@Article{info:doi/10.2196/68483, author="Wight, Lisa and Tenove, Chris and Hirani, Saima and Tworek, Heidi", title="Mental Health and Coping Strategies of Health Communicators Who Faced Online Abuse During the COVID-19 Pandemic: Mixed Methods Study", journal="JMIR Infodemiology", year="2025", month="Apr", day="2", volume="5", pages="e68483", keywords="mental health", keywords="online harassment", keywords="online abuse", keywords="coping strategies", keywords="resilience", keywords="social media", keywords="online advocacy", keywords="public health communication", keywords="health communication", abstract="Background: During the COVID-19 pandemic, health experts used social media platforms to share information and advocate for policies. Many of them faced online abuse, which some reported took a toll on their mental health and well-being. Variation in the impacts of online abuse on mental health, well-being, and professional efficacy suggest that health communicators may differ in their coping strategies and ultimately their resilience to such abuse. Objective: We aimed to explore the impacts of online abuse on health communicators' mental health and well-being as well as their emotion- and problem-focused coping strategies. Methods: We recruited health communicators (public health officials, medical practitioners, and university-based researchers) in Canada who engaged in professional online communication during the COVID-19 pandemic. In phase 1, semistructured interviews were conducted with 35 health communicators. In phase 2, online questionnaires were completed by 34 individuals before participating in workshops. Purposive recruitment resulted in significant inclusion of those who self-identified as racialized or women. Interview and workshop data were subjected to inductive and deductive coding techniques to generate themes. Descriptive statistics were calculated for selected questionnaire questions. Results: In total, 94\% (33/35) of interviewees and 82\% (28/34) of questionnaire respondents reported experiencing online abuse during the study period (2020-2022). Most health communicators mentioned facing an emotional and psychological toll, including symptoms of depression and anxiety. Racialized and women health communicators faced abuse that emphasized their ethnicity, gender identity, and physical appearance. Health communicators' most common emotion-focused coping strategies were withdrawing from social media platforms, avoiding social media platforms altogether, and accepting online abuse as unavoidable. Common problem-focused coping strategies included blocking or unfriending hostile accounts, changing online behavior, formal help-seeking, and seeking peer support. Due to the impacts of online abuse on participants' mental health and well-being, 41\% (14/34) of the questionnaire respondents seriously contemplated quitting health communication, while 53\% (18/34) reduced or suspended their online presence. Our findings suggest that health communicators who used problem-focused coping strategies were more likely to remain active online, demonstrating significant professional resilience. Conclusions: Although health communicators in our study implemented various emotion- and problem-focused coping strategies, they still faced challenges in dealing with the impacts of online abuse. Our findings reveal the limitations of individual coping strategies, suggesting the need for effective formal organizational policies to support those who receive online abuse and to sanction those who perpetrate it. Organizational policies could improve long-term outcomes for health communicators' mental health and well-being by mitigating online abuse and supporting its targets. Such policies would bolster professional resilience, ensuring that important health information can still reach the public and is not silenced by online abuse. More research is needed to determine whether gender, race, or other factors shape coping strategies and their effectiveness. ", doi="10.2196/68483", url="https://infodemiology.jmir.org/2025/1/e68483" } @Article{info:doi/10.2196/70508, author="Schulz, Johannes Peter and Boldi, Marc-Olivier and van Ackere, Ann", title="Adolescent Cyberbullying and Cyber Victimization: Longitudinal Study Before and During COVID-19", journal="J Med Internet Res", year="2025", month="Mar", day="25", volume="27", pages="e70508", keywords="cyberbullying and cyber victimization among adolescents", keywords="COVID-19", keywords="panel study", keywords="longitudinal data analysis", keywords="parental communication", keywords="exposure to violent media content", abstract="Background: Adolescent cyberbullying has been a persistent issue, exacerbated by the shift to remote learning and increased screen time during the COVID-19 pandemic. These changes have sparked concerns about potential increases in cyberbullying and its associated risks. Objective: This study aims to explore how factors such as age, exposure to violent media, parental communication quality, internet access, sex, and sibling relationships influence cyberbullying behavior at school. Additionally, we examine how the COVID-19 pandemic may have altered these dynamics. Methods: Leveraging a panel dataset, we examine the same group of adolescents both before and during the pandemic. The analysis focused on identifying relationships between the selected factors and cyberbullying perpetration and victimization, with an emphasis on the dynamics introduced by the COVID-19 pandemic. Results: Perceived quality of parental communication was found to reduce the risk of both cyberbullying perpetration and victimization, with the former effect becoming more pronounced during the COVID-19 pandemic. Exposure to violent media increased both cyberbullying perpetration and victimization, but the effect on perpetration decreased during the COVID-19 pandemic. The well-established correlation between internet access and both cyberbullying perpetration and victimization remained unaffected by COVID-19. Surprisingly, adolescents with siblings were less likely to become victims or perpetrators of school-related cyberbullying, irrespective of the pandemic. Conclusions: In hindsight, COVID-19, functioning as a kind of natural experiment, has provided us with a unique opportunity to examine the effects of a global event, forcing major behavioral changes on the persistent challenge of cyberbullying in middle schools. ", doi="10.2196/70508", url="https://www.jmir.org/2025/1/e70508" } @Article{info:doi/10.2196/64451, author="Liu, Xingyun and Liu, Miao and Kang, Xin and Han, Nuo and Liao, Yuehan and Ren, Zhihong", title="More Cyberbullying, Less Happiness, and More Injustice---Psychological Changes During the Pericyberbullying Period: Quantitative Study Based on Social Media Data", journal="J Med Internet Res", year="2025", month="Feb", day="25", volume="27", pages="e64451", keywords="cyberbullying", keywords="pericyberbullying period", keywords="social media", keywords="well-being", keywords="morality", keywords="suicide risk", keywords="personality traits", abstract="Background: The phenomenon of cyberbullying is becoming increasingly severe, and many studies focus on the negative psychological impacts of cyberbullying survivors. However, current survey methods cannot provide direct and reliable evidence of the short-term psychological effects of cyberbullying survivors, as it is impractical to measure psychological changes before and after such an unpredictable event in a short period. Objective: This study aims to explore the psychological impacts of cyberbullying on survivors during the pericyberbullying period, defined as the critical time frame surrounding the first cyberbullying incident, encompassing the psychological changes before, during, and after the event. Methods: We collected samples from 60 cyberbullying survivors (experimental group, 94/120, 78\% female) and 60 individuals who have not experienced cyberbullying (control group, matched by sex, location, and number of followers) on Sina Weibo, a social media platform developed by Sina Corporation. During the pericyberbullying period, we retrospectively measured psychological traits 3 months before and after the first cyberbullying incident for both groups. Social media data and predictive models were used to identify survivors' internal psychological traits, including happiness, suicide risk, personality traits, and moral perceptions of the external environment. Network analysis was then performed to explore the interplay between cyberbullying experiences and psychological characteristics. Results: During the pericyberbullying period, survivors exhibited significantly reduced happiness (t59=2.14; P=.04), marginally increased suicide risk, and significant changes in the Big 5 personality traits, including decreased conscientiousness (t59=2.27; P=.03), agreeableness (t59=2.79; P=.007), and extraversion (t59=2.26; P=.03), alongside increased neuroticism (t59=--3.42; P=.001). Regarding moral perceptions of the external environment, survivors showed significant increases in communicative moral motivation (t59=--2.62; P=.011) and FairnessVice (t59=--2.20; P=.03), with a marginal rise in PurityVice (t59=--1.88; P=.07). In contrast, the control group exhibited no significant changes during the same time frame. Additionally, network analysis revealed that beyond cyberbullying experiences, core psychological characteristics in the network were neuroticism, conscientiousness, and Oxford Happiness. Conclusions: By leveraging noninvasive retrospective social media data, this study provides novel insights into the short-term psychological impacts of cyberbullying during the pericyberbullying period. The findings highlight the need for timely interventions focusing on enhancing survivors' happiness, reducing suicide risk, adjusting personality traits, and rebuilding moral cognition to mitigate the negative effects of cyberbullying. ", doi="10.2196/64451", url="https://www.jmir.org/2025/1/e64451", url="http://www.ncbi.nlm.nih.gov/pubmed/39998871" } @Article{info:doi/10.2196/67962, author="Midgett, Aida and Doumas, M. Diana and Peralta, Claudia and Peck, Matt and Reilly, Blaine and Buller, K. Mary", title="Usability Testing of a Bystander Bullying Intervention for Rural Middle Schools: Mixed Methods Study", journal="JMIR Hum Factors", year="2025", month="Feb", day="21", volume="12", pages="e67962", keywords="technology-based bullying intervention", keywords="STAC-T", keywords="usability testing", keywords="middle school", keywords="rural", abstract="Background: Targets of bullying are at high risk of negative socioemotional outcomes. Bullying programming in rural schools is important as bullying is more prevalent in those schools compared to urban schools. Comprehensive, school-wide bullying programs require resources that create significant barriers to implementation for rural schools. Because technology-based programs can reduce implementation barriers, the development of a technology-based program increases access to bullying prevention in rural settings. Objective: We aimed to conduct usability testing of a bystander bullying intervention (STAC-T). We assessed usability and acceptability of the STAC-T application and differences in usability between school personnel and students. We were also interested in qualitative feedback about usability, program features, and feasibility. Methods: A sample of 21 participants (n=10, 48\% school personnel; n=11, 52\% students) recruited from 2 rural middle schools in 2 states completed usability testing and a qualitative interview. We used descriptive statistics and 2-tailed independent-sample t tests to assess usability and program satisfaction. We used consensual qualitative research as a framework to extract themes about usefulness, relevance, needs, barriers, and feedback for intervention development. Results: Usability testing indicated that the application was easy to use, acceptable, and feasible. School personnel (mean score 96.0, SD 3.9) and students (mean score 88.6, SD 9.5) rated the application well above the standard cutoff score for above-average usability (68.0). School personnel (mean score 6.10, SD 0.32) and students (mean score 6.09, SD 0.30) gave the application high user-friendliness ratings (0-7 scale; 7 indicates highest user-friendliness). All 10 school personnel stated they would recommend the program to others, and 90\% (9/10) rated the program with 4 or 5 stars. Among students, 91\% (10/11) stated they would recommend the program to others, and 100\% (11/11) rated the program with 4 or 5 stars. There were no statistically significant differences in ratings between school personnel and students. Qualitative data revealed school personnel and students found the application useful, relevant, and appropriate while providing feedback about the importance of text narration and the need for teacher and parent training to accompany the student program. The data showed that school personnel and students found a tracker to report different types of bullying witnessed and strategies used to intervene by students a useful addition to STAC-T. School personnel reported perceiving the program to be practical and very likely to be adopted by schools, with time, cost, and accessibility being potential barriers. Overall, findings suggest that the STAC-T application has the potential to increase access to bullying prevention for students in rural communities. Conclusions: The results demonstrate high usability and acceptability of STAC-T and provide support for implementing a full-scale randomized controlled trial to test the efficacy of the application. ", doi="10.2196/67962", url="https://humanfactors.jmir.org/2025/1/e67962" } @Article{info:doi/10.2196/58127, author="Bowen-Forbes, Camille and Khondaker, Tilovatul and Stafinski, Tania and Hadizadeh, Maliheh and Menon, Devidas", title="Mobile Apps for the Personal Safety of At-Risk Children and Youth: Scoping Review", journal="JMIR Mhealth Uhealth", year="2024", month="Nov", day="5", volume="12", pages="e58127", keywords="children", keywords="youth", keywords="personal safety apps", keywords="smartphones", keywords="mobile apps", keywords="violence", keywords="bullying", keywords="suicide prevention", keywords="youth support", keywords="homeless support", keywords="mobile phone", abstract="Background: Personal safety is a widespread public health issue that affects people of all demographics. There is a growing interest in the use of mobile apps for enhancing personal safety, particularly for children and youth at risk, who are among the most vulnerable groups in society. Objective: This study aims to explore what is known about the use of mobile apps for personal safety among children and youth identified to be ``at risk.'' Methods: A scoping review following published methodological guidelines was conducted. In total, 5 databases (Scopus, SocINDEX, PsycINFO, Compendex, and Inspec Archive) were searched for relevant scholarly articles published between January 2005 and October 2023. The gray literature was searched using Google and Google Scholar search engines. The results were reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. For summarizing the features and users' experiences of the apps, a published framework for evaluating the quality of mobile health apps for youth was used. Results: A total of 1986 articles were identified, and 41 (2.1\%) were included in the review. Nine personal safety apps were captured and categorized into 4 groups based on the goals of the apps, as follows: dating and sexual violence prevention (n=4, 44\% of apps), bullying and school violence prevention (n=2, 22\% of apps), self-harm and suicide prevention (n=2, 22\% of apps), and homeless youth support (n=1, 11\% of apps). Of the 41 articles, 25 (61\%) provided data solely on app descriptions and features, while the remaining 16 (39\%) articles provided data on app evaluations and descriptions. Outcomes focused on app engagement, users' experiences, and effectiveness. Four articles reported on app use, 3 (75\%) of which reported relatively high app use. Data on users' experience were obtained from 13 studies. In general, participants found the app features to be easy to use and useful as educational resources and personal safety tools. Most of the views were positive. Negative perceptions included redundancy of app features and a lack of usefulness. Five apps were evaluated for effectiveness (n=2, 40\% dating and sexual violence prevention; n=2, 40\% self-harm and suicide prevention; and n=1, 20\% bullying and school violence prevention) and