***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background This study examined access to digital technologies , skills and experience , and preferences for using web-based and other digital technologies  to obtain health information and advice among older adults in a large health plan . A primary aim was to assess the extent to which digital divides by race/ethnicity and age group might affect the ability of a large percentage of seniors , and especially those in vulnerable groups , to engage with online health information and advice modalities ( eHIA ) and mobile health ( mHealth ) monitoring tools . Methods A mailed survey was conducted with age-sex stratified r and om sample s of English-speaking non-Hispanic white , African-American/black ( black ) , Hispanic/Latino ( Latino ) , Filipino-American ( Filipino ) , and Chinese-American ( Chinese ) Kaiser Permanente Northern California members who were aged 65–79 years . Respondent data were weighted to the study population for the cross-sectional analyses . Results Older seniors and black , Latino , and Filipino seniors have less access to digital tools , less experience performing a variety of online tasks , and are less likely to believe that they would be capable of going online for health information and advice compared to younger and white Non-Hispanic seniors . Consequently , they are also less likely to be interested in using eHIA modalities . Conclusions The same subgroups of seniors that have previously been shown to have higher prevalence of chronic conditions and greater difficulties with healthcare access are also less likely to adopt use of eHIA and  mHealth monitoring technologies . At the patient population level , this digital divide is important to take into account when planning health information and chronic disease management programs . At the individual patient level , to provide good patient-centered care , it is important for providers to assess rather than assume digital access , eHealth skills , and preferences prior to recommending use of web-based re sources and mHealth tools Background Our labor force is aging , but aged workers are not yet coached on how to stay cognitively fit for the job . Objective In this study , we tested whether a self-motivated , complex eHealth intervention could improve multiple health-related behaviors that are associated with cognitive aging among working Dutch adults . Methods This quasi-experimental prospect i ve study with a pre-post design was conducted with employees of Dutch medium to large companies . All employees with Internet access , a good underst and ing of the Dutch language , and who provided digital informed consent were eligible to participate . In total , 2972 participants ( 2110/2972 , 71.11 % females ) with a mean ( st and ard deviation , SD ) age of 51.8 ( SD 12.9 ) years were recruited ; 2305 became active users of the intervention , and 173 completed the 1-year follow-up . This self-motivated eHealth lifestyle intervention stimulates participants to set personally relevant , monthly health behavior change goals using Goal Attainment Scaling and to realize these goals by implementing behavior change techniques grounded in behavior change theory . The primary outcomes were the goal - setting success rate and the change in overall lifestyle score from baseline to the 1-year follow-up ; the score was based on physical activity , diet , smoking , alcohol , sleep , and stress scores . The secondary outcomes were the changes in body weight , body mass index , specific lifestyle characteristics , and website usage . Results A total of 1212 participants set 2620 behavior change goals ; 392 participants assessed 1089 ( 1089/2288 , 47.59 % ) goals and successfully achieved 422 ( 422/1089 , 38.75 % ) of these goals . Among the goal - setting participants in follow-up , this led to a + 0.81-point improvement ( 95 % CI 0.49 - 1.13 , P<.001 ) in overall lifestyle ( d=0.32 ) and weight loss of 0.62 kg ( 95 % CI −1.16 to −0.07 , P=.03 ) . These participants also showed significant improvement in 8 out of 11 specific lifestyle components . Conclusions Among an adult Dutch population , this eHealth intervention result ed in lifestyle changes in behavioral risk factors associated with cognitive decline , and these improvements lasted over the period of 1 year . Given the general aging of our workforce , this eHealth intervention opens new avenues for the widespread use of cost-effective self-motivated prevention programs aim ed at prevention of early-stage cognitive decline and more self-management of their risk factors . Trial Registration Nederl and s Trial Register : NTR4144 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=4144 ( Archived by WebCite at http://www.webcitation.org/6cZzwZSg3 ) Longst and ing disparities in substance use disorders and treatment access exist among American Indians/Alaska Natives ( AI/AN ) .  