily , Eljasz Pawel , Cowell Daniel , Tomasik Jakub , Bahn Sabine
Published: August 2021

Background

Diagnosing major depressive disorder (MDD) is challenging, with diagnostic manuals failing to capture the wide range of clinical symptoms that are endorsed by individuals with this condition.

Objective

This study aims to provide evidence for an extended definition of MDD symptomatology.

Methods

Symptom data were collected via a digital assessment developed for a delta study. Random forest classification with nested cross-validation was used to distinguish between individuals with MDD and those with subthreshold symptomatology of the disorder using disorder-specific symptoms and transdiagnostic symptoms. The diagnostic performance of the Patient Health Questionnaire–9 was also examined.

Results

A depression-specific model demonstrated good predictive performance when distinguishing between individuals with MDD (n=64) and those with subthreshold depression (n=140) (area under the receiver operating characteristic curve=0.89; sensitivity=82.4%; specificity=81.3%; accuracy=81.6%). The inclusion of transdiagnostic symptoms of psychopathology, including symptoms of depression, generalized anxiety disorder, insomnia, emotional instability, and panic disorder, significantly improved the model performance (area under the receiver operating characteristic curve=0.95; sensitivity=86.5%; specificity=90.8%; accuracy=89.5%). The Patient Health Questionnaire–9 was excellent at identifying MDD but overdiagnosed the condition (sensitivity=92.2%; specificity=54.3%; accuracy=66.2%).

Conclusions

Our findings are in line with the notion that current diagnostic practices may present an overly narrow conception of mental health. Furthermore, our study provides proof-of-concept support for the clinical utility of a digital assessment to inform clinical decision-making in the evaluation of MDD.
The Role of Online Arts and Humanities in Medical Student Education: Mixed Methods Study of Feasibility and Perceived Impact of a 1-Week Online Course
Authors: Stouffer Kaitlin , Kagan Heather J , Kelly-Hedrick Margot , See Julia , Benskin Elizabeth , Wolffe Suzy , Yenawine Philip , Chisolm Margaret S
Published: August 2021

Background

The arts and humanities have been integrated into medical student education worldwide. Integrated arts and humanities courses have been found to serve four primary functions: mastering skills, perspective taking, personal insight, and social advocacy. To what extent and how arts and humanities programs achieve these educational outcomes remain unclear.

Objective

In this study, we aimed to explore how the arts and humanities may lead to perceived benefits in clinical skills development, professional identity formation, and self-care, and to evaluate the feasibility of delivering an arts and humanities–based course online.

Methods

We developed and delivered a 1-week online arts and humanities course to second- through fourth-year medical students. A total of 18 students enrolled in the course across its 2 offerings in Spring 2020. The course was primarily visual arts based but also included activities based in other arts and humanities, such as literature, reflective writing, dance, film, music, philosophy, and religion. Using a mixed methods approach, daily polls assessed student engagement in and perceptions of the various activities, and a postcourse survey assessed student perceptions of the course as a whole.

Results

At least 93% of poll respondents (14/15 to 17/18) across the 2 cohorts rated each type of activity as good or excellent. Qualitative analysis of student responses to the postcourse survey revealed themes concerning both the form (overall course design and online format) and the function of the course (skills development, appreciation of new perspectives, and personal inquiry).

Conclusions

Results suggested that the arts and humanities may support the development of clinically relevant skills and attitudes. A more unique finding was that integrative arts and humanities courses delivered online—including those that are primarily visual arts based—engage students and may yield personal and professional benefits.