were all associated with a statistically significant reduction (P=.001 to .048) in harm or risk to participants at the 95\% CI. Conclusions: Although many personal safety apps are available, few studies have specifically evaluated those designed for youth. However, the evidence suggests that mobile safety apps generally appear to be beneficial for reducing harm to at-risk children and youth without any associated adverse events. Recommendations for future research have been made to strengthen the evidence and increase the availability of effective personal safety apps for children and youth. ", doi="10.2196/58127", url="https://mhealth.jmir.org/2024/1/e58127" } @Article{info:doi/10.2196/60626, author="Kvestad, Ingrid and Adolfsen, Frode and Angeles, Corinne Renira and Brandseth, Lekve Oda and Breivik, Kyrre and Evertsen, Grete Janne and Foer, Kv{\aa}le Irene and Haaland, Morten and Homola, Millerjord Birgit and Hoseth, Elisabeth Gro and Jonsson, Josefine and Kjerstad, Egil and Kyrrestad, Henriette and Martinussen, Monica and Moberg, Annelene and Moberg, Karianne and Skogstrand, Anita and Solberg, Remme Line and Aasheim, Merete", title="Effectiveness of a Bullying Intervention (Be-Prox) in Norwegian Early Childhood and Education Care Centers: Protocol for a Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Oct", day="24", volume="13", pages="e60626", keywords="peer bullying in early childhood education and care", keywords="The Bernese Program", keywords="cluster randomized controlled trial", keywords="bullying", keywords="child", keywords="preschool", keywords="program evaluation", abstract="Background: A new and growing body of research has studied bullying among children in early childhood education and care centers (ECECs). The Bernese Program (Be-Prox) is designed to systematically prevent and handle bullying between children in Swiss ECECs. However, the effectiveness of the Be-Prox intervention has not yet been explored in a Norwegian ECEC setting. Objective: This study aims to evaluate the effectiveness of Be-Prox in preventing and handling bullying among peers in Norwegian ECECs. Methods: ECECs from 2 Norwegian municipalities were invited to participate in a cluster randomized controlled trial (RCT) to evaluate the effectiveness of the Be-Prox intervention on peer bullying in Norwegian ECECs. After baseline measures were taken, project ECECs were randomized to either an intervention or a control arm. The Be-Prox intervention was introduced to ECECs in the intervention arm through 6 modules over a 9-month period immediately after the randomization. ECECs in the control arm participated in the data collection and were offered the Be-Prox intervention the following year. The primary outcome of the effect evaluation is the mean sum of negative behavior between peers after the Be-Prox training is completed in the intervention arm. Secondary outcomes include child bystander behavior, teacher self-efficacy, and ECEC's authoritative climate. An extensive implementation and process evaluation, as well as cost-effectiveness analyses, will be conducted alongside the RCT. Results: Baseline data collection was conducted in September 2023, and the postintervention data collection started in May 2024. At baseline, we collected data on 708 children and 413 personnel from 38 project ECECs in the 2 Norwegian municipalities. The results from the study will be available in late 2024 at the earliest. Conclusions: The proposed project includes a comprehensive evaluation of the effectiveness of Be-Prox in Norwegian ECECs directly targeting the prevention and handling of bullying, including implementation and cost-effectiveness evaluations. The results from the project have the potential to fill in identified knowledge gaps in the understanding of negative behavior and bullying between peers in ECECs, and how these may be prevented. If proven efficient, our ambition is to offer Be-Prox to Norwegian ECECs as an evidence-based practice to prevent and handle bullying among preschool children. Trial Registration: ClinicalTrials.gov NCT06040437; https://clinicaltrials.gov/study/NCT06040437 International Registered Report Identifier (IRRID): DERR1-10.2196/60626 ", doi="10.2196/60626", url="https://www.researchprotocols.org/2024/1/e60626" } @Article{info:doi/10.2196/54066, author="Feng, Yonggang and Xue, Qihui and Yu, Peng and Peng, Lanxiang", title="The Relationship Between Epidemic Perception and Cyberbullying Behaviors of Chinese Adolescents During the COVID-19 Pandemic: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2024", month="Oct", day="2", volume="10", pages="e54066", keywords="COVID-19", keywords="epidemic perception", keywords="cyberbullying behaviors", keywords="insomnia", keywords="anxiety and depression", abstract="Background: In response to the COVID-19 outbreak, the government initiated measures for social distancing, leading to a gradual transition of adolescents' social interactions toward web-based platforms. Consequently, web-based behaviors, particularly cyberbullying, have become a prominent concern. Considering that adolescents experience more intense feelings, the widely increased negative emotions and strains perceived from the COVID-19 pandemic may end up engaging in cyberbullying behaviors. In addition, during the COVID-19 pandemic, adolescents experiencing insomnia and negative affect are more prone to diminished self-control, which is associated with cyberbullying behaviors. Objective: This study aims to investigate the relationship between epidemic perception and cyberbullying behaviors, while also examining the serial mediating roles of insomnia and negative affect on the relationship between epidemic perception and cyberbullying behaviors. Methods: This study presents a large-scale web-based survey conducted during the period of concentrated COVID-19 outbreaks, encompassing 20,000 Chinese adolescents. A total of 274 submitted questionnaires were discarded because of high levels of missing data or their answers were clearly fictitious or inconsistent. The final count of valid participants amounted to 19,726 (10,371 boys, age range: 12?18 years; mean 14.80, SD 1.63 years). The Perceptions of COVID-19 Scale, Negative Affect Scale, Insomnia Scale, and Cyberbullying Behavior Scale were used to assess participants' responses on the Questionnaire Star platform. Results: The results show that epidemic perception is positively correlated with cyberbullying behaviors (r=0.13; P<.001), insomnia (r=0.19; P<.001), and negative affect (r=0.25; P<.001). Insomnia is positively correlated with negative affect (r=0.44; P<.001) and cyberbullying behaviors (r=0.30; P<.001). Negative affect is positively correlated with cyberbullying behaviors (r=0.25; P<.001). And insomnia and negative affect play independent mediating and serial mediating roles in epidemic perception and cyberbullying behaviors. Conclusions: This study provides additional empirical evidence on the relationship between the perception of COVID-19 pandemic and cyberbullying in adolescents. In addition, the study offers recommendations for implementing interventions targeted at mitigating cyberbullying in adolescents during the COVID-19 pandemic. ", doi="10.2196/54066", url="https://publichealth.jmir.org/2024/1/e54066" } @Article{info:doi/10.2196/47233, author="Li, Jiaqi and Jin, Yu and Xu, Shicun and Wilson, Amanda and Chen, Chang and Luo, Xianyu and Liu, Yuhang and Ling, Xi and Sun, Xi and Wang, Yuanyuan", title="Effects of Bullying on Anxiety, Depression, and Posttraumatic Stress Disorder Among Sexual Minority Youths: Network Analysis", journal="JMIR Public Health Surveill", year="2023", month="Nov", day="1", volume="9", pages="e47233", keywords="sexual minority youths", keywords="bullying victimization", keywords="anxiety", keywords="depression", keywords="posttraumatic stress disorder", keywords="network analysis", keywords="Bayesian network", abstract="Background: Bullying victimization is highly prevalent among sexual minority youths, particularly in educational settings, negatively affecting their mental health. However, previous studies have scarcely explored the symptomatic relationships among anxiety, depression, and posttraumatic stress disorder (PTSD) among sexual minority youths who experienced bullying on college campuses. Objective: The objectives of our study were to (1) characterize the anxiety-depression-PTSD network structures of gay or lesbian, bisexuals, and other sexual minority youths previously bullied on college campuses; and (2) compare symptomatic associations in the anxiety-depression-PTSD networks among bullied sexual minority youths and heterosexual youths' groups. Methods: This cross-sectional study recruited college participants from Jilin Province, China. Data were analyzed using a subset of the data extracted after screening for sexual orientation and history of bullying victimization. Sexual minority youths were then divided into 3 subgroups: gay or lesbian (homosexual), bisexual, and other. Mental health symptom severity was assessed using scales: the 7-item Generalized Anxiety Disorder Scale measuring anxiety, the 9-item Patient Health Questionnaire measuring depression, and the 10-item Trauma Screening Questionnaire measuring PTSD symptoms. Combining the undirected and Bayesian network analyses, the anxiety-depression-PTSD networks were compared among sexual minority youths subgroups, and the difference between heterosexual youths and sexual minority youths was investigated. Chi-square tests were used to compare the difference in categorical variables, while independent-sample t tests were run on continuous variables. Results: In this large-scale sample of 89,342 participants, 12,249 identified as sexual minority youths, of which 1603 (13.1\%, 95\% CI 12.5\%-13.7\%) reported being bullied on college campuses in the past year. According to the expected influence (EI) and bridge expected influence (bEI) index, in the global network structure of anxiety, depression, and PTSD, sad mood (EI=1.078, bEI=0.635) and irritability (EI=1.077, bEI=0.954) were identified as central and bridge symptoms; emotional cue reactivity (EI=1.015) was a central symptom of PTSD in this global network. In the anxiety-depression-PTSD Bayesian network, anhedonia had the highest prediction priority for activating other symptoms; and feeling afraid linked symptoms from anxiety to the PTSD community. Compared to their heterosexual counterparts, sexual minority youths exhibited a stronger association between difficulty concentrating and appetite. The ``sad mood-appetite'' edge was strongest in the gay or lesbian network; the ``irritability-exaggerated startle response'' edge was strongest in the bisexual network. Conclusions: For the first time, this study identified the most central and bridge symptoms (sad mood and irritability) within the depression-anxiety-PTSD network of sexual minority youths with past bullying-victim experiences on college campuses. Emotional cue reactivity, anhedonia, and feeling afraid were other vital symptoms in the comorbid network. Symptomatic relationships existed showing heterogeneity in bullied heterosexual youths and sexual minority youth networks, which also was present within the sexual minority youth subgroups. Consequently, refined targeted interventions are required to relieve anxiety, depression, and PTSD symptoms. ", doi="10.2196/47233", url="https://publichealth.jmir.org/2023/1/e47233", url="http://www.ncbi.nlm.nih.gov/pubmed/37910159" } @Article{info:doi/10.2196/40022, author="Midgett, Aida and Doumas, M. Diana and Buller, K. Mary", title="Posttraining Outcomes, Acceptability, and Technology-Based Delivery of the STAC Bystander Bullying Intervention Teacher Module: Mixed Methods Study", journal="JMIR Form Res", year="2022", month="Aug", day="3", volume="6", number="8", pages="e40022", keywords="teacher bullying interventions", keywords="technology-based bullying intervention", keywords="STAC", keywords="middle school", abstract="Background: Bullying is a significant problem for youth associated with wide-ranging negative consequences. Providing students who witness bullying with intervention strategies to act as defenders can reduce bullying and negative associated outcomes for both targets and bystanders. Educating teachers about bullying and training them to support students to intervene as defenders may increase the efficacy of bystander programs as teachers' attitudes and responses to bullying relate to bystander behavior. This is particularly important in middle school, when bullying peaks and rates of reporting bullying to teachers begin to decline. Reducing implementation barriers, including limited time and resources, must also be considered, particularly for schools in low-income and rural areas. Technology-based programs can increase access and scalability but require participant buy-in for adoption. Objective: We used a mixed methods design to inform the development of the STAC teacher module, a companion training to a brief bullying bystander intervention. STAC stands for the four bystander intervention strategies: Stealing the Show, Turning it Over, Accompanying Others, and Coaching Compassion. Objectives included examining the effectiveness of the STAC teacher module and informing the translation of the training into a technology-based format that can be used as a companion to the technology-based STAC. Methods: A sample of 17 teachers recruited from 1 middle school in a rural, low-income community completed pre- and posttraining surveys assessing immediate outcomes (ie, knowledge, confidence, comfort, and self-efficacy), intention to use program strategies, and program acceptability and relevance, followed by a qualitative focus group obtaining feedback regarding program appropriateness, feasibility, content, perception of need, and desire for web-based training. Descriptive statistics, 2-tailed independent-sample t tests, and thematic analyses were used to analyze the data. Results: Assessment of pre- and posttraining surveys indicated that teachers reported an increase in knowledge and confidence to support defenders, confidence and comfort in managing bullying, and bullying self-efficacy. Furthermore, most participants reported that they were likely or very likely to use STAC strategies to support students who intervene in bullying. Quantitative and qualitative data revealed that participants found the training easy to use, useful, relevant, and appropriate. Qualitative data provided feedback on ways of improving the program, including revising role-plays and guidance on understanding student behavior. Participants shared positive perceptions regarding program feasibility and need for bullying-specific prevention, the most significant barriers being cost and parent buy-in, suggesting the importance of including parents in the prevention process. Finally, participants shared the strengths of a web-based program, including ease of implementation and time efficiency, while indicating the importance of participant engagement and administration buy-in. Conclusions: This study demonstrates the effectiveness of the STAC teacher module in increasing knowledge and bullying self-efficacy and provides support for developing the module, including key information regarding considerations for web-based translation. ", doi="10.2196/40022", url="https://formative.jmir.org/2022/8/e40022", url="http://www.ncbi.nlm.nih.gov/pubmed/35921129" } @Article{info:doi/10.2196/35558, author="Simpson, Naomi and Steen, Mary and Vernon, Rachael and Briley, Annette and Wepa, Dianne", title="Developing Conflict Resolution Strategies and Building Resilient Midwifery Students: Protocol for a Mixed Methods Research Study", journal="JMIR Res Protoc", year="2022", month="Feb", day="18", volume="11", number="2", pages="e35558", keywords="midwifery students", keywords="workplace", keywords="bullying", keywords="violence", keywords="conflict", keywords="abuse", keywords="resilience", abstract="Background: Workplace bullying and violence (WBV) are well-documented issues in the midwifery profession. Negative workplace culture, conflict, and bullying are the most common forms of workplace violence experienced by midwives. Workplace violence increases the risk of midwives experiencing burnout, compassion fatigue, psychological trauma, poor mental health, absenteeism, loss of passion for the midwifery profession, job dissatisfaction, and poor job retention. Midwifery students describe workplace violence in the form of physical, emotional, or verbal abuse, and bullying. Therefore, there is a justification to develop