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Journal Description


JMIR Research Protocols (ISSN 1929-0748) is a unique Pubmed- and (new!) Scopus-indexed journal, publishing peer-reviewed, openly accessible research ideas and grant proposals, study and trial protocols, reports of ongoing research, current methods and approaches, and preliminary results from pilot studies or formative research informing the design of medical and health-related research and technology innovations.

While the original focus was on eHealth studies, JMIR Res Protoc now publishes protocols and grant proposals in all areas of medicine, and their peer-review reports, if available (preliminary results from pilot studies, early results, and formative research should now be published in JMIR Formative Research).

While the original focus was on the design of medical and health-related research and technology innovations, JRP publishes research protocols, proposals, feasibility studies, methods and early results in all areas of medical and health research.

JMIR Res Protoc is fully open access, with full-text articles deposited in PubMed Central.

Publishing research protocols, grant proposals, pilot/feasibility studies and early reports of ongoing and planned work encourages collaboration and early feedback, and reduces duplication of effort.

JMIR Res Protoc is compatible with the concept of "Registered Reports" and since May 2018, published protocols receive a Registered Report Identifier (What is a Registered Report Identifier?) and acceptance of the subsequent results paper is "in principle" guaranteed in any JMIR journal and partner journals - see What is a Registered Report?

JMIR Res Protoc will be a valuable ressource for researchers who want to learn about current research methodologies and how to write a winning grant proposal.

JMIR Res Protoc creates an early scientific record for researchers who have developed novel methodologies, software, innovations or elaborate protocols.

JMIR Res Protoc provides a "dry-run" for peer-review of the final results paper, and allows feedback/critique of the methods, often while they still can be fixed.

JMIR Res Protoc faciliates subsequent publication of results demonstrating that the methodology has already been reviewed, and reduces the effort of writing up the results, as the protocol can be easily referenced.

JMIR Res Protoc demonstrates to reviewers of subsequent results papers that authors followed and adhered to carefully developed and described a-priori methods.

Studies whose protocols or grant proposals have been accepted in JMIR Res Protoc are "in principle accepted" for subsequent publication of results in other JMIR journals as long as authors adhere to their original protocol - regardless of study results (even if they are negative), reducing publication bias in medicine.

Authors publishing their protocols in JMIR Res Protoc will receive a 20% discount on the article processing fee if they publish their results in another journal of the JMIR journal family (for example, JMIR for ehealth studies, i-JMR for others).

JMIR Res Protoc is also a unique crowdfunding platform, allowing backers to crowdfund carefully peer-reviewed projects that are not junk-science, and giving researchers additional small funding to conduct and publish their research results. Each article is published with a crowdfunding widget, allowing readers to make nominal donations to the project, which benefit the authors (currently in beta).

Need more reasons? Read the Knowledge Base article on "Why should I publish my protocol/grant proposal"!


Recent Articles:

  • Baseline interview with a respondent. Source: Image created by the authors; Copyright: The Authors; URL:; License: Creative Commons Attribution + Noncommercial (CC-BY-NC).

    The Effect of Improved Access to Family Planning on Postpartum Women: Protocol for a Randomized Controlled Trial


    Background: The World Health Organization recommends that a woman waits at least 24 months after a live birth before getting pregnant again; however, an estimated 25% of birth intervals in low-income countries do not meet this recommendation for adequate birth spacing, and the unmet need for postpartum family planning (PPFP) services is high. Few randomized controlled trials have assessed the causal impact of access to PPFP services, and even fewer evaluations have investigated how such interventions may affect postpartum contraceptive use, birth spacing, and measures of health and well-being. Objective: This protocol paper aims to describe a randomized controlled trial that is being conducted to identify the causal impact of an intervention to improve access to PPFP services on contraceptive use, pregnancy, and birth spacing in urban Malawi. The causal effect of the intervention will be determined by comparing outcomes for respondents who are randomly assigned to an intervention arm against outcomes for respondents who are randomly assigned to a control arm. Methods: Married women aged 18-35 years who were either pregnant or had recently given birth were randomly assigned to either the intervention arm or control arm. Women assigned to the intervention arm received a package of services over a 2-year intervention period. Services included a brochure and up to 6 home visits from trained family planning counselors; free transportation to a high-quality family planning clinic; and financial reimbursement for family planning services, consultations, and referrals for services. Two follow-up surveys were conducted 1 and 2 years after the baseline survey. Results: A total of 2143 women were randomly assigned to either the intervention arm (n=1026) or the control arm (n=1117). Data collection for the first follow-up survey began in August 2017 and was completed in February 2018. A total of 1773 women, or 82.73% of women who were eligible for follow-up, were successfully contacted and reinterviewed at the first follow-up. Data collection for the second follow-up survey began in August 2018 and was completed in February 2019. A total of 1669 women, or 77.88% of women who were eligible for follow-up, were successfully contacted and reinterviewed at the second follow-up. The analysis of the primary outcomes is ongoing and is expected to be completed in 2021. Conclusions: The results of this trial seek to fill the current knowledge gaps in the effectiveness of family planning interventions on improving fertility and health outcomes. The findings also show that the benefits of improving access to family planning are likely to extend beyond the fertility and health domain by improving other measures of women’s well-being. Trial Registration: American Economics Association Registry Trial Number AEARCTR-0000697; Registry for International Development Impact Evaluations (RIDIE) Trial Number RIDIE-STUDY-ID-556784ed86956;

  • 1: Bronchoscopic view of the trachea and the catheter (blue). A) Trachea during inspiration in pressure 0 cmH2O. B) trachea during expiration in pressure 0 cmH2O C) trachea during inspiration in pressure 18 cmH2O D) trachea during expiration in pressure 18 cmH2O. Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Improving Airways Patency and Ventilation Through Optimal Positive Pressure Identified by Noninvasive Mechanical Ventilation Titration in Mounier-Kuhn...