Computerized , web-delivered interventions have potential to increase access to quality treatment and improve patient outcomes . Prior research supports the efficacy of a web-based version [ therapeutic education system ( TES ) ] of the community reinforcement approach to improve outcomes among out patients in substance abuse treatment ; however , TES has not been tested among AI/AN . The results from this mixed method acceptability study among a diverse sample of urban AI/AN ( N = 40 ) show that TES was acceptable across seven indices ( range 7.8–9.4 on 0–10 scales with 10 indicating highest acceptability ) . Qualitative interviews suggest adaptation specific to AI/AN culture could improve adoption . Additional efforts to adapt TES and conduct a larger effectiveness study are warranted Background Web-based surveys are increasingly used to capture data essential for human immunodeficiency virus ( HIV ) prevention research . However , there are challenges in ensuring the informed consent of Web-based research participants . Objective The aim of our study was to develop and assess the efficacy of alternative methods of administering informed consent in Web-based HIV research with men who have sex with men ( MSM ) . Methods From July to September 2014 , paid advertisements on Facebook were used to recruit adult MSM living in the United States for a Web-based survey about risk and preventive behaviors . Participants were r and omized to one of the 4 methods of delivering informed consent : a professionally produced video , a study staff-produced video , a frequently asked questions ( FAQs ) text page , and a st and ard informed consent text page . Following the behavior survey , participants answered 15 questions about comprehension of consent information . Correct responses to each question were given a score of 1 , for a total possible scale score of 15 . General linear regression and post-hoc Tukey comparisons were used to assess difference ( P<.001 ) in mean consent comprehension scores . A mediation analysis was used to examine the relationship between time spent on consent page and consent comprehension . Results Of the 665 MSM participants who completed the comprehension questions , 24.2 % ( 161/665 ) received the st and ard consent , 27.1 % ( 180/665 ) received the FAQ consent , 26.8 % ( 178/665 ) received the professional consent video , and 22.0 % ( 146/665 ) received the staff video . The overall average consent comprehension score was 6.28 ( SD=2.89 ) . The average consent comprehension score differed significantly across consent type ( P<.001 ) , age ( P=.04 ) , race or ethnicity ( P<.001 ) , and highest level of education ( P=.001 ) . Compared with those who received the st and ard consent , comprehension was significantly higher for participants who received the professional video consent ( score increase=1.79 ; 95 % CI 1.02 - 2.55 ) and participants who received the staff video consent ( score increase=1.79 ; 95 % CI 0.99 - 2.59 ) . There was no significant difference in comprehension for those who received the FAQ consent . Participants spent more time on the 2 video consents  ( staff video median time=117 seconds ; professional video median time=115 seconds ) than the FAQ ( median=21 seconds ) and st and ard consents ( median=37 seconds ) . Mediation analysis showed that though time spent on the consent page was partially responsible for some of the differences in comprehension , the direct effects of the professional video ( score increase=0.93 ; 95 % CI 0.39 - 1.48 ) and the staff-produced video ( score increase=0.99 ; 95 % CI 0.42 - 1.56 ) were still significant . Conclusions Video-based consent methods improve consent comprehension of MSM participating in a Web-based HIV behavioral survey . This effect may be partially mediated through increased time spent review ing the consent material ; however , the video consent may still be superior to st and ard consent in improving participant comprehension of key study facts . Trail Registration Clinical trials.gov NCT02139566 ; https:// clinical trials.gov/ct2/show/NCT02139566 ( Archived by WebCite at http://www.webcitation.org/6oRnL261N ) Background Conventional Web-based search engines may be unusable by individuals with low health literacy for finding health-related information , thus precluding their use by this population . Objective We describe a conversational search engine interface design ed to allow individuals with low health and computer literacy identify and learn about clinical trials on the Internet . Methods A r and omized trial involving 89 participants compared the conversational search engine interface ( n=43 ) to the existing conventional keyword- and facet-based search engine interface ( n=46 ) for the National Cancer Institute Clinical Trials data base . Each participant performed 2 tasks : finding a clinical trial for themselves and finding a trial that met prespecified criteria . Results Results indicated that all participants were more satisfied with the