conflict resolution strategies and resilience in midwifery students prior to graduation. Objective: Our aim is to develop and facilitate a bespoke education program for South Australian midwifery students to enable them to develop skills in conflict resolution, build resilience, and identify self-care strategies. Methods: This study will undertake a preparatory phase summarizing the body of literature on midwifery students' knowledge, understanding, and experiences of WBV. Following this, a 3-phase sequential mixed methods research design study will be undertaken. In Phase 1, quantitative data will be collected via a semistructured questionnaire and a validated conflict measurement tool, before and after attending an education workshop, and will be analyzed using descriptive and inferential statistics. Results from Phase 1 will inform and guide the development of an interview schedule for Phase 2. In Phase 2, qualitative data will be gathered by facilitating one-to-one interviews and a thematic analysis will be undertaken to gain a deeper understanding of midwifery students' experiences of WBV. In Phase 3, data integration using triangulation will be undertaken and meta-inferences will be developed via the integration of results and findings from Phases 1 and 2. Results: The preparatory phase will commence in October 2021. Phase 1 will commence in 2022 with analysis of pre- and posteducation results anticipated to be completed by December 2022. Phase 2 will be developed from findings of the preparatory phase and results of Phase 1. An interpretation of verbatim interview transcripts is estimated to be undertaken by April 2023. Phase 3 of the study is expected to commence in May 2023, and this will involve the analysis of collective evidence gathered from Phases 1 and 2. The anticipated completion date for the study is December 2023. Conclusions: The outcomes of this research will provide insights into the prevalence and impact of WBV experienced by midwifery students. The findings of the research will report on levels of knowledge, skills, and confidence, and will assess the impact of a bespoke conflict resolution and resilience education workshop for midwifery students in managing WBV. International Registered Report Identifier (IRRID): PRR1-10.2196/35558 ", doi="10.2196/35558", url="https://www.researchprotocols.org/2022/2/e35558", url="http://www.ncbi.nlm.nih.gov/pubmed/34995202" } @Article{info:doi/10.2196/30286, author="Ademiluyi, Adesoji and Li, Chuqin and Park, Albert", title="Implications and Preventions of Cyberbullying and Social Exclusion in Social Media: Systematic Review", journal="JMIR Form Res", year="2022", month="Jan", day="4", volume="6", number="1", pages="e30286", keywords="cyberbullying", keywords="cybervictimization", keywords="cyberaggression", keywords="bullying", keywords="mental health", keywords="social isolation", keywords="social media", keywords="mobile phone", abstract="Background: The growth of social networking has created a paradigm in which many forms of personal communication are being replaced by internet communication technologies, such as social media. This has led to social issues, such as cyberbullying. In response, researchers are investigating cyberbullying to determine its implications in various life sectors. Objective: This manuscript reviews the methods, results, and limitations of the current cyberbullying research and discusses the physical and mental repercussions of cyberbullying and social exclusion as well as methods of predicting and counteracting these events. On the basis of the findings, we discuss future research directions. Methods: Using ScienceDirect, ACM Digital Library, and PubMed, 34 research articles were used in this review. A review was conducted using the selected articles with the goal of understanding the current landscape of cyberbullying research. Results: Studies have analyzed correlations between depressive and suicidal ideations in subjects as well as relationships in the social, educational, and financial status of the perpetrators. Studies have explored detection methods for monitoring cyberbullying. Automated detection has yet to become effective and accurate; however, several factors, such as personal background and physical appearance, have been identified to correlate with the likelihood that a person becomes a survivor or perpetrator of web-based cybervictimization. Social support is currently common in recovery efforts but may require diversification for specific applications in web-based incidents. Conclusions: Relations between social status, age, gender, and behaviors have been discovered that offer new insights into the origins and likeliness of cyberbullying events. Rehabilitation from such events is possible; however, automatic detection is not yet a viable solution for prevention of cyberbullying incidents. Effects such as social exclusion and suicidal ideations are closely tied to incidents of cyberbullying and require further study across various social and demographical populations. New studies should be conducted to explore the experiences of survivors and perpetrators and identify causal links. The breadth of research includes demographics from China, Canada, Taiwan, Iran, the United States, and Namibia. Wider ranges of national populations should be considered in future studies for accurate assessments, given global internet communication technology activity. The studies emphasize the need for formal classification terminology. With formal classification, researchers will have a more definite scope, allowing specific research on a single definable topic rather than on general bullying events and symptoms. Of all the studies, 2 used a longitudinal design for their research methodology. The low number of longitudinal studies leaves gaps between causation and correlation, and further research is required to understand the effects of cyberbullying. Research addressing ongoing victimization is required for the various forms of cyberbullying; social support offers the most effective current standard for prevention. ", doi="10.2196/30286", url="https://formative.jmir.org/2022/1/e30286", url="http://www.ncbi.nlm.nih.gov/pubmed/34982712" } @Article{info:doi/10.2196/29737, author="Vallury, Dee Kari and Baird, Barbara and Miller, Emma and Ward, Paul", title="Going Viral: Researching Safely on Social Media", journal="J Med Internet Res", year="2021", month="Dec", day="13", volume="23", number="12", pages="e29737", keywords="cyber bullying", keywords="online bullying", keywords="research activities", keywords="occupational safety", keywords="research ethics", keywords="students", keywords="bullying", keywords="social media", doi="10.2196/29737", url="https://www.jmir.org/2021/12/e29737", url="http://www.ncbi.nlm.nih.gov/pubmed/34898450" } @Article{info:doi/10.2196/31789, author="Kaiser, Sabine and Martinussen, Monica and Adolfsen, Frode and Breivik, Kyrre and Kyrrestad, Henriette", title="An App-Based Intervention for Adolescents Exposed to Cyberbullying in Norway: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Nov", day="8", volume="10", number="11", pages="e31789", keywords="cyberbullying", keywords="intervention", keywords="mobile app", keywords="adolescents", keywords="NettOpp", keywords="mental health", keywords="health care", abstract="Background: Adolescents exposed to negative online events are at high risk to develop mental health problems. Little is known about what is effective for treatment in this group. NettOpp is a new mobile app for adolescents who have been exposed to cyberbullying or negative online experiences in Norway. Objective: The aim of this paper is to provide a description of the content of the intervention and about a randomized controlled trial that will be conducted to examine the effectiveness of NettOpp. This protocol is written in accordance with the Spirit 2013 Checklist. Methods: An effectiveness study with a follow-up examination after 3 months will be conducted to evaluate the mobile app. Adolescents will be recruited through schools and will be randomly assigned to the intervention (NettOpp) group and a waiting-list control group. The adolescents (aged 11 to 16 years) will respond to self-report questionnaires on the internet. Primary outcomes will be changes in mental health assessed with the Strengths and Difficulties Questionnaire, the WHO-Five Well-being Index, and the Child and Adolescent Trauma Screen. Results: Recruitment will start in January 2022. The results from this study will be available in 2023. Conclusions: There are few published evaluation studies on app-based interventions. This project and its publications will contribute new knowledge to the field. Trial Registration: ClinicalTrials.gov NCT04176666; https://clinicaltrials.gov/ct2/show/NCT04176666 International Registered Report Identifier (IRRID): PRR1-10.2196/31789 ", doi="10.2196/31789", url="https://www.researchprotocols.org/2021/11/e31789", url="http://www.ncbi.nlm.nih.gov/pubmed/34747704" } @Article{info:doi/10.2196/32382, author="Doumas, M. Diana and Midgett, Aida and Myers, Valerie and Buller, Klein Mary", title="Usability of a Technology-Based Bystander Bullying Intervention for Middle School Students in Rural, Low-Income Communities: Mixed Methods Study", journal="JMIR Form Res", year="2021", month="Oct", day="26", volume="5", number="10", pages="e32382", keywords="technology-based bullying intervention", keywords="STAC-T", keywords="usability testing", keywords="middle school", keywords="rural", keywords="low-income", keywords="mobile phone", abstract="Background: Students who are targets of bullying and who witness bullying are at high risk for negative mental health outcomes. Bystander training is essential to reduce bullying and the negative associated consequences for targets and bystanders. Resources necessary for program delivery, however, pose significant barriers for schools, particularly those in rural, low-income communities. Technology-based programs can reduce health disparities for students in these communities through cost-effective, easy-to-disseminate programming. Objective: The aim of this study is to conduct usability testing of a bystander bullying web app prototype, STAC-T (technology-based STAC, which stands for the 4 bystander strategies Stealing the Show, Turning it Over, Accompanying Others, and Coaching Compassion) as an initial step in the development of a full-scale STAC-T intervention. Objectives include assessing usability and acceptability of the STAC-T prototype, understanding school needs and barriers to program implementation, and assessing differences in usability between school personnel and students. Methods: A sample of 16 participants, including school personnel and students recruited from 3 middle schools in rural, low-income communities, completed usability testing followed by a qualitative interview. Descriptive statistics, 2-tailed independent sample t tests, and consensual qualitative research were used to assess usability and program satisfaction and to extract themes related to acceptability, feasibility, needs, barriers, and feedback for intervention development. Results: Usability testing indicated that the app was easy to use, acceptable, and feasible. Both school personnel (mean rating 89.6, SD 5.1) and students (mean rating 91.8, SD 7.0) rated the app well above the standard cutoff score for above-average usability (ie, 68), and both school personnel (mean rating 5.83, SD 0.41) and students (mean rating 6.10, SD 0.57) gave the app high user-friendliness ratings (0-7 scale, with 7 as high user-friendliness). The overall ratings also suggested that school personnel and students were satisfied with the program. Of the 6 school personnel who said they would recommend the program, 1 (17\%), 4 (66\%), and 1 (17\%) rated the program as 3, 4, and 5 stars, respectively; 80\% (8/10) of students said they would recommend the program; and 60\% (6/10) and 40\% (4/10) rated the program as 4 stars and 5 stars, respectively. Qualitative data revealed that school personnel and students found the STAC-T app to be useful, user-friendly, and relevant, while providing feedback related to the importance of digital learning activities that engage the user. Data from school personnel also indicated positive perceptions regarding program feasibility and probability of program adoption, with the most significant barrier being cost, suggesting the importance of considering the financial resources available to schools in rural, low-income communities when setting the price point for the full-scale STAC-T intervention. Conclusions: This study provides support for the full-scale development of the STAC-T app and provides key information for revision to enhance used engagement. Trial Registration: ClinicalTrials.gov NCT04681495; https://clinicaltrials.gov/ct2/show/NCT04681495 ", doi="10.2196/32382", url="https://formative.jmir.org/2021/10/e32382", url="http://www.ncbi.nlm.nih.gov/pubmed/34582355" } @Article{info:doi/10.2196/26484, author="Evans, Yolanda and Hutchinson, Jeffrey and Ameenuddin, Nusheen", title="Opportunity, Challenge, or Both? Managing Adolescent Socioemotional and Mental Health During Web-Based Learning", journal="JMIR Ment Health", year="2021", month="Sep", day="15", volume="8", number="9", pages="e26484", keywords="pandemic", keywords="technology", keywords="media", keywords="bullying", keywords="mental health", keywords="distance learning", doi="10.2196/26484", url="https://mental.jmir.org/2021/9/e26484", url="http://www.ncbi.nlm.nih.gov/pubmed/34524094" } @Article{info:doi/10.2196/26197, author="Bickham, S. David and Moukalled, Summer and Inyart, K. Heather and Zlokower, Rona", title="Evaluating a Middle-School Digital Citizenship Curriculum (Screenshots): Quasi-Experimental Study", journal="JMIR Ment Health", year="2021", month="Sep", day="15", volume="8", number="9", pages="e26197", keywords="digital citizenship", keywords="cyberbullying", keywords="evaluation", keywords="media literacy", keywords="middle school", keywords="conflict resolution", keywords="internet safety", keywords="mobile phone", abstract="Background: Screenshots is an in-school curriculum that seeks to develop positive digital social skills in middle school students with the long-term goal of improving their health and well-being. The program imparts knowledge and teaches skills upon which young adolescents can build a set of beliefs and behaviors that foster respectful interactions, prosocial conflict resolutions, and safe and secure use of communication technology. Intervening in this way can improve young people's mental health by limiting their exposure to cyberbullying and other forms of negative online interactions. This study reports on an evaluation of the Screenshots program conducted with seventh graders in a public school system in a midsized New England city. Objective: This study aims to determine the effectiveness of the Screenshots program in increasing participants' knowledge about key concepts of digital citizenship and in shifting beliefs and intended behaviors to align with prosocial and safe online interactions. In addition, the study examines whether the program has varying effects on males' and females' conflict and bullying resolution strategies. Methods: This quasi-experimental evaluation was conducted in four middle schools in which one group of seventh graders received the Screenshots curriculum and another did not. Before and after the curriculum, all students completed a questionnaire that measured their knowledge of and beliefs about digital citizenship and related online behavioral concepts, their attitudes regarding strategies for stopping online bullying, and their intended online conflict resolution behaviors. Results: The sample included 92 students who received the curriculum and 71 students who were included in the comparison group. Pre- to postinstruction retention rates ranged from 52\% (33/63) to 84\% (21/25), varying by school and condition. The results showed an increase in knowledge about key curricular concepts for some students (F1,32=9.97; P=.003). In response to some individual items, students decreased their belief supportive of a negative online behavior (F1,76=9.00; P=.004) and increased their belief consistent with an online safety behavior (F1,42=4.39; P=.04) compared with the comparison group. Gender moderated the results related to conflict resolution, with males from one school reducing their endorsement of an aggressive option (F2,40=5.77; P=.006) and males from another school increasing their reported tendency to pursue a nonaggressive