    Background: Mounier-Kuhn syndrome or congenital tracheobronchomegaly is a rare disease characterized by dilation of the trachea and the main bronchi within the thoracic cavity. The predominant signs and symptoms of the disease include coughing, purulent and abundant expectoration, dyspnea, snoring, wheezing, and recurrent respiratory infection. Symptoms of the disease in some patients are believed to be pathological manifestations arising due to resident tracheobronchomalacia. Although treatment options used for the management of this disease include inhaled bronchodilators, corticosteroids, and hypertonic solution, there is no consensus on the treatment. The use of continuous positive airway pressure (CPAP) has been reported as a potential therapeutic option for tracheobronchomalacia, but no prospective studies have demonstrated its efficacy in this condition. Objective: The purpose of this is to identify the presence of tracheobronchomalacia and an optimal CPAP pressure that reduces the tracheobronchial collapse in patients with Mounier-Kuhn syndrome and to analyze the repercussion in pulmonary ventilation. In parallel, we aim to evaluate the prevalence of obstructive sleep apnea/hypopnea syndrome. Methods: This interventional, open-label, single-arm clinical trial will enroll patients who are diagnosed Mounier-Kuhn syndrome. Patient evaluation will be conducted in an outpatient clinic and involve 3 visits. Visit 1 will involve the collection and registration of social demographic, clinical, and functional data. Visit 2 will entail polysomnography, bronchoscopy for the evaluation of tracheobronchomalacia, titration of the optimal pressure that reduces the degree of collapse of the airway, and electrical impedance tomography. In visit 3, patients exhibiting a reduction in collapse areas will be requested to undergo chest computed tomography during inspiration and forced expiration with and without positive pressure (titrated to determine optimal CPAP pressure). Results: This protocol is a doctorate project. The project was submitted to the institutional review board on January 24, 2017, and approval was granted on February 2, 2017 (Brazilian Research database number CAAE 64001317.4.000.0068). Patient evaluations started in April 2018. Planned recruitment is based on volunteers’ availability and clinical stability, and interventions will be conducted at least once a month to finish the project at the end of 2020. A preliminary analysis of each case will be performed after each intervention, but detailed results are expected to be reported in the first quarter of 2021. Conclusions: There is no consensus on the best treatment options for managing Mounier-Kuhn syndrome. The use of positive pressure could maintain patency of the collapsed airways, functioning as a “pneumatic stent” to reduce the degree of airflow obstruction. This, in turn, could promote mobilization of thoracic secretion and improve pulmonary ventilation. Trial Registration: NCT03101059;

  • Source: Image created by authors; Copyright: Monash University; URL:; License: Creative Commons Attribution + Noncommercial (CC-BY-NC).

    Personalized Approach Bias Modification Smartphone App (“SWIPE”) to Reduce Alcohol Use Among People Drinking at Hazardous or Harmful Levels: Protocol for...


    Background: Alcohol accounts for 5.1% of the global burden of disease and injury, and approximately 1 in 10 people worldwide develop an alcohol use disorder. Approach bias modification (ABM) is a computerized cognitive training intervention in which patients are trained to “avoid” alcohol-related images and “approach” neutral or positive images. ABM has been shown to reduce alcohol relapse rates when delivered in residential settings (eg, withdrawal management or rehabilitation). However, many people who drink at hazardous or harmful levels do not require residential treatment or choose not to access it (eg, owing to its cost, duration, inconvenience, or concerns about privacy). Smartphone app–delivered ABM could offer a free, convenient intervention to reduce cravings and consumption that is accessible regardless of time and place, and during periods when support is most needed. Importantly, an ABM app could also easily be personalized (eg, allowing participants to select personally relevant images as training stimuli) and gamified (eg, by rewarding participants for the speed and accuracy of responses) to encourage engagement and training completion. Objective: We aim to test the feasibility and acceptability of “SWIPE,” a gamified, personalized alcohol ABM smartphone app, assess its preliminary effectiveness, and explore in which populations the app shows the strongest indicators of effectiveness. Methods: We aim to recruit 500 people who drink alcohol at hazardous or harmful levels (Alcohol Use Disorders Identification Test score≥8) and who wish to reduce their drinking. Recruitment will be conducted through social media and websites. The participants’ intended alcohol use goal (reduction or abstinence), motivation to change their consumption, and confidence to change their consumption will be measured prior to training. Participants will be instructed to download the SWIPE app and complete at least 2 ABM sessions per week for 4 weeks. Recruitment and completion rates will be used to assess feasibility. Four weeks after downloading SWIPE, participants will be asked to rate SWIPE’s functionality, esthetics, and quality to assess acceptability. Alcohol consumption, craving, and dependence will be measured prior to commencing the first session of ABM and 4 weeks later to assess whether these variables change significantly over the course of ABM. Results: We expect to commence recruitment in August 2020 and complete data collection in March 2021. Conclusions: This will be the first study to test the feasibility, acceptability, and preliminary effectiveness of a personalized, gamified ABM intervention smartphone app for hazardous or harmful drinkers. Results will inform further improvements to the app, as well as the design of a statistically powered randomized controlled trial to test its efficacy relative to a control condition. Ultimately, we hope that SWIPE will extend the benefits of ABM to the millions of individuals who consume alcohol at hazardous levels and wish to reduce their use but cannot or choose not to access treatment. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000638932p;

  • Source: PromMera; Copyright: PromMera/PlaceIt; URL:; License: Creative Commons Attribution (CC-BY).

    App Technology to Support Physical Activity and Intake of Vitamins and Minerals After Bariatric Surgery (the PromMera Study): Protocol of a Randomized...