conversational interface based on 7-point self-reported satisfaction ratings ( task 1 : mean 4.9 , SD 1.8 vs mean 3.2 , SD 1.8 , P<.001 ; task 2 : mean 4.8 , SD 1.9 vs mean 3.2 , SD 1.7 , P<.001 ) compared to the conventional Web form-based interface . All participants also rated the trials they found as better meeting their search criteria , based on 7-point self-reported scales ( task 1 : mean 3.7 , SD 1.6 vs mean 2.7 , SD 1.8 , P=.01 ; task 2 : mean 4.8 , SD 1.7 vs mean 3.4 , SD 1.9 , P<.01 ) . Participants with low health literacy failed to find any trials that satisfied the prespecified criteria for task 2 using the conventional search engine interface , whereas 36 % ( 5/14 ) were successful at this task using the conversational interface ( P=.05 ) . Conclusions Conversational agents can be used to improve accessibility to Web-based search es in general and clinical trials in particular , and can help decrease recruitment bias against disadvantaged population OBJECTIVE To examine the feasibility , acceptability , and initial efficacy of a  technology-based weight loss intervention for urban , low-income mothers . METHODS Eighteen obese , ethnic minority , socioeconomically disadvantaged mothers in the first year after childbirth were r and omly assigned to either : 1 ) technology-based intervention , which included empirically supported behavior-change strategies , daily skills , and self-monitoring text messages with personalized feedback , biweekly counseling calls from a health coach , and access to a Facebook support group , or 2 ) usual-care control . RESULTS After 14 weeks of treatment , the technology-based intervention participants had significantly greater weight loss ( -2.9 ± 3.6 kg ) than usual care ( 0.5 ± 2.3 kg ; adjusted mean difference : -3.2 kg , 95 % confidence interval -6.2 to -0.1 kg , P = .04 ) . One-third of intervention participants ( 3 of 9 ) and no control participants lost > 5 % of their initial body weight at follow up . CONCLUSIONS AND IMPLICATION S Results suggest the potential for using technology to deliver a postpartum weight loss intervention among low-income racial/ethnic minorities Background Evidence -based preventive services for early detection of cancer and other health conditions offer profound health benefits , yet Americans receive only half of indicated services . Policy initiatives promote the adoption of information technologies to engage patients in care . We developed a theory-driven interactive preventive health record ( IPHR ) to engage patients in health promotion . The model defines five levels of functionality : ( 1 ) collecting patient information , ( 2 ) integrating with electronic health records ( EHRs ) , ( 3 ) translating information into lay language , ( 4 ) providing individualized , guideline -based clinical recommendations , and ( 5 ) facilitating patient action . It is hypothesized that personal health records ( PHRs ) with these higher levels of functionality will inform and activate patients in ways that simpler PHRs can not . However , realizing this vision requires both technological advances and effective implementation based upon clinician and practice engagement . Methods / design We are starting a two-phase , mixed- method trial to evaluate whether the IPHR is scalable across a large number of practice s and how its uptake differs for minority and disadvantaged patients . In phase 1 , 40 practice s from three practice -based research networks will be r and omized to add IPHR functionality to their PHR versus continue to use their existing PHR . Throughout the study , we will engage intervention practice s to locally tailor IPHR content and learn how to integrate new functions into their practice workflow . In phase 2 , the IPHR to all nonintervention practice s to observe whether the IPHR can be implemented more broadly ( Scalability ) . Phase 1 will feature an implementation assessment in intervention practice s , based on the RE- AIM model , to measure Reach ( creation of IPHR accounts by patients ) , Adoption ( practice decision to use the IPHR ) , Implementation ( consistency , fidelity , barriers , and facilitators of use ) , and Maintenance ( sustained use ) . The incremental effect of the IPHR on receipt of 
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RESULTS Currently , eHealth tools are continuously used by vulnerable groups but to a small extent .
eHealth tools that use multimodal content ( such as videos ) and have the possibility for direct communication with providers show improved adherence among vulnerable groups .
eHealth tools that use multimodal content and provide the possibility for direct communication with providers have a higher adherence among vulnerable groups .
However , most of the eHealth tools are not embedded within the health care system .
They are usually focused on specific problems , such as diabetes or obesity .
Hence , they do not provide comprehensive services for patients .