option (F2,28=3.65; P=.04). On average, participants reported learning something new from the classes. Conclusions: This study represents a rare evaluation of an in-school digital citizenship program and demonstrates the effectiveness of Screenshots. Students' increased knowledge of key curricular concepts represents a foundation for developing future beliefs and healthy behaviors. Differences in how adolescent males and females experience and perpetrate online aggression likely explain the conflict resolution findings and emphasize the need to examine gender differences in response to these programs. Students' high ratings of the relevance of Screenshots' content reinforce the need for this type of intervention. ", doi="10.2196/26197", url="https://mental.jmir.org/2021/9/e26197", url="http://www.ncbi.nlm.nih.gov/pubmed/34524098" } @Article{info:doi/10.2196/26029, author="Kutok, R. Emily and Dunsiger, Shira and Patena, V. John and Nugent, R. Nicole and Riese, Alison and Rosen, K. Rochelle and Ranney, L. Megan", title="A Cyberbullying Media-Based Prevention Intervention for Adolescents on Instagram: Pilot Randomized Controlled Trial", journal="JMIR Ment Health", year="2021", month="Sep", day="15", volume="8", number="9", pages="e26029", keywords="cyberbullying", keywords="adolescents", keywords="mobile application", keywords="messaging", keywords="brief interventions", keywords="social media", keywords="recruitment", keywords="mobile phone", abstract="Background: Between 15\% and 70\% of adolescents report experiencing cybervictimization. Cybervictimization is associated with multiple negative consequences, including depressed mood. Few validated, easily disseminated interventions exist to prevent cybervictimization and its consequences. With over 97\% of adolescents using social media (such as YouTube, Facebook, Instagram, or Snapchat), recruiting and delivering a prevention intervention through social media and apps may improve accessibility of prevention tools for at-risk youth. Objective: This study aims to evaluate the feasibility and acceptability of and obtain preliminary outcome data on IMPACT (Intervention Media to Prevent Adolescent Cyber-Conflict Through Technology), a brief, remote app-based intervention to prevent and reduce the effect of cyberbullying. Methods: From January 30, 2020, to May 3, 2020, a national sample of 80 adolescents with a history of past-year cybervictimization was recruited through Instagram for a randomized control trial of IMPACT, a brief, remote research assistant--led intervention and a fully automated app-based program, versus enhanced web-based resources (control). Feasibility and acceptability were measured by consent, daily use, and validated surveys. Although not powered for efficacy, outcomes (victimization, bystander self-efficacy, and well-being) were measured using validated measures at 8 and 16 weeks and evaluated using a series of longitudinal mixed models. Results: Regarding feasibility, 24.5\% (121/494) of eligible participants provided contact information; of these, 69.4\% (84/121) completed full enrollment procedures. Of the participants enrolled, 45\% (36/80) were randomized into the IMPACT intervention and 55\% (44/80) into the enhanced web-based resources groups. All participants randomized to the intervention condition completed the remote intervention session, and 89\% (77/80) of the daily prompts were answered. The retention rate was 99\% (79/80) at 8 weeks and 96\% (77/80) at 16 weeks for all participants. Regarding acceptability, 100\% (36/36) of the intervention participants were at least moderately satisfied with IMPACT overall, and 92\% (33/36) of the participants were at least moderately satisfied with the app. At both 8 and 16 weeks, well-being was significantly higher ($\beta$=1.17, SE 0.87, P=.02 at 8 weeks and $\beta$=3.24, SE 0.95, P<.001 at 16 weeks) and psychological stress was lower ($\beta$=?.66, SE 0.08, P=.04 at 8 weeks and $\beta$=?.89, SE 0.09, P<.001 at 16 weeks) among IMPACT users than among control group users. Participants in the intervention group attempted significantly more bystander interventions than those in the control group at 8 weeks ($\beta$=.82, SE 0.42; P=.02). Conclusions: This remote app-based intervention for victims of cyberbullying was feasible and acceptable, increased overall well-being and bystander interventions, and decreased psychological stress. Our findings are especially noteworthy given that the trial took place during the COVID-19 pandemic. The use of Instagram to recruit adolescents can be a successful strategy for identifying and intervening with those at the highest risk of cybervictimization. Trial Registration: ClinicalTrials.gov NCT04259216; http://clinicaltrials.gov/ct2/show/NCT04259216. ", doi="10.2196/26029", url="https://mental.jmir.org/2021/9/e26029", url="http://www.ncbi.nlm.nih.gov/pubmed/34524103" } @Article{info:doi/10.2196/25900, author="Ranney, L. Megan and Pittman, K. Sarah and Moseley, Isabelle and Morgan, E. Kristen and Riese, Alison and Ybarra, Michele and Cunningham, Rebecca and Rosen, Rochelle", title="Cyberbullying Prevention for Adolescents: Iterative Qualitative Methods for Mobile Intervention Design", journal="JMIR Form Res", year="2021", month="Aug", day="27", volume="5", number="8", pages="e25900", keywords="adolescent", keywords="mobile health", keywords="digital health", keywords="cyberbullying", keywords="user-centered design", keywords="qualitative", keywords="mobile phone", abstract="Background: Cybervictimization among adolescents is associated with multiple negative mental health consequences. Although pediatricians often screen for cyberbullying, validated and acceptable programs to reduce the frequency and impact of adolescent cybervictimization are lacking. Objective: This study uses agile qualitative methods to refine and evaluate the acceptability of a mixed-modality intervention, initiated within the context of usual pediatric care, for adolescents with a history of cyberharassment and cyberbullying victimization. Methods: Three groups of adolescents were successively recruited from an urban primary care clinic to participate in three consecutive iterations (1, 2, and 3) of the program, which consisted of a brief in-clinic intervention followed by 8 weeks of daily, automated SMS text messaging. After 2 weeks of messaging, iteration 1 (I1) participants completed semistructured interviews regarding intervention experiences. Participant feedback was evaluated via framework matrix analysis to guide changes to the program for iteration 2 (I2). Feedback from 2-week interviews of I2 participants was similarly used to improve the program before initiating iteration 3 (I3). Participants in all 3 iterations completed the interviews after completing the program (8 weeks). Daily response rates assessed participant engagement, and satisfaction questionnaires assessed acceptability. Results: A total of 19 adolescents (aged 13-17 years) reporting past-year cybervictimization were enrolled: 7 in I1, 4 in I2, and 8 in I3. Demographic variables included the following: a mean age of 15 (SD 1.5) years; 58\% (11/19) female, 42\% (8/19) male, 63\% (12/19) Hispanic, 37\% (7/19) non-Hispanic, 79\% (15/19) people of color, and 21\% (4/19) White. A total of 73\% (14/19) self-identified as having a low socioeconomic status, and 37\% (7/19) self-identified as lesbian, gay, or bisexual. The average past 12-month cybervictimization score at baseline was 8.2 (SD 6.58; range 2-26). Participant feedback was used to iteratively refine intervention content and design. For example, participants in I1 recommended that the scope of the intervention be expanded to include web-based conflicts and drama, rather than narrowly focusing on cyberbullying prevention. On the basis of this feedback, the I2 content was shifted toward more general de-escalation skills and bystander empowerment. Overall, 88.34\% (940/1064) of the daily queries sent to participants across all 3 iterations received a reply. Participant satisfaction improved considerably with each iteration; 0\% (0/7) of I1 participants rated the overall quality of Intervention to Prevent Adolescent Cybervictimization with Text message as excellent, compared to 50\% (2/4) of I2 participants and 86\% (6/7) of I3 participants. Engagement also improved between the first and third iterations, with participants replying to 59.9\% (235/392) of messages in I1, compared to 79.9\% (358/488) of messages in I3. Conclusions: This study shows the value of structured participant feedback gathered in an agile intervention refinement methodology for the development of a technology-based intervention targeting adolescents. ", doi="10.2196/25900", url="https://formative.jmir.org/2021/8/e25900", url="http://www.ncbi.nlm.nih.gov/pubmed/34448702" } @Article{info:doi/10.2196/29582, author="Kim, Jin Yun and Qian, Linchao and Aslam, Shahzad Muhammad", title="Cyberbullying Among Traditional and Complementary Medicine Practitioners in the Workplace: Protocol for a Cross-sectional Descriptive Study", journal="JMIR Res Protoc", year="2021", month="Aug", day="12", volume="10", number="8", pages="e29582", keywords="cyberbullying", keywords="traditional medicine", keywords="workplace", keywords="practitioners", keywords="medical professional", abstract="Background: Cyberbullying is becoming prevalent among health care professionals and may cause a variety of mental health issues. Traditional and complementary medicine practitioners remain an important pillar of the health care system in Malaysia. Objective: This paper presents a study protocol for an online survey (Cyberbullying Among Traditional and Complementary Medicine Practitioner [TCMPs]) that will collect the first nationwide representative data on cyberbullying behavior among traditional and complementary medicine practitioners in Malaysia. The objectives of the survey are to (1) evaluate the cyberbullying behavior among traditional and complementary medicine practitioners in Malaysia, (2) identify sociodemographic and social factors related to cyberbullying, and (3) evaluate the association between cyberbullying behavior, sociodemographic, and social factors. Methods: A snowball sampling strategy will be applied. Traditional and complementary medicine practitioners who are permanent Malaysian residents will be randomly selected and invited to participate in the survey (N=1023). Cyberbullying behavior will be measured using the Cyberbullying Behavior Questionnaire (CBQ). Data on the following items will be collected: work-related bullying, person-related bullying, aggressively worded messages, distortion of messages, sending offensive photos/videos, hacking computers or sending a virus or rude message, and threatening messages about personal life or family members. We will also collect data on participants' sociodemographic characteristics, social factors, and substance abuse behavior. Results: This cross-sectional descriptive study was registered with Research Registry (Unique Identifying Number 6216; November 05, 2020). This research work (substudy) is planned under a phase 1 study approved by the Research Management Centre, Xiamen University Malaysia. This substudy has been approved by the Research Ethics Committee of Xiamen University Malaysia (REC-2011.01). The cross-sectional survey will be conducted from July 01, 2021, to June 30, 2022. Data preparation and statistical analyses are planned from January 2022 onward. Conclusions: The current research can contribute to identify the prevalence of workplace cyberbullying among Malaysian traditional and complementary medicine practitioners. The results will help government stakeholders, health professionals, and education professionals to understand the psychological well-being of Malaysian traditional and complementary medicine practitioners. Trial Registration: Research Registry Unique Identifying Number 6216; https://tinyurl.com/3rsmxs7u International Registered Report Identifier (IRRID): PRR1-10.2196/29582 ", doi="10.2196/29582", url="https://www.researchprotocols.org/2021/8/e29582", url="http://www.ncbi.nlm.nih.gov/pubmed/34387559" } @Article{info:doi/10.2196/28805, author="De Gagne, C. Jennie and Cho, Eunji and Yamane, S. Sandra and Jin, Haesu and Nam, D. Jeehae and Jung, Dukyoo", title="Analysis of Cyberincivility in Posts by Health Professions Students: Descriptive Twitter Data Mining Study", journal="JMIR Med Educ", year="2021", month="May", day="13", volume="7", number="2", pages="e28805", keywords="cyberincivility", keywords="digital professionalism", keywords="health professions students", keywords="social media", keywords="social networking sites", keywords="Twitter", abstract="Background: Health professions students use social media to communicate with other students and health professionals, discuss career plans or coursework, and share the results of research projects or new information. These platforms allow students to share thoughts and perceptions that are not disclosed in formal education settings. Twitter provides an excellent window through which health professions educators can observe students' sociocultural and learning needs. However, despite its merits, cyberincivility on Twitter among health professions students has been reported. Cyber means using electronic technologies, and incivility is a general term for bad manners. As such, cyberincivility refers to any act of disrespectful, insensitive, or disruptive behavior in an electronic environment. Objective: This study aims to describe the characteristics and instances of cyberincivility posted on Twitter by self-identified health professions students. A further objective of the study is to analyze the prevalence of tweets perceived as inappropriate or potentially objectionable while describing patterns and differences in the instances of cyberincivility posted by those users. Methods: We used a cross-sectional descriptive Twitter data mining method to collect quantitative and qualitative data from August 2019 to February 2020. The sample was taken from users who self-identified as health professions students (eg, medicine, nursing, dental, pharmacy, physician assistant, and physical therapy) in their user description. Data management and analysis were performed with a combination of SAS 9.4 for descriptive and inferential statistics, including logistic regression, and NVivo 12 for descriptive patterns of textual data. Results: We analyzed 20 of the most recent tweets for each account (N=12,820). A total of 639 user accounts were analyzed for quantitative analysis, including 280 (43.8\%) medicine students and 329 (51.5\%) nursing students in 22 countries: the United States (287/639, 44.9\%), the United Kingdom (197/639, 30.8\%), unknown countries (104/639, 16.3\%), and 19 other countries (51/639, 8.0\%). Of the 639 accounts, 193 (30.2\%) were coded as having instances of cyberincivility. Of these, 61.7\% (119/193), 32.6\% (63/193), and 5.7\% (11/193) belonged to students in nursing, medicine, and other disciplines, respectively. Among 502 instances of cyberincivility identified from 641 qualitative analysis samples, the largest categories were profanity and product promotion. Several aggressive or biased comments toward other users, politicians, or certain groups of people were also found. Conclusions: Cyberincivility is a multifaceted phenomenon that must be considered in its complexity if health professions students are to embrace a culture of mutual respect and collaboration. Students' perceptions and reports of their Twitter experiences offer insights into behavior on the web and the evolving role of cyberspace, and potentially problematic posts provide opportunities for teaching digital professionalism. Our study indicates that there is a continued need to provide students with guidance and training regarding the importance of maintaining a professional persona on the web. ", doi="10.2196/28805", url="https://mededu.jmir.org/2021/2/e28805", url="http://www.ncbi.nlm.nih.gov/pubmed/33983129" } @Article{info:doi/10.2196/19651, author="Yang, Qian and Tai-Seale, Ming and Liu, Stephanie and Shen, Yi and Zhang, Xiaobin and Xiao, Xiaohua and Zhang, Kejun", title="Measuring Public Reaction to Violence Against Doctors in China: Interrupted Time Series Analysis of Media Reports", journal="J Med Internet Res", year="2021", month="Feb", day="16", volume="23", number="2", pages="e19651", keywords="violence against doctors", keywords="government intervention", keywords="public opinion", keywords="patient--physician relationship", abstract="Background: Violence against doctors in China