    Background: To optimize postoperative outcomes after bariatric surgery, lifestyle changes including increased physical activity are needed. Micronutrient deficiency after surgery is also common and daily supplementation is recommended. Objective: The aim of the PromMera study is to evaluate the effects of a 12-week smartphone app intervention on promotion of physical activity (primary outcome) and adherence to postsurgery vitamin and mineral supplementation, as well as on other lifestyle factors and overall health in patients undergoing bariatric surgery. Methods: The PromMera study is a two-arm, randomized controlled trial comprising patients undergoing bariatric surgery. Participants are randomized postsurgery 1:1 to either the intervention group (ie, use of the PromMera app for 12 weeks) or the control group receiving only standard care. Clinical and lifestyle variables are assessed pre- and postsurgery after 18 weeks (postintervention assessment), 6 months, 1 year, and 2 years. Assessments include body composition using Tanita or BOD POD analyzers, muscle function using handgrip, biomarkers in blood, and an extensive questionnaire on lifestyle factors. Physical activity is objectively measured using the ActiGraph wGT3X-BT triaxial accelerometer. Results: A total of 154 participants have been enrolled in the study. The last study participant was recruited in May 2019. Data collection will be complete in May 2021. Conclusions: Implementing lifestyle changes are crucial after bariatric surgery and new ways to reach patients and support such changes are needed. An app-based intervention is easily delivered at any time and can be a key factor in the adoption of healthier behavioral patterns in this rapidly growing group of patients. Trial Registration: NCT03480464;

  • Example of LN analysis at pathology. Some LN appearing blue (SLN) are hyperfluorescent meaning that there is a correlation between LN detected by peritumoral injection and LN detected after IV ICG injection. Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Systemic Sentinel Lymph Node Detection Using Fluorescence Imaging After Indocyanine Green Intravenous Injection in Colorectal Cancer: Protocol for a...


    Background: Nodal staging is a major concern in colorectal cancer as it is an important prognostic factor. Several techniques that could potentially improve patient treatment and prognosis have been developed to increase the accuracy of nodal staging. Sentinel lymph node detection has been shown to accurately reflect nodal status in various tumors and has become the standard procedure in nodal staging of breast cancer and melanoma. However, in colorectal cancer, sentinel lymph node detection techniques are still controversial as the sensitivity reported in the literature varies from one study to another. Recently, indocyanine green fluorescence–guided surgery has been reported to be a useful technique for detection of macroscopic and microscopic metastatic deposits in lymph nodes after intravenous administration of indocyanine green dye. However, no studies have focused on the potential role of sentinel lymph node detection after systemic administration of indocyanine green dye, so-called systemic sentinel lymph nodes, or on the correspondence between the identification of the sentinel lymph node by standard local injection techniques and the detection of fluorescent lymph nodes with this new approach. Objective: The aim of this protocol is to validate the concept of sentinel lymph nodes identified by fluorescence imaging after intravenous injection of indocyanine green dye and to compare the sentinel lymph nodes identified by fluorescence imaging with sentinel lymph nodes detected by the standard blue dye technique. Methods: This study (SeLyNoFI; Sentinel Lymph Nodes Fluorescence Imaging) is a diagnostic, single-arm, open-label feasibility study, including patients with colorectal adenocarcinoma with or without metastatic disease who are admitted for elective colorectal resection of the primary tumor. This study evaluates the feasibility of a new approach for improving the accuracy of nodal staging using fluorescence imaging after intravenous administration of indocyanine green dye. Sensitivity, positive predictive value, and accuracy of the classical blue dye technique and of the investigatory fluorescence imaging technique will be calculated. Translational research will be proposed, if applicable. Results: As of June 2020, this study has been registered. Submission for ethical review is planned for September 2020. Conclusions: The potential correlation between the two different approaches to detect sentinel lymph nodes offers new strategies for improving the accuracy of nodal staging in colorectal cancer. This new concept of the systemic sentinel lymph node and a greater understanding of the interactions between systemic sentinel lymph nodes and standard sentinel lymph nodes may provide important information regarding the underlying mechanism of primary tumor lymphatic drainage. The enhanced permeability and retention effect can also play a role in the fluorescence of systemic sentinel lymph nodes, especially if these lymph nodes are inflamed. In this case, we can even imagine that this new technique will highlight more instances of lymph node–positive colorectal cancer.

  • Psicologia y Tecnologia webpage. Source: The Authors / Placeit; Copyright: The Authors / Placeit; URL:; License: Licensed by JMIR.

    Feasibility of the Internet Attachment–Based Compassion Therapy in the General Population: Protocol for an Open-Label Uncontrolled Pilot Trial


    Background: Compassion-based interventions delivered over the internet are showing promising results for the promotion of psychological health and well-being. Several studies have highlighted their feasibility, acceptance, and preliminary efficacy. However, this is an incipient field of research, and to the best of our knowledge, there are no data available from Spanish-speaking countries. Objective: The aim of this study is to investigate the feasibility, acceptance, and preliminary efficacy of the Internet Attachment–Based Compassion Therapy (iABCT), a web-based version of the Attachment-Based Compassion Therapy, in Spanish speakers from the general population. Methods: This feasibility study features a single-arm, uncontrolled, within-group design with an embedded qualitative and quantitative process evaluation at baseline, immediately after the intervention and at the 3-month follow-up. A minimum of 35 participants from the general population will be allocated to iABCT. Feasibility measures will include attrition rate, patterns of use of the web-based system, and participants’ acceptability, usability, and opinion. The primary outcome was measured using the Pemberton Happiness Index. Secondary outcomes were measured using the Compassion Scale, Self-Compassion Scale, Forms of Self-Criticizing/Attacking and Self-Reassuring Scale-Short form, Five Facets of Mindfulness Questionnaire, Relationships Questionnaire, General Health Questionnaire, Non-Attachment Scale, International Positive and Negative Affect Schedule Short Form, Purpose-In-Life Test, and difficulties regarding the practice of compassion (Compassion Practice Quality Questionnaire). Mixed models will be used to evaluate primary and secondary outcome measures. A qualitative content analysis of the participants’ qualitative responses will also be performed. Results: Enrollment started in February 2020 and will be finished in April 2020. Data analysis will start in October 2020. Conclusions: To our knowledge, this study will, for the first time, show data on the feasibility, acceptability, and preliminary efficacy of web-based compassion (and self-compassion) training—that is, the adapted iABCT—in Spanish speakers from the general population. Further aspects of their implementation (ie, facilitators, barriers, and unwanted effects) and mechanisms of change will be investigated. This study will allow the revision and fine-tuning of the developed intervention, study design, and planning procedures, as well as the initiation of a future randomized controlled trial. Clinical Trial: NCT03918746. Registered on April 17, 2019. Protocol version 1, 6 March 2019.

  • Source: Pexels; Copyright: Dominika Roseclay; URL:; License: Licensed by JMIR.

    The Parenting Education Needs of Women Experiencing Incarceration in South Australia: Proposal for a Mixed Methods Study


    Background: The mother-child relationship is extremely important, and for mothers experiencing incarceration, this relationship has unique challenges. There is limited evidence currently available to identify the type and content of parenting education that would best suit women who are incarcerated. Objective: This study aims to design and evaluate a parent education program for women experiencing incarceration in South Australia. The program must meet the specific needs of incarcerated women and considers the cultural needs of Aboriginal and or Torres Strait Islanders and migrant women. Hereafter Aboriginal and/or Torres Strait Islander peoples will be referred to as Aboriginal; the authors acknowledge the diversity within Aboriginal cultures. Methods: This study will utilize a mixed methods approach, including six phases framed by a community-based theoretical model. This methodology provides a collaborative approach between the researcher and the community to empower the women experiencing incarceration, allowing their parenting education needs to be addressed. Results: A scoping review was undertaken to inform this study protocol. This paper describes and discusses the protocol for this mixed methods study. Recruiting commenced in December 2019, results will be published in 2020, and the project will be completed by August 2022. This project has been supported by a Research Training Scholarship from the Australian Government. Conclusions: The scoping review highlighted a lack of rigorous evidence to determine the most appropriate parenting education program to suit women experiencing incarceration specifically, and there was little consideration for the cultural needs of women. It also became clear that when quantitative and qualitative data are utilized, the women’s voices can assist in the determination of what works, what will not work, and what can be improved. The data collected and analyzed during this study, as well as the current evidence, will assist in the development of a specific parenting education program to meet the needs of women experiencing incarceration in South Australia and will be implemented and evaluated as part of the study. Trial Registration:

  • Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution + Noncommercial + NoDerivatives (CC-BY-NC-ND).

    Technology-Based Stepped Care to Stem Transgender Adolescent Risk Transmission: Protocol for a Randomized Controlled Trial (TechStep)


    Background: Transgender youth demonstrate significantly higher rates of engagement in sexual risk behaviors relative to their cisgender or gender-conforming counterparts, including high rates of condomless anal intercourse and engagement in sex work. In addition, transgender youth experience increased physical or sexual abuse, victimization, substance use, mental health disorders, incarceration, and homelessness. Owing to these syndemic health disparities, transgender youth are at substantially increased risk of HIV infection. Objective: This protocol aims to describe a randomized controlled trial (RCT), Adolescent Medicine Trials Network 160 TechStep (N=250), which assesses the differential immediate and sustained effects of each of 3 conditions (text messaging, WebApp, or information-only control) for reducing sexual risk behaviors and increasing pre-exposure prophylaxis (PrEP) uptake among high-risk, HIV-negative transgender youth and young adults (aged 15-24 years). Methods: Participants will be recruited through web-based (targeted social media sites and apps) and offline (print ads and flyers) advertisements, peer and clinic referrals, and street- and venue-based outreach, and by contacting potential participants who have requested contact for future studies. Participants will be randomized into 1 of the 3 conditions: (1) text messaging, (2) WebApp, or (3) information-only control for 6 months. Assessments will occur at baseline and at 3, 6, and 9 months. Participants who do not show improvements in sexual risk or PrEP uptake at the 3-month assessment will be rerandomized to receive weekly electronic coaching (eCoaching) sessions in addition to their assigned text messaging or WebApp intervention, or remain in the original text messaging or WebApp intervention using a 2:1 ratio. Participants originally assigned to the information-only condition are not eligible for rerandomization. Results: Funding for TechStep was awarded in June 2017. Phase 1 was approved by the Institutional Review Board (IRB) in April 2018. Recruitment began in November 2018 for phase 1, the formative phase. Initial phase 2 IRB approval came in June 2019. The data collection for phase 2, the RCT, is expected to be completed in April 2021. As of March 2020, 54 participants have been enrolled in TechStep. The final results are anticipated in May 2021. Conclusions: By providing culturally responsive, technology-based interventions, TechStep aims to improve sexual health outcomes among HIV-negative transgender youth and young adults at high risk of HIV. TechStep will evaluate the efficacy of technology-based interventions for reducing HIV sexual risk behaviors and increasing PrEP initiation, adherence, and persistence. The suite of technology-based interventions developed in TechStep, and assessed for efficacy in a 3-condition RCT, represents an important advancement in intervention science toward developing tailored and scalable interventions for transgender youth and young adults. Trial Registration: NCT04000724;

  • Source: Shutterstock; Copyright: GaudiLab; URL:; License: Licensed by the authors.

    Closing the COVID-19 Psychological Treatment Gap for Cancer Patients in Alberta: Protocol for the Implementation and Evaluation of Text4Hope-Cancer Care


    Background: Cancer diagnoses and treatments usually engender significant anxiety and depressive symptoms in patients, close relatives, and caregivers. Providing psychological support during the coronavirus disease (COVID-19) pandemic presents additional challenges due to self-isolation and social or physical distancing measures in place to limit viral spread. This protocol describes the use of text messaging (Text4Hope-Cancer Care) as a convenient, cost-effective, and accessible population-level mental health intervention. As demonstrated in previous research, this evidence-based program supports good outcomes and high user satisfaction. Objective: We will implement daily supportive text messaging as a way of reducing and managing anxiety and depression related to cancer diagnosis and treatment in Alberta, Canada. Prevalence of anxiety and depressive symptoms, their demographic correlates, and Text4Hope-Cancer Care–induced changes in anxiety and depression will be evaluated. Methods: Alberta residents with a cancer diagnosis and the close relatives of those dealing with a cancer diagnosis can self-subscribe to the Text4Hope-Cancer Care program by texting “CancerCare” to a dedicated text number. Self-administered, anonymous, online questionnaires will be used to assess anxiety and depressive symptoms using the Hospital Anxiety and Depression Scale (HADS). Data will be collected at onset from individuals receiving text messages, and at the mid- and endpoints of the program (ie, at 6 and 12 weeks, respectively). Data will be analyzed with parametric and nonparametric statistics for primary outcomes (ie, anxiety and depressive symptoms) and usage metrics, including the number of subscribers and user satisfaction. In addition, data mining and machine learning analysis will focus on determining subscriber characteristics that predict high levels of symptoms of mental disorders, and may subsequently predict changes in those measures in response to the Text4Hope-Cancer Care program. Results: The first research stage, which was completed in April 2020, involved the creation and review of the supportive text messages and uploading of messages into a web-based text messaging service. The second stage, involving the launch of the Text4Hope-Cancer Care program, occurred in May 2020. Conclusions: Text4Hope-Cancer Care has the potential to provide key information regarding the prevalence rates of anxiety and depressive symptoms in patients diagnosed or receiving care for cancer and their caregivers. The study will generate demographic correlates of anxiety and depression, and outcome data related to this scalable, population-level intervention. Information from this study will be valuable for health care practitioners working in cancer care and may help inform policy and decision making regarding psychological interventions for cancer care.

  • Source: Unsplash; Copyright: Robina Weermeijer; URL:; License: Licensed by JMIR.

    Near-Infrared Cerebrovascular Reactivity for Monitoring Cerebral Autoregulation and Predicting Outcomes in Moderate to Severe Traumatic Brain Injury:...


    Background: Impaired cerebrovascular reactivity after traumatic brain injury (TBI) in adults is emerging as an important prognostic factor, with strong independent association with 6-month outcomes. To date, it is unknown if impaired cerebrovascular reactivity during the acute phase is associated with ongoing impaired continuously measured cerebrovascular reactivity in the long-term, and if such measures are associated with clinical phenotype at those points in time. Objective: We describe a prospective pilot study to assess the use of near-infrared spectroscopy (NIRS) to derive continuous measures of cerebrovascular reactivity during the acute and long-term phases of TBI in adults. Methods: Over 2 years, we will recruit up to 80 adults with moderate/severe TBI admitted to the intensive care unit (ICU) with invasive intracranial pressure (ICP) monitoring. These patients will undergo high-frequency data capture of ICP, arterial blood pressure (ABP), and NIRS for the first 5 days of care. Patients will then have 30 minutes of noninvasive NIRS and ABP monitoring in the clinic at 3, 6, and 12 months post-injury. Outcomes will be assessed via the Glasgow Outcome Scale and Short Form-12 questionnaires. Various relationships between NIRS and ICP-derived cerebrovascular reactivity metrics and associated outcomes will be assessed using biomedical signal processing techniques and both multivariate and time-series statistical methodologies. Results: Study recruitment began at the end of February 2020, with data collection ongoing and three patients enrolled at the time of writing. The expected duration of data collection will be from February 2020 to January 2022, as per our local research ethics board approval (B2018:103). Support for this work has been obtained through the National Institutes of Health (NIH) through the National Institute of Neurological Disorders and Stroke (NINDS) (R03NS114335), funded in January 2020. Conclusions: With the application of NIRS technology for monitoring of patients with TBI, we expect to be able to outline core relationships between noninvasively measured aspects of cerebral physiology and invasive measures, as well as patient outcomes. Documenting these relationships carries the potential to revolutionize the way we monitor patients with TBI, moving to more noninvasive techniques.

  • Source:; Copyright:; URL:; License: Licensed by JMIR.

    Effectiveness of Combining Organizational Alcohol Policy and Skills Training for Managers to Reduce Hazardous Alcohol Consumption in Swedish Workplaces:...


    Background: High alcohol consumption poses risks to individual health and society. Previous alcohol interventions have mainly focused on high-risk consumers or young adults in school-based settings. Since the majority of the adult population is in the workforce, the workplace can be considered a favorable arena for implementing interventions. Objective: This protocol describes a project aimed at increasing knowledge of the effectiveness of combining the implementation of an organizational alcohol policy with skills training for managers as a workplace alcohol prevention program, by evaluating the intervention and exploring managers’ perceptions of the intervention. Methods: Organizations with at least 100 employees were invited to take part in the project. A total of 11 organizations (744 managers and 11,761 employees) were included in the project. Data are collected through self-administered online surveys at baseline, 12 months, and 24 months. The primary outcome is managers’ inclination to initiate an early alcohol intervention (eg, by initiating a dialogue) when concern regarding employees’ hazardous alcohol consumption arises. The secondary outcomes of interest are managers’ and employees’ organizational alcohol policy knowledge and changes in alcohol consumption, as measured using the Alcohol Use Disorder Identification Test (AUDIT) score. A linear mixed-model framework will be used to model variability on different levels. Primary analysis will follow an intention-to-treat approach. Additionally, managers’ responses from semistructured interviews will be analyzed using thematic analysis to explore managers’ experiences regarding the prevention program. Results: This study is ongoing. The overall study start was on January 2018, and the study is planned to end in December 2020. Baseline and 12-month follow-up measurements have been collected. Conclusions: This project is designed to evaluate the effectiveness of an alcohol prevention program regarding higher inclination to initiate early alcohol interventions after policy implementation and skills training among managers, compared to the usual practices in the workplace. The results from this study can contribute to increased knowledge about alcohol interventions and future prevention programs in the workplace. Trial Registration: ISRCTN17250048;

  • SMART Project Logo. Source: Image created by the authors; Copyright: The authors; URL:; License: Copyright held by authors is pending..

    Evaluation of a Stepped-Care eHealth HIV Prevention Program for Diverse Adolescent Men Who Have Sex With Men: Protocol for a Hybrid Type 1 Effectiveness...


    Background: Adolescent men who have sex with men (AMSM), aged 13 to 18 years, account for more than 80% of teen HIV occurrences. Despite this disproportionate burden, there is a conspicuous lack of evidence-based HIV prevention programs. Implementation issues are critical as traditional HIV prevention delivery channels (eg, community-based organizations, schools) have significant access limitations for AMSM. As such, eHealth interventions, such as our proposed SMART program, represent an excellent modality for delivering AMSM-specific intervention material where youth are. Objective: This randomized trial aimed to test the effectiveness of the SMART program in reducing condom-less anal sex and increasing condom self-efficacy, condom use intentions, and HIV testing for AMSM. We also plan to test whether SMART has differential effectiveness across important subgroups of AMSM based on race and ethnicity, urban versus rural residence, age, socioeconomic status, and participation in an English versus a Spanish version of SMART. Methods: Using a sequential multiple assignment randomized trial design, we will evaluate the impact of a stepped-care package of increasingly intensive eHealth interventions (ie, the universal, information-based SMART Sex Ed; the more intensive, selective SMART Squad; and a higher cost, indicated SMART Sessions). All intervention content is available in English and Spanish. Participants are recruited primarily from social media sources using paid and unpaid advertisements. Results: The trial has enrolled 1285 AMSM aged 13 to 18 years, with a target enrollment of 1878. Recruitment concluded in June 2020. Participants were recruited from 49 US states as well as Puerto Rico and the District of Columbia. Assessments of intervention outcomes at 3, 6, 9, and 12 months are ongoing. Conclusions: SMART is the first web-based program for AMSM to take a stepped-care approach to sexual education and HIV prevention. This design indicates that SMART delivers resources to all adolescents, but more costly treatments (eg, video chat counseling in SMART Sessions) are conserved for individuals who need them the most. SMART has the potential to reach AMSM to provide them with a sex-positive curriculum that empowers them with the information, motivation, and skills to make better health choices. Trial Registration: Identifier NCT03511131;

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    Open Peer Review Period: Aug 11, 2020 - Oct 6, 2020

    Background: Breast cancer (BC) is the most common form of cancer among American women, accounting for 22% of all cancer survivors nationally. Yet, availability of adequate resources and tools for supp...

    Background: Breast cancer (BC) is the most common form of cancer among American women, accounting for 22% of all cancer survivors nationally. Yet, availability of adequate resources and tools for supporting BC survivors has not kept up with the rapid advancement in treatment options, resulting in unmet supportive care needs, particularly among low income and minority populations. The project explores an alternative means of delivering BC survivorship care plans (SCP), with the aim to improve survivor morbidity, patient knowledge, and self-management of treatment-related symptoms; and to address the inconsistencies in follow up care visits. Objective: The overall goal of this project is to improve uptake of survivorship care plan recommendations via an educational intervention for breast cancer survivors, with the aim to improve treatment-related morbidity, patient knowledge, self-management, and adherence to follow up visits. The specific aims of the study are to (1) evaluate the feasibility of the online SCP, and (2) to assess the impact of the online SCP on survivorship outcomes. Methods: We will enroll 50 BC survivors who have completed initial breast cancer treatment into a pilot two-armed, randomized, wait list-controlled trial, and collect data at baseline and 6 months. For the first aim, we will use mixed methods, including surveys and personal interviews among the intervention group, to determine the feasibility of providing an online, interactive SCP (ACESO), based on the survivors’ online user experience and their short-term adoption. For the secondary aim, we will compare the two groups to assess the primary outcomes of treatment-related morbidity (body weight, fatigue, depression, anxiety, sexual function, distress, and sleep quality); and the secondary outcomes of survivor knowledge, self-efficacy for self-management, perceived peer support, and adherence to SCP recommended post-treatment follow-up visits to oncology and primary care. We assess these outcomes by using measurements from validated instruments with robust psychometric properties. Results: We have developed and refined the online breast cancer survivorship plan (ACESO) with consultation from breast cancer oncologists, nurse, and survivors. We expect to begin enrolling participants in the following year. Conclusions: The results of this pilot study will inform the feasibility and design of a larger scale, pragmatic trial to evaluate the impact of an online breast caner survivorship care plan on treatment-related morbidity, and self-efficacy for self-management.

  • Codesigned Gamified Attention Bias Modification for Individuals with Opioid Use Disorder: Study Protocol of a Randomized Controlled Trial

    Date Submitted: Aug 11, 2020

    Open Peer Review Period: Aug 11, 2020 - Oct 6, 2020

    Background: Substance use disorders are prevalent globally. In 2019, there has been a large increase in individuals abusing opioids; a 56% increment from previous estimates, and this led to the World...

    Background: Substance use disorders are prevalent globally. In 2019, there has been a large increase in individuals abusing opioids; a 56% increment from previous estimates, and this led to the World Health Organization declaring there being an Opioid epidemic. Locally, in Singapore, Opioids are also highly abused. The recent advances in experimental psychology has led to there being better understanding of automatic, unconscious processes, such as that of attentional biases. Prior research has demonstrated there being robust attentional biases amongst individuals diagnosed with opioid use disorders; and even those who are maintained on methadone maintenance therapy. To date, there remains no prior studies that have evaluated the effectiveness of bias modification amongst Asian individuals, and amongst a cohort of participants with opioid use disorders. No prior evaluations have evaluated the effectiveness of a codesigned mobile attention bias modification intervention. Objective: Given this, this current study investigates the effectiveness of the codesigned intervention as compared to the conventional intervention in reducing the magnitude of the attentional biases, where effectiveness is defined as a substantial significant reduction in the magnitude of attentional biases (when comparing the magnitude at baseline and that at the end of the intervention). Methods: This proposed study is a non-blinded randomized controlled trial, comparing the codesigned attention bias modification intervention against the conventional intervention. Prior to randomization, all participants will be assessed to determine if they are eligible and if they have underlying positive baseline biases. This study uses a 2 (Intervention: codesigned versus conventional) x 2 (time: baseline, completion of intervention) design. Power computation reveals that 162 participants per arm are required, considering a 65% attrition rates (for participants without baseline biases). Participants enrolled into this trial are either randomized into receiving the conventional intervention or the codesigned intervention. Results: We are in the process of seeking extramural funding. Once funding has been secured, we will apply for ethical approval from the National Healthcare Group’s Domain Specific Research Board. The results arising from the study will be disseminated by conferences and research publications. Conclusions: This study is the first study that seeks to examine the effectiveness of a codesigned attention bias modification intervention against the conventional intervention. The results arising from the definitive study will have an implication on future attention bias modification intervention for individuals with substance use disorders. Clinical Trial: This trial has not been registered.

  • QueerVIEW: Protocol for a Technology-Mediated Qualitative Photo Elicitation Study with Sexual and Gender Minority Youth in Ontario, Canada

    Date Submitted: Aug 7, 2020

    Open Peer Review Period: Aug 7, 2020 - Oct 2, 2020

    Background: The experiences of resilience and intersectionality in the lives of contemporary sexual and gender minority youth (SGMY) are important to explore. SGMY face unique experiences of discrimin...

    Background: The experiences of resilience and intersectionality in the lives of contemporary sexual and gender minority youth (SGMY) are important to explore. SGMY face unique experiences of discrimination in both online and offline environments, yet simultaneously build community and seek support in innovative ways. SGMY who identify as transgender, trans*, or gender non-conforming, and/or have experiences in child welfare, with homelessness, and/or immigration have been particularly understudied. A qualitative exploration that leverages technology may derive new understandings of the negotiations of risk, resilience, and identity intersections that impact the wellbeing of vulnerable SGMY. Objective: The objectives of the QueerVIEW study were to: a) enhance understanding of SGMY identities, both online and offline; b) better understand experiences of intersectionality among culturally, regionally, and racially diverse SGMY in Ontario, Canada; c) explore online and offline sources and processes of resilience for these SGMY; and d) develop and apply a virtual photo elicitation methodological approach. Methods: This is the first study to pilot a completely virtual approach to a photo elicitation investigation with youth, including data collection, recruitment, interviewing, and analysis. Recruited through social media, SGMY completed a brief screening survey, submitted 10 to 15 digital photos, and then participated in a semi-structured interview that focused on their submitted photos and life experiences. Online data collection methods were employed through encrypted online file transfer and secure online interviews. Data is being analyzed using a constructivist grounded theory approach with six coders participating in structured online meetings that triangulated photo, video, and textual data. Results: Data collection with thirty participants is completed, and analyses are underway. SGMY expressed appreciation for the photo elicitation and online design of the study and commonly reported emotional catharsis from participating in this process. It is anticipated that results will form a model of how participants work towards integrating their online and offline experiences and identities into developing a sense of oneself as resilient. Conclusions: This protocol presents an innovative, technology-enabled qualitative study that completely digitized a popular arts-based research method, photo elicitation, which has potential utility for marginalized populations in an online era. The research design and triangulated analyses can generate more nuanced conceptualizations of SGMY identities and resilience than more traditional approaches. Considerations for conducting online research may be useful for other qualitative research.

  • Complementary and alternate therapies (CAM) in the management of novel Corona virus (COVID-19): protocol for systematic review and meta-analysis

    Date Submitted: Aug 2, 2020

    Open Peer Review Period: Aug 2, 2020 - Sep 27, 2020

    Background: In December 2019, a new coronavirus (COVID19) infected pneumonia broke out in the Chinese province of Wuhan. With the nature of the spread around the word, it has been announced as pandemi...

    Background: In December 2019, a new coronavirus (COVID19) infected pneumonia broke out in the Chinese province of Wuhan. With the nature of the spread around the word, it has been announced as pandemic and many complementary and alternative therapies (CAM) are being tried along with conventional approaches for the effective management of COVID 19. Objective: This paper presents the protocol for the systematic review and meta-analysis of the studies using various CAM therapies for the management of COVID19 pneumonia. Methods: Electronic databases such as PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) will be used for the searching the relevant trials and studies with keywords related to COVID-19 and CAM therapies. Two independent reviewers will screen all the list of the trials and extract the relevant variables. Additionally, we will also evaluate the risk of bias of the selected studies. Results: Review Manager software (RevMan; version 5.3.5) and R statistical software (version 3.6.1) will be used for the data analysis. Risk ratio (RR) would be estimated for dichotomous outcomes and the mean differences (MD) would be measured for continuous outcomes. Heterogeneity with the help of I2 statistic will be used for the assessment of inconsistency across studies with the level of significance at P< 0.10. We would also assess publication bias using funnel plots, Egger’s test and Begg’s test for the selected studies. Conclusions: The protocol for the systematic review and meta-analysis would investigate the preventive and treatment effects of various CAM therapies for COVID-19 associated pneumonia and also assess the benefits and harms of the CAM therapies in the COVID-19 management. Clinical Trial: Systematic review registration: PROSPERO registration number- CRD42020187532

  • Protocol: Impact of Nutrition Education on Nutrition Capacity of Caregivers and Nutrition Outcomes of Indigenous Mbororo Children in the West Region of Cameroon: Cluster Randomized Controlled Trial

    Date Submitted: Aug 1, 2020

    Open Peer Review Period: Aug 1, 2020 - Sep 26, 2020

    Background: Inadequate diets and life-threatening infections have profound adverse implications for child growth, development and survival, particularly among marginalized populations. Evidence of the...

    Background: Inadequate diets and life-threatening infections have profound adverse implications for child growth, development and survival, particularly among marginalized populations. Evidence of the effectiveness of community-based nutrition education interventions in improving child feeding and nutrition outcomes among Indigenous Mbororo population in Cameroon is scare. Objective: This study aims at investigating the impact of culturally-tailored community-based nutrition education intervention (Nu-WASHE) on caregivers’ knowledge attitude and practice (KAP) regarding complementary feeding and nutrition outcomes of Indigenous Mbororo children (3-59 months) in the Foumban and Galim health districts of the West region of Cameroon. Methods: A two-arm cluster randomized controlled trial will be conducted in the Foumban health district (FHD) and Galim health district (GHD). The intervention and control arms will each comprise of 5 clusters with 121 child-caregiver pairs. The intervention will consist of twelve 90 to 120 minutes facilitated group sessions, using 5 caregivers’ peer-support platforms. Six trained female Mbororo nutrition volunteers resident in the communities and 6 community health workers will lead the intervention under supervision. The control arm will receive routine facility-based nutrition education. Data will be collected at 3 months and 6 months follow-up. Both descriptive statistics and multivariate logistic models will be used to estimate the effect of Nu-WASHE (independent variable) on outcome variables (complementary feeding KAP, child’s weight, height/length, and morbidity status) within and between both arms. Clustering effect will be considered in the analysis. An approval (ref: 2019/1002-07/UB/SG/IRB/FHS) was obtained from the Faculty of Health Sciences-Institutional Review Board of the University of Buea. Results: From the pre-intervention study undertaken in September 2019, baseline data was collected and partially analyzed to inform the design of this proposed experimental study. In February 2020, 10 Mbororo communities (clusters) with 242 child-caregiver pairs were selected for the trial. Six community nutrition volunteers (CNV) and 6 community health workers (CHW) were selected and trained. Due to the COVID-19 preventive measures, implementation of the trial could not effectively start in March 2020 as scheduled. Conclusions: The findings of this study will provide evidence on the impact of culturally-tailored and Health belief Model-based nutrition education for behavior change as a complementary strategy for strengthening health facility-based approaches to the burden of malnutrition among the study population. Clinical Trial: The protocol was submitted to the WHO Pan Africa Clinical Trial Registry in South Africa for review. Feedback is still being awaited. The last correspondence was on July 4, 2020

  • Operating Room Instruction for COVID-19 Epidemic: A Meta-Synthesis

    Date Submitted: Aug 1, 2020

    Open Peer Review Period: Aug 1, 2020 - Sep 26, 2020

    Background: COVID-19crisis changes the patients' treatment procedures worldwide. Preventive procedures should be developed for COVID-19 in order to prevent its development, managethis epidemic properl...

    Background: COVID-19crisis changes the patients' treatment procedures worldwide. Preventive procedures should be developed for COVID-19 in order to prevent its development, managethis epidemic properly, and provide safe and effective service. Operating room is aplace where it is important to follow the instructions to cope with this disease because the operating room staffsare at the highest risk of infection with COVID-19. The present study aimed to design instructions for behavior in the operating room during the COVID-19 epidemic. Objective: The present study aimed to design instructions for behavior in the operating room during the COVID-19 epidemic. Methods: The present study was conducted by a systematic review method. Searching was performed by keywords COVID-19, surgery, operating room, anesthesia, and instructions on PUBMED, Science Direct, Ovid, and ProQuest databases; and 98 studied were obtained. It decreased to 42 items after repeating the duplicate items and reviewing the summary of articles, and finally 23 studies were selected for review. First, the articles were reviewed based on the titles and summary, and if they were included in the study if they had the inclusion criteria. The inclusion criteria were English and Persian languages; the relevance of articles on COVID-19, surgery and anesthesia. Results: : Patients should be screened for COVID-19 for surgery, and caution should be exercised if they had ear, nose and throat, jaw and face, head and neck surgeries. Intubation is one of the most risky activities that need to be done with full caution. Chlorine for the surface and equipment, and Ultraviolet (UV) for operating rooms are now the most accessible and effective disinfectants. Conclusions: Following the operating instructions in the operating room prevented the transmission of COVID among patients and staff and helped to perform safe surgery during the COVID-19 epidemic. Clinical Trial: -