Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Guidelines for physical activity and exercise during pregnancy recommend that all women without contraindications engage in regular physical activity to improve both their own health and the health of their baby. Many women are uncertain how to safely engage in physical activity and exercise during this life stage and are increasingly using mobile apps to access health-related information. However, the extent to which apps that provide physical activity and exercise advice align with current evidence-based pregnancy recommendations is unclear. Objective: This study aims to conduct a systematic search and content analysis of apps that promote physical activity and exercise in pregnancy to examine the alignment of the content with current evidence-based recommendations; delivery, format, and features of physical activity and exercise instruction; and credentials of the app developers. Methods: Systematic searches were conducted in the Australian App Store and Google Play Store in October 2020. Apps were identified using combinations of search terms relevant to pregnancy and exercise or physical activity and screened for inclusion (with a primary focus on physical activity and exercise during pregnancy, free to download or did not require immediate paid subscription, and an average user rating of ≥4 out of 5). Apps were then independently reviewed using an author-designed extraction tool. Results: Overall, 27 apps were included in this review (Google Play Store: 16/27, 59%, and App Store: 11/27, 41%). Two-thirds of the apps provided some information relating to the frequency, intensity, time, and type principles of exercise; only 11% (3/27) provided this information in line with current evidence-based guidelines. Approximately one-third of the apps provided information about contraindications to exercise during pregnancy and referenced the supporting evidence. None of the apps actively engaged in screening for potential contraindications. Only 15% (4/27) of the apps collected information about the user’s current exercise behaviors, 11% (3/27) allowed users to personalize features relating to their exercise preferences, and a little more than one-third provided information about developer credentials. Conclusions: Few exercise apps designed for pregnancy aligned with current evidence-based physical activity guidelines. None of the apps screened users for contraindications to physical activity and exercise during pregnancy, and most lacked appropriate personalization features to account for an individual’s characteristics. Few involved qualified experts during the development of the app. There is a need to improve the quality of apps that promote exercise in pregnancy to ensure that women are appropriately supported to engage in exercise and the potential risk of injury, complications, and adverse pregnancy outcomes for both mother and child is minimized. This could be done by providing expert guidance that aligns with current recommendations, introducing screening measures and features that enable personalization and tailoring to individual users, or by developing a recognized system for regulating apps.

Problem: Think-pair-share (TPS) is a teaching strategy that promotes active and collaborative learning; however, the effectiveness and applicability of this strategy in its original or altered form remain to be established, especially in health professions education. As a first step in this direction, the objective of our study was to examine the perceived effectiveness and applicability of TPS including storytelling (TPS-S) in an oral pathology seminar from the perspectives of students, seminar instructors, and peer instructors (experienced instructors who observed the seminar). Intervention: Prompts for individual thinking (T), pair discussion (P), and class sharing (S) included clinical case-based questions related to diagnosis and management and wildcards with additional information about the cases. In addition to the traditional TPS phases, the experiences of the leading instructor in dealing with the cases discussed in the seminar were shared through storytelling to model good practices in clinical diagnosis and management. Context: Our study was conducted in the School of Dentistry at the University of Alberta. Participants in this mixed-method study included third (Y3) and fourth (Y4) year dental students (n = 55) in their clinical training, seminar instructors (n = 2), and peer instructors (n = 3). Data from students, seminar instructors, and peer instructors were obtained through the Student Evaluation of Educational Quality (SEEQ) questionnaire, journaling, and interview, respectively. Descriptive statistics were performed to analyze SEEQ dimensions and statements (factors). MANOVA was used to determine significant differences between Y3 and Y4 students for SEEQ dimensions and ANOVA to identify the factors that accounted for significant differences. Qualitative data were analyzed using inductive content analysis. Impact: Participants positively valued the TPS-S seminar. Students rated all SEEQ dimensions between good and very good and regarded the seminar as superior to traditional lectures. Perceived conditions that facilitated the implementation of TPS-S included the use of real-life clinical cases, instructor facilitation skills, and the scaffolded structure of the seminar. Perceived conditions that hindered the implementation of TPS-S included unequal participation of Y3 and Y4 students, time constraints, and issues related to student pairing. Lessons learned: TPS-S was perceived as effective to improve clinical learning and applicable to dental clinical education as long as its implementation matches the characteristics of the learning context. Further evidence is needed to empirically demonstrate the effectiveness and applicability of TPS-S.

Many adolescents with obesity do not meet recommendations for nutrition, physical and sedentary activities, and sleep habits, all of which can influence weight management. To explore barriers and enablers that influenced the adoption of lifestyle behavior changes among adolescents receiving multidisciplinary clinical care for pediatric weight management. In this multi-centre, qualitative description study, we used purposeful sampling to recruit 13–17 year olds (body mass index ≥85^th percentile) enrolled in one of two pediatric weight management clinics in Edmonton and Ottawa, Canada. Adolescents participated in one-on-one, in-person, semi-structured interviews in English or French. Interviews lasted 30–60 minutes, were audio-recorded, transcribed verbatim, and managed using NVivo 11. Data were triangulated using transcripts, field notes, and memos and analyzed by two independent researchers using inductive, semantic thematic analysis. In total, 19 adolescents (12 Anglophone and 7 Francophone; 15.1±1.7 years old; 3.5±0.6 BMI z-score; n = 11 female; n = 13 Caucasian) participated. Adolescents reported diverse barriers to and enablers of healthy nutrition, physical and sedentary activities, and sleep habits, which we organized into the following themes: physiological mechanisms and physical health status, self-regulation for behavior change, controllability and competence beliefs, social relationships and interactions, and accessibility to and availability of opportunities for lifestyle enhancement. Across these themes and lifestyle areas, we identified three shared barriers and/or enablers, including the degree of controllability, the impact of mental health, and social pressures related to weight management. This research provides evidence that can be used to tailor interventions and health services delivery, including a focus on psychosocial well-being, to support adolescents with obesity in making and maintaining healthy lifestyle behavior changes.

All too often, what’s important to patients differs from what health researchers want to study. A recent review in the field of kidney dialysis, for example, showed that only one in five clinical studies addressed an issue that was on a top-10 list prioritized by patients, their caregivers and