is a serious problem that has attracted attention from both domestic and international media. Objective: This study investigates readers' responses to media reports on violence against doctors to identify attitudes toward perpetrators and physicians and examine if such trends are influenced by national policies. Methods: We searched 17 Chinese violence against doctors reports in international media sources from 2011 to 2020. We then tracked back the original reports and web crawled the 19,220 comments in China. To ascertain the possible turning point of public opinion, we searched violence against doctors--related policies from Tsinghua University ipolicy database from 2011 to 2020, and found 19 policies enacted by the Chinese central government aimed at alleviating the intense patient--physician relationship. We then conducted a series of interrupted time series analyses to examine the influence of these policies on public sentiment toward violence against doctors over time. Results: The interrupted time series analysis (ITSA) showed that the change in public sentiment toward violence against doctors reports was temporally associated with government interventions. The declarations of 10 of the public policies were followed by increases in the proportion of online public opinion in support of doctors (average slope changes of 0.010, P<.05). A decline in the proportion of online public opinion that blamed doctors (average level change of --0.784, P<.05) followed the declaration of 3 policies. Conclusions: The government's administrative interventions effectively shaped public opinion but only temporarily. Continued public policy interventions are needed to sustain the reduction of hostility toward medical doctors. ", doi="10.2196/19651", url="http://www.jmir.org/2021/2/e19651/", url="http://www.ncbi.nlm.nih.gov/pubmed/33591282" } @Article{info:doi/10.2196/18643, author="Hawkins, Natasha and Jeong, Sarah and Smith, Tony", title="Creating Respectful Workplaces for Nurses in Regional Acute Care Settings: Protocol for a Sequential Explanatory Mixed Methods Study", journal="JMIR Res Protoc", year="2021", month="Jan", day="11", volume="10", number="1", pages="e18643", keywords="bullying", keywords="culture", keywords="negative behavior", keywords="nurses", keywords="methods", keywords="workforce", abstract="Background: Negative workplace behaviour among nurses is an internationally recognised problem, despite the plethora of literature spanning several decades. The various forms of mistreatments and uncaring attitudes experienced by nurses include workplace aggression, incivility, bullying, harassment and horizontal violence. Negative behaviour has detrimental effects on the individual nurse, the organisation, the nursing profession and patients. Multi-level organisational interventions are warranted to influence the ``civility norms'' of the nursing profession. Objective: The aim of this study is to investigate the self-reported exposure to and experiences of negative workplace behaviours of nursing staff and their ways of coping in regional acute care hospitals in one Local Health District (LHD) in NSW before and after Respectful Workplace Workshops have been implemented within the organisation. Methods: This study employs a mixed methods sequential explanatory design with an embedded experimental component, underpinned by Social World's Theory. This study will be carried out in four acute care regional hospitals from a Local Health District (LHD) in New South Wales (NSW), Australia. The nurse unit managers, registered nurses and new graduate nurses from the medical and surgical wards of all four hospitals will be invited to complete a pre-survey examining their experiences, perceptions and responses to negative workplace behaviour, and their ways of coping when exposed. Face-to-face educational workshops will then be implemented by the organisation at two of the four hospitals. The workshops are designed to increase awareness of negative workplace behaviour, the pathways to seek assistance and aims to create respectful workplaces. Commencing 3 months after completion of the workshop implementation, follow up surveys and interviews will then be undertaken at all four hospitals. Results: The findings from this research will enhance understanding of negative workplace behaviour occurring within the nursing social world and assess the effectiveness of the LHD's Respectful Workplace Workshops upon the levels of negative workplace behaviour occurring. By integrating qualitative and quantitative findings it will allow for a dual perspective of the social world of nurses where negative and/or respectful workplace behaviours occur, and provide data grounded in individuals lived experiences, positioned in a macro context Conclusions: It is expected that evidence from this study will inform nursing practice, and future policy development aimed at creating respectful workplaces. Trial Registration: Australian New Zealand Clinical Trials Registry (Registration No. ACTRN12618002007213; 14 December 2018). International Registered Report Identifier (IRRID): PRR1-10.2196/18643 ", doi="10.2196/18643", url="http://www.researchprotocols.org/2021/1/e18643/", url="http://www.ncbi.nlm.nih.gov/pubmed/33427678" } @Article{info:doi/10.2196/25860, author="Agley, Jon and Jun, Mikyoung and Eldridge, Lori and Agley, L. Daniel and Xiao, Yunyu and Sussman, Steve and Golzarri-Arroyo, Lilian and Dickinson, L. Stephanie and Jayawardene, Wasantha and Gassman, Ruth", title="Effects of ACT Out! Social Issue Theater on Social-Emotional Competence and Bullying in Youth and Adolescents: Cluster Randomized Controlled Trial", journal="JMIR Ment Health", year="2021", month="Jan", day="6", volume="8", number="1", pages="e25860", keywords="cyberbullying", keywords="bullying", keywords="social-emotional learning", keywords="SEL", keywords="social-emotional competence", keywords="RCT", keywords="randomized controlled trial", keywords="outcome", keywords="emotion", keywords="bully", keywords="prevention", keywords="school", keywords="intervention", keywords="assessment", keywords="effectiveness", keywords="implementation", keywords="fidelity", keywords="reception", keywords="children", keywords="young adults", keywords="adolescents", abstract="Background: Schools increasingly prioritize social-emotional competence and bullying and cyberbullying prevention, so the development of novel, low-cost, and high-yield programs addressing these topics is important. Further, rigorous assessment of interventions prior to widespread dissemination is crucial. Objective: This study assesses the effectiveness and implementation fidelity of the ACT Out! Social Issue Theater program, a 1-hour psychodramatic intervention by professional actors; it also measures students' receptiveness to the intervention. Methods: This study is a 2-arm cluster randomized control trial with 1:1 allocation that randomized either to the ACT Out! intervention or control (treatment as usual) at the classroom level (n=76 classrooms in 12 schools across 5 counties in Indiana, comprised of 1571 students at pretest in fourth, seventh, and tenth grades). The primary outcomes were self-reported social-emotional competence, bullying perpetration, and bullying victimization; the secondary outcomes were receptiveness to the intervention, implementation fidelity (independent observer observation), and prespecified subanalyses of social-emotional competence for seventh- and tenth-grade students. All outcomes were collected at baseline and 2-week posttest, with planned 3-months posttest data collection prevented due to the COVID-19 pandemic. Results: Intervention fidelity was uniformly excellent (>96\% adherence), and students were highly receptive to the program. However, trial results did not support the hypothesis that the intervention would increase participants' social-emotional competence. The intervention's impact on bullying was complicated to interpret and included some evidence of small interaction effects (reduced cyberbullying victimization and increased physical bullying perpetration). Additionally, pooled within-group reductions were also observed and discussed but were not appropriate for causal attribution. Conclusions: This study found no superiority for a 1-hour ACT Out! intervention compared to treatment as usual for social-emotional competence or offline bullying, but some evidence of a small effect for cyberbullying. On the basis of these results and the within-group effects, as a next step, we encourage research into whether the ACT Out! intervention may engender a bystander effect not amenable to randomization by classroom. Therefore, we recommend a larger trial of the ACT Out! intervention that focuses specifically on cyberbullying, measures bystander behavior, is randomized by school, and is controlled for extant bullying prevention efforts at each school. Trial Registration: Clinicaltrials.gov NCT04097496; https://clinicaltrials.gov/ct2/show/NCT04097496 International Registered Report Identifier (IRRID): RR2-10.2196/17900 ", doi="10.2196/25860", url="http://mental.jmir.org/2021/1/e25860/", url="http://www.ncbi.nlm.nih.gov/pubmed/33338986" } @Article{info:doi/10.2196/14371, author="Kliem, S{\"o}ren and Krieg, Yvonne and Lohmann, Anna and M{\"o}{\ss}le, Thomas", title="Evaluation of the Universal Prevention Program Klasse2000 in Fourth Grade Primary School Children: Protocol for a Propensity Score-Matching Approach", journal="JMIR Res Protoc", year="2020", month="Aug", day="20", volume="9", number="8", pages="e14371", keywords="Klasse2000", keywords="prevention program", keywords="student survey", keywords="propensity score matching", keywords="evaluation", abstract="Background: Klasse2000 is the most widely adopted school-based prevention program in Germany. It addresses health promotion, addiction, and violence prevention in primary schools. As a universal prevention program, it has reached more than 1.4 million German children in the past 25 years. Objective: The effectiveness of Klasse2000 will be evaluated with a large representative survey among students. Students who have participated in the prevention program (intervention group) will be compared with students who did not participate (control group). The comparison will cover the following outcome domains: well-being, self-esteem, emotion regulation, food habits, behavioral problems, and school and classroom atmosphere. Furthermore, victimization and perpetration regarding bullying, alcohol consumption, smoking, and media consumption are assessed. Methods: To control for potential group differences, treatment effects will be estimated using propensity score-matching, which matches students from the intervention and control groups based on an identical propensity score or a propensity score that does not differ by more than a previously defined distance. The treatment effect will then be estimated in the matched sample taking the matching process into account. Results: Enrollment of schools began in March 2017. A total of 6376 students participated in the survey (n=4005 in control group; n=2371 in Klasse2000). The parent survey was returned by 52.13\% (3324/6376) of parents. Results are expected in mid-2020. Conclusions: The results on the effectiveness of the Klasse2000 prevention program will form an empirical basis for legitimizing universal prevention programs and for planning future prevention approaches. Trial Registration: German Clinical Trials Register DRKS00014332; https://tinyurl.com/y2trvq4p International Registered Report Identifier (IRRID): DERR1-10.2196/14371 ", doi="10.2196/14371", url="https://www.researchprotocols.org/2020/8/e14371", url="http://www.ncbi.nlm.nih.gov/pubmed/32815524" } @Article{info:doi/10.2196/19008, author="Aref-Adib, Golnar and Landy, Gabriella and Eskinazi, Michelle and Sommerlad, Andrew and Morant, Nicola and Johnson, Sonia and Graham, Richard and Osborn, David and Pitman, Alexandra", title="Assessing Digital Risk in Psychiatric Patients: Mixed Methods Study of Psychiatry Trainees' Experiences, Views, and Understanding", journal="JMIR Ment Health", year="2020", month="Jul", day="29", volume="7", number="7", pages="e19008", keywords="risk assessment", keywords="internet", keywords="suicide", keywords="self-injurious behavior", keywords="mental health", keywords="psychiatrists", keywords="mixed methods", keywords="mobile phone", abstract="Background: The use of digital technology can help people access information and provide support for their mental health problems, but it can also expose them to risk, such as bullying or prosuicide websites. It may be important to consider internet-related risk behavior (digital risk) within a generic psychiatric risk assessment, but no studies have explored the practice or acceptability of this among psychiatrists. Objective: This study aimed to explore psychiatry trainees' experiences, views, and understanding of digital risk in psychiatry. We predicted that clinician awareness would be highest among trainees who work in child and adolescent mental health services. Methods: We conducted a cross-sectional survey of psychiatry trainees attending a UK regional trainees' conference to investigate how they routinely assess patients' internet use and related risk of harm and their experience and confidence in assessing these risks. We conducted focus groups to further explore trainees' understandings and experiences of digital risk assessment. Descriptive statistics and chi-squared tests were used to present the quantitative data. A thematic analysis was used to identify the key themes in the qualitative data set. Results: The cross-sectional survey was completed by 113 out of 312 psychiatry trainees (response rate 36.2\%), from a range of subspecialties and experience levels. Half of the trainees (57/113, 50.4\%) reported treating patients exposed to digital risk, particularly trainees subspecializing in child and adolescent psychiatry (17/22, 77\% vs 40/91, 44\%;P=.02). However, 67.3\% (76/113) reported not feeling competent to assess digital risk. Child and adolescent psychiatrists were more likely than others to ask patients routinely about specific digital risk domains, including reckless web-based behavior (18/20, 90\% vs 54/82, 66\%; P=.03), prosuicide websites (20/21, 95\% vs 57/81, 70\%; P=.01), and online sexual behavior (17/21, 81\% vs 44/81, 54\%; P=.02). Although 84.1\% (95/113) of the participants reported using a proforma to record general risk assessment, only 5\% (5/95) of these participants prompted an assessment of internet use. Only 9.7\% (11/113) of the trainees had received digital risk training, and 73.5\% (83/113) reported that they would value this. Our thematic analysis of transcripts from 3 focus groups (comprising 11 trainees) identified 2 main themes: barriers to assessment and management of digital risk, and the double-edged sword of web use. Barriers reported included the novelty and complexity of the internet, a lack of confidence and guidance in addressing internet use directly, and ongoing tension between assessment and privacy. Conclusions: Although it is common for psychiatrists to encounter patients subject to digital risk, trainee psychiatrists lack competence and confidence in their assessment. Training in digital risk and the inclusion of prompts in standardized risk proformas would promote good clinical practice and prevent a potential blind spot in general risk assessment. ", doi="10.2196/19008", url="http://mental.jmir.org/2020/7/e19008/", url="http://www.ncbi.nlm.nih.gov/pubmed/32726288" } @Article{info:doi/10.2196/17224, author="Rivas, Ryan and Shahbazi, Moloud and Garett, Renee and Hristidis, Vagelis and Young, Sean", title="Mental Health--Related Behaviors and Discussions Among Young Adults: Analysis and Classification", journal="J Med Internet Res", year="2020", month="May", day="29", volume="22", number="5", pages="e17224", keywords="social media", keywords="data analysis", keywords="supervised machine learning", keywords="universities", keywords="students", abstract="Background: There have been recurring reports of web-based harassment and abuse among adolescents and young adults through anonymous social networks. Objective: This study aimed to explore discussions on the popular anonymous social network Yik Yak related to social and mental health messaging behaviors among college students, including cyberbullying, to provide insights into mental health behaviors on college campuses. Methods: From April 6, 2016, to May 7, 2016, we collected anonymous conversations posted on Yik Yak at 19 universities in 4 different states and performed statistical analyses and text classification experiments on a subset of these messages. Results: We found that prosocial messages were 5.23 times more prevalent than bullying messages. The frequency of cyberbullying messages was positively associated with messages seeking emotional help. We found significant geographic variation in the frequency of messages offering supportive vs bullying messages. Across campuses, bullying and political discussions were positively associated. We also achieved a balanced accuracy of over 0.75 for most messaging behaviors and topics with a support vector machine classifier. Conclusions: Our results show that messages containing data about students' mental health--related attitudes and behaviors are prevalent on anonymous social networks, suggesting that these data can be mined for real-time analysis. This information can be used in education and health care services to better engage with students, provide insight into conversations that lead to cyberbullying, and reach out to students who need support. ", doi="10.2196/17224", url="http://www.jmir.org/2020/5/e17224/", url="http://www.ncbi.nlm.nih.gov/pubmed/32469317" } @Article{info:doi/10.2196/16210, author="Arpaci, Ibrahim and Abdeljawad, Thabet and Balo?lu, Mustafa and Kesici, ?ahin and Mahariq, Ibrahim", title="Mediating Effect of Internet Addiction on the Relationship Between Individualism and Cyberbullying: Cross-Sectional Questionnaire Study", journal="J Med Internet Res", year="2020", month="May", day="28", volume="22", number="5", pages="e16210", keywords="vertical individualism", keywords="horizontal individualism", keywords="cyberbullying", keywords="internet addiction", abstract="Background: Among a variety of dynamics that may have effects on internet-related behaviors, cultural orientation is particularly important. Previous studies suggest that individualism is a strong determinant of certain behaviors. In addition, findings suggest that vertical individualism may lead to the development of more tolerance for addiction and aggression on the internet. Objective: This study aimed to investigate whether vertical individualism has significant positive effects on cyberbullying and internet addiction and whether horizontal individualism has significant negative effects on cyberbullying and internet addiction. A theoretical model was specified to test the relationships among vertical versus horizontal individualism, cyberbullying, and internet addiction. Methods: A total of 665 college students were selected using a convenience sampling method and willingly participated in the study. Participants' ages ranged from 17 to 19 years (mean 17.94 years, SD 1.12 years). Of the group, 462 were women (462/665, 69.5\%), and 203 were men (203/665, 30.5\%). Study majors represented were mathematics (113/665, 17\%), sciences (102/665, 15.3\%), instructional technology (99/665, 14.9\%), psychology (98/665, 14.7\%), and others (253/665, 38.1\%). Self-report instruments were used to measure vertical/horizontal individualism, cyberbullying, and internet addiction. Results: Results show a significant positive effect of vertical individualism (effect size 0.10) and significant negative effect of horizontal individualism (effect size --0.12) on cyberbullying. In addition, the direct effect of vertical individualism on internet addiction was significant (effect size 0.28), but the direct effect of horizontal individualism was not (effect size --0.05). Internet addiction had a significant direct effect on cyberbullying (effect size 0.39) as well as an intervening effect on the relationship between vertical individualism and cyberbullying. Results also indicate significant gender differences in cultural patterns and internet addiction. Conclusions: The findings suggest that horizontal and vertical individualism have significant effects on internet addiction. The findings also suggest that vertical individualists are more vulnerable to internet addiction. Further, the findings indicate a significant relationship between internet addiction and cyberbullying. ", doi="10.2196/16210", url="http://www.jmir.org/2020/5/e16210/", url="http://www.ncbi.nlm.nih.gov/pubmed/32463369" } @Article{info:doi/10.2196/16747, author="Ma, Shu-Ching and Chou, Willy and Chien, Tsair-Wei and Chow, Chi Julie and Yeh, Yu-Tsen and Chou, Po-Hsin and Lee, Huan-Fang", title="An App for Detecting Bullying of Nurses Using Convolutional Neural Networks and Web-Based Computerized Adaptive Testing: Development and Usability Study", journal="JMIR Mhealth Uhealth", year="2020", month="May", day="20", volume="8", number="5", pages="e16747", keywords="nurse bullying", keywords="NAQ-R assessment", keywords="receiver operating characteristic curve", keywords="convolutional neural network", keywords="computerized adaptive testing", abstract="Background: Workplace bullying has been measured in many studies to investigate its effects on mental health issues. However, none have used web-based computerized adaptive testing (CAT) with bully classifications and convolutional neural networks (CNN) for reporting the extent of individual bullying in the workplace. Objective: This study aims to build a model using CNN to develop an app for automatic detection and classification of nurse bullying-levels, incorporated with online Rasch computerized adaptive testing, to help assess nurse bullying at an earlier stage. Methods: We recruited 960 nurses working in a Taiwan Ch-Mei hospital group to fill out the 22-item Negative Acts Questionnaire-Revised (NAQ-R) in August 2012. The k-mean and the CNN were used as unsupervised and supervised learnings, respectively, for: (1) dividing nurses into three classes (n=918, 29, and 13 with suspicious mild, moderate, and severe extent of being bullied, respectively); and (2) building a bully prediction model to estimate 69 different parameters. Finally, data were separated into training and testing sets in a proportion of 70:30, where the former was used to predict the latter. We calculated the sensitivity, specificity, and receiver operating characteristic curve (area under the curve [AUC]), along with the accuracy across studies for comparison. An app predicting the respondent bullying-level was developed, involving the model's 69 estimated parameters and the online Rasch CAT module as a website assessment. Results: We observed that: (1) the 22-item model yields higher accuracy rates for three categories, with an accuracy of 94\% for the total 960 cases, and accuracies of 99\% (AUC 0.99; 95\% CI 0.99-1.00) and 83\% (AUC 0.94; 95\% CI 0.82-0.99) for the lower and upper groups (cutoff points at 49 and 66 points) based on the 947 cases and 42 cases, respectively; and (2) the 700-case training set, with 95\% accuracy, predicts the 260-case testing set reaching an accuracy of 97. Thus, a NAQ-R app for nurses that predicts bullying-level was successfully developed and demonstrated in this study. Conclusions: The 22-item CNN model, combined with the Rasch online CAT, is recommended for improving the accuracy of the nurse NAQ-R assessment. An app developed for helping nurses self-assess workplace bullying at an early stage is required for application in the future. ", doi="10.2196/16747", url="https://mhealth.jmir.org/2020/5/e16747", url="http://www.ncbi.nlm.nih.gov/pubmed/32432557" } @Article{info:doi/10.2196/17900, author="Agley, Jon and Jayawardene, Wasantha and Jun, Mikyoung and Agley, L. Daniel and Gassman, Ruth and Sussman, Steve and Xiao, Yunyu and Dickinson, L. Stephanie", title="Effects of the ACT OUT! Social Issue Theater Program on Social-Emotional Competence and Bullying in Youth and Adolescents: Protocol for a Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2020", month="Apr", day="13", volume="9", number="4", pages="e17900", keywords="social and emotional learning", keywords="bullying", keywords="social-emotional competence", keywords="psychodrama", keywords="randomized controlled trial", abstract="Background: Students in the United States spend a meaningful portion of their developmental lives in school. In recent years, researchers and educators have begun to focus explicitly on social and emotional learning (SEL) in the school setting. Initial evidence from meta-analyses suggests that curricula designed to promote SEL likely produce benefits in terms of social-emotional competence (SEC) and numerous related behavioral and affective outcomes. At the same time, there are often barriers to implementing such curricula as intended, and some researchers have questioned the strength of the evaluation data from SEL programs. As part of the effort to improve programming in SEL, this paper describes the protocol for a cluster randomized trial of the ACT OUT! Social Issue Theater program, a brief psychodramatic intervention to build SEC and reduce bullying behavior in students. Objective: The objective of this trial is to examine if a short dose of interactive psychodrama can affect SEC metrics and bullying experiences in schoolchildren in either the short (2-week) or medium (6-month) term. Methods: The ACT OUT! trial is a cluster randomized superiority trial with 2 parallel groups. The unit of measurement is the student, and the unit of randomization is the classroom. For each grade (fourth, seventh, and 10th), an even number of classrooms will be selected from each school---half will be assigned to the intervention arm and half will be assigned to the control arm. The intervention will consist of 3 moderated psychodramatic performances by trained actors, and the control condition will be the usual school day. Outcome data will be collected at baseline (preintervention), 2-week postintervention (short term), and 6-month postintervention (medium term). Outcomes will include social-emotional competency; self-reported bullying and experiences of being bullied; receptivity to the program; and school-level data on truancy, absenteeism, and referrals to school displinary action for bullying. A power analysis adjusted for clustering effect, design effect, and potential attrition yielded a need for approximately 1594 students, consisting of an estimated 80 classrooms split evenly into intervention and control arms. Results: This study was funded in June 2019; approved by the Indiana University Institutional review board on September 17, 2019; began subject recruitment on November 5, 2019; and prospectively registered with ClinicalTrials.gov. Conclusions: Many states have issued recommendations for the integration of SEL into schools. The proposed study uses a rigorous methodology to determine if the ACT OUT! psychodramatic intervention is a cost-effective means of bolstering SEC and reducing bullying incidence in schools. Trial Registration: ClinicalTrials.gov NCT04097496; https://clinicaltrials.gov/ct2/show/NCT04097496 International Registered Report Identifier (IRRID): PRR1-10.2196/17900 ", doi="10.2196/17900", url="http://www.researchprotocols.org/2020/4/e17900/", url="http://www.ncbi.nlm.nih.gov/pubmed/32281541" } @Article{info:doi/10.2196/16762, author="Gabrielli, Silvia and Rizzi, Silvia and Carbone, Sara and Donisi, Valeria", title="A Chatbot-Based Coaching Intervention for Adolescents to Promote Life Skills: Pilot Study", journal="JMIR Hum Factors", year="2020", month="Feb", day="14", volume="7", number="1", pages="e16762", keywords="life skills", keywords="chatbots", keywords="conversational agents", keywords="mental health", keywords="participatory design", keywords="adolescence", keywords="bullying", keywords="cyberbullying", keywords="well-being intervention", abstract="Background: Adolescence is a challenging period, where youth face rapid changes as well as increasing socioemotional demands and threats, such as bullying and cyberbullying. Adolescent mental health and well-being can be best supported by providing effective coaching on life skills, such as coping strategies and protective factors. Interventions that take advantage of online coaching by means of chatbots, deployed on Web or mobile technology, may be a novel and more appealing way to support positive mental health for adolescents. Objective: In this pilot study, we co-designed and conducted a formative evaluation of an online, life skills coaching, chatbot intervention, inspired by the positive technology approach, to promote mental well-being in adolescence. Methods: We co-designed the first life skills coaching session of the CRI (for girls) and CRIS (for boys) chatbot with 20 secondary school students in a participatory design workshop. We then conducted a formative evaluation of the entire intervention---eight sessions---with a convenience sample of 21 adolescents of both genders (mean age 14.52 years). Participants engaged with the chatbot sessions over 4 weeks and filled in an anonymous user experience questionnaire at the end of each session; responses were based on a 5-point Likert scale. Results: A majority of the adolescents found the intervention useful (16/21, 76\%), easy to use (19/21, 90\%), and innovative (17/21, 81\%). Most of the participants (15/21, 71\%) liked, in particular, the video cartoons provided by the chatbot in the coaching sessions. They also thought that a session should last only 5-10 minutes (14/21, 66\%) and said they would recommend the intervention to a friend (20/21, 95\%). Conclusions: We have presented a novel and scalable self-help intervention to deliver life skills coaching to adolescents online that is appealing to this population. This intervention can support the promotion of coping skills and mental well-being among youth. ", doi="10.2196/16762", url="http://humanfactors.jmir.org/2020/1/e16762/", url="http://www.ncbi.nlm.nih.gov/pubmed/32130128" } @Article{info:doi/10.2196/14776, author="Williamson, Heidi and Hamlet, Claire and White, Paul and Marques, R. Elsa M. and Paling, Thomas and Cadogan, Julia and Perera, Rohan and Rumsey, Nichola and Hayward, Leighton and Harcourt, Diana", title="A Web-Based Self-Help Psychosocial Intervention for Adolescents Distressed by Appearance-Affecting Conditions and Injuries (Young Persons' Face IT): Feasibility Study for a Parallel Randomized Controlled Trial", journal="JMIR Ment Health", year="2019", month="Nov", day="22", volume="6", number="11", pages="e14776", keywords="physical appearance, body image, disfigurement", keywords="visible difference", keywords="adolescents", keywords="young people", keywords="psychological support", keywords="online intervention.", abstract="Background: Disfigurement (visible difference) from wide-ranging congenital or acquired conditions, injuries, or treatments can negatively impact adolescents' psychological well-being, education and health behaviours. Alongside medical interventions, appearance-specific cognitive behavioural and social skills training to manage stigma and appearance anxiety may improve psychosocial outcomes. YP Face IT (YPF), is a Web-based seven session self-help program plus booster quiz, utilising cognitive behavioural and social skills training for young people (YP) struggling with a visible difference. Co-designed by adolescents and psychologists, it includes interactive multimedia and automated reminders to complete sessions/homework. Adolescents access YPF via a health professional who determines its suitability and remotely monitors clients' usage. Objective: To establish the feasibility of evaluating YPF for 12-17 year olds self-reporting appearance-related distress and/or bullying associated with a visible difference. Methods: Randomized controlled trial with nested qualitative and economic study evaluating YPF compared with usual care (UC). Feasibility outcomes included: viability of recruiting via general practitioner (GP) practices (face to face and via patient databases) and charity advertisements; intervention acceptability and adherence; feasibility of study and data collection methods; and health professionals' ability to monitor users' online data for safeguarding issues. Primary psychosocial self-reported outcomes collected online at baseline, 13, 26, and 52 weeks were as follows: appearance satisfaction (Appearance Subscale from Mendleson et al's (2001) Body Esteem Scale); social anxiety (La Greca's (1999) Social Anxiety Scale for Adolescents). Secondary outcomes were; self-esteem; romantic concerns; perceived stigmatization; social skills and healthcare usage. Participants were randomised using remote Web-based allocation. Results: Thirteen charities advertised the study yielding 11 recruits, 13 primary care practices sent 687 invitations to patients on their databases with a known visible difference yielding 17 recruits (2.5\% response rate), 4 recruits came from GP consultations. Recruitment was challenging, therefore four additional practices mass-mailed 3,306 generic invitations to all 12-17 year old patients yielding a further 15 participants (0.5\% response rate). Forty-seven YP with a range of socioeconomic backgrounds and conditions were randomised (26\% male, 91\% white, mean age 14 years (SD 1.7)); 23 to YPF, 24 to UC). At 52 weeks, 16 (70\%) in the intervention and 20 (83\%) in UC groups completed assessments. There were no intervention-related adverse events; most found YPF acceptable with three withdrawing because they judged it was for higher-level concerns; 12 (52\%) completed seven sessions. The study design was acceptable and feasible, with multiple recruitment strategies. Preliminary findings indicate no changes from baseline in outcome measures among the UC group and positive changes in appearance satisfaction and fear of negative evaluation among the YPF group when factoring in baseline scores and intervention adherence. Conclusions: YPF is novel, safe and potentially helpful. Its full psychosocial benefits should be evaluated in a large-scale RCT, which would be feasible with wide-ranging recruitment strategies. Trial Registration: ISRCTN registry ISRCTN40650639; http://www.isrctn.com/ISRCTN40650639 ", doi="10.2196/14776", url="http://mental.jmir.org/2019/11/e14776/", url="http://www.ncbi.nlm.nih.gov/pubmed/31755870" } @Article{info:doi/10.2196/13936, author="Barker, M. Kathryn and Subramanian, V. S. and Selman, Robert and Austin, Bryn S.", title="Gender Perspectives on Social Norms Surrounding Teen Pregnancy: A Thematic Analysis of Social Media Data", journal="JMIR Pediatr Parent", year="2019", month="Sep", day="17", volume="2", number="2", pages="e13936", keywords="teenage childbearing", keywords="teen pregnancy", keywords="adolescent sexual behavior", keywords="social media", keywords="social norms", keywords="gender", abstract="Background: Social concern with teen pregnancy emerged in the 1970s, and today's popular and professional health literature continues to draw on social norms that view teen pregnancy as a problem---for the teen mother, her baby, and society. It is unclear, however, how adolescents directly affected by teen pregnancy draw upon social norms against teen pregnancy in their own lives, whether the norms operate differently for girls and boys, and how these social norms affect pregnant or parenting adolescents. Objective: This research aims to examine whether and how US adolescents use, interpret, and experience social norms against teen pregnancy. Methods: Online ethnographic methods were used for the analysis of peer-to-peer exchanges from an online social network site designed for adolescents. Data were collected between March 2010 and February 2015 (n=1662). Thematic analysis was conducted using NVivo software. Results: American adolescents in this online platform draw on dominant social norms against teen pregnancy to provide rationales for why pregnancy in adolescence is wrong or should be avoided. Rationales range from potential socioeconomic harms to life-course rationales that view adolescence as a special, carefree period in life. Despite joint contributions from males and females to a pregnancy, it is primarily females who report pregnancy-related concerns, including experiences of bullying, social isolation, and fear. Conclusions: Peer exchange in this online forum indicates that American adolescents reproduce prevailing US social norms of viewing teen pregnancy as a social problem. These norms intersect with the norms of age, gender, and female sexuality. Female adolescents who transgress these norms experience bullying, shame, and stigma. Health professionals must ensure that strategies designed to prevent unintended adolescent pregnancy do not simultaneously create hardship and stigma in the lives of young women who are pregnant and parent their children. ", doi="10.2196/13936", url="http://pediatrics.jmir.org/2019/2/e13936/", url="http://www.ncbi.nlm.nih.gov/pubmed/31536963" } @Article{info:doi/10.2196/12683, author="Moreno, Andreas Megan and Midamba, Nikita and Berman, S. Henry and Moreno, S. Peter and Donlin, Mike and Schlocker, Erik", title="Cyberbullying Among Adolescents: Stakeholder-Driven Concept Mapping Approach", journal="JMIR Pediatr Parent", year="2019", month="Jun", day="28", volume="2", number="1", pages="e12683", keywords="cyberbullying", keywords="adolescent", abstract="Background: Cyberbullying includes bullying behaviors on the Web; these behaviors are inconsistently measured and lack standardized definitions. The Uniform Definition of Bullying provides a consensus-based definition of bullying, and it highlights the need for an evidence-based definition of a model for cyberbullying. Objective: Toward understanding the key elements and constructs defining cyberbullying, the objective of this study was to develop a stakeholder-driven conceptual model of cyberbullying. Methods: Concept mapping is a validated research method that leverages both qualitative and quantitative approaches to integrate stakeholder input on complex topics. This process was used to develop a concept map and adapt it through participant input to a conceptual model. The validated concept mapping approach includes 5 steps: preparation, generation (brainstorming), structuring (sorting), representation (statistical analysis), and interpretation. We recruited stakeholder participants, including adolescents, as well as parents and professionals representing education, health, and the justice system. Analysis included hierarchical cluster analysis to develop a cluster map representing cyberbullying, followed by adaptation of that map to a conceptual model through qualitative participant feedback. Results: A total of 177 participants contributed to the concept mapping process, including 69\% females, 50\% adults, and 68\% Caucasian, representing each of our stakeholder groups. A total of 228 brainstorming items were generated and sorted into a concept map that included 9 clusters. Clusters included topics that had strong overlap with traditional bullying, such as consequences for perpetrators and targets, with example items ``alienating'' and ``crippling.'' Some clusters were unique, such as cyberbullying techniques, with example item ``excessive messaging,'' and characteristics of the cyberbullying experience, with example item ``constant.'' Through the interpretation step, a conceptual model emerged, illustrating connections and distinctions between traditional bullying and cyberbullying. Conclusions: We found that in generating a stakeholder-driven concept map of cyberbullying, participants could not describe cyberbullying without integrating key concepts from traditional bullying. On the basis of our conceptual model, there are unique characteristics of cyberbullying that suggest that uniform definitions of bullying need to be evaluated to ensure their application to cyberbullying. ", doi="10.2196/12683", url="http://pediatrics.jmir.org/2019/1/e12683/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518321" } @Article{info:doi/10.2196/12164, author="Coulter, WS Robert and Sang, M. Jordan and Louth-Marquez, William and Henderson, R. Emmett and Espelage, Dorothy and Hunter, C. Simon and DeLucas, Matthew and Abebe, Z. Kaleab and Miller, Elizabeth and Morrill, A. Brooke and Hieftje, Kimberly and Friedman, S. Mark and Egan, E. James", title="Pilot Testing the Feasibility of a Game Intervention Aimed at Improving Help Seeking and Coping Among Sexual and Gender Minority Youth: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2019", month="Feb", day="15", volume="8", number="2", pages="e12164", keywords="sexual and gender minorities", keywords="adolescent", keywords="video games", keywords="feasibility studies", keywords="help-seeking behavior", keywords="adaptation, psychological", keywords="alcohol drinking", keywords="cigarette smoking", keywords="vaping", keywords="mental health", keywords="randomized controlled trial", abstract="Background: Sexual and gender minority youth (SGMY; eg, lesbian, gay, bisexual, and transgender youth) experience myriad substance use and mental health disparities compared with their cisgender (nontransgender) heterosexual peers. Despite much research showing these disparities are driven by experiences of bullying and cyberbullying victimization, few interventions have aimed to improve the health of bullied SGMY. One possible way to improve the health of bullied SGMY is via a Web-accessible game intervention. Nevertheless, little research has examined the feasibility of using a Web-accessible game intervention with SGMY. Objective: This study aimed to describe the protocol for a randomized controlled trial (RCT) pilot, testing the feasibility and limited efficacy of a game-based intervention for increasing help-seeking--related knowledge, intentions, self-efficacy, behaviors, productive coping skills use, and coping flexibility and reducing health risk factors and behaviors among SGMY. Methods: We enrolled 240 SGMY aged 14 to 18 years residing in the United States into a 2-arm prospective RCT. The intervention is a theory-based, community-informed, computer-based, role playing game with 3 primary components: encouraging help-seeking behaviors, encouraging use of productive coping, and raising awareness of Web-based resources. SGMY randomized to both the intervention and control conditions will receive a list of SGMY-inclusive resources, covering a variety of health-related topics. Control condition participants received only the list of resources. Notably, all study procedures are conducted via the internet. We conveniently sampled SGMY using Web-based advertisements. Study assessments occur at enrollment, 1 month after enrollment, and 2 months after enrollment. The primary outcomes of this feasibility study include implementation procedures, game demand, and game acceptability. Secondary outcomes include help-seeking intentions, self-efficacy, and behaviors; productive coping strategies and coping flexibility; and knowledge and use of Web-based resources. Tertiary outcomes include bullying and cyberbullying victimization, loneliness, mental health issues, substance use, and internalized sexual and gender minority stigma. Results: From April to July 2018, 240 participants were enrolled and randomized. Half of the enrolled participants (n=120) were randomized into the intervention condition and half (n=120) into the control condition. At baseline, 52.1\% (125/240) of the participants identified as gay or lesbian, 26.7\% (64/240) as bisexual, 24.2\% (58/240) as queer, and 11.7\% (28/240) as another nonheterosexual identity. Nearly half (113/240) of participants were a gender minority: 36.7\% (88/240) were cisgender boys, and 16.3\% (39/240) were cisgender girls. There were no differences in demographic characteristics between intervention and control condition participants. Conclusions: Web-accessible game interventions overcome common impediments of face-to-face interventions and present a unique opportunity to reach SGMY and improve their health. This trial will provide data on feasibility and limited efficacy that can inform future Web-based studies and a larger RCT aimed at improving health equity for SGMY. Trial Registration: ClinicalTrials.gov NCT03501264; https://clinicaltrials.gov/ct2/show/NCT03501264 (Archived by WebCite at http://www.webcitation.org/72HpafarW) International Registered Report Identifier (IRRID): DERR1-10.2196/12164 ", doi="10.2196/12164", url="http://www.researchprotocols.org/2019/2/e12164/", url="http://www.ncbi.nlm.nih.gov/pubmed/30767903" } @Article{info:doi/10.2196/jmir.9044, author="John, Ann and Glendenning, Charles Alexander and Marchant, Amanda and Montgomery, Paul and Stewart, Anne and Wood, Sophie and Lloyd, Keith and Hawton, Keith", title="Self-Harm, Suicidal Behaviours, and Cyberbullying in Children and Young People: Systematic Review", journal="J Med Internet Res", year="2018", month="Apr", day="19", volume="20", number="4", pages="e129", keywords="cyberbullying", keywords="bullying", keywords="self-injurious behavior", keywords="suicide", keywords="suicide, attempted", keywords="suicidal ideation", abstract="Background: Given the concerns about bullying via electronic communication in children and young people and its possible contribution to self-harm, we have reviewed the evidence for associations between cyberbullying involvement and self-harm or suicidal behaviors (such as suicidal ideation, suicide plans, and suicide attempts) in children and young people. Objective: The aim of this study was to systematically review the current evidence examining the association between cyberbullying involvement as victim or perpetrator and self-harm and suicidal behaviors in children and young people (younger than 25 years), and where possible, to meta-analyze data on the associations. Methods: An electronic literature search was conducted for all studies published between January 1, 1996, and February 3, 2017, across sources, including MEDLINE, Cochrane, and PsycINFO. Articles were included if the study examined any association between cyberbullying involvement and self-harm or suicidal behaviors and reported empirical data in a sample aged under 25 years. Quality of included papers was assessed and data were extracted. Meta-analyses of data were conducted. Results: A total of 33 eligible articles from 26 independent studies were included, covering a population of 156,384 children and young people. A total of 25 articles (20 independent studies, n=115,056) identified associations (negative influences) between cybervictimization and self-harm or suicidal behaviors or between perpetrating cyberbullying and suicidal behaviors. Three additional studies, in which the cyberbullying, self-harm, or suicidal behaviors measures had been combined with other measures (such as traditional bullying and mental health problems), also showed negative influences (n=44,526). A total of 5 studies showed no significant associations (n=5646). Meta-analyses, producing odds ratios (ORs) as a summary measure of effect size (eg, ratio of the odds of cyber victims who have experienced SH vs nonvictims who have experienced SH), showed that, compared with nonvictims, those who have experienced cybervictimization were OR 2.35 (95\% CI 1.65-3.34) times as likely to self-harm, OR 2.10 (95\% CI 1.73-2.55) times as likely to exhibit suicidal behaviors, OR 2.57 (95\% CI 1.69-3.90) times more likely to attempt suicide, and OR 2.15 (95\% CI 1.70-2.71) times more likely to have suicidal thoughts. Cyberbullying perpetrators were OR 1.21 (95\% CI 1.02-1.44) times more likely to exhibit suicidal behaviors and OR 1.23 (95\% CI 1.10-1.37) times more likely to experience suicidal ideation than nonperpetrators. Conclusions: Victims of cyberbullying are at a greater risk than nonvictims of both self-harm and suicidal behaviors. To a lesser extent, perpetrators of cyberbullying are at risk of suicidal behaviors and suicidal ideation when compared with nonperpetrators. Policy makers and schools should prioritize the inclusion of cyberbullying involvement in programs to prevent traditional bullying. Type of cyberbullying involvement, frequency, and gender should be assessed in future studies. ", doi="10.2196/jmir.9044", url="http://www.jmir.org/2018/4/e129/", url="http://www.ncbi.nlm.nih.gov/pubmed/29674305" } @Article{info:doi/10.2196/mededu.9128, author="Berryman, K. Elizabeth and Leonard, J. Daniel and Gray, R. Andrew and Pinnock, Ralph and Taylor, Barry", title="Self-Reflected Well-Being via a Smartphone App in Clinical Medical Students: Feasibility Study", journal="JMIR Med Educ", year="2018", month="Mar", day="07", volume="4", number="1", pages="e7", keywords="mental health", keywords="medical students", keywords="medical education", keywords="bullying", keywords="teaching", keywords="mhealth", abstract="Background: Well-being in medical students has become an area of concern, with a number of studies reporting high rates of clinical depression, anxiety, burnout, and suicidal ideation in this population. Objective: The aim of this study was to increase awareness of well-being in medical students by using a smartphone app. The primary objective of this study was to determine the validity and feasibility of the Particip8 app for student self-reflected well-being data collection. Methods: Undergraduate medical students of the Dunedin School of Medicine were recruited into the study. They were asked to self-reflect daily on their well-being and to note what experiences they had encountered during that day. Qualitative data were also collected both before and after the study in the form of focus groups and ``free-text'' email surveys. All participants consented for the data collected to be anonymously reported to the medical faculty. Results: A total of 29 participants (69\%, 20/29 female; 31\%, 9/29 male; aged 21-30 years) were enrolled, with overall median compliance of 71\% at the study day level. The self-reflected well-being scores were associated with both positive and negative experiences described by the participants, with most negative experiences associated with around 20\% lower well-being scores for that day; the largest effect being ``receiving feedback that was not constructive or helpful,'' and the most positive experiences associated with around 20\% higher scores for that day. Conclusions: The study of daily data collection via the Particip8 app was found to be feasible, and the self-reflected well-being scores showed validity against participant's reflections of experiences during that day. ", doi="10.2196/mededu.9128", url="http://mededu.jmir.org/2018/1/e7/", url="http://www.ncbi.nlm.nih.gov/pubmed/29514774" } @Article{info:doi/10.2196/mhealth.4936, author="Ybarra, L. Michele and Prescott, L. Tonya and Espelage, L. Dorothy", title="Stepwise Development of a Text Messaging-Based Bullying Prevention Program for Middle School Students (BullyDown)", journal="JMIR mHealth uHealth", year="2016", month="Jun", day="13", volume="4", number="2", pages="e60", keywords="bullying", keywords="mhealth", keywords="text messaging", keywords="youth", keywords="prevention", abstract="Background: Bullying is a significant public health issue among middle school-aged youth. Current prevention programs have only a moderate impact. Cell phone text messaging technology (mHealth) can potentially overcome existing challenges, particularly those that are structural (e.g., limited time that teachers can devote to non-educational topics). To date, the description of the development of empirically-based mHealth-delivered bullying prevention programs are lacking in the literature. Objective: To describe the development of BullyDown, a text messaging-based bullying prevention program for middle school students, guided by the Social-Emotional Learning model. Methods: We implemented five activities over a 12-month period: (1) national focus groups (n=37 youth) to gather acceptability of program components; (2) development of content; (3) a national Content Advisory Team (n=9 youth) to confirm content tone; and (4) an internal team test of software functionality followed by a beta test (n=22 youth) to confirm the enrollment protocol and the feasibility and acceptability of the program. Results: Recruitment experiences suggested that Facebook advertising was less efficient than using a recruitment firm to recruit youth nationally, and recruiting within schools for the pilot test was feasible. Feedback from the Content Advisory Team suggests a preference for 2-4 brief text messages per day. Beta test findings suggest that BullyDown is both feasible and acceptable: 100\% of youth completed the follow-up survey, 86\% of whom liked the program. Conclusions: Text messaging appears to be a feasible and acceptable delivery method for bullying prevention programming delivered to middle school students. ", doi="10.2196/mhealth.4936", url="http://mhealth.jmir.org/2016/2/e60/", url="http://www.ncbi.nlm.nih.gov/pubmed/27296471" } @Article{info:doi/10.2196/resprot.5292, author="Mishna, Faye and McInroy, B. Lauren and Lacombe-Duncan, Ashley and Bhole, Payal and Van Wert, Melissa and Schwan, Kaitlin and Birze, Arija and Daciuk, Joanne and Beran, Tanya and Craig, Wendy and Pepler, J. Debra and Wiener, Judith and Khoury-Kassabri, Mona and Johnston, David", title="Prevalence, Motivations, and Social, Mental Health and Health Consequences of Cyberbullying Among School-Aged Children and Youth: Protocol of a Longitudinal and Multi-Perspective Mixed Method Study", journal="JMIR Res Protoc", year="2016", month="May", day="24", volume="5", number="2", pages="e83", keywords="cyberbullying", keywords="ICT", keywords="children", keywords="youth", keywords="parents", keywords="teachers", keywords="victimization", keywords="mental health", keywords="longitudinal", keywords="mixed methods", abstract="Background: While the online environment may promote important developmental and social benefits, it also enables the serious and rapidly growing issue of cyberbullying. Cyberbullying constitutes an increasing public health problem -- victimized children and youth experience a range of health and mental health concerns, including emotional and psychosomatic problems, maladaptive behaviors, and increased suicidality. Perpetrators demonstrate a lack of empathy, and may also struggle with health and mental health issues. Objective: This paper describes the protocols applied in a longitudinal and multi-perspective mixed-methods study with five objectives: (1) to explore children/youth's experiences, and children/youth's, parents', and teachers' conceptions, definitions, and understanding of cyberbullying; (2) to explore how children/youth view the underlying motivations for cyberbullying; (3) to document the shifting prevalence rates of cyberbullying victimization, witnessing, and perpetration; (4) to identify risk and protective factors for cyberbullying involvement; and (5) to explore social, mental health, and health consequences of cyberbullying. Methods: Quantitative survey data were collected over three years (2012-2014) from a stratified random baseline sample of fourth (n=160), seventh (n=243), and tenth (n=267) grade children/youth, their parents (n=246), and their teachers (n=103). Quantitative data were collected from students and teachers during in-person school visits, and from parents via mail-in surveys. Student, parent, and teacher surveys included questions regarding: student experiences with bullying/cyberbullying; student health, mental health, and social and behavioral issues; socio-demographics; and information and communication technology use. In-depth semi-structured qualitative interviews were conducted twice with a sub-sample of students (n=57), purposively selected based on socio-demographics and cyberbullying experience, twice with their parents (n=50), and once with their teachers (n=30). Results: Data collection for this study is complete. Planned analyses include transition probabilities and repeated measures analyses to determine involvement in cyberbullying. Repeated measures analyses, including between-subject factors (eg, socio-demographics), will be utilized to determine factors that protect or increase risk of involvement in cyberbullying. Qualitative analysis utilizing grounded theory is planned, to permit rich understanding of participant experiences and perspectives. Results will be reported in 2016 and 2017. Conclusions: This study will offer insight into the contemporary phenomenon of cyberbullying while also informing interventions to curb cyberbullying and address its pervasive social, mental health, and health consequences. Knowledge mobilization strategies and implications for research and practice are discussed. ", doi="10.2196/resprot.5292", url="http://www.researchprotocols.org/2016/2/e83/", url="http://www.ncbi.nlm.nih.gov/pubmed/27220556" } @Article{info:doi/10.2196/jmir.4803, author="Carrotte, R. Elise and Vella, M. Alyce and Lim, SC Megan", title="Predictors of ``Liking'' Three Types of Health and Fitness-Related Content on Social Media: A Cross-Sectional Study", journal="J Med Internet Res", year="2015", month="Aug", day="21", volume="17", number="8", pages="e205", keywords="fitspiration", keywords="social media", keywords="blogging", keywords="adolescent", keywords="physical fitness", keywords="eating disorders", keywords="women's health", abstract="Background: Adolescence and young adulthood are key periods for developing norms related to health behaviors and body image, and social media can influence these norms. Social media is saturated with content related to dieting, fitness, and health. Health and fitness--related social media content has received significant media attention for often containing objectifying and inaccurate health messages. Limited research has identified problematic features of such content, including stigmatizing language around weight, portraying guilt-related messages regarding food, and praising thinness. However, no research has identified who is ``liking'' or ``following'' (ie, consuming) such content. Objective: This exploratory study aimed to identify demographics, mental health, and substance use--related behaviors that predicted consuming 3 types of health and fitness--related social media content---weight loss/fitness motivation pages (ie, ``fitspiration''), detox/cleanse pages, and diet/fitness plan pages---among young social media users. Methods: Participants (N=1001; age: median 21.06, IQR 17.64-24.64; female: 723/1001, 72.23\%) completed a cross-sectional 112-question online survey aimed at social media users aged between 15-29 years residing in Victoria, Australia. Logistic regression was used to determine which characteristics predicted consuming the 3 types of health and fitness--related social media content. Results: A total of 378 (37.76\%) participants reported consuming at least 1 of the 3 types of health and fitness--related social media content: 308 (30.77\%) fitspiration pages, 145 (14.49\%) detox pages, and 235 (23.48\%) diet/fitness plan pages. Of the health and fitness--related social media content consumers, 85.7\% (324/378) identified as female and 44.8\% (324/723) of all female participants consumed at least 1 type of health and fitness--related social media content. Predictors of consuming at least one type of health and fitness--related social media content in univariable analysis included female gender (OR 3.5, 95\% CI 2.5-4.9, P<.001), being aged 15-17 years (OR 3.0, 95\% CI 2.2-4.0, P<.001), residing outside a major city (OR 2.0, 95\% CI 1.4-2.9, P<.001), having no post--high school education (OR 2.2, 95\% CI 1.7-2.9, P<.001), being born in Australia (OR 2.0, 95\% CI 1.2-3.2, P=.006), having a self-reported eating disorder (OR 2.4, 95\% CI 1.5-3.9, P<.001), being a victim of bullying (OR 1.7, CI 1.3-2.3, P<.001), misusing detox/laxative teas or diet pills (OR 4.6, 95\% CI 2.8-7.6, P<.001), never using illegal drugs (OR 1.6, 95\% CI 1.2-2.0, P=.001), and not engaging in risky single occasion drinking on a weekly basis (OR 2.0, 95\% CI 1.3-3.0, P=.003). Conclusions: Consumers of health and fitness--related social media content were predominantly teenaged girls. There is a need to ensure that this social media content portrays responsible health messages and to research further the role of fitspiration pages, detox pages, and diet/fitness plan pages in influencing body image and health behaviors. ", doi="10.2196/jmir.4803", url="http://www.jmir.org/2015/8/e205/", url="http://www.ncbi.nlm.nih.gov/pubmed/26297689" } @Article{info:doi/10.2196/jmir.2819, author="Ma, Shu-Ching and Chien, Tsair-Wei and Wang, Hsiu-Hung and Li, Yu-Chi and Yui, Mei-Shu", title="Applying Computerized Adaptive Testing to the Negative Acts Questionnaire-Revised: Rasch Analysis of Workplace Bullying", journal="J Med Internet Res", year="2014", month="Feb", day="17", volume="16", number="2", pages="e50", keywords="computerized adaptive testing", keywords="computer on wheels", keywords="classic test theory", keywords="item response theory", keywords="nonadaptive testing", keywords="the Negative Acts Questionnaire-Revised", abstract="Background: Workplace bullying is a prevalent problem in contemporary work places that has adverse effects on both the victims of bullying and organizations. With the rapid development of computer technology in recent years, there is an urgent need to prove whether item response theory--based computerized adaptive testing (CAT) can be applied to measure exposure to workplace bullying. Objective: The purpose of this study was to evaluate the relative efficiency and measurement precision of a CAT-based test for hospital nurses compared to traditional nonadaptive testing (NAT). Under the preliminary conditions of a single domain derived from the scale, a CAT module bullying scale model with polytomously scored items is provided as an example for evaluation purposes. Methods: A total of 300 nurses were recruited and responded to the 22-item Negative Acts Questionnaire-Revised (NAQ-R). All NAT (or CAT-selected) items were calibrated with the Rasch rating scale model and all respondents were randomly selected for a comparison of the advantages of CAT and NAT in efficiency and precision by paired t tests and the area under the receiver operating characteristic curve (AUROC). Results: The NAQ-R is a unidimensional construct that can be applied to measure exposure to workplace bullying through CAT-based administration. Nursing measures derived from both tests (CAT and NAT) were highly correlated (r=.97) and their measurement precisions were not statistically different (P=.49) as expected. CAT required fewer items than NAT (an efficiency gain of 32\%), suggesting a reduced burden for respondents. There were significant differences in work tenure between the 2 groups (bullied and nonbullied) at a cutoff point of 6 years at 1 worksite. An AUROC of 0.75 (95\% CI 0.68-0.79) with logits greater than --4.2 (or >30 in summation) was defined as being highly likely bullied in a workplace. Conclusions: With CAT-based administration of the NAQ-R for nurses, their burden was substantially reduced without compromising measurement precision. ", doi="10.2196/jmir.2819", url="http://www.jmir.org/2014/2/e50/", url="http://www.ncbi.nlm.nih.gov/pubmed/24534113" } @Article{info:doi/10.2196/ijmr.1835, author="Beran, Tanya and Stanton, Lauren and Hetherington, Ross and Mishna, Faye and Shariff, Shaheen", title="Development of the Bullying and Health Experiences Scale", journal="Interact J Med Res", year="2012", month="Nov", day="09", volume="1", number="2", pages="e13", keywords="mental health", keywords="school bullying", keywords="cyberbullying", keywords="peer victimization", keywords="psychosocial impact", keywords="children", abstract="Background: Until recently, researchers have studied forms of bullying separately. For 40 years, research has looked at the traditional forms of bullying, including physical (eg, hitting), verbal (eg, threats), and social (eg, exclusion). Attention focused on cyberbullying in the early 2000s. Although accumulating research suggests that bullying has multiple negative effects for children who are targeted, these effects excluded cyberbullying from the definition of bullying. Objective: This paper responds to the need for a multidimensional measure of the impact of various forms of bullying. We used a comprehensive definition of bullying, which includes all of its forms, to identify children who had been targeted or who had participated in bullying. We then examined various ways in which they were impacted. Methods: We used an online method to administer 37 impact items to 377 (277 female, 100 male) children and youth, to develop and test the Bullying and Health Experience Scale. Results: A principal components analysis of the bullying impact items with varimax rotation resulted in 8 factors with eigenvalues greater than one, explaining 68.0\% of the variance. These scales include risk, relationships, anger, physical injury, drug use, anxiety, self-esteem, and eating problems, which represent many of the cognitive, psychological, and behavioral consequences of bullying. The Cronbach alpha coefficients for the 8 scales range from .73 to .90, indicating good inter-item consistency. Comparisons between the groups showed that children involved in bullying had significantly higher negative outcomes on all scales than children not involved in bullying. Conclusions: The high Cronbach alpha values indicate that the 8 impact scales provide reliable scores. In addition, comparisons between the groups indicate that the 8 scales provide accurate scores, with more negative outcomes reported by children involved in bullying compared to those who are not involved in bullying. This evidence of reliability and validity indicates that these scales are useful for research and clinical purposes to measure the multidimensional experiences of children who bully and are bullied. ", doi="10.2196/ijmr.1835", url="http://www.i-jmr.org/2012/2/e13/", url="http://www.ncbi.nlm.nih.gov/pubmed